In Debate
Does Psychoanalysis Have a Future? No.
E Fuller Torrey1
(Can J Psychiatry 2005;50:743–744)
Click here for author affiliations.
Psychoanalysis has no future except as a historical footnote in the evolution of the understanding of human behaviour and psychotherapy. In the early years of the 20th century, psychoanalysis was regarded as a novel approach to both of these, but in the early years of the 21st century, it is regarded, in the words of neurologist Macdonald Critchley, as merely “the treatment of the id by the odd” (1, p 244). During the intervening century, it became evident that psychoanalysis 1) has no scientific foundation, 2) is no more effective than other forms of psychotherapy, 3) is not useful for solving social problems, and 4) is culture-bound.
The fact that psychoanalysis has no scientific foundation should not surprise us. In 1900, Freud wrote to a friend, “I am not really a man of science, not an observer, not an experimenter, and not a thinker. I am nothing but by temperament a conquistador—an adventurer” (2, p 398). Freud criticized colleagues who attempted to scientifically validate his theories, responding testily that his theories needed no validation. During these same years, Freud was participating in seances and was intensely interested in numerology, mental telepathy, and other aspects of the occult. In a letter, he confessed that “if I had my life to live over again I should devote myself to psychical research rather than to psychoanalysis” (3, p 392).
Attempts by researchers to scientifically validate Freud’s theories have failed, even when carried out by those sympathetic to the theories, such as Ernest Hilgard, Paul Kline, Seymour Fisher, and Roger Greenberg (4). There are indeed clusters of adult personality traits consistent with the oral, anal, and Oedipal clusters described by Freud, but attempts to link such personality traits to child-rearing practices and early life experiences have been singularly unsuccessful. Instead, adoption studies and studies of identical twins reared apart have made it clear that genes determine more than one-half of human personality traits. Early childhood experiences, except when grossly aberrant, are now known to play a relatively minor role in determining adult personality traits.
Freud’s theories also included the importance of the unconscious and dream interpretation, neither concept original with him but both popularized by him. Recent neuroscience has suggested that both the unconscious and dreams are much more complex than envisioned by Freud, but his historical role in making them widely known will probably constitute his most important, if not exclusive, legacy.
Scientifically, therefore, Freud considered his psychoanalytic theories as revealed truths, not empirical postulates in need of scientific validation. As such, Freud’s theories are similar to religious beliefs. The challenge for the 21st century is to put human behaviour on a solid neurochemical and neurophysiological foundation; Freud’s theories have no contribution to make to this endeavour.
Despite having no scientific foundation, Freud’s theories might still be useful to future generations if they led to an effective form of psychotherapy for the treatment of psychiatric disorders. The main purpose of Freud’s theories, in fact, was the treatment of individuals with psychiatric dysfunction, especially those afflicted by what were then referred to as neuroses. Since Freud introduced psychoanalysis as a form of psychotherapy a century ago, much research has been carried out on the components and efficacy of psychotherapy.
There is strong evidence that psychotherapy is sometimes effective in helping individuals with neuroses or selected other forms of psychiatric dysfunction. The effectiveness of all psychotherapies, however, appears to originate in nonspecific attributes common to all psychotherapies: a shared worldview, the personal qualities of the therapist (genuineness, empathy, and warmth), the expectations of the person seeking help, and an emerging sense of mastery (5). Therapists in all cultures throughout the world use and manipulate these 4 attributes of psychotherapy to produce improvement in the person seeking help. There is no evidence that psychoanalysis, as one form of psychotherapy, has any advantage over other forms of psychotherapy. Moreover, for some conditions, psychoanalysis appears to be an inferior form of psychotherapy. For severe psychiatric disorders, such as schizophrenia or bipolar disorder with psychotic features, psychoanalysis may even produce a worsening of the patient’s symptoms, compared with supportive or less intensive forms of psychotherapy.
Compared with many other forms of psychotherapy, psychoanalysis also has many disadvantages. It is extremely expensive and time-consuming, and it can accommodate only a few individuals. A 1966 study of American psychoanalysts reported that the average psychoanalyst was treating only 28 patients yearly and saw an additional 23 in consultation. Further, the patients seen were almost all well educated and in the highest socioeconomic brackets, reflecting Freud’s own practice. Such studies led Dr Robert Michels, himself a psychoanalyst, to comment,
If we regard it [psychoanalysis] as a medical treatment, this limited availability is a public health crisis and ethical scandal. Seen as a way of illuminating and enriching life, however, psychoanalysis resembles world travel, a season ticket to the opera, or higher education at a great private university (6).
