In 1881, a young woman in Vienna discovered she had lost her native German tongue. She could speak nothing but English. Bertha Pappenheim was diagnosed by her doctor with hysteria. The symptoms included contractures, hallucinations, and aphasia ― the loss of basic functions such as language. They were resistant to conventional treatment; and so Pappenheim became the first ever patient of psychoanalysis. Her name, in one of the practice’s foundational texts, Studies on Hysteria, is Anna O.
The original patient of psychoanalysis was never treated by the father of psychoanalysis, Sigmund Freud; she was treated instead by its John the Baptist, Josef Breuer, who co-wrote Studies on Hysteria. “The discovery of Breuer’s,” wrote Freud of his colleague in 1917, “is still the foundation of psycho-analytical theory”. What Breuer discovered, and Freud later developed, was that neurotic conditions could be treated by a “talking cure”. By talking about her childhood experiences to the analyst, the patient can relieve herself of the disorders that burden her — and subsequently alleviate, with the help of the analyst, the physical manifestations of such disorders.
Psychoanalysis, then, is medical treatment by language. Adam Phillips, one of the leading psychoanalysts in England, writes that “Freud was as much, if not more, of writer than a doctor”. Like the Fin-de-Siècle writers who uncovered the dark undercurrents of bourgeois conventions, or the modernist writers who questioned coherent narratives, Freud was an integral part of the lively intellectual culture that witnessed the collapse of the Austro-Hungarian Empire and much of continental Europe. And it was very much a literary culture.
To briefly psychoanalyse: as a child Freud was gifted at languages, became familiar with Greek, Latin, Spanish, Italian, French and English. And yet it was medicine he ultimately studied at the University of Vienna: as the firstborn son, he wanted to be dutiful and serve his impoverished family.
All of which begs the question that haunts his legacy: did his treatment work?
Mikkel Borch-Jacobsen, in Freud’s Patients: A Book of Lives (out last month), thinks not. “Freud’s cures were largely ineffectual,” he writes, “when they were not downright destructive”. Borch-Jacobsen examines 38 patients Freud treated in his 50-year practice, but his book is concerned less with the efficacy of psychoanalysis and more with portraying, in selective but vivid detail, the individuals Freud treated. “We all know the characters described by Freud in his case studies,” he writes, “but do we know these illustrious pseudonyms?” His book is “an attempt to reconstruct the sometimes comical, most often tragic and always captivating stories of these patients who have long been nameless and faceless”.
Anna Von Lieben, referred to as Cäcilie M by Freud, was his most important patient for a period of six years, beginning in 1887. She was, Borch-Jacobsen writes, part of the “Viennese Jewish upper bourgeoisie”: brought up in a palace, where her family hosted Brahms, Strauss and Liszt. She was treated in Paris by Freud’s hero, Jean-Martin Charcot, otherwise known as the Napoleon of Neuroses. In Vienna, she was also a patient of Breuer.
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
To join the discussion in the comments, become a paid subscriber.
Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.
SubscribeI’ve actiually experienced a psychoanalysis, as in four days a week on the couch psychoanalysis, and I found it life changing in very positive ways. I’m not sure where this tragic outlook you speak of comes from, although there is a certain suffering in life that must be dealt with. I don’t see that as morbid or even controversial. People can get stuck in that suffering, and part of a good analysis is a dive into the darker aspects of our psyche.
Yet there is also insight into strengths and compassions. I had suffered much relational damage growing up and entering into a theraputic relationship allowed all of my neurosis to play out and be understood and dealt with, as well as offering a venue to showcase my strengths. It was both extremely difficult and immensely enjoyable. My relationships improved, especially those with my husband and children, I changed course in my career in satisfactory ways, I re-ignited old passions and hobbies, and grieved and let go of old hurts. I looked at the best and worst parts of myself.
Psychoanalysis isn’t for everyone of course. It’s often intense and always rediculously time consuming and expensive, but for someone like myself with deep relational wounds and the resources to embark on such an endevour, re-experiencing these wounds within the boundaries of a safe yet intense theraputic relationship was transformationally insightful and healing, regardless of what the “theory” says.
