Time to cast out voodoo therapy

一月 15, 1999

Psychoanalysis may be on its deathbed, but some of its ideas are clinging on to cause real harm, says Frederick Crews

For almost 20 years I have been arguing that Freudian psychoanalysis, for all its undoubted resonance within our culture, lacks any credibility as a body of knowledge. During these two decades, scholars have unearthed much damaging new evidence about the dubious hand-me-down sources and the shaky logical status of ideas that once appeared to have been soberly derived from Freud's "clinical findings". The emerging record shows an unscrupulous man who lied about his therapeutic triumphs.

Far more important than any biographical revelations about Freud, however, is a truth already apparent to some observers before I began voicing scepticism in 1980. Philosophers such as Ernest Nagel and Frank Cioffi had already shown that psychoanalysis amounts to a self-validating system of thought.

No adequate response has been made to their demonstration that most Freudian concepts and propositions are too vague to bear any testable real-world consequences: that the dyad of analyst and analysand facilitates suggestion from the dominant to the weaker party; that causal inferences about long-past traumas cannot be reliably ascertained from free associations and dream reports; and that an analyst's compliant anecdotal mode of reporting his uncheckable data guarantees that he will "always be right".

But if psychoanalysis is plainly pseudoscientific to the core, why do Freud and his brainchild still find so many fervent defenders? As the late Ernest Gellner maintained, part of the answer can be found in the indoctrinating character of a personal analysis, which typically humbles and disorients the overawed initiate and then gradually rehabilitates him within the faith.

More broadly, resentment of the empirical attitude itself may be helping to keep Freud's tradition afloat. This romantic parochialism, whereby the intuition-based Freudian outlook on "human reality" is allowed to downgrade the very idea of disciplined objectivity, is widely embraced in Western Europe and the Anglophone world among humanists who fancy themselves guardians of modern culture and enemies of "scientism".

In this endgame, the Freudians' greatest ally is the wider public's sheer indifference. For most of us, assessing psychoanalytic claims is scarcely a higher priority than passing judgement on palmistry or the ouija board.

But, because classical Freudianism once held such imposing sway, most of its elements remain entrenched in popular belief and stand ready for adaptation to bolder and more drastic therapies. What they have in common with old-style psychoanalysis is their commitment to "depth". Each of them assumes that the patient's trouble stems not from immediate circumstances but from the repression of traumatic early experiences that must be restored to conscious memory and "worked through" if psychic wholeness is to be obtained. If the patient is incapable of remembering the arbitrarily posited traumas, they presumably lie too deeply buried in "the unconscious" and must be hauled up with strong therapeutic coaxing.

The most damaging of such treatments has been "recovered memory therapy" (RMT), which seeks to retrieve traces of early sexual molestation whose repression or dissociation has allegedly caused the patient to fall ill.

RMT typically leads to accusations that prove tragic for supposed "perpetrators" and "survivors" alike.

The UK's Royal College of Psychiatrists minces no words in calling RMT outright professional misconduct, and other organisations have issued their own warnings against inducing false memories and linking them to monomaniacal notions of etiology and cure. The one conspicuous exception is psychoanalytic associations; to my knowledge, not one of them, anywhere, has seen fit to declare itself on the topic in any way. It would seem that the official silence has to do with a large and especially awkward skeleton rattling in the Freudian closet.

Shockingly, RMT is advocated and actively practised by a number of credentialed psychoanalysts. Moreover, it is clear that there could have been no RMT without a number of assumptions that came straight from Freud.

These include the cardinal concept of repression, the unique explanatory status accorded to buried sexual memories, the misapprehension that memory of childhood events would be complete in the absence of trauma, a belief in the photographic accuracy of memories conjured in therapy, the expectation that a "transference" will reveal tell-tale early relationships, and the notion - closer to voodoo than to modern medicine - that the only way to exorcise a disorder of the mind is to re-enact the occasion of its origin.

If these quack tenets had not lingered in our midst as part of a general reverence towards Freud, legitimate concern over childhood sexual abuse would have stayed focused on its proper target - real violators whose misdeeds have been detected in conformity with universally accepted rules of evidence.

At this point I can hear Freudian academics protesting that the concept of repression is too well supported to be consigned to the general dustbin.

But is it? In the sense that matters to Freud's theory and to that of his RMT heirs, repression is not mere forgetting or even a habit of turning one's thoughts away from disagreeable topics. Rather, it is a self-protective psychic reflex that consigns a troubling memory to the unconscious, where symptomatic "compromise formations" are generated between the bottled-up thoughts and the censoring impulse that continuously keeps them down.

Where is the evidence that would warrant our continuing to put such a concept into play? Satisfied analysands will reply that they have personally experienced the reality of Freud's mechanism by having "explored their repressions" on the couch. But such proof is not binding on the uninitiated. The problem is that every school of therapy coaches its clients to reinterpret their experience in the light of certain favoured postulates. Convictions acquired in therapy have the same persuasive value (zero) for independent observers as convictions acquired in church.

Clearly, then, neither repression nor any other Freudian notion can be adequately tested "on the couch". If the test is to be suggestion proof, it must be conducted completely outside the clinical setting. And even then it must avoid the trap of asking believers in repression whether or not they now recognise instances of it within their histories. Instead, researchers need to poll known survivors of indisputable post-infantile horrors - fires and floods, kidnappings, rapes, witnessed murders, imprisonment in concentration camps - and to discover whether those victims, any of them, coped by forgetting that the event had occurred at all. Such studies have already been done. They offer no grounds whatsoever for believing that such a thing as repression exists, much less that it makes up a regular feature of mental life.

Although psychoanalysis as Freud conceived it lies on its deathbed, plenty of zealots are prepared to turn the old scheme to sinister new ends. We will be safe from such eventualities only when "the unconscious" is widely understood to be, not a deep and mysterious region of the psyche, but an imaginary power in whose name a secular priesthood, tapping our perennial hunger for revelation and absolution, once held us in thrall.

Frederick Crews is editor of Unauthorised Freud: Doubters Confront a Legend, which will be published by Penguin on January 28, price Pounds 20.



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