Psychoanalytic Method and the Mischief of Freud-Bashers

Psychiatric TimesPsychiatric Times Vol 13 No 12
Volume 13
Issue 12

Psychotherapy is as old as civilization. Literally soul therapy, the term is a misnomer, since soul is a mystical notion and what is meant is the whole person. The misnomer also survives in the name psychiatry, literally soul medicine. Yet nobody is crusading against psychiatry and psychotherapy because soul is unscientific. What is important is that psychotherapy and psychiatry are job descriptions that refer to what we actually do when as providers or recipients of the service called psychotherapy, we use words to convey meaningful messages to each other, or to evoke desirable acts from each other.

Psychotherapy is as old as civilization. Literally soul therapy, the term is a misnomer, since soul is a mystical notion and what is meant is the whole person. The misnomer also survives in the name psychiatry, literally soul medicine. Yet nobody is crusading against psychiatry and psychotherapy because soul is unscientific. What is important is that psychotherapy and psychiatry are job descriptions that refer to what we actually do when as providers or recipients of the service called psychotherapy, we use words to convey meaningful messages to each other, or to evoke desirable acts from each other.

Doings, i.e., operations, are in the realm of method. Operationally, we should properly call psychotherapy word therapy. But we think and speak with words: it is not only the proverbial pen but also the spoken word that is mightier than the sword. Words connect us as speakers and listeners, both in everyday dialogue and in that special conversation we call psychotherapy, words that speak of love or hatred, that hurt or heal.

Healing human suffering through the spoken word has its roots in such a common experience as the soothing words of the mother to a child that is hurting, whether physically or psychologically. Later in life such solicitude is sublimated as care and empathy, the sympathy for another person's suffering, an essential ingredient of every therapy. Anna O. made history when she called the conversations with her doctor, Josef Breuer (1895d), the future mentor of Freud, the "talking cure," at a time when cure still meant treatment. Here is another interesting connection between words and what they stand for. Today treatment means physical therapy of physical illness, but etymologically treatment is related to tractatus and treatise, i.e., discourse. Similarly, doctor, one who treats the body, derives from the Latin verb docere, to teach, as in doctrine, or teaching.

Today psychotherapy is practiced formally by professionals-psychiatrists, psychologists, social workers and psychoanalysts-and informally, by others, in ways folksy or fancy, in all walks of life. It is also practiced in dealings with doctors, dentists, lawyers, clergy and in the mass media. Prominent in the history of psychotherapy and its entry into medical science were pioneers Franz Anton Mesmer and his followers and Sigmund Freud, the founder of psychoanalysis.

The Method

Freud coined the term psychoanalysis as a synonym for psychotherapy and developed a method, or technique, for understanding and interpreting the verbal productions of persons in health and disease. He enriched the method of psychotherapy he learned from Breuer by adding the technique of free association and the concept of transference. This enabled Freud to discover depth psychology, an analytical method for understanding the meaningful connection between manifest content of symptoms, thoughts, dreams and acts and their latent content, and hence the motivational dynamics of consciously deliberate versus covertly-driven behavior.

The discovery that symptoms had this dual structure, conscious and unconscious, that they were not just brain events but mind events, enabled Freud to elucidate the role of fantasy, the emotions, psychological trauma and the role of sex and love in human relations. But experiences are told in words, meanings are shaped into memories, metaphors, and myths, i.e., stories. In time, the above-defined aspects of Freud's method became the generic foundation for all the other schools of dynamic verbal therapy, whatever their theories (Lothane 1981, 1983, 1984, 1994a).

Following early endorsement by psychiatry's Eugen Bleuler in Zurich, psychoanalysis went on to revolutionize the static-descriptive, organic psychiatry of the turn of the century , converting it into the dynamic psychiatry of today, especially in the United States. Freud influenced the ideas of Adolf Meyer, M.D., a Swiss immigrant who knew Bleuler, William Alanson White, M.D., and the interpersonal dynamic concepts of Harry Stack Sullivan, M.D.