Maybe you could have saved a lot of money to achieve all that by reading the astrology column of the newspapers?
It was an intelligent comment that deserved respect
Thank you for your to the point comment.
J Hop offered her experience in general but specific enough way to provoke a better and, certainly, a respectful reply.
I’m sure you didn’t mean to be unkind but that was crass.
I don’t know why you got downvoted. Are you not allowed to parody pseudoscience?
Downvoting tends to indicate disagreement not forbidding.
Who says there was any Freudian analysis there? psychoanalysis has largely moved on. Talking cures work because someone with experience of the human condition is listening to you. In fact modern day talking cures are more likely to use meditation, CBT, NLP and other techniques derived almost entirely outside the formal university systems.
I don’t think you can have an analysis without aspects of Freud being utilized considering he’s the founder of the field, however, I agree that modern psychoanalysis is not based entirely on Freud. Much of Freud has been debunked, while some theories stand solid still, and there have been so many other contributers to the field. Winnicott, Jung, Erikson, Klien among others. Also most good therapists of any modality will incorporate other modalities if needed, but that doesn’t mean that analysis is interchangable with something like CBT. It’s a very different approach with very different end goals.
Thanks for this well balanced contribution to an endless debate.
Anecdotes are not data. Unless it can be robustly demonstrated that psychoanalytic treatment overall improves the wellbeing of patients more than doing nothing (remember our moods can change hugely with time), then it has no medical benefit. (We should also investigate the possibility that it is effective in a way, but makes things worse, as is often alleged!). I’m open to persuasion, but my understanding is there is no such body of evidence in its favour.
Beside the not insubstantial fact that many people are not up to such a deep dive into their psyches, the damn cost of psychoanalysis(and nowadays the reluctance of insurance companies-here in the U.S. and the NHS to cover it) puts it outside the reach of many of us.
“Psychoanalysis has largely moved on”
The way Frederick Crews puts it, psychoanalysts have a whole series of “yes, but“s.
You were lucky. People rarely get through therapy without their relationship collapsing, even if it was benign at the outset. I believe therapy should come with a health warning for the damage it does to marriages.
Thanks to the author for an interesting essay. I had never considered Freud as primarily a storyteller and, like a novelist, a mirror (however flawed) to humanity.
Here in the States psychological therapy is still very popular but Freudian, and even Jungian, therapy is out of favor although still available (as is a vast range of other types of therapy). Most people have some sort of medical insurance that covers psychological illness although it certainly won’t pay for years of analysis. So, in that regard, extensive psychoanalysis is still the preserve of the affluent just as it was in Freud’s day.
Medical insurance companies underwrite psychological treatment and they are bottom line oriented, so it’s probably no surprise that most talk therapy is provided by psychologists, or licensed social workers, rather than the more expensive psychiatrists who have a medical degree. Patients will see a psychologist for talk therapy and, if necessary, they’ll have a much shorter session with a psychiatrist who prescribes drugs. The use of psychoactive drugs is something else that hasn’t changed much since Freud’s day: as described in the article, his early patients’ progress probably depended more on morphine than therapy. And today’s antidepressants and anxiolytics are, like morphine, quite addictive.
Again given the emphasis on economic efficiency by the medical insurance companies, the currently favored psychological treatment for anxiety and depression is some form of evidence-based therapy (EBT) in which psychological problems are treated as a failure to properly evaluate reality and the patient is encouraged to explore the mistaken beliefs that underlie their problems. Insurance companies have little tolerance for abstract theories of the id, ego or Jungian archetypes.
I have always instinctively been drawn to Jung’s theories. The idea of a collective unconscious and universal archetypes, as revealed in myths and in dreams, feels true to me. If I ever become rich I think I would undertake a course of Jungian analysis and perhaps make sense of the world and my place in it before I die.
If you want someone who is prepared to reel out a lot of new age hocus pocus verbiage in exchange for considerable sums of money then I am of course always available.
