| The Magazine of the CALIFORNIA ACADEMY OF SCIENCES |
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Counterpoints In Science The Literate Freud Sigmund Freud, the founder of psychoanalysis, wanted to be recognized for his scientific contributions to understanding how the mind works, and he was disappointed that the Nobel Committee never gave him the nod. His talents as a writer, however, were recognized in 1930 when he was awarded the Goethe Prize, Germany’s most prestigious literary honor. The conjunction of extraordinary scientific and literary talent in one individual is rare, but perhaps it is fitting that they came together in the man who more than any other explored the scope and depth of the human mind. Freud practiced medicine in Vienna at the turn of the 20th century, specializing in neurology, one of the most precise and scientific branches of medicine. He spent a year in Paris studying with the famous neurologist Jean-Martin Charcot. Charcot treated many patients with what was then called hysteria, a disorder involving violent outbursts of emotion, pain, or paralysis of the limbs. On returning to Vienna, Freud treated hysterical patients with hypnosis and discovered that their symptoms had often begun with some traumatic event in childhood, frequently a sexual episode. Recall and discussion of the event sometimes resulted in relief or cure of symptoms. Freud concluded that hysteria and other neuroses were manifestations of bottled-up energy generated by early experiences and could be treated by recovering the memories and feelings associated with those experiences. Dissatisfied with hypnosis, which often gave only temporary relief, he developed the technique of psychoanalysis, the “talking cure,” in which patients lie on a couch and discuss whatever thoughts come into their heads. The therapist (who for the first few years of psychoanalytic history was Freud alone) mostly listens and offers occasional interpretations to help the patient understand her or his behavior. When the treatment is successful, the patient both feels better and is better able to deal with stressful situations. Early in the 20th century, many physicians and some non-physicians joined Freud in the psychoanalytic movement. Freud’s ideas about the unconscious mind have had a tremendous impact, not only on the treatment of mental disease, but on anthropology, education, art, and literature. His case histories often read like O. Henry short stories, with plot twists and unexpected endings, and The Interpretation of Dreams, the story of his own self-analysis, has the excitement and suspense of a novel. Freud’s theories initially met a firestorm of disapproval, especially his discovery that repressed sexuality was usually a factor in neurotic behavior. Later, his ideas were widely accepted, in one form or another, as the basis for treating mental disorders. During the past three decades, though, Freud’s influence and reputation have declined, as new psychotropic drugs like Valium and Prozac have supplemented or replaced one-on-one psychotherapy. In these impatient days, quickie cures are what we want, and no medical insurer will pay for the leisurely pace and intensive time investment of psychoanalysis. New writings about Freud and psychoanalysis question whether Freud’s ideas have, after a hundred years, stood the test of time; whether he should be ranked as one of the great scientists of the past century (perhaps of any century); or whether he was the charlatan and fantasist his many detractors claim. To answer this question, four psychoanalysts recently set out to evaluate the effectiveness of their profession. Their task was a difficult one. Drugs like Valium and Prozac can be evaluated by the double-blind method, in which equal groups of patients are given either the drug or a placebo, without either doctors or patients knowing which is which. It’s hard to imagine a psychoanalytic placebo or control group. In Sweden, where there is a long waiting list at public clinics for psychiatric treatment, patients who received treatment were compared with those still waiting. However, this attempt had to be abandoned when it was discovered that most of those on the waiting list had gone ahead and consulted private psychiatrists. In Does Psychoanalysis Work? (Yale University Press, 2000), an account of their evaluation, these psychoanalysts report only four large studies of psychoanalysis that they consider scientifically valid. These were carried out at the Menninger Foundation, Columbia University, the Boston Psychoanalytic Institute, and the New York Psychoanalytic Institute. While reading this book I discovered that I had been one of the subjects analyzed, in both senses of that word. The Columbia group included 700 cases accepted for low-fee psychoanalysis from 1945-1971. In 1950, I was a second-year medical student at Columbia, about to become a father. I had left physics for medicine and was beginning to think I had made a terrible mistake. My medical courses, unlike my previous physics courses, seemed to require regurgitation of masses of half-digested facts rather than comprehending a coherent body of knowledge. Faced with the imminent responsibility of parenthood, yet uncertain about my professional direction, I applied to the clinic for help to relieve my tremendous anxiety. Like all the therapists in the Columbia study, mine was a student physician in psychoanalytic training. He was a short, blond, pleasant, intelligent, soft-spoken mid-westerner. Five days a week, for eleven months, we spent an hour together in deep conversation. My job was to say whatever I was thinking, his was to help me see patterns of thought and behavior that would help explain my present and past emotional conflicts, relieve my high anxiety, and discover better ways of achieving my goals in life. Freud succinctly summed up the goals of psychoanalysis as the capacity to love and work. What volumes of effort, frustration, misery, and joy are condensed into those two little words! Of course my belief that my psychoanalysis made