From INTELLIGENT LIFE Magazine, Winter 2010
It is just over a century since psychoanalysis was first recognised as a science. In 1909 Sigmund Freud gave five lectures at Clark University in Massachusetts that surveyed and explained the fledgling discipline’s achievements to that point—the interpretation of dreams, the analysis of hysteria, the meaning behind jokes, the reasons we make stupid mistakes. Key to them all was the operation of the unconscious, the back-seat driver whispering to us to behave in ways we’d officially disown.
Later, Freud was to remark that his discovery amounted to a third and final nail in the coffin of human pride. The first was Copernicus’s bubble-bursting calculation that the Earth orbits the sun, thus displacing mankind from its central position in the universe. Second came Darwin’s finding that rather than being God’s special creature, descended from Adam and Eve, man was a monkey. And now Freud’s own postulation of an unconscious implied that we were strangers even to ourselves.
In adding to this demoralising ledger of human limits, however, Freud had unlocked a hitherto concealed dimension. Formerly obscure or ignored parts of the mental map now had a legend, and psychoanalysis established itself as the compass by which the terra incognita could be navigated. Before long the unconscious had slipped off the couch and entered the lingua franca, and today it’s virtually impossible to talk about human behaviour without drawing more or less explicitly on Freud’s lexicon. Not only do we speak readily about “unconscious” motivation, but we’ll happily deploy fancy psychoanalytic concepts like “being in denial” in the most ordinary conversations.
Yet for all its seepage into everyday life, psycho-analysis finds itself routinely denounced, even by those in its intellectual debt. Set aside the practical objections —becoming an analysand involves five sessions a week, at perhaps £70 per session, over many years—psychoanalysis, they say, reduces everything to sex. Worse, it does so in a form that looks misogynistic. As for its being a science, that’s laughable—believing that a fireside chat with a patient about their childhood can disclose the deep structure of the psyche is plain arrogant. Not to mention the potential for planting thoughts in the patient’s mind which happen to prove the theory you set out with.
So it’s not surprising that in the face of these perceived flaws psychoanalysis’s therapeutic rival, Cognitive Behavioural Therapy (CBT), has gained ground. Although both approaches pursue the same outcome—happy patients—the underlying method couldn’t be more different. Where psychoanalysis sifts the inner self to shift the outer, CBT adjusts external behaviour to ameliorate the internal state. Psychoanalysis gets to the root cause, often lying in one’s early years, where CBT focuses on the presenting issue. CBT is much more short-term, usually limited to about 30 sessions; doesn’t talk about erotic life unless it comes up; and generally takes an empirical approach that’s easily associated with the scientific. And where psychoanalysis leaves patients haplessly to work through their own psychic detritus, CBT sets homework.
The cause of CBT has also been served by the wider health system, in which all activity is now measured to within an inch of its life, targets become paramount, practitioners get held mercilessly to account, and patients transmogrify into customers demanding accessibility. In this transparent and shadowless world, CBT provides the comforting illusion that the lugubrious terrain of mental health can yield to instant illumination under a striplight. And because it positions itself among the empirical sciences, it enjoys an affinity with pharmacologically oriented psychiatry in which symptoms, should they fail to be dissolved by therapy, can be handily lined up with drugs. Needless to say, this is a system that plays well with the pharmaceutical giants.
The irony is that in becoming more “scientific”, CBT becomes less therapeutic. Now, Freud himself liked to be thought of as a scientist (he began his career in neurology, working on the spinal ganglia), but it’s the non-scientific features that make psychoanalysis the more, not the less, powerful. I’m referring to the therapeutic relationship itself. Although like psychoanalysis largely a talking cure, CBT prefers to set aside the emotions in play between doctor and patient. Psychoanalysis does the reverse. To the annoyance no doubt of many a psychoanalytic patient, the very interaction between the two becomes the subject-matter of the therapy.
This emotional muddling between analyst and patient is known in the trade as “transference”, and it’s important because it’s the way most of our relationships play out in the real world—as ambiguously defined contracts. This isn’t to say the analyst is short of techniques for managing that muddle, but it is to say that there’s no naively “clinical” position to be assumed. The consulting room thus transforms itself into a laboratory in which patients can learn about their impact on someone else in real time, and thus grow in self-awareness—which is the prerequisite for self-improvement.
The respected therapist and writer Irvin Yalom, among others, argues that depression and associated forms of sadness stem from an inability to make good contact with others. Relationships are fundamental to happiness. And so a science that has the courage to include the doctor’s relationship with the patient within the treatment itself, and to work with it, is a science already modelling the solution it prescribes. What psychoanalysis loses in scientific stature, it gains in humanity.
Robert Rowland Smith is author of "Breakfast with Socrates" and the forthcoming "Driving with Plato" (Profile). IIlustration by Brett Ryder.
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