Have you ever undergone Jungian Analysis? I did after two very traumatic experiences in my life, and it was no hocus pocus, as you write. The sessions were deeply healing, but Jungian analysis takes time and isn’t an instant cure. In severe cases Jungian Psychologist will refer you to a Psychiatrist for prescriptions, but you still continue your sessions with the Psychologist.
I enjoyed reading ‘Memories, dreams, reflections’ and ‘The Undiscovered Self’ very much. I found ‘Four Archetypes’ tougher to get to grips with, but ultimately very rewarding.
I would like to share a quote from the latter which struck a chord with me:
“Man’s worst sin is unconsciousness…
Can we not understand that all the outward tinkerings and improvements do not touch man’s inner nature and that everything ultimately depends upon wether the man who weilds the science is capable of responsibility or not?
How to proceed if the best men in the nation would rather preach dogmatisms and platitudes than take the human psyche seriously?”
Carl Jung, First published as a lecture: ‘Zur psychologie Des Geistes’ (Phenomenology of the Spirit)
1945.
Kind of misses the whole point of Freud really – at least to me.
Freud was a very dark force, Freud’s works taken along with Existentialists, and Marx, in ‘The Frankfurt School’ became ‘Cultural Marxism. A particularly wicked and depraved philosophy – ‘Critical Theory, Post Modernism, and the majority of what is degenerate in modern society comes from that group in Wiemar Germany (and then through Columbia University) to now have pretty much destroyed the education system – and Western Society its self really.
Too long a story to get into – but interesting if you do care to look up ‘Frankfurt School’, although WIKI has been taken by their ilk – still worth a look.
Another poster below mentions Jung – whom I really admire, his archetypes, and the great ‘Synchronicity’, and the words ‘ Holy S*hit’ from a vision he had where he saw Holy Excrement slowly was falling onto the Vienna Cathedral from heaven as a great blessing…. in a cool take on how vastly above us is anything devine, and even the smallest part of it is so above us… Jung so superior to the miserable atheist Freud with his low look at all humanity reduced to baseness…
I like to say that “there is no science of the mind.”
What credentials does one need to be a talk therapist these days? A year and a half studying to be a “Licensed Clinical Whatever.”
For many, many people, the therapist functions as a “rent-a-friend,” someone who can’t tire of listening to and empathizing with one’s perceived problems because (s)he is getting paid to listen.
On the positive side, as someone who has been through it, I would say that listening to oneself spin out a narrative of one’s life week after week helps to explain oneself to oneself, novelistically as it were. It almost doesn’t matter who, if anyone, is listening!
I also agree with J Bryant that Jung was another thing altogether. He is very much destined to come back into fashion as philosophers and scientists begin to push the notion that consciousness, not matter, is primary (see esp Bernardo Kastrup). He definitely was onto something with the collective unconsciousness.
The final paragraph could equally be applied to Shakespeare. The article’s basic point – psychoanalysis is not useful – is not particularly insightful. There’s a more “useful” discussion to be had on the extent to which some of the most valuable human activities/outputs lack basic usefulness. Referring back to Shakespeare – his value doesn’t lie in showing us an escape route from the dark pit of human existence, rather, he shines a bright light into its murkiest corners whether that helps us or not …
Shakespeare wrote plays designed to be both entertaining, thought-provoking and a display of humanistic virtuosity. He did not posit a grand theory about human nature, merely showed us it. This is quite distinct to what psychotherapists attempted to do. Indeed as I am aware the only art that ever emerged successfully from psychotherapy was Salvador Dali’s surrealist paintings that, I would submit, were successful more because they were entertaining and curious rather than because of any deep connection to the supposed mysteries of the human psyche.
I wouldn’t disagree with your response. I think we just differ in our subsequent reactions. I read and enjoy psychoanalysis like literature (Freud wrote beautifully) and I wouldn’t go near a psychoanalyst’s couch (I’m in denial). My problem with the article is that it struggles to see anything beyond the concept of utility when judging what “helps” humankind.
I would love to dismiss talking therapies along with crystal healing and that massage without touching – Reiki? But the truth is I’ve spent a lot of hours talking through problems with my wife and friends. If I didn’t have friends or a wife, I can imagine finding a quiet talk useful. In my experience, insight *can* come in the process of describing exactly why I’m angry, or hurt. Charlatans and con-men aside, I think the basic idea probably does work.
