Saturday, January 9, 2016

Will Freud Return from the Dead?

Psychoanalysis has long since died out. I did my best to give it a decent burial in my book The Last Psychoanalyst.

Still, as often happens, some people still believe that if we beat it hard enough we can revive it. Some people think that pictures of brain waves can prove that Freud was right while others keep insisting that psychoanalysis can work as a clinical practice. To be fair, true Freudian psychoanalysts never really believed that it worked clinically and do not care.

The stakes are higher than you think. In yesterday’s and today’s culture wars Freudian psychoanalysis has become a pillar of leftist thinking. If you think that this is about the most effective treatment of depression you are missing the point.

It’s about belong to a cult, to a pseudo-religion and affirming the value of Western decadence. Those who are theoretically sophisticated, like the followers of French analyst Jacques Lacan, believe that psychoanalysis affirms the values of traditional Catholicism against Protestantism. That is, they see today’s culture wars within the context of yesterday’s. They believe that an ethic of desire should trump a work ethic; socialism should trump capitalism; idealism should trump empiricism; storytelling should trump science.

French analysts are clear on this point. They do not care about whether cognitive and behavioral treatments work. They are horrified at the prospect that empiricism and pragmatism will infest the souls of French children. Especially, as I recounted in my book and as Sophie Robert has demonstrated in two documentary films, when it comes to autism.

To the pure of soul, psychoanalytic treatment indoctrinates people in an ideology that make them part of a cult and that will make them fearsome culture warriors in the fight against Anglo-American hegemony. Scratch beneath the surface of an American analyst who imagines that he is theoretically sophisticated and your will find a sewer’s worth of crackpot leftist thought. Most of the time. it is pure gibberish. 

The reality is obvious. No one is interested in psychoanalysis any more. No one with any sense still undergoes psychoanalytic treatment. The great majority of psychoanalysts no longer practice anything resembling traditional Freudian psychoanalysis. As I have noted, psychoanalysis has gone the way of alchemy. And, not a minute too soon.

Still, hope blooms eternal and those who have been duped by Freud are happy to cling to their illusions. Among them Oliver Burkeman, a journalist writing for the Guardian. Note, that he is writing for the most leftist British publication, the kind of place that routinely runs the anti-capitalist rants of a Naomi Klein.

Burkeman’s screed about psychoanalysis and cognitive therapy has heated up the souls of those unhappy few who still believe in psychoanalysis. Thus, I feel obliged to respond to it.

In this I was preceded by Jesse Singal in the Science of Us column in New York Magazine. Singal points out correctly that Burkeman’s article is riddled with errors and misrepresentations. One expects as much from someone who is defending psychoanalysis.

For example, Burkeman declares that analyst David Pollens:

… has an impressive track record treating anxiety, depression and other disorders in adults and children, through the medium of uncensored and largely unstructured talk.

Of course, you must ask how Burkeman knows this. Has he surveyed all of the doctor’s patients? Has he read a scientific study of those patients? Has he drawn a conclusion from the testimony of friends who are in treatment with Pollens? No one knows the answer, so the point is propaganda.

Burkeman describes Pollens as not facing his patients and training them in the bad habit of “uncensored and largely unstructured talk.” Whatever the claims that Burkeman or Pollens make, training people in bad habits, in dysfunctional and anti-social behaviors does not improve their lives or their mental health. It makes them dysfunctional and anti-social. Considering the amount of time and effort they invest in the process it is not surprising that they think it was money and time well spend.

Burkeman’s column is entitled: “The Therapy Wars: the Revenge of Freud.” Cleverly, and psychoanalytically, he folds the debate into a narrative that is intended to threaten people. He is correct to see it in terms of war. And he should know that all’s fair in war. So, it’s not really about presenting a better treatment or better ideas.

He understands that it’s a culture war and that by affirming the higher truth of Freudian fiction you are taking sides with the radical left. Second, psychoanalysis will not try to persuade you that it's ideas are valid. It will threaten you. If you reject Freud he will come back and take revenge on you.

