Jamieson Webster's Psycho Pharmacopeia

Jamieson Webster is a psychologist practicing Freudian psychoanalysis. By her own account this makes her an anachronism-- fair enough-- and this explains the sense one has reading her extended New York Review of Books essay on “The Psychopharmacology of Everyday” life that one is entering a time warp. She recalls a time when naive young psychoanalysts thought that their magic verbal potions could cure just about anything. For the most part they failed. As has Freudian theory and practice. And yet, Webster soldiers on, impervious to facts and to reality.

Most of those who were trained in psychoanalysis have long since abandoned the field. That includes your humble blogger... but you probably know that already.

As it happens, Webster has no credentials or qualifications in psychiatry, neurology, psychopharmacology or biochemistry. Apparently, this has not prevented the editors of the New York Review of Books of publishing her Freudian reflections on such matters. One does not want to overdo the importance of credentials, but seriously, couldn't the Review have found someone who knew something about psychopharmacology? Where’s Robert Silvers now that we need him?

Webster does recount that she worked in a psychiatric hospital at one point. For my part I have no credentials or qualifications in these sciences, though I did work in a psychiatric clinic for several years in the 1970s. I was training in psychoanalysis in France at the time and had the good fortune of having a supervisor who told me one day in no uncertain terms that I had no right to an opinion about medication. Apparently, Webster did not receive the same lesson.

I mention my own experience in a psychiatric clinic in France because the clinic in question, called the Clinic of Freschines was a sister clinic of the famed clinic called La Borde. Both were in the Loire Valley. La Borde was founded after World War II. Freschines was a spin off, run by people who had worked at La Borde. It was founded in the early 1970s.

Webster seems to feel some nostalgia for La Borde, even though she knows nothing about it. In a note to her NYRB article she is quoted as saying this:

“I am fascinated by the experiments of psychoanalysts and existential psychiatrists in the mid-1950s to the 1970s from R.D. Laing to Deleuze and Guattari at La Borde Clinic, to Françoise Dolto and Maud Mannoni with children in Paris, all working with those who suffered from severe forms of mental illness,” Jamieson explained. “There was a courage, openness, and humanitarian effort that is unequaled… The work is painstaking, delicate, and feels like a dying art. I really wish something like this was more possible here. I miss working in the hospital—but also don’t want to work in a hospital the way they operate now. So the piece really comes from this frustrated desire.”

Interesting that she would mention La Borde in an essay that recommends less medication. For example, she says this about antidepressants:

One thing I will say is that I prefer my patients not to be on them if possible, or eventually to get off them. True, the lows aren’t as low, but neither are the highs high, and pleasure is limited to some medial zone.

Trust me, my old supervisor would have seriously disapproved of her offering an opinion about medication.

Discussing the treatment of schizophrenia, she refers to Freud, who did not treat psychosis, and a Canadian group that has been asserting for some three decades now that they can treat schizophrenia with an inpatient treatment facility with little or no medication. In truth, I knew the leaders of this group decades ago. I think very well of them. The notion that anyone can mostly dispense with medication and cure schizophrenia has been tried on numerous occasions at numerous places… with results that have turned out to be disappointing.

When La Borde first opened its doors today’s psychiatric medication was unavailable. The clinic tried to treat psychosis with what was called institutional psychotherapy… wherein they did not lock people up, did not have bars on the windows, but provided a mini social organization that would allow people to participate in a variety of activities, to have a voice in the organization of the clinic and to feel like something other than a clinic patient.

Those who were there at the clinic's beginning told me that without medication, the results were a nightmare. As soon as medication was available, the psychiatrists at La Borde embraced it wholeheartedly. Patients in that clinic and in Freschines received drugs like Thorazine, Melleril, Haloperidol, Anafranil, Tofranil, Tranxene and Valium. This was before the advent of Clozaril and a newer class of anti-psychotic drugs. Come to think of it, Webster has nothing to say about them.

One day, I recall,

a pharmaceutical representative was visiting La Borde. He explained to the psychiatric directorate that he was in favor of institutional therapy-- because La Borde ordered as much medication per capita as the French psychiatric hospitals.

But, to be fair, La Borde and Freschines were most proud of their use of insulin shock therapy to treat early-onset schizophrenia and electroshock therapy to treat depression. The latter was most often used with young female depressives. Figure it out.

In fact, La Borde was so proud of its use of insulin shock that it even made a movie about it. As for the efficacy of this crackpot theory, it was developed by Dr. Manfred Sakel at Mount Sinai Hospital in New York City. It was eventually dropped because its positive effects seemed to have a great deal to do with patient selection.

Given that I myself knew very little about this treatment-- and had certainly not observed it producing any benefits-- I was happy one day to meet a physician from Mount Sinai Hospital… specifically, a resident in neurology. When I asked her about their experience with insulin treatment, she explained that they had stopped using it. Why, I asked. Because it kills brain cells, she replied.

Naturally, being young and naive, I raised this point at a staff meeting at Freschines a couple of days later. I was sternly informed, by the clinic director himself, that the woman was spreading disinformation promoted by the CIA. Apparently, the CIA did not want to cure schizophrenia… for reasons that escape me. I mention this to give you a flavor of the kind of thinking that was animating the work at these institutions.

