The rise and demise of psychoanalysis
(Investigator 90, 2003 May)
When Sigmund Freud described a new method of treatment of psychoneuroses in 1900 he was considered brilliantly original, but also outrageous.
Freud was born in Freiberg, Germany in 1856. He died in London in 1939. His new form of therapy, which he called psychoanalysis, was primarily concerned with sex, and this was at a time when this subject was taboo. In Victorian England even piano legs were covered.
It was courageous of Freud to write openly about this subject in a period when it was discussed only in whispers. He produced neologisms such as superego and id, and new concepts such as dream censor, condensation, and displacement in dream symbolism. Freud studied Greek mythology, and the Oedipus myth was integrated into his therapy, resulting in his famous Oedipus Complex.
In Shakespeare's Hamlet, psychoanalysts consider Freud's Oedipus Complex is being acted out in a disguised form. Freud's famous works, The Interpretation of Dreams (1900), and Introductory Lectures on Psychoanalysis (1922) described the methods of his therapy, and psychoanalysis developed a cult following.
Freud had the gift of language, and was a brilliant writer. Besides his native German he spoke English and French fluently, and also Latin, Greek, Spanish and Italian. He was not the originator of the unconscious (as often claimed by his followers), but he had novel ideas of its contents.
The basis of psychoanalysis was to uncover these contents by free association and dream analysis, and thus lead the way to resolving unconscious conflicts. Freud considered dreams to be the disguised fulfilments of repressed wishes. Dreams contained symbols which disguised the dream's true meaning. Psychoanalysis aimed at exposing the significance of these symbols, and the cathartic insight gained by the patient relieved his symptoms. Symptomatic cures (Freud's term), simply removing symptoms eg by hypnosis or drugs, was useless according to Freud. Unless the underlying cause was removed by psychoanalysis the symptoms, or new ones, would return.
Freud was trained in the scientific discipline of medicine and he specialised in neurology before he turned to psychiatry. He clearly had a scientific attitude when he stated "Truth cannot be tolerant". But the major criticism of his work is that it lacks rigorous scientific testing of his many hypotheses. Psychoanalysis is based on Freudian dogma and doctrine. There were no scientific studies, no critical analyses, no rigorous testing.
Psychoanalysts have difficulty in accepting criticism of Freudian analysis, although this is a recognised procedure in advancing science, and critical papers can expect a hostile reception (present article included). Clinical trials comparing psychoanalysis with other methods of psychotherapy and untreated groups are resisted or dismissed by psychoanalysts.
As a result Karl Popper (1959) labelled psychoanalysis a pseudoscience. In Freud's opinion experimental evidence was not needed to confirm his hypotheses (Eysenck & Wilson, 1973). It should be noted that in the early days of psychoanalysis double blind clinical trials had not yet been thought of.
Freud conceived a complicated structure of the human mind, based on flimsy anecdotal evidence and dogma. His writing and exceptional language skills were so persuasive (and brilliant) that dogmatic statements, without scientific evidence, were accepted as the truth almost without question by his followers. Psychoanalysis became more akin to a religion, with Freud being the God-like figure. Belief, which has no place in science, became the rule.
Freud's psychoanalysis extended into non-medical disciplines such as anthropology. Here again, dogma rather than scientific evidence was presented. Margaret Mead's field studies in Samoa in 1925 (Coming of Age in Samoa, 1928) suggested an idyllic life of young Samoans, free of inhibitions, with promiscuous sexual freedom. As a result, said Mead, there was an absence of neurosis, rape, crime and many other problems of Western societies in this South Pacific paradise. This appeared to confirm Freud's views that sexual inhibition was the basis of neuroses. However Derek Freeman showed clearly that Mead's work was entirely incorrect both in her findings and conclusions (Freeman, D. 1996).
The most recent method of psychotherapy is cognitive behavioural therapy. This short-term (3 – 4 months) treatment aims at removing symptoms rapidly, and is very effective. Contrary to Freud's dictum that removing symptoms without dealing with the underlying cause would result in a return or replacement of symptoms, this has been found to be incorrect. There is no recurrence of symptoms and patients are quickly cured. In fact the symptoms are the disease (Rachman & Hodgson, 1980)
Freud laid down a recommendation that psychoanalysts needed to be analysed themselves to be effective therapists. His point was that this would enable the therapist to neutralise his own prejudices which might slant his reactions and interpretations in the analyst/patient situation.