Of course, anyone who knows how things work in Paris, one of the very few places where psychoanalysis is neither dead nor on life support, knows that analysts happily punish deviants. They prefer punishment to rational argument. Because, they are true Freudians.

Fair enough, Burkeman presents the views of some of those who have denounced Freudian psychoanalysis, these representing acccepted opinion. One might add that Jacques Lacan, the most influential psychoanalyst since Freud, once called psychoanalysis a scam. So, it’s not just a bunch of malcontents.

Burkeman writes:

“Arguably no other notable figure in history was so fantastically wrong about nearly every important thing he had to say” than Sigmund Freud, the philosopher Todd Dufresne declared a few years back, summing up the consensus and echoing the Nobel prize-winning scientist Peter Medawar, who in 1975 called psychoanalysis “the most stupendous intellectual confidence trick of the 20th century”. It was, Medawar went on, “a terminal product as well – something akin to a dinosaur or a zeppelin in the history of ideas, a vast structure of radically unsound design and with no posterity.”

And, Burkeman correctly points out the reason why leftists disparage cognitive behavioral treatment (CBT). It helps people to function in society, to get back to work and it does not cost enough. Psychoanalysis, whatever its disadvantages, helps you to get into your mind and to get in touch with your desires. Since it is a protracted guilt trip, it extorts a great deal of money.

He writes:

CBT has always had its critics, primarily on the left, because its cheapness – and its focus on getting people quickly back to productive work – makes it suspiciously attractive to cost-cutting politicians.

Naturally, Burkeman caricatures CBT. In reality, it has many different facets. Some involve teaching people how to overcome their persistently negative and self-deprecating thoughts. Some concern learning how to function in the world. Much of it helps people to build character and to help them to learn balanced judgments, the better to deal with reality.

One must note that Freudian psychoanalysis has never been shown to be of any real use against depression. In its classical form it insists that patient and analyst do not relate to each other. A patient is not allowed to address or to be addressed by his analyst in face-to-face conversation. Free association, which I have elsewhere described as a very bad habit, precludes conversation and human connection.

CBT began when therapists like Albert Ellis and Aaron Beck decided that they needed to find something to treat patients that psychoanalysis was ignoring or had failed.

Also, the form of CBT developed by Marsha Linehan has been shown to be far more effective in treating borderline patients than is any other form of talk therapy. In New York psychiatric hospitals therapists learn Linehan, not psychoanalysis.

And, when it comes to autism, cognitive treatments work while psychoanalysis does not. This has not prevented French analysts, on cultural grounds, from insisting that autistic French children not receive it.

Burkeman also understands a point that philosopher Karl Popper made some seven decades ago. Namely, that psychoanalysis is not a science because no result could disprove or falsify it:

The basic premise of psychoanalysis, after all, is that our lives are ruled by unconscious forces, which speak to us only indirectly: through symbols in dreams, “accidental” slips of the tongue, or through what infuriates us about others, which is a clue to what we can’t face in ourselves. But all this makes the whole thing unfalsifiable. Protest to your shrink that, no, you don’t really hate your father, and that just shows how desperate you must be to avoid admitting to yourself that you do.

If Burkeman wants to limit himself to Freudian theories, this analysis is correct. But, it is fair to note that there are dozens of different kinds of psychodynamic treatment, practiced differently by different practitioners. Most analysts these days practice something far closer to coaching than either the caricature of CBT that Burkeman offers or the psychodynamic therapies that can mean whatever you want them to mean.

Aside from the fact that experimental results should be doubted, especially in the psycho fields, one remarks other cases that have been far from positive. I have written about some of them on this blog. See links here and here.

Worse yet, Burkeman caricatures CBT as being merely an effort at rewiring the brain. Today’s cognitive therapists understand well that you cannot just rewire your brain. To function better in the world, you need to learn how to function better in the world. This involves changing habits and learning good behaviors. It also requires building character.

When Burkeman introduces the example of a patient who is being treated for depression by a CBT-based computer program, he is, as Jesse Singal notes well, distorting cognitive treatment beyond recognition.