As for the experience in Canada, Webster reports this:

There are alternatives to this system. As Sigmund Freud posited decades ago, a psychotic person who is helped to pass through the most acute phase of their symptoms by being kept safe, and who then receives a continuous form of talk treatment, as well as some means of education or ability to work, can potentially stabilize without excessive medication. A fascinating, rare collective of psychoanalysts in Quebec known as “the 388” have created a clinic that provides psychoanalytic treatment and 24/7 emergency care to individuals suffering from psychotic problems. A study of eighty-two patients treated in their facility for three years or more demonstrated that the program was able to reduce incidences of hospitalization by 78 percent, while 82 percent were living autonomously and 56 percent were able to provide for themselves financially. Proving that such a course of treatment costs far less in the end than the conventional one, the 388 group has recently been asked by the Canadian government to open more facilities and expand its approach.

How meaningful is this? Not very meaningful at all. In truth, the sampling size is too small, and besides, we do not know what they mean by “psychotic problems.” At Freschines, a clinic without locks on the doors or bars on the windows, the directors were careful to accept only patients who were less dangerous to themselves or others. At a time when we have seen untreated psychotics commit mass murder in places like Aurora, CO, Sandy Hook, CT, Parkland, Fl, and Thousand Oaks, CA… we do not need anyone suggesting that severely mentally ill patients can dispense with their medication.

Webster suggests that Gilles Deleuze and Felix Guattari were working at La Borde. In truth, Deleuze was not working there, though he might have visited. David Cooper, an associate of R. D. Laing and a proponent of anti-psychiatry, was in residence at La Borde when I was at Freschines. I recall one lecture that the director of La Borde, Dr. Jean Oury gave, where he declared that “the anti-psychiatry just killed one of my patients.” Anti-psychiatry recommends that people not take their medication. In many cases, Oury explained, this produces calamities.

As for the delicate sensibility, the openness and humanitarianism of Felix Guattari, I will share an anecdote, that I received on excellent authority. It tells of the time when Guattari summarily threw his wife out of their home… because wanted his mistress to move in. His distraught wife then tried to throw herself out the window of a high rise, only to be constrained. She was placed in a psychiatric clinic for treatment with anti-depressants.  For the record several staff members at La Borde committed suicide when I was at Freschines.

Webster pays lip service to the occasional usefulness of medication, but she ought to have noted that, when it comes to a neurological condition like autism, psychoanalysts in France have rejected any treatment that is not Freudian. The nation has been denounced by the Council of Europe for failing to offer the best available treatments, which are cognitive and behavioral. But, analysts believe that such treatments will corrupt the pure souls of French autistic children, because they were invented in America.

Rejecting science in favor of psychoanalytic storytelling does not help patients. As I have noted in my book The Last Psychoanalyst, psychoanalysis is nothing but overpriced storytelling.

Effectively, Webster is not writing about psychopharmacology, about which she knows precious little. She is working to rehabilitate Freud. She is more propagandist for Freudian ideology than analyst of medical treatments. She can make up stories to explain everything, but completely ignores the neurological dimension of every topic she is discussing. And naturally, she ignores cognitive and behavioral treatments.

So she happily regales us with misinformation about the treatment of hysteria, which apparently inaugurated psychoanalysis. In the matter of whether or not Freud ever cured any of the hysterics he claimed to have cured, Mikkel Borch-Jacobson has researched the subject extensively and has discovered that Freud’s work was a manifest failure. Webster does not mention it at all.

Instead, she suggests that treating hysteria with psychoanalysis is easy:

Freud actually finds the hysteric easier to treat because, more often than not, the hysterical patient is avoiding something in the external world—usually sexuality—whereas the compulsion neurotic is rigorously avoiding something in their internal mental life. It is not easy to turn someone’s attention toward what they want to stay away from, especially when it is something on the inside. This force of resistance has to be overcome. But the hysteric is easily led to the source of his or her suffering, trauma, and conflict, and the bodily symptoms, and failure to attend to life, vanish.

This is nonsense. Besides, most psychiatrists agree that conversion hysteria vanished from the psychiatric clinic sometime around the 1920s. Perhaps it still exists in France, in their time warp, but it no longer exists here.

As for Freud’s contribution to the treatment of hysteria, consider his analysis of a patient he called Dora. When she was barely thirteen and a half, Dora’s father’s mistress's husband made a sexual advance toward her. She rebuffed the advance by slapping his face. When Freud analyzed her dreams, he concluded that she had fallen ill because she could not accept that she really wanted to have sex with this man.

After all, the Freudian theory of hysteria, easily expanded to include all women, is that hysterics do not know what they want. But, ask yourself this: what is the meaning of consent, or lack of same, if she does not know what she wants. After all, when Freud visited the Salpetriere he must have known that the neurology residents, charged with caring for hysterics, where sexually assaulting them. Whether consenting or not, their position as patients made even their consent non-consenting.

Obviously, psychoanalysis outside of America has not had its #MeToo movement. If it ever does, people will perhaps discover that psychoanalysts have committed sexual assaults in sessions, in sessions of training analysis and even in supervision sessions. Again, some were clearly unwanted, but others fall into a zone of ambiguity. Considering that these women’s careers were at risk, do you really want to consider that they were acting on their desire or that they were consenting?

If you don’t understand that, you don’t understand Freud.