Saving Dr. Freud

A strange choice, I must say. Over the years Frederick Crews wrote many of his blistering critiques of Freud for the New York Review of Books. Now that Crews has produced a magisterial biography of Freud, the NYRB has chosen, as a reviewer, Lisa Appignanesi, Chair of the Trustees of the Freud Museum. Obviously, they were not looking for an impartial or objective or fair-minded reviewer. They did not find one. Whatever the faults of the Crews biography, he deserved better from the NYRB.

As for qualifications, Appignanesi is a writer, a teacher of literature and the widow of one John Forrester, a Cambridge professor who wrote extensively about psychoanalysis, particularly about Jacques Lacan. One imagines that she knows something about psychoanalysis, but she is hardly an expert in clinical matters. She has undertaken to rescue Freud's reputation and his ideas from well-deserved oblivion. Given her ideological blinders she does not know that Freud is beyond saving.

So, she debunks Crews by saying first that Crews is fighting a straw Freud. She declares that no one really cares much about Freud himself or his practice or his patients. It’s all in the ideas. We can dispense with the rest. If Freud were a scientist—Appignanesi still thinks he is—this might be pertinent. But Freud was a culture warrior, dedicating himself to subverting Western civilization, especially the kind associated with Protestantism.

She seems to understand that Freud was a world class storyteller, one who would appeal to a novelist like Appignanesi, but that his theories are nothing more than that:

The idealization of Freud the man that Crews is so keen to prove a blinding illusion is hardly prevalent. Most scholars, commentators, and even analysts don’t need it to make use of Freud’s insights into the opacity and unpredictability of the human mind, or the ways in which love and hate coexist, or how our childhoods echo through us, sometimes trapping us, or how our identifications with early figures in our lives shape the complicated humans we become.

Having a special fondness for empty arguments from authority she declares that Freud must have been a scientist because he was welcomed by the Royal Society of British scientists. She adds that Pope Pius XII himself declared Freud to be a scientist and that Pope Francis had been in psychoanalysis. Thus, she considers the case closed:

Perhaps Pope Pius XII hadn’t noticed this when in 1953 he formally approved “the use of psychoanalysis as a healing device,” indicating that “science affirms that recent observations have brought to light the hidden layers of the psychic structure of man.”¹ Pope Francis himself recently revealed that he had had psychoanalysis at the age of forty-two. He called his analyst a courageous woman.

Since Appignanesi ignores the fact that Freud’s claim to be a scientist was definitively debunked by Karl Popper, who remarked that since Freud would not admit to their being any evidence that could falsify his theory he was not doing science. Add to that Nobel prize winning biologist Peter Medawar’s point-- published in the NYRB, I believe-- that Freud knew nothing about biology and was perpetrating a massive confidence trick, and you shrug your shoulders over the claims of a cult follower like Appignenesi.

And yet, she adds that psychoanalysis is more like religious movement, even a cult. In truth, I have written about this extensively myself, but I only note here that the same simple-minded thinking that declared Freud to be a scientist on the say-so of two popes does not recognize that you cannot be a scientist and a cult leader at the same time.

In her words:

Crews doesn’t explore—as Ernest Gellner did in The Psychoanalytic Movement (1985)—how the growth of psychoanalysis may be understood as akin to the development of a religious movement, or how its claims, while pretending to be scientific, are actually those of a belief system in disguise.

She is correct however to point out that, when Freud began his work, treatment for mental illness was not very good.

Crews has a good grasp of the general culture of neurological and psychiatric medicine at the turn of the last century, but in his zealous attempt to indict Freud, he fails to give it proper historical weight. There were no cures for psychiatric illnesses, including hysteria, with its wide range of often severe symptoms. Treatments were harsh, penitential, and sometimes terminal.

At the time, these were not considered to be psychiatric illnesses. They were not considered to be neuroses. They were considered neurological disorders. Some, especially the outbreak of hysteria, was produced by social contagion.

Much of the rest was considered the work of witches and devils, and was treated by priests. Freud understood this and wrote about it in the case of Christoph Hatzmann.

She continues:

But hypnotism was one of the time’s scientific experimental methods, and in Charcot’s case a diagnostic tool. Crews chooses not to mention that what Freud learned from Charcot was “la chose genitale”—the sexuality that was everywhere in the hospital and in the stories the hysterics told about themselves and to which Freud, unlike Charcot, listened.

Of course, I myself gave weight to these facts in my last book about Freud. The author ignores it.

Appagnanesi gives Freud credit for trying to cure the mental ill, many of whom were people suffering from neurological disorders. Psychoanalysis has often overreached, in its effort to treat people who suffered from brain diseases or neurological or metabolic disorders.