As I have said, psychoanalysis is overpriced storytelling. Freudian theories about the mind are fictions. And, that does explain why stories about therapy sell very well. But, note that these are just stories. While it is better for your mind to possess a coherent story, they do not produce anything resembling cure.

Burkeman offers this point:

That sentiment may help explain the commercial success of The Examined Life, Stephen Grosz’s 2013 collection of tales from the analyst’s couch, which spent weeks on UK bestseller lists and has been translated into more than 30 languages. Its chapters consist not of experimental findings or clinical diagnoses, but of stories, many of which involve a jolt of insight as the patient suddenly gets a sense of the depths he or she contains. There’s the man who lies compulsively, in a bid for secret intimacy with those he can persuade to join him in deceit, just like his mother hid evidence of his bedwetting; and the woman who finally realises how effortfully she’s been denying the evidence of her husband’s infidelity when she notices how neatly someone has stacked the dishwasher.

Of course, Grosz thinks that these stories are the meaning of the patients’ lives. He does not note the absurdity of this notion and the fact that he is now practicing metaphysics.

But, if psychodynamic therapy was doing such a good job, why was it replaced by CBT and other forms of therapy? After all, it wasn’t for lack of trying. And we would note, for those who care about depression, that the death knell for psychoanalysis was rung most effectively by psychotropic medications and even by aerobic conditioning. We should also note that in Great Britain, most patients prefer CBT as a treatment, more even than medication.

For those who do not recall it, when Prozac was introduced the press was filled with stories about people who had been doing long term psychodynamic therapy and who had sunk into a mild and semi-permanent depression. When they took their pills the depression lifted and they saw that the Freudian project was wrong. They discovered that they did not need to follow Freud on the road to common unhappiness.

And remember, Freud distorted the evidence of his treatment and frankly lied about many others. Freud was a master storyteller, a genius, if you like, but he knew, as Lacan did, that calling psychoanalysis a treatment was simply a way to dupe the gullible into joining the cause.

1 comment:

Ares Olympus said...

Oliver Burkeman: Before laying the groundwork for CBT, Albert Ellis had in fact originally trained as a psychoanalyst. But after practising for some years in New York in the 1940s, he found his patients weren’t getting better – and so, with a self-confidence that would come to define his career, he concluded that analysis, rather than his own abilities, must be to blame.

That's a good slam. You either have to blame yourself, your patients, or the methods.

Perhaps simpler methods like CBT are better on the egos of therapists since it requires the patient to be responsible for his own reforms.

OTOH, for more conscientious therapists, ones who are not just interested in blame, this predicament is why many modern therapists might lean towards generalists now - having low level understanding of many methods, including CBT, on the assumption that some methods will work better for some patients than others.

It does make sense to try the simpler solutions first, so treatment should first (1) Look at acute issues with low grade talk therapy, maybe more like life coaching (2) Look for with systemic issues like "emotional reasoning" and self-regulation skills, maybe like behaviorism or CBT, and (3) Look at less conscious behavior like denial and help break down defense mechanisms that are impeding self-correction, which may require therapists whose skills are not entirely teachable.

And there's also some wider question of general human development versus pathology that needs correction. Like Scott Peck talks about "legitimate suffering" which we experience when we're in a place of learning and "neurotic suffering" where you're resisting experience with preconceived explanations and judgments that prevent learning.

For the first case, I like Jung's quote, of course "soul" is not a scientific word, but it does suggest there's a choice and an intuitive destination to move towards.
“There is no coming to consciousness without pain. People will do anything, no matter how absurd, in order to avoid facing their own Soul. One does not become enlightened by imagining figures of light, but by making the darkness conscious.”

A therapist might have to see what a patient needs in a moment. Some want a bandaid and empathy, and they want to go back to sleep. And others are interested in a harder path, to go beyond error-correction and suppressing bad moods.

I imagine depression contains this predicament. If you're a divided person with 6 different drives in conflict, you need those different selves to be aware of each other. But if some conflicts take a lifetime to integrate, then maybe a good therapist (or life coach) can help identify the key conflicts that can make progress in this moment. While if CBT just tells people they're thinking wrong, it might be disrespectful to the unconscious trying to get your attention.