Tuesday, April 24, 2007

Will Freud Finally Slip?

Pushed to the fringes of academia,
psychoanalysts are concerned their practice is dying

Joseph Brean
National Post

Saturday, April 21, 2007

It would have been disappointing to leave the annual meetings of the American Psychological Association, Division 39 (Psychoanalysis), in Toronto this week without hearing a Freudian slip.

Luckily, in a panel on the sorry state of psychoanalytic research in universities, Joel Weinberger, a professor at Adelphi University on Long Island, N.Y., observed that, by failing to adequately mentor the students who will take their place, "we are shooting ourselves in the groin."

It was rich, because psychoanalysis is indeed gravely wounded, unable to attract new talent because of its financial impotence, and dying a slow death on the margins of academia, where it is maligned by mainstream psychologists as unscientific, sex-obsessed, postmodern witchcraft. So where else would the mortal blow be struck against this century- old talk therapy? Achilles had his heel. Freudians have their groins.

"I'm pretty sure that psychoanalysis will survive," said Nancy McWilliams, president of Division 39, in a keynote lecture on Thursday evening. "At least in intellectual circles and among those who can afford intensive and long-term treatments ... Whether we will survive in psychology is another matter."

Dr. McWilliams, who is in private practice in New Jersey and a professor at Rutgers University, spoke of the "increasing estrangement between academia and psychoanalysis," and complained that psychologists in other fields repackage their ideas as new discoveries that fit the modern scientific fashion, with its emphasis on genetics and drugs.

She said the upshot is that today there are fewer arrogant psychoanalysts, who were attracted to the field because of its popularity in the mid-20th century. Nowadays, the hot-heads go into genetics or pharmacology.

"They hurt a lot of feelings," she said of her predecessors. "They insulted a lot of academics. We can't afford to talk like that anymore."

Joel Paris, chairman of the department of psychiatry at McGill University, said the continuing decline of psychoanalysis in Canada and the United States is partly due to the decline in religion, because church "was the place in the community where suffering was explained." But it also reflects a mood shift among potential patients. "The same people who would have come in to me and said, 'Can you get me into therapy?' are now asking, 'Can you get me a better anti-depressant?' " Dr. Paris said in a phone interview.

Dr. McWilliams said recent psychology graduates, pressured by their employers to produce research and grant money, do not have the time to get crucial experience in private clinical practice, and even those who are intellectually sympathetic to Freud's legacy eventually lose touch with what it means to be a therapist. For older, psychoanalytically minded university psychologists, there is a temptation to migrate to the philosophy, sociology, or English departments, just to be able to speak in metaphor with their colleagues.

Her address was not entirely negative. She did, for example, suggest that, over time, an analyst could have helped Cho Seung-hui, the Virginia Tech shooter, "to make sense of his suffering." But overall, the entire conference, which continues this weekend at the Royal York Hotel, was steeped in pessimism. Stories abounded of students who lack the philosophical background to properly discuss 19th-century Viennese thought, and of analysts forced to hide their psychoanalytical background on grant applications, or are treated like "dinosaurs" and "twoheaded freaks" in their faculty lounges.

"They're giving us a taste of our own medicine that we gave them 20 years ago, with our arrogance and dismissiveness in terms of their methodologies," said Michael Nash, professor of psychology at the University of Tennessee.

"We deal in meaning, and that's not the currency right now," he said.

In university psychology departments, the dominant field is Cognitive Behavioural Therapy, which aims to influence emotions by getting patients to modify thoughts and behaviours. It is more closely allied with the fields of pharmacology and genetics, and as a result, it receives most of the research money, which in turn determines what sort of young professor a department is inclined to hire.

Psychoanalysis aims to do the opposite of CBT, to influence thoughts and behaviours by targeting the emotional roots of the problem. To do so, it relies

on exhaustive discussion in often arcane and abstract terms, with outcomes that have proved nearly impossible to measure. And so compared to CBT's short-term, targeted interventions, the multi-year process of psychoanalysis can make it seem as Dr. Paris described it: "marginal ... more an exploration of self than a medical treatment."

Even in the wider culture, mental illness has come to be seen as more physiological than intellectual, and more genetic than environmental, which makes people more inclined to take pills than to probe their psyches. In the age of the "chemical imbalance," when cigars are just cigars, and Ativan and Prozac hold more promise than Oedipal complexes and penis envy, the couch is looking increasingly like a horse and buggy.