a huge positive difference in my life is precisely the kind of anecdotal report that the authors of this book are trying to transcend with more solid statistical information. Data from the case records was evaluated according to 38 variables and nine psychometric scales. Therapeutic benefit was measured in three ways: whether analyst and patient agreed that maximum benefit had been achieved; overall improvement in the areas of disturbance; and changed scores between the beginning and end of treatment. By these criteria, 67 percent of the patients were much improved, 30 percent had no change, and 3 percent were worse. Similar results were observed in the other three large studies. The Menninger Foundation project developed a health-sickness rating scale going from 0 (sickest) to 100 (healthiest). This scale measured seven factors: 1) emotional dependence versus independence; 2) seriousness of symptoms; 3) subjective discomfort and distress; 4) environmental effects; 5) utilization of abilities; 6) interpersonal relationships; and 7) breadth and depth of interests. On average, patients treated by psychoanalysis gained 20 points on this scale. This study confirmed something that Freud had observed in his own patients: the healthier the person was at the beginning of analysis, the more likely she or he was to benefit. It takes a lot of “ego strength” to face the frightening beasts in one’s own interior jungle. To many of Freud’s detractors, psychoanalysis is a hoax and Freud not a scientist at all. In the postmodern world of wholesale deconstruction, various writers have accused Freud of dishonesty, sexism, fraud, and even adultery with his sister-in-law. The title of Israel Rosenfield’s recent novel, Freud’s Megalomania (W.W. Norton 2000), seems to promise another hostile rant against Freud, but it actually has a hidden meaning-not that Freud himself was a megalomaniac, but the author imagines that Freud wrote an article called “Megalomania” that was never published during his lifetime. The thesis of this work of fiction is that at the end of his life Freud realized that his ideas about the Oedipus complex and other intra-psychic conflicts were all wrong, inspiring him to write this manuscript, in which he concludes that all mental illness springs from megalomania, the drive for power and recognition. Unfortunately for Rosenfield, this pseudo-Freudian manuscript completely lacks the literary skill, authorial confidence, and beguiling conversational voice of the winner of the Goethe Prize. As Daniel Mendelsohn remarks of Megalomania in The New York Review of Books (Nov 2, 2000), “The (perhaps unintended) effect of Rosenfield’s mimicry is to make you appreciate the real thing all the more.” The novel’s anti-Freudian protagonist, Professor Albert Stewart, admits, “Even if much has been learned about the brain in the last half century, we are still no closer to understanding the mysteries of sex, desire, consciousness, walking, seeing, thinking, hypocrisy, deception, and lying... Knowing that there is more of a particular neurotransmitter when we are depressed does not explain depression any better than Freudian theory.” Mendelsohn comments in his review, “What data cannot provide is meaning. For that, we need narrative-we need Freud... Even if Freud is (scientifically) wrong, as a writer-a mythographer of the soul, let’s call it-he produced rich and brilliantly textured narratives that help us think about the world and our lives in it... But then, the paradox that a myth, a fiction, can be truer and more meaningful than ‘fact’ is one that literature, rather than science, alone can understand.” Perhaps the question whether Freud was a great scientist cannot be answered within the ordinary definition of the term. Posterity has no doubt about the scientific status of Archimedes, Copernicus, Newton, or Einstein, whose hypotheses generated masses of readily testable observations and experiments. Maybe Freud violated the ultimate taboo by examining the workings of the human mind and formulating a scientific theory, psychoanalysis, both to understand the mind and attempt to treat its malfunctions. Freud described himself, along with Copernicus and Darwin, as one of those who had disturbed the world’s sleep, shattering the pleasant dream that we occupy a special place in the universe. Each paid a price for his vision: the rage and abuse of those rudely awakened. Can we be grateful to those who discovered that we are not at the center of the solar system? That we were not created de novo but evolved like other animals? That we are not rational and godlike but buffeted and driven by unconscious thoughts and forgotten experiences? Freud worked in the no-man’s land between the rational structure of 19th century science, which he aspired to extend to the study of the human brain, and the battlefield of human passions previously explored mostly by writers like Shakespeare, Goethe, and Dostoyevsky, whom he acknowledged for their deep insights. He liked to quote Hamlet’s remark, “There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.” Six decades after his death, Freud continues to frustrate his critics by being so hard to pigeonhole-and by being a better writer than they are. According to London’s Times Literary Supplement, Freud is currently the world’s most cited author. He did basic research on the anatomy of eels, wrote a much-praised book about speech disorders, discovered the emotional bases of hysteria and other neuroses, and was the first systematic explorer of the dark continent of the unconscious. Like his literary forebears, Virgil and Dante, he returned from the Stygian underworld to write travel reports that will be read as long as there are human readers. If his map of that hidden realm within us was imperfect, he at least had the courage to venture into the fearful unknown, showing the way for others to follow. Jerold M. Lowenstein is professor of medicine at the University of California at San Francisco. jlowen@itsa.ucsf.edu |
Spring 2001
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