With no scientific foundation as a theory of human behaviour and no comparative advantage as a form of psychotherapy, there is one additional route by which Freud’s work might survive for future generations. If Freud’s theories or therapies could be shown to improve child-rearing practices, decrease divorce, decrease suicide, decrease delinquency or crime, or bring about any other social benefit, then they might be worth preserving.
Such is not the case. Dr Benjamin Spock, the leading apostle for Freudian theory in child rearing, who himself underwent 3 psychoanalyses, carried out an intensive study of 21 mothers. He found that the mothers who were most knowledgeable about Freudian theory had more problems, not fewer problems, in raising children (7). One might also expect that psychoanalysts themselves would raise children who have fewer problems than the children of other professionals; although this has never been formally tested, suggesting it to mental health professionals elicits embarrassed smiles of the “you’ve got to be kidding” variety.
The most definitive test of Freudian therapy to ameliorate social problems was carried out between 1937 and 1945 in Boston. More than 600 boys judged likely to become delinquent were randomly assigned to a combination of psychoanalytic and Rogerian psychotherapy for 5 years or to a no-treatment control group. Follow-up studies at 3 and 10 years after completion of the study revealed no difference between the groups in their arrest records. A 30-year follow-up, however, reported that “a higher proportion of criminals from the treatment group than of criminals from the control group committed more than one crime,” and the difference was statistically significant. Further analysis revealed that longer and more intensive psychotherapy increased the chances of later criminal behaviour (9). This was the last major attempt to assess the effectiveness of Freudian therapy to ameliorate social problems.
In addition to the aforementioned reasons for doubting that psychoanalysis has any future, it should be noted that Freud’s theories are culture-bound. Freud rose to prominence in the waning years of the Victorian era, at which time sexual issues were rarely discussed. Freud was viewed as a sexual liberator, the commanding general who put the forces of celibacy and puritanism to rout. He was thus admired, even venerated, by leaders of the American left, including anarchist Emma Goldman and Marxists Max Eastman and Floyd Dell. Freud himself was politically conservative and never understood why his theories had become adopted by political leftists, but the era’s political and cultural context was a major source of Freud’s popularity in America.
Those days are now but a dim memory for Americans. Hugh Hefner has long since replaced Freud as the American apostle of sexual liberation, and American Marxism died with the prisoners in Stalin’s gulag. There are therefore no political or cultural conditions comparable to the early 20th century, conditions that fertilized the flowering of Freud’s theories.
In summary, Freudian theories in general and psychoanalysis in particular have no future. They have no scientific foundation and are thus unable to contribute anything useful to theories of human behaviour, they have no comparative advantage and multiple disadvantages as a form of psychotherapy, and they do not contribute to the solution of any social problems. In addition, they became popular in a period during which political and cultural conditions were very different from those in the present or likely to exist in the future.
What is likely to happen? Freudian theories and therapy will slowly wither and die, to be preserved only in historical overviews of human behaviour and psychotherapy. This, in fact, is already taking place. Like the Cheshire cat, psychoanalysis is slowly fading from view, except in this case, the grin is fading first, and the genitals will fade last of all.
References
1. Critchley M, cited in: Thornton EM. The Freudian fallacy: an alternative view of Freudian theory. Garden City (NY): Dial Press; 1984. p 244.
2. Jones E. The life and work of Sigmund Freud. Volume 1. New York: Basic Books; 1953. p 348. [Quoting a Freud letter of 1 February 1900].
3. Freud to Hereward Carrington, 1921, quoted in Jones E. The life and work of Sigmund Freud, op. Vol 3. New York: Basic Books; 1953. p 392.
4. Torrey EF. Witch doctors and psychiatrists: the common roots of psychotherapy and its future. New York: Harper and Row; 1986.
5. Rogow AA. The psychiatrists. New York: GP Putnam’s Sons; 1970. p 62.
6. Michels R. Psychoanalysis: the second century. Harv Ment Health Lett 1990;Dec:5–7.
7. Torrey EF. Freudian fraud: the malignant effect of Freud’s theory on American thought and culture. New York: Harper Collins; 1992 and Bethesda (MD): Lucas Books; 1999. p 141–2.
8. McCord J. Crime in moral and social contexts—the American Society of Criminology, 1989 Presidential Address. Criminology 1990;28:1–26.
9. McCord J. Criminology. A thirty-year follow-up of treatment effects. Am Psychol 1978;33:284–9.
Author(s)
1. Dr F Torrey, Associate Director, Laboratory Research, Stanley Medical Research Institute, Bethesda, Maryland.
Address for correspondence: Dr F Torrey, 5430 Grosvenor Lane, Suite 200, Bethesda, MD 20814–2142
e-mail: torreyf@stanleyresearch.org
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