Pop culture is where psychoanalysis gets its easiest ride, although usually with mock deference. The famous psychoanalytic technique of free association, in which a patient is asked to blurt out whatever is in their mind to help give voice to their inner conflicts, has been mocked almost to death, and the image of the analyst's couch continues to thrive in New Yorker cartoons, such as the one of the analyst asking the empty couch how long it has had these hallucinations, or the one who exclaims, "Wow! You need professional help."

But generally, the image of the greybearded, pipe-smelling man named Dr. Von Stumpf, or the feline woman with Oriental tastes named Tziporah, talking some anguished soul through their memories of toilet training, can seem at best

quaint, if not a bit nutty and sex-obsessed.

At its worst, it can look like a vastly expensive, risky and potentially pointless exercise in validating the anxieties of neurotic, middle-aged, urban wine-alcoholics with corporate health insurance, liberal arts educations and frustrated libidos. Not that there's anything wrong with any of that, but psychoanalysis is not the mental health breakthrough it was once hyped as, and it remains deeply resistant to objective, scientific study. Among the problems is that psychoanalysis takes upwards of three years, and you cannot have long-term control groups of mentally ill patients receiving no treatment. Another question is how do you measure peace of mind, or an epiphany?

The difficulty for modern analysts is in coming to terms with this frustration.

At one point, in the 1950s and '60s, when analysis was new and cost a princely $25 an hour, there was no problem. The future was Freudian. By the 1970s, just about every Canadian had experienced at least a taste of it in the Jungian imagery of Robertson Davies' Deptford Trilogy, and by the end of that decade, Woody Allen had started to mine the field for comedy.

In recent years, psychoanalysts have had a tendency to clutch at the discoveries of neuroscience, which show processes of the brain that are not present to consciousness, and to hold them up as objective proof of their theories. But it is a huge leap to do as the analysts do, and describe these processes as equivalent to Freud's unconscious. This problem of semantics hangs over the entire emerging field of neuropsychoanalysis.

On television, it is a different story. Since it started in 1999, The Sopranos, in which an emotionally conflicted mobster and his female analyst exhibit textbook desires of transference and countertransference, has eased the pain immensely, by almost single-handedly resurrecting psychoanalysis as a topic of current discussion. But despite the ringing endorsements of people in the field grateful for the publicity, Tony's sessions with Dr. Melfiare about as accurate a depiction of the profession as CSI and Law & Order are of forensic scientists, police and criminal lawyers, which is to say accurate enough for a television drama.

In his 2006 book The Fall of an Icon, Dr. Paris writes that "the most serious problem for analysis has been its failure to keep its promises ... Once seen as a uniquely powerful method of treating the mentally ill, analysis has not been proved effective for severely disturbed patients."

The less it is studied, the more difficult it is to convince research funding bodies and health care providers that it should be funded at all. And so, in flirting with expulsion from the academy, modern psychoanalysis risks ending up like sailing or wine collecting, a hobby for the rich. Scott Bishop, an assistant professor of psychology at the University of Toronto and an analyst in private practice, calls Dr. Paris "completely incorrect."

"We've proven that most of what happens in the brain is unconscious. That's one of Freud's central tenets," he said. "A lot of critics of psychoanalysis are actually criticizing Freud, as if psychoanalysis hasn't evolved since Freud."

Shortly after the Second World War, about five years after Freud's death, Viktor E. Frankl, the Holocaust survivor and psychiatrist, gave a lecture to a club of Viennese intellectuals. He said psychoanalysis, in its initial incarnation, "not only adopted objectivity --it succumbed to it ... psychoanalysis made the human person into an object, the human being in a thing," and the whole enterprise is hindered by its "technically minded, mechanistic view" of the self.

In a way, the achievements of psychoanalysis since Frankl's criticism can be seen as a resolution of this problem, of ironing out the rough theoretical edges. Now it is pharmacology and CBT that are "technically minded and mechanistic," and exaggerating their potential, according to the analysts.

Freud might be famously dead, but as they search for new ways to prove their worth, Freudians still have a chance. As Dr. Weinberger, the Freudian slipper, said on Thursday, "We can despair and go home, or we can come up with some sort of compromise solution, which is what I thought psychoanalysis was all about."

© National Post 2007

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