Freud: wrong, right, wrong-headed? The fourth and final part*

A while ago now, I was taken to task about Freud etc by an old friend who has spent many years working as a mental health professional. I, of course, have no such experience. He challenged me to defend the old fella against a 4-D attack, the last of which is . . .

Divination

‘Perhaps I mean divine guidance,’ wrote my friend, adding that he sees Freudian theory as impossible to test or disprove. ‘There’s the impression of depth of insight – but that could be illusory.’

The result of this, he says, is that it ‘tempts practitioners to think they know much better than their clients what’s wrong, while human qualities such as trust and respect can get dissolved away. I’ve seen it happen. Worse, I’ve inflicted it.’

Well, I think there are two questions there — though they are linked. One is about science and knowledge, the other about professionalism and humanity. Deep Freudians would — perhaps defensively — claim that it is only psychoanalytic thought and insight which is capable of resolving the conundrum about handling actual patients, as opposed to just mouthing off about the brain and mind and people (ie what I do).

So, the first question. Again, I can divide this into two answers.

One, yes, there is a tendency for therapists and psychoanalyticisers to worship at their own altar. Or, at least, by worshipping at Freud’s altar, hanging on his every word, use the perceived glories of his thought as mirrors reflecting and focussing their own perceived originality and wisdom.

(During the Freud units of my course, I sometimes felt like I was in a psychoanalytic version of Talmudic exegesis — studying and turning over every word of God’s given texts in search of new levels of meaning. That was on good days. On bad days, I sometimes felt like I was in the ‘meaning of the dropped sandal’ scene in The Life of Brian. Sometimes, I’d point out that this was how I felt. This did not always go down well.)

Actually, to tell the truth, there can be more than a tendency for therapists to worship blindly at their own altar, particularly in the academic world. Research shows — consistently and surprisingly unequivocally — that therapy (of whatever kind) works. (That is, the patients get better/feel better/are more capable of running and enjoying their lives.) But . . . that ‘whatever kind’ is the crucial phrase. The research is quite clear that the therapist’s training background or theoretical stance seems of surprising unimportance.

What does help patients to get ‘better’ is the human relationship with the therapist. (The ‘better’ is in quotes not for any silly, naive relativist reason but to indicate how wide a range of outcomes I am using it to encompass.)

The crucial thing is that the patient likes/respects the therapist. And the crucial thing about that liking/respecting is not abstract. It’s clear and concrete: it facilitates the patient’s capacity to take ‘criticism’. That is, interpretations which, in whatever way, challenge the patient’s view of the world/themselves. In effect, we trust the judgment of those we like**.

The second part of the first-question and answer is about whether Freudian theory is provable or testable. Well, actually and contrary to most statements on the subject, it is. The best comparison is with Darwin’s theory of evolution. To all but religious fundamentalists, it’s clearly true — or, at least, it provides a superior explanation for the world than any alternative. In particular, one that enables predictions to be made. But is it testable or provable in the way chemistry is? No.

Psychoanalytic theory has a similar status. Potentially, at least. Many, if not most, of its supporters are of a non-scientific bent, quite without interest in testing or proving it. They just accept it — the way, say, Othello accepted Iago’s description of reality. (See below for another tragic Shakespearean allusion/illusion.)

That doesn’t mean you can’t demonstrate some elements of psychoanalytic supposition through experiments. Ramachandran’s famous work on stroke patients, for example, can be mined for significance in terms of Freudian conceptions of unconscious processes. A stroke-inflicted patient says her paralysed left hand is not her own but her mother’s. Yet, when asked to touch her left hand against her nose, she uses her right hand to lift her left hand — the one that she says is her mother’s — to her nose. The unconscious and the process of denial seem — to me, anyway — the clearest and cleanest explanation.

The second question is about psychoanalysts’ (and, by extension, all therapists’) essential humanity. Well, that is not easy to answer. My personal experience has been essentially positive. With one obvious exception, therapists I’ve consulted*** have been intelligent, thoughtful and considerate — perhaps overly so, viewed through my tough-hearted view of life.

Yet I’ve heard many horror stories from other people — some, though not all, of which I believe. Therapists often cross boundaries. A 1990 north American study found 'sexual abuse of female patients by roughly 7-10% of male therapists of every stripe and level of experience'. The second husband of the first wife of Freud’s grandson had a quite terrible experience at the hands and couch of one of the eminences of British psychoanalysis. He died recently. I might write about him sometime — in particular, how the psychoanalytic establishment dealt with his story.

Mostly, though, therapists and analysts are in denial about the range, extent and meaning of these failures and failings. Which brings me back to Ramachandran’s stroke-begotten woman. And the tentative suggestion that this also perhaps indicates that psychoanalytic theory can be used, reflectively, to examine psychoanalytic practice. Denial is a human constant, it seems.

It also leads to one of my current obsessions, the Dunning-Kruger Effect. That is, the sad fact that the incompetent are doubly cursed by their incompetence. They are not just incompetent but incapable of recognising their incompetence. They simply can’t see how badly they do things — so they can’t take the steps necessary to improve. The competent, by contrast, are more likely to understate their competence — not out of false modesty but because they compare themselves to the really competent.

A notable study of this phenomenon is of medical students so . . . one, we’re not talking just society’s least able, two, that really makes me worry about an impending routine visit to the doctor.

If you want to read more about this, I suggest a visit here (http://opinionator.blogs.nytimes.com/2010/06/20/the-anosognosics-dilemma-1/). It’s a piece in the New York Times Opinionator by the documentary film-maker Errol Morris. It taught me loads of interesting stuff about Woodrow Wilson, bank-robbers and the strangenesses of the goings-on in the neurology department of Salpetriere in the late 19th century. It’s not a short piece. In fact, it’s five pieces. Set aside an hour or two to make your way through them all.

An extract . . . Errol Morris is talking to Ramachandran. He asks: ‘Do we live in a cloud of belief that is separate from the reality of our circumstances?’

Ramachandran replies: ‘Absolutely, and overall, fortunately, it's a positive cloud in most of us. If we knew about the real facts and statistics of mortality, we'd be terrified.’

Happy reading.

* The first three parts were Determination, Distance and Denseness.

** This is, of course, one of the main motors of life’s tragedies. Macbeth, for example, chose to believe that the judgment of the object of his sexual desire was fully equivalent to an accurate, independent, peer-reviewed, chi-square-tested assessment of the realities of late mediaeval Scottish political interests and alignments.

*** That sentence poses a variant on the Nick Clegg question about sexual experience, doesn’t it. How many analysts/therapists’ couches (or chairs) have you been on? In my case, more than five but less than ten. Being more precise would involve defining what is meant by ‘therapist’. And, of course, by ‘I’.

Ameuses-yeux?

Icelandic politics part one

Icelandic politics part two

Outside Rod

Next up Vicky Christina Barcelona: what’s that all about, eh? And: who would Freud have supported in the World Cup?