Sure. But Freudian psychology is not based on ‘talking therapies’. It is based on absurdly curdled set of fanciful ideas. Idea that include, to wit: idiosyncratic anecdotes from his patients, bizarre untested suppositions about the nature childhood development, overstretched period-piece metaphores about steam engines and a whole raft of concepts such as super egos, id and so on that William of Ockham would describe as entities posited without necessity.
Thank you for taking the time to reply – also to the interestingly named Ferrusian Gambit. I described Freudian analysis as a ‘talking therapy’ only because I believe successes attributed to it are probably because talking does help. (The rest is probably bunk, in my opinion.)
People want to know how they work – *why* they do the things they do. It’s reasonable to look for answers from those who claim to have them. However, the moment I hear certainty, I begin to think of snake oil salesmen. Freud said children liked being jogged on a knee because of an*l stimulation. He rather lost me with that. Being thrown into the air is fun. If he did’t know *that*, was he right about anything?
Freud, along with others such as Jung and Klein, were pioneers who should be permitted the first word and not the last. As Joe Schwartz observes in Cassandra’s daughter, a seminal history of psychoanalysis, Freud’s main contribution was the ‘analytic hour’. Things have moved on in the past 120 years and Mr Owolade’s critique is intellectually shallow and consequently much ado about nothing.
So Freud’s enduring contribution was the period of time by which he charged his patients? How appropriate.
“Therapeutic hour” is so harmful idea and it is sign of stupidity of psychotherapy world and psychotherapists’. It is actually very time inefficient, both for therapists and clients. Imagine surgeons operating “we have 2 hours, actually 1:30, so they can clean up for next operation, we will stitch you and give you huge amount of pain killers, we will continue next week”.
For me, any therapist in private practice who sticks to 50 minutes “hour” is just a charlatan with major red flag.
There are good and bad therapists in all modalities.
My few brushes with psychoanalysis were mainly unsatisfactory. I didn’t relate at all and it was hugely expensive – so unless you have endless disposable income to discover if it works for you, I can’t think this is the route for a lot of people. I studied psychology for a couple of years and found it dry, so it is probably no surprise that I was an unwilling patient.
I have found a lot of help with one particular therapist (logo therapy) and a number of spiritual advisors who bring a very rounded set of tools to navigate life.
I feel the ultimate (but unhelpful) comment coming on:
“One size does not fit all”
The headline seems to me almost a statement of obviousness and the main article unspooled as such. Karl Popper debunked Freudian nonsense much more effectively a long time ago when it was still taken seriously by people who should have known better.
I think Freud was a bit of a fraud but he did open the door for Jung whose intellect was far greater, more open than Freud’s, imo, an anthropologist and philosopher as much as a doctor. Followers of Jung like Marie Von Franz and Esther Harding had many interesting insights also.
Whether we like it or not Freud and those who came after him had an influence across all the arts in the 20th century, DH Lawrence, Virginia Woolf, Paul Klee, Gustave Klimt for example.
There was a dark side to Freud and his obsession with sex explaining everything was daft but it has’nt all been negative.
Did Freud posit a hypothesis of how mental health issues arise, and then seek or present clinical evidence capable of either supporting or disproving it?
My recollection is that he didn’t, in which case how is he different from Doris Stokes or Uri Geller (other than in being a good writer)?
This article misses the chance to use Freudian psychoanalysis as the prime example of how the West is not immune to pseudoscience. Freud is more like Lysenko than Shakespeare. The quote from Frederick Crews’ ‘pugnacious biography’ misses the point that Crews demolished Freud. The author also misses the opportunity to show the close analogy between the mass psychosis of Freudianism and the current hysteria, e.g. ‘White Fragility’. Both depend on claims that attempts to falsify them can be explained away by the pseudotheories themselves.