She does not fault Freud for not curing his patients, but she should have mentioned that in his early case studies Freud claimed to have cured them. Thus, a so-called man of science presented fraudulent representations of the effectiveness of his method.

Freud at least attempted to do so. At the time, mental hospitals and private clinics used whatever drugs they could find, from chloral to potassium bromide, to calm their patients. The anguished behavior of the ill—often verbally, sexually, and physically agitated—is well known. It’s hardly surprising that Josef Breuer used sedatives on Bertha Pappenheim, known as Anna O., the first patient in the Studies on Hysteria, or that Freud at first tried that and whatever other techniques were available to him. Managing such patients was the best that could be done. Failure was the norm.

Freud did contribute the notion that remembering past traumas would release patients from their hold. Crews wrote about the way this notion informed the abuses of the recovered-memory movement in the New York Review of Books. Appignanesi ignores all of it.

She sees Freud as a nice man performing a harmless procedure. If it did not work, nothing else did either:

Yet Freud left drugs and hypnotism behind for his new, far gentler talking and listening therapy. Most hospitals and asylums, even clinics, did not. In the course of the more “scientific” twentieth century came miracle cures, often deadly on application, such as insulin, tooth-pulling, lobotomy, and electroconvulsive therapy (ECT). Modern ECT entails a more powerful application of electricity than the nineteenth-century electrotherapies the young Freud used, and for which Crews mocks him.

And she adds that Freud’s patients did not commit suicide. Psychiatrists have long known that if you do not want your patients to commit suicide the best approach is not to treat suicidal patients. Yet, she ignores the case of Victor Tausk—a sometime patient of Freud’s—and, in France the case of Lucien Sebag. She also has nothing to say about the psychiatric clinics that were run according to psychoanalytic principles. Before the advent of modern medications, those clinics produced some very ugly results—for pretending that they could treat schizophrenia and severe depression with talk:

Whatever Freud’s highhanded and patriarchal misreadings of this troubled adolescent girl, Dora didn’t commit suicide, as her parents were worried she might; nor did Freud’s other patients. That may not be a miraculous result, but neither is it a total failure, as anyone working in today’s challenging mental health environment would surely agree. Freud, unlike many in his time, at least acknowledged that women’s voices were worth listening to—that women were sexual beings with desires.

Trust me, Freud did not discover that women were sexual beings with desire. The notion is risible on its face. And he did not, as he claimed, discover that children were not innocent. The major theologians in Christendom were on the case centuries before him.

Appignanesi draws a stark parallel between the benign psychoanalysts on the one side and the terrible drug companies on the other. She fails to notice that if psychoanalysis had been an effective treatment people would not have been flocking to these medications:

The recent exposure of the extent to which negative evidence in clinical trials of much-hyped psychoactive drugs was massaged away with the help of doctors on pharmaceutical company payrolls, the way clinical results highlighted only what would prove profitable, the masking of side effects, suicide among them—all this has made the purported misdeeds of psychoanalysts look benign.³ The talking therapies may produce no instant miracles; neither do they do comparable harm. Insurers may want to think again about costs over a patient’s lifetime. Then, too, hand in hand with the development of these new, highly touted “scientific” psychoactive drugs, the number of sufferers from mental disorders has grown enormously.

One might say a word about correlation and causation. The use of psychoactive drugs does not necessarily cause mental illness. One suspects that the increased cases of mental illness derive from psychosocial factors, from  an increasingly fragmented society where children are not taught to fit in and to get along with other children, but to seek individual autonomy, independence and self-actualization.

For all we know the therapy culture, brought into the latter half of the twentieth century by one Benjamin Spock is a major culprit in producing social anomie. Or else, we might say that the tyranny of science, the sense that science can answer all questions has produced an ethical morass where people have no reliable principles or precepts to guide their lives.

Of course, one needs to distinguish between SSRIs and the other psychiatric medications. When it comes to psychosis or severe depression or phobias or bipolar illness… these medications have been a godsend for many patients. Those psychoanalysts who advise patients not to take their medications ought to bear some responsibility for the negative outcomes, including suicides, that befall those who refuse treatment. Of course, the anti-psychiatry movement of R. D. Laing did its best to persuade patients not to take their drugs. It certainly caused damage. It was not benign.

And let’s not forget the efforts of French psychoanalysts to ensure that autistic children in France not receive the best available treatment, that being cognitive and behavioral. Let’s not forget the social service agencies that remove autistic children from their homes in France because Freudian analysts have persuaded them that these children became autistic because their mothers were frigid or otherwise toxic. Put that on the account of Freudian theory.