Wednesday, July 15, 2015

Psychoanalysis Today

You can’t say I didn’t inform you. Even though psychoanalysis has quietly passed into the realm of historical relics, some intrepid souls still cling to it. They are attempting to revive it with neuroscience.

As my analyst used to say, they will do anything to gain credentials.

As for the state of psychoanalysis today, journalist Casey Schwartz described it in the New York Times:

The ideas of psychoanalysis, its very vocabulary — those familiar terms like ‘‘id, ego and superego,’’ ‘‘the Oedipus complex,’’ ‘‘penis envy,’’ ‘‘castration anxiety’’ — come across, for many, as quaint souvenirs pulled from a dusty attic. The very project of psychoanalysis — to cure through self-­awareness, through an exhaustive exploration of the patient’s unconscious mind — is increasingly at odds with what most people seem to want: to fix their problems as quickly and painlessly as possible. With millions of Americans now taking pills for depression, expecting to feel better in a matter of weeks, the concept of signing up for a psychological treatment that can stretch on for years no longer seems to make the kind of sense it used to.

Of course, Schwartz is also passing on the slander that psychoanalysts have always used to befoul the competition. The truth remains that psychoanalysis does not fix problems at all. Most people have decided that it is not worth the time or the effort to sign up for an extended treatment that has not been shown to produce consistent and observable benefits.

It is worth underscoring, because the author does not, that psychoanalysis failed because it did not produce good clinical results, not because we did not take enough brain scans. Machines are not going to be its salvation.

While Schwartz and several analysts say that treatment can produce changes in mental functioning or processing, not all change is for the better. If you make someone lie on the couch for several hours a week and force him to acquire the highly dysfunctional habit of free association, he will certainly change, but in the sense of being more socially maladroit and disconnected. If he feels better about his anomie, we all wish him well. If you think that that is a good clinical result, you should try to extricate yourself from the cold grip of psychoanalysis

You do not learn how to connect by failing to connect with your analyst. When you are free associating you cannot connect.

Schwartz's description of the state of today’s psychoanalysts resonates with my own:

Attend any psychoanalytic conference, and you are likely to hear a version of some doomsday refrain. Across the United States, the average age of American psychoanalysts is rising, as psychoanalytic institutes, where analysts are trained, are declining in membership. Many practitioners fear that the entire discipline is in danger of fading away.

Or better, to demonstrate a point I made at length in my book The Last Psychoanalyst, even a great defender of the Freudian faith understands well that it has a lot more to do with religion than with science:

‘‘Psychoanalysis needs to change its culture,’’ says Andrew J. Gerber, a psychoanalyst and an assistant professor of clinical psychiatry at Columbia University. ‘‘There is an aspect of psychoanalysis that feels faith-­based. You believe it because we told you to believe it. Because Freud said it. Because I, as your supervisor, told it to you. Because you experienced it in your analysis. And while I wouldn’t say those aren’t valid reasons to have an idea, they’re not reasons to continue to believe the idea is true in the face of other evidence.’’

Of course, nothing would prevent you from hooking up a few electrodes to the brain of someone who is meditating or praying. That does not make meditation or religion into a scientific discipline.

Another person who is hard at work trying to salvage something from psychoanalysis, Dr. Bradley Peterson does not believe that psychoanalysis has a future as a clinical practice:

Bradley Peterson, a psychoanalyst, child psychiatrist and the director of the Institute for the Developing Mind at Children’s Hospital in Los Angeles, also sees the need for a different approach to the discipline. ‘‘I think most people would agree that psychoanalysis as a form of treatment is on its last legs,’’ Peterson told me. ‘‘It needs to partner with contemporary science in order to transmit to the next generation some of its learnings.’’

South African psychoanalyst Mark Solms is trying to trick people into thinking that psychoanalysis provides insight into the mind. Schwartz describes one of his discoveries:

Solms noticed, for example, that patients with damage to the right half of their brains often seemed eerily similar — uncannily aloof, bemused and self-­involved, their personalities transformed. It was only when he turned to the psychoanalytic literature that he could name the distinctive quality he observed: narcissism. He would go on to write about the role of the brain’s right hemisphere in our ability to understand the boundaries between ourselves and the world around us, as well as the way we distort those boundaries when that side of the brain is injured.

Since when is Narcissism a brain disease? What have you learned when you have discovered that you can make a correlation between a neurological injury and a fictional character? Because, keep in mind, Narcissus comes to us from Ovid’s Metamorphosis. 

It is altogether possible to conduct your life as though were a fictional character—good luck to those who want to try it at home—but if psychoanalysis has nothing more to offer than a systematic effort to convince people to confuse fictional characters with real people, its future does not look very bright, with or without neuroscience.

Do you really believe that you can learn how to relate to human beings by learning that you have been mistaking your psychoanalyst—and presumably everyone else—for your mother.

I have already written sufficiently about transference, so I will not go into it too deeply here. If the new versions of the theory suggest that we recall people from our past and sometimes see different qualities from those who are most important to us in those we are meeting anew, it does not seem quite so revolutionary. If your mother was a fine human being you might well want to marry someone who was like her. That does not mean that you wanted to commit incest with your mother.

This does not mean that the more we are aware of our mistakes the more we are going to see people as they really are.

The theory seems to be based on the notion of a psychic cleanse that will open what William Blake called “the doors of perception?” If so, it is trafficking in an illusion created by romantic poets. It is not science.

Since the psychoanalytic patient is precluded from seeing his analyst as the analyst really is, how is he learning how to see anyone else in the same way.

As the clinical practice of psychoanalysis dies out, some of its practitioners are trying to bring it back to life by pretending that it’s science. That means that if you do not get better, it’s your fault, not Freud’s. Funnily enough, it’s what Freud always thought.

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