Furthermore it was a valuable training method for the therapist. It takes several years to complete. However, it seems that therapists with only a few months' training obtain just as effective results as therapists with a full training analysis (Smith et al, 1980). The same authors found that the duration of treatment was unrelated to results.
Freud did not consider that it was necessary for therapists to have a medical qualification to practise psychoanalysis. As a result it has been eagerly taken up by "counsellors", therapists, social workers and probation officers, some of whom have had limited formal training. Non-medical clinical psychologists who practise psychotherapy are, of course, highly trained. A full formal psychoanalysis takes three to five years.
One of the basic concepts of psychoanalysis is that symbolism in dreams express unresolved problems of childhood sexuality, eg the Oedipus Complex. However, new discoveries about dreaming throw serious doubt on this hypothesis. Dreams occur in rapid eye movement (REM) sleep. During dreaming the eyes move rapidly from one side to the other, and this can be observed in the sleeper by movements of the closed eyelids. It can also be confirmed by the electroencephalogram which shows absent alpha rhythm when dreaming occurs. Thus REM and absent alpha rhythm indicate dreaming. But REM sleep (ie dreaming occurs in the new born infant. Furthermore it can be demonstrated in the unborn foetus by ultra-sound imaging.
Obviously it is illogical to relate these findings to sexual problems. These discoveries contradict one of the essential criteria of psychoanalytic therapy.
Criticism of psychoanalysis may be summarised as follows:
1. It is a very lengthy and expensive procedure.
2. Three to five years' psychoanalysis is no more effective than short term (three to six months) psychotherapy (Rachman and Wilson, 1980).
3. The length of training of therapists is uncorrelated to therapeutic success.
4. Cognitive behaviour therapy is significantly more successful and much more rapid in effect than psychoanalysis.
5. Psychoanalysis is based on highly speculative doctrine and dogma – not on scientific studies.
Do these points mean that Freud's work can be dismissed as of no significance today? They certainly do not mean this. Freud's contributions have been an enormous boost to psychotherapy in general. He produced new ideas on the psychological significance of mental symptoms. He conceived the concepts of repression and conflict as a cause of symptoms. Above all, in a time of sexual inhibition he led the way to the open discussion of sex which we accept as normal today. He was more than fifty years ahead of his time. Many of his neologisms have become part of our everyday language. Clearly his genius had a huge influence on modern thought – in literature, anthropology, mythology, language, social sciences, painting, and art. It is non-medical disciplines rather than therapy which have benefited from his work.
Eysenck H. J. & Wilson G. D.- The Experimental Study of Freudian Theory, Methuen, London, 1973.
Freeman, D. Margaret Mead & the Heretic, - Penguin, Australia 1996.
Freeman, D. Lecture, Australian Skeptics Annual Convention, Monash University, 1996.
Freud, S. Introductory Lectures on Psychoanalysis, Allen & Unwin, London, 1933.
Freud, S. The Interpretation of Dreams, Allen & Unwin London, 1937.
Mead, M. Coming of Age in Samoa, New York, 1973.
Popper, K. R. - The Logic of Scientific Discovery, London, 1939.
Rachman, S. & Wilson, G. T. – The Effects of Psychological Therapy, Pergamon, London, 1980.
Rachman, S. & Hodgson, R. Obsessions & Compulsions, Pergamon, London, 1980.
Smith, M. L., Glass G. V., and Miller T. I. – The Benefits of Psychotherapy, Johns Hopkins University Press, Baltimore, 1980.
COMMENT ON BOCKNER
(Investigator 91, 2003 July)
Dr Bockner (#90 pp. 10-12) may or may not be aware that many anthropologists reject Freeman's criticisms of Margaret Mead, at least in part. If he is, he should acknowledge this in his wording, however convinced he personally may be that Freeman is right.