It’s true that psychoanalysis doesn’t work, but it’s not supposed to work, any more than Antiracism is designed to end racism.
https://www.amazon.com/Freud-Making-Illusion-Frederick-Crews/dp/1627797173
Yes – Freud was “fake it till you make it” Vienna style!
Crews demolished Freud but gets no thanks for it.
The Stoics in Ancient Greece were onto the problem and the cure. Know yourself. Nothing new since then if you want to be honest with yourself.
Freud and his followers certainly found a good way to extract a lot of money from their clients. For me, as an amateur but with an interest in psychology, Freudian psychoanalysis is no better and probably much worse than today’s NLP which at least can be carried out a lot faster.
Jung has always made a lot more sense to me.
I have experienced various therapies, inc. psychoanalysis and I would say that psychoanalysis is one of the worst, and has spawned even worse ones. At the same time, I think a balanced caring therapist focused on helping a client to develop positive everyday relationships will be good, whatever the therapeutic school.
Friendships- a few deep ones – can do a world of wonders.
Freud’s literary genius is also too seductive to writers. They often, therefore, fail to see how Freud was eclipsed by his peers, even in his own lifetime. Those around him could follow his direction of travel without Freud’s particular impediments.
Klein and Winnicott developed object relations, a model for understanding how we live inside each other, the mystery of ourselves being the depth of our connection, not our mutual alienation.
Practical features of therapy that Freud actively rejected became central, such as the countertransference that links.
Then, the presence of being within which we know our particular being, and which is closer to us than we are to ourselves, was articulated by Bion and Jung.
Freud was a brilliant start, not a tragic end.
First of all, psychoanalysis is a theory. It offers models of therapeutic techniques. It is akin to the theory of flight (Bernoulli’s Theorem versus Newton’s Third Law). The psychoanalytic model is concerned with behavior, cognition, traits, the unconscious mind, etc. The theory of flight is concerned with lift, thrust, drag, weight, etc. Neither model has an acceptable lay explanation for how it works and/or fails that everyone can agree upon. Thing is:
Thus, the title of this article, “Psychoanalysis doesn’t work” is objectively true. So is “Machines don’t fly.” Indicting a theory because it fails is harmful, stunts progress. What if the Wright Brothers believed, like everyone else, that “Big, heavy machines don’t fly.” (Today, some people still believe that when boarding a 180-tonne 747.)
Secondly, some claim psychoanalysis is pseudoscience. It’s not so. Rather, it is protoscience. It’s important. The fact is fundamental advances in Big Science originate from science fiction, protoscience, and spirituality. See:
http://www.colabria.com/the-fiction-of-big-science/
It’s better to embrace psychoanalysis as a robust theory and allow the practice to readily follow.
You are confused about the word ‘theory‘. In everyday speech, theory can imply an explanation that represents an unsubstantiated and speculative guess, whereas a scientific theory is an explanation of an aspect of the natural World and universe that has been repeatedly tested and verified in accordance with the scientific method, using accepted protocols of observation, measurement, and evaluation of results.
The correct usage of theory is as the Ancient Greeks (400-200 BC) intended: rational speculation and appreciative deliberation. It’s no more and no less.
Theory evolved two millennia before Francis Bacon (1561-1626), the Father of the Scientific Method. Bacon’s Empiricism and the Scientific Method had a good run. It ended in the mid-20th Century except for the banalest questions. Hijacking theory by tacking ‘scientific’ to it illegitimate, uninformed, and dangerous.
Your tone seems to advance belligerent empiricism and the scientific method fetish like some engineering college sophomore. Beware!
Critical, system-level patterns and behaviors of inquiry are objectively absent from belligerent empiricism and the scientific method.
These include socioeconomics, imagination, spirituality, exaptation, original thinking, network multiformity, conceptual blending, abduction, protoscience, disequilibrium, serendipity, narrative, fiction, lateral thinking, etc., and yes, of course, theory. These and many others are the essential cognitive patterns that deliver ideas, invention, innovation, and produce positive outcomes.
Gordon, try to keep up!
Sorry … the theory of flight absolutely has an acceptable lay explanation for how it works that everyone can and does agree upon. To understand your error, look up the logical fallacy called false equivalence.