Freud's Window on the Mind
Persaud, Raj, The Independent (London, England)
NO ONE knows how much we spend in Britain on private psychotherapy, but some indication of its popularity can be seen in a recent survey showing that last year Italians spent more than pounds 1bn on psychotherapy - roughly the same as on sport or entertainment. In the light of the recent spate of media attacks on the credibility of Sigmund Freud, the founding father of psychoanalysis, should we be regarding psychotherapy as closer to a sport or entertainment than a serious therapeutic enterprise?
Frederick Crews, Professor of English at the University of California, initiated the current furore with a controversial article in the New York Review of Books at the end of 1993, in which he suggested Freud's interpretations were driven by ruthless self-interest rather than any objective fact.
Furthermore, says Professor Crews, Freud appears to have claimed cure in several cases, while knowing full well this was never achieved. One of his first claimed treatment successes was eventually tracked down by journalists in the Seventies, having been in and out of treatment for 70 years - Sergei Pankeev declared his treatment had been "a catastrophe" and that he was in the same state as when he first went to Freud.
There is a widespread public belief that all modern psychiatric therapy is based on psychoanalytic principles, so unease about Freud creates apprehension over the whole psychiatric enterprise itself. Psychiatry appears to be a worthless navel-gazing exercise for the middle classes, who are too wealthy to have any real problems; while the genuinely psychotic, who wander the streets directing the traffic, appear simply too ill to be helped.
If psychiatrists really did do no more than talk to their seriously ill patients about early childhood sexuality, the profession certainly would be useless at treating mental illness. In fact, psychiatrists use a wide range of treatments, including a plethora of new, effective medications, as well as behaviour, cognitive, group, family and couple therapies. This eclectic combination of approaches (many of them blatantly anti-Freudian) ensures that psychiatry is able to help the vast majority of patients as effectively as modern cardiology and obstetrics. The comparison with other medical specialities is important, because psychiatry is a branch of medicine and is not synonymous with psychology, psychotherapy or psychoanalysis.
Of all these separate professions, only psychiatrists actually hold medical degrees and are therefore allowed to prescribe medication or other physical treatments, as well as being trained to detect the numerous physical causes of mental distress. Psychologists also hold university degrees, but these tend to focus on the emotional and social antecedents of mental states, rather than the biological, which is a larger part of the psychiatrist's medical training.
Psychologists' academic background, being rooted in scientific experiments on observable behaviour, means their treatments frequently encourage patients to be active and perform practical tasks to help themselves, rather than merely talk about them, as in most other psychotherapy.
In contrast, those who call themselves psychotherapists have received training that focuses on talking treatments by small organisations, which, rather worryingly, have thus far been left to supervise and regulate themselves largely outside academic requirements and the clinical standards of the NHS.
Psychoanalysis is only one form of these talking treatments. It derives its ancestry from Freud, and achieves change through the development of a deep relationship between client and therapist over many years of hour-long sessions, three or five times a week. In this situation good treatment is always more a case of how good the therapist is, rather than how good the theory, but because psychoanalysts disapprove of clients "shopping around" this vital consumer's perspective has been neglected. …