Psychoanalysis on the Rocks

Hope dies hard. Psychoanalysis has gone the way of alchemy, but an intrepid band of loyalists believes that it can make a comeback.

In itself this is a bad sign. If people are wishing for your comeback, that suggests that you have nowhere to go but up.

I will save the debate on the clinical effectiveness of psychoanalysis for another time. For today I want simply to consider the PR hit that Freud and psychoanalysis took in today’s New York Times book review.

Tasked with reviewing Jeffrey Lieberman’s book Shrinks, Natalie Angier, the Times science correspondent recalls her own experience of orthodox Freudian analysis:

One of the most miserable experiences of my young adulthood, in the mid-1980s, was the year I spent in formal Freudian psychoanalysis. How well I remember lying on that uncomfortable couch with its built-in simulacrum of a pillow, as I struggled desperately to just “let my mind go,” to free associate, to disinter childhood memories or impulses that might prove remotely useful to me or at least satisfy my psychiatrist, who often seemed to be picking distractedly at lint on her skirt. She was a brilliant woman, no doubt about it, yet I always left her office feeling like a failure, and the science writer in me couldn’t help wondering, Where is the clinical evidence that this excruciating and expensive ordeal really works?

Folks, this is the New York Times. Its science writer is calling psychoanalysis an “excruciating and expensive ordeal.” Excuse her pragmatism, but she is asking if there is any evidence that it works.

She finds an answer in Lieberman’s book:

… the evidence, quite simply, doesn’t exist. Whether for the treatment of relatively mild afflictions like my dysthymia, or for serious conditions like bipolar disorder, schizophrenia or depression, psychoanalysis never had much, if any proof of efficacy. Yet the Freudian conceit that repressed desires and conflicts were the source of mental illness, and that talking those urges out of hiding could lead to a cure, dominated American psychiatry for over half a century, Lieberman says, stranding the field in “an intellectual desert” from which it has only recently emerged. “Sigmund Shlomo Freud,” Lieberman writes, was “simultaneously psychiatry’s greatest hero and its most calamitous rogue.”

How did Freud deal with the fact that psychoanalysis could not provide evidence to suggest that it worked: First, he attacked anyone who questioned him. (My Lacanian friends have made this into an art form.) Second, he transformed psychoanalysis into a “petrified religion,” or what I more correctly called a pseudo-religion.

Angier writes:

Freud knew he lacked evidence for many of his “daring ideas about mental illness,” Lieberman says. Yet rather than conducting research to fill in the gaps, he instead began attacking anybody who questioned him. “He demanded complete loyalty to his theory, and insisted that his disciples follow his clinical techniques without deviation,” Lieberman argues, thereby “fossilizing a promising and dynamic scientific theory into a petrified religion.”

Don’t say I didn’t tell you.