Letters to the Editor
Re: In Debate: Does Psychoanalysis Have a Future?
Dear Editor: E Fuller Torrey takes his place in the long and ever- extending line of psychoanalysis- and Freud-bashers (1). At issue in these ceaseless attacks is why they continue to occur. The cover of the Journal containing this debate has a photo reminiscent of phrenology, a long-discarded theory of mental functioning, but no one bothers to bash phrenology these days. If psychoanalysis is equally unproven, futile, outmoded, and dead, why has it not been similarly discarded?
Virtually every attacker ignores the scholarly evidence failing to support his claims or deals with such evidence in a superficial and dogmatic manner. Thus critics fall prey to their own criticism: they do not use an evidence-based approach. I am refering to more recent attackers cited by Glen O Gabbard (2) (Fuller Torrey and Frederick Crews) and Joel Paris (3). These writers sound more like armchair philosophers or friends arguing over beer than scientists examining facts. Fuller Torrey relies on a study conducted between 1937 and 1945.
In addition to the work of Drew Westen, Peter Fonagy, Anthony Bateman, Rolf Sandell, and others Gabbard mentions, I would cite several other researchers whose publications also support psychoanalytic concepts or the effectiveness of psychoanalytic or long-term psychodynamic treatment (4–9). The journal Neuropsychoanalysis is another example.
Central to this debate is more than psychoanalysis or the persona of Freud—it is our struggle to define psychiatry and its legitimate subject matter. Is irrationality a central part of human psychological life? Can the subjectivity of the mind and the unconscious be examined scientifically? Is long term psychoanalytic treatment effective?
The virulent attacks on psychoanalysis represent a testament to its ongoing relevance and vitality. Further, the irrationality of the attacks supports the central tenet of analysis—that its attackers, like the rest of us, are governed by forces often outside our awareness or immediate control.
In my opinion, criticism as expressed by Fuller Torrey, Crews, and Paris, does not do justice to the available evidence. Although there is not yet any randomized, controlled trial (RCT) of psychoanalysis, at this point it is only to a quite small degree that our daily clinical practice in psychiatry can be informed solely by RCTs.
References
1. Fuller Torrey E. Does psychoanalysis have a future? No. Can J Psychiatry 2005;50:743–4.
2. Gabbard GO. Does psychoanalysis have a future? Yes. Can J Psychiatry 2005;50:741–2.
3. Paris J. The fall of an icon. Psychoanalysis and academic psychiatry. Toronto (ON): University of Toronto Press; 2005.
4. Bucci W. Toward a “psychodynamic science”: the state of current research. J Am Psychoanal Assoc 2001;49(1):57–68.
5. Freedman N, Hoffenberg JD, Vorus N, Frosch A. The effectiveness of psychoanalytic psychotherapy: the role of treatment duration, frequency of sessions and the therapeutic relationship. J Am Psychoanal Assoc 1999;47:741–72.
6. Leuzinger-Bohleber M, Ulrich S, Ruger B, Beutel M. How to study the ‘quantity of psychoanalytic treatments’ and their long-term effects on patients’ well-being. Int J Psychoanal 2003;84:263–90.
7. Ablon JS, Jone EE. On analytic process. J Am Psychoanal Assoc 2005;53:541–68.
8. Brakel L. The psychoanalytic assumption of the primary process: extra-psychoanalytic evidence and findings. J Am Psychoanal Assoc 2004;52:113–61.
9. Shevrin H, Bond JA, Brakel LAW, Williams WJ. Conscious and unconscious processes: psychodynamic, cognitive, and neurophysiologic convergences. New York (NY): Guilford Press; 1996.
Daniel Frank, MD, FRCPC
Montreal, Quebec
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