The foregoing is relevant to meet the currently oft-heard criticism that psychotherapy or psychoanalysis is not scientific, as if scientific is one and the same defining criterion for all the known sciences. Are botany, mathematics, paleontology, physics and psychology sciences in the same way? Rather, since science means knowledge, to qualify as a scientific discipline, psychoanalysis should be defined by its own method. When seen from the vantage of method, psychotherapy qualifies as scientific when it is empirical, i.e., based on experience, observation, rigorous thinking and critical judgment. To proceed empirically is not the same as being able to reproduce observed phenomena experimentally, in closed laboratory situations, nor does it mean that every phenomenon can be quantified: experimentation and quantification cannot be the sole scientific criteria for studying persons in life situations.

To make another comparison: medicine is not a quantitative science per se, it is an empirical art of healing the body utilizing a number of basic sciences: anatomy, physiology, bacteriology, pathology, pharmacology and others. Psychotherapy, psychoanalysis and dynamic psychiatry are empirical healing arts of persons suffering from problems in living and/or mental disorders.

What are their basic sciences? The social sciences of anthropology, history and philosophy, but also knowledge provided by the sciences of experimental psychology, biology, epidemiology, pharmacology. As healing arts and as discourse, both medicine and psychotherapy can be enriched by human wisdom from any source, most importantly by great literature, art and religion. Over and above, both medicine and psychotherapy are ruled by a special code of ethics that applies to the doctor/patient relationship. The Hippocratic oath in medicine and the requirement of impartiality in psychoanalysis are both based on the principle of serving, not using, the patient.

Whereas the therapeutic situation is not reproducible like a laboratory experiment, no more than a life situation is, it can be defined methodologically and tested operationally. While imperfect and liable to error, it remains a unique field of observation of human nature, and when properly controlled for error, it becomes a reliable setup for such observation. A well-managed psychotherapeutic situation, and a properly conducted case study, meet the requirements of science, e.g., as shown in studies by Luborsky. In summary, psychotherapy is an empirical method, or technique, based on procedures and processes employed in the therapeutic situation, and in keeping with ethical principles.

The Theories

The method of psychoanalysis is most often confused with the various theories or doctrines or schools of psychoanalysis, a confusion that began with Freud himself. One of the reasons for the confusion is a tendency to overgeneralize empirical data of observation, converting them into universal theories of causation. The two best-known examples of such zealous generalizing as to cause of disorder were (1) Freud's theory of the sexual etiology of the neuroses and (2) his so-called seduction theory. Regarding the first, both adult and infantile sexuality are ubiquitous phenomena, and can act as a potential cause of mental disorder; but to qualify as an actual-both sufficient and efficient-cause, it has to be clinically demonstrated in a given case. The same goes for aggression or any other dynamic motivational factor. Viruses are everywhere, but they do not cause a manifest viral illness by their mere presence in us, and when they do, it must be clinically proven, other cofactors considered. Therefore, sexuality does play a decisive role in many cases, but not uniformly in all cases.Regarding seduction theory, in 1896 Freud discussed seduction and sexual trauma, i.e., the traumatic arousal of infantile sexuality by abusive manipulations, or seductions, of parents and others, as a ubiquitous cause of neurosis. In 1897 Freud realized, to his own dismay, he had overstated the causal role of childhood seduction as an actual remembered experience, since patients confessed to having fabricated such stories. In 1905 Freud still held infantile sexual trauma as fact, but added other factors to the equation of childhood sexual experiences: spontaneous sexual activity, e.g., masturbation and the associated guilt and shame, thus the compensatory fantasies of being seduced.

