In Defense of Psychoanalysis - Introduction
Table of Contents
By: Dr. Sam Vaknin
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No social theory has been more influential and, later, more reviled than psychoanalysis. It burst upon the scene of modern thought, a fresh breath of revolutionary and daring imagination, a Herculean feat of model-construction, and a challenge to established morals and manners. It is now widely considered nothing better than a confabulation, a baseless narrative, a snapshot of Freud's tormented psyche and thwarted 19th century Mitteleuropa middle class prejudices.
Most of the criticism is hurled by mental health professionals and practitioners with large axes to grind. Few, if any, theories in psychology are supported by modern brain research. All therapies and treatment modalities - including medicating one's patients - are still forms of art and magic rather than scientific practices. The very existence of mental illness is in doubt - let alone what constitutes "healing". Psychoanalysis is in bad company all around.
Some criticism is offered by practicing scientists - mainly experimentalists - in the life and exact (physical) sciences. Such diatribes frequently offer a sad glimpse into the critics' own ignorance. They have little idea what makes a theory scientific and they confuse materialism with reductionism or instrumentalism and correlation with causation.
Few physicists, neuroscientists, biologists, and chemists seem to have plowed through the rich literature on the psychophysical problem. As a result of this obliviousness, they tend to proffer primitive arguments long rendered obsolete by centuries of philosophical debates.
Science frequently deals matter-of-factly with theoretical entities and concepts - quarks and black holes spring to mind - that have never been observed, measured, or quantified. These should not be confused with concrete entities. They have different roles in the theory. Yet, when they mock Freud's trilateral model of the psyche (the id, ego, and superego), his critics do just that - they relate to his theoretical constructs as though they were real, measurable, "things".
The medicalization of mental health hasn't helped either.
Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain – or are ameliorated with medication. Yet the two facts are not ineludibly facets of the same underlying phenomenon. In other words, that a given medicine reduces or abolishes certain symptoms does not necessarily mean they were caused by the processes or substances affected by the drug administered. Causation is only one of many possible connections and chains of events.
To designate a pattern of behavior as a mental health disorder is a value judgment, or at best a statistical observation. Such designation is effected regardless of the facts of brain science. Moreover, correlation is not causation. Deviant brain or body biochemistry (once called "polluted animal spirits") do exist – but are they truly the roots of mental perversion? Nor is it clear which triggers what: do the aberrant neurochemistry or biochemistry cause mental illness – or the other way around?
That psychoactive medication alters behavior and mood is indisputable. So do illicit and legal drugs, certain foods, and all interpersonal interactions. That the changes brought about by prescription are desirable – is debatable and involves tautological thinking. If a certain pattern of behavior is described as (socially) "dysfunctional" or (psychologically) "sick" – clearly, every change would be welcomed as "healing" and every agent of transformation would be called a "cure".
The same applies to the alleged heredity of mental illness. Single genes or gene complexes are frequently "associated" with mental health diagnoses, personality traits, or behavior patterns. But too little is known to establish irrefutable sequences of causes-and-effects. Even less is proven about the interaction of nature and nurture, genotype and phenotype, the plasticity of the brain and the psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements.
Nor is the distinction between psychotropic substances and talk therapy that clear-cut. Words and the interaction with the therapist also affect the brain, its processes and chemistry - albeit more slowly and, perhaps, more profoundly and irreversibly. Medicines – as David Kaiser reminds us in "Against Biologic Psychiatry" (Psychiatric Times, Volume XIII, Issue 12, December 1996) – treat symptoms, not the underlying processes that yield them.
So, what is mental illness, the subject matter of Psychoanalysis?
Someone is considered mentally "ill" if:
1. His conduct rigidly and consistently deviates from the typical, average behavior of all other people in his culture and society that fit his profile (whether this conventional behavior is moral or rational is immaterial), or
2. His judgment and grasp of objective, physical reality is impaired, and
3. His conduct is not a matter of choice but is innate and irresistible, and
4. His behavior causes him or others discomfort, and is
5. Dysfunctional, self-defeating, and self-destructive even by his own yardsticks.
Descriptive criteria aside, what is the essence of mental disorders? Are they merely physiological disorders of the brain, or, more precisely of its chemistry? If so, can they be cured by restoring the balance of substances and secretions in that mysterious organ? And, once equilibrium is reinstated – is the illness "gone" or is it still lurking there, "under wraps", waiting to erupt? Are psychiatric problems inherited, rooted in faulty genes (though amplified by environmental factors) – or brought on by abusive or wrong nurturance?
These questions are the domain of the "medical" school of mental health.
Others cling to the spiritual view of the human psyche. They believe that mental ailments amount to the metaphysical discomposure of an unknown medium – the soul. Theirs is a holistic approach, taking in the patient in his or her entirety, as well as his milieu.
The members of the functional school regard mental health disorders as perturbations in the proper, statistically "normal", behaviors and manifestations of "healthy" individuals, or as dysfunctions. The "sick" individual – ill at ease with himself (ego-dystonic) or making others unhappy (deviant) – is "mended" when rendered functional again by the prevailing standards of his social and cultural frame of reference.
In a way, the three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant. Still, they share not only their subject matter – but, to a counter intuitively large degree, a faulty methodology.
As the renowned anti-psychiatrist, Thomas Szasz, of the State University of New York, notes in his article "The Lying Truths of Psychiatry", mental health scholars, regardless of academic predilection, infer the etiology of mental disorders from the success or failure of treatment modalities.
This form of "reverse engineering" of scientific models is not unknown in other fields of science, nor is it unacceptable if the experiments meet the criteria of the scientific method. The theory must be all-inclusive (anamnetic), consistent, falsifiable, logically compatible, monovalent, and parsimonious. Psychological "theories" – even the "medical" ones (the role of serotonin and dopamine in mood disorders, for instance) – are usually none of these things.
The outcome is a bewildering array of ever-shifting mental health "diagnoses" expressly centred around Western civilization and its standards (example: the ethical objection to suicide). Neurosis, a historically fundamental "condition" vanished after 1980. Homosexuality, according to the American Psychiatric Association, was a pathology prior to 1973. Seven years later, narcissism was declared a "personality disorder", almost seven decades after it was first described by Freud.
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