The Magazine

The Death of Freud and the Rebirth of Psychiatry

Jul 17, 2000, Vol. 5, No. 41 • By PAUL R. MCHUGH
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The psychiatrists-in-training, preoccupied by their own therapy, gravitated toward the patients who were most like themselves, withdrawing attention from the seriously mentally ill (patients with schizophrenia and manic-depression). Young and articulate patients, often female and worried over romantic adversities, were sought out, especially if they (or their parents) were wealthy enough to support the standard psychoanalytic treatment, a years-long course of fifty-minute therapy sessions as frequent as five times a week. A corrupting self-absorption pervaded psychiatric departments.

The seriously mentally ill -- the counterparts of the seriously physically ill, who were the mainstays of training programs in the other medical specialties -- were considered "too regressed" for educational purposes, too damaged by experience in their childhood to be promptly helped by psychotherapy. They were transferred to the state hospitals, though authorities in the universities promised that their time for treatment would come after the less-seriously disturbed had resolved their troubles. It never did.

Scientific research was neglected. Why do research when we already knew, on the basis of Freud's writings, just what constituted the causes of mental problems? Research -- if you can dignify such work by that term -- took the form of composing ingenious metaphors linking conjectured sexual conflicts to the symptoms seen in patients.

The classic Freudian example proposed that paranoid delusions -- especially the persecutory, jealous, or amorous ones -- were all distorted expressions of homosexual conflict derived from "arrests" in childhood sexual development. Thus a man's latent, unconscious, and unacceptable idea "I love him," once transformed by unconscious mechanisms, manifested itself as one of three delusional beliefs: the persecutory ("He hates me"), the jealous ("My wife loves him"), or the amorous ("Another woman loves me").

By the 1950s, leading American psychoanalysts were competing to see who could derive the flashiest connections from superficial resemblances between mental symptoms and events in patients' lives. The interpretation of genital symbols became a way of finding sexual meaning in mental disorders. None of this could be called research, and none of it advanced the care and treatment of patients or the elucidation of mental illnesses.

A telling and ultimately fatal flaw within the psychoanalytic movement was its fissiparous character -- present almost from the start, when Adler and Jung split from Freud to produce their own schools of thought. In America, the Freudian school was initially successful in dominating the strategically crucial centers of the university clinics and teaching hospitals in the East and the salons of Los Angeles and Hollywood in the West (where Freudian ideas influenced the motion picture industry).

Dissension between orthodox and reform sects of American Freudianism soon erupted, as subgroups of psychoanalysts hived off into separate psychoanalytic training institutes in every large city, with much ill will and repudiation all round. Each center devolved its own organization, initiation rights, rules of membership, and official doctrine about the "keys to meaning." Each presented itself as providing a different kind of analyst -- and postulants faced the problem of choosing among them. This fractionalizing demonstrated the cultic character of psychoanalysis; it was more Greco-Roman than modern, in its call for commitments to different conceptions of reality rather than to the single medico-scientific method guided by observation, reason, and experiment.

This sectarianism not only added heat to psychoanalytic convictions, but made criticism of Freudian ideas more difficult. Psychoanalytic propositions became moving targets, and challenges from psychiatrists outside the establishment were evaded or rejected as ignorant of the present state of the art.

I can testify to the frustration felt by those questioning psychoanalytic concepts such as repression, the dynamic unconscious, dream interpretation, and the rest of it. We were dismissed as being either in bad faith ("Freud bashing") or simple-minded and insensitive, given the "advancing" character of theory and the subtle, "concerned" thought of psychoanalysts. I learned firsthand the validity of philosopher Ernest Gellner's comment about psychoanalysis: "Evasion is not brought in to save the theory: It is the theory."