Freud never claimed that seduction does not exist. He entitled a chapter in Wolf Man (1918) "The seduction and its immediate consequences." Elsewhere (in a 1924 footnote to the 1896 paper and in his papers on female sexuality of 1931), Freud reaffirmed the reality of seduction. This sketchy account shows that Freud's error was to posit childhood seduction, i.e., childhood sexual trauma, as a universal cause of disorder, and he duly corrected this impression. It is thus amazing that analysts still maintain, erroneously, that the seduction theory is dead, that Freud's bad theory was replaced by a better theory, i.e., the sexual drive theory and the oedipus complex.

Freud never gave up the seduction theory (Lothane 1987), for there is no causal contradiction but a requisite complementarity between spontaneous childhood sexuality and the premature sexual arousal of children when used as incestuous sexual objects. It was never an either/or proposition between a memory of an actual event or a fabrication of one, but the subtle interplay of perception and fantasy, impression and impulse, fantasy and memory, which happens to us all and in all ages. This is what Freud-bashers fail to understand.

Freud -Bashing

Freud critic J.M. Masson (1976) stated that Freud never abrogated the seduction theory. However, in 1981, The New York Times reported that Masson accused Freud of cowardliness and dishonesty for abandoning the seduction theory! Clearly, it was not Freud but Masson who changed his mind, and without offering a clear explanation. What got analysts even more incensed was a comment in Masson's "revelations": He accused psychoanalysis of being sterile, and that hurt. Understandably, analysts retaliated, and the resulting furor became grist for fascinating copy by Janet Malcolm in The New Yorker, creating a media circus.

Masson's accusations of Freud climaxed in his 1984 strident best-seller, The Assault on Truth. But it was Freud who was assaulted and truth lost out. Masson may have actually believed he was trying to heal psychoanalysis; what he succeeded in doing was to usher in an era of Freud-bashing. In an antipsychiatry book of 1988 Masson went so far as to issue a "battle cry" for the abolition of psychotherapy. He might as well have promoted the abolition of parenthood.

None of Freud's numerous theories were found thornier than his sexual theory of neurosis and sexuality and his prescription for sexual happiness in society, expounded in 1905 and 1908, respectively. They provoked bashing, defined as hurling hard verbal abuse at a person or group with a view to discredit and destroy, by prominent colleagues such as Aschaffenburg, Hoche and Krafft-Ebing. Ad hominem attacks on Freud, as well, ensued. In a 1992 book, E. Fuller Torrey, M.D., claimed that Freud's sexual theories had the malignant effect of destroying American sexual morality. Nevertheless, he also found some good things to say.

The strategy of the current crop of Freud-bashers is to assault as evil both Freud and his psychoanalytic method, relentlessly and implacably. The front-runner in this crusade is literature professor Frederick Crews, formerly a pro-Freudian, thus a variation on the theme of "the God that failed." Crews' Freud-bashing rhetoric, filled with emotionality, seizes upon Freud's occasional cognitive or ethical lapses, or mistakes in interpreting cases.Under the cover of Esterson's thin revisionist thesis that the seduction theory, as "the myth of the birth of psychoanalysis," became the "founding of psychoanalysis per se," Crews argues that both the "feminists and the defenders of children [who hold]...that those stories [of sexual abuse] were true have been drastically misled." Is Crews denying the reality of child abuse, which Freud clearly stated in his 1896 paper? The culprit is Freud himself, alleges Crews, "[who] laid down the outlines of the seduction plots, which he then fleshed out from the 'clues' supplied by his bewildered and frightened patients, whose signs of distress he took to be proof that his constructions were correct." Although "it may seem wonderful," mocks Crews, "that [Freud] was able to let go of his seduction theory at all," in truth Freud was so beset with a "severe problem with reality testing, dishonesty and cowardice" that, in desperation, he replaced the phony seduction theory with another phony theory, to wit: "in their fantasy life, [patients] and every other child who ever breathed had been the would-be seducers of their opposite-sex parents."

What is the moral of this story? Psychotherapy and psychoanalysis are here to stay. Moreover, the current either/or between biological and psychodynamic psychiatry, between dialogue and drugs, is another pseudoissue: there is a need for both, there will always be a dynamic psychiatry.




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