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Why we still need Dr Freud Biology alone can't unpack the unconscious

The good doctor. (Hans Casparius/Hulton Archive/Getty Images)

The good doctor. (Hans Casparius/Hulton Archive/Getty Images)


March 19, 2024   6 mins

Not much is uncontroversial when it comes to the life and work of Sigmund Freud, but one thing ought to be: he was a lousy psychotherapist. Take the case of his patient Horace Frink, who Freud diagnosed with a serious case of latent homosexuality, pressing him to marry his mistress as a cure. Doubtful, but choosing to trust the great man’s judgment, Frink and the woman both abandoned their (devastated) spouses and took his advice. Soon a guilt-ridden Frink turned violent, his new wife demanded a divorce, and he descended into a psychosis punctuated by several suicide attempts.

But then Freud, by his own admission, was much less interested in healing the sick than in pioneering the “science” he called psychoanalysis. So he would have been dismayed to learn that, by the turn of the millennium, most psychiatrists would view his theories in roughly the same way chemists viewed alchemy: as a faintly embarrassing remnant of their field’s unscientific prehistory. “Freud’s ideas”, declared a major history of psychiatry in 1998, “are vanishing like the last snows of winter”. Ironically, Freud’s single surviving legacy in Western medicine looked set to be the use of talk therapies largely cleansed of psychoanalytic content.

This was a brutal demotion in status for a man whose impact was compared, in his lifetime, to that of Darwin. And even if that comparison was Freud’s own, it says a great deal that he wasn’t laughed out of Vienna for making it. Just as Darwin had uncovered the evolution of species by studying the flora and fauna of the Galapagos Islands, Freud believed he had uncovered the evolution of the mind by studying the unhappy patients on his couch. Many eminent contemporaries took him at his own estimation: Einstein wrote him fan mail, and Bertrand Russell campaigned for him to be awarded the Nobel Prize in Medicine. And Freud’s ideas came to hold such sway that through the Seventies the DSM-II, the American “bible” of psychiatric diagnosis, comprised a medley of psychoanalytic terms like “hysterical neurosis” and “schitzoid personality”.

Within a generation, university students were becoming more likely to encounter Freud’s ideas on a course in literary theory than one in psychology or psychiatry. One reason was the new discovery of primary sources which, in the Eighties and Nineties, turned assassinating Freud’s character into something of a public bloodsport among intellectuals. The wise and humble doctor eulogised by Auden now stood accused (irrefutably) of clinical ineptitude and scientific recklessness verging on fraud, (plausibly) of conducting an affair with his wife’s sister, and (absurdly) of attempted murder and child abuse.

But far more damaging for Freud’s ideas was the rise, in the latter half of the 20th century, of an alternative view of mental illness based on three things: genes, brains and drugs. The decoding of the complete human genome promised to unveil the origins of psychological suffering in our parents’ DNA rather than in their care-giving styles. New brain imaging technology would enable us to observe psychiatric disorders in the contours of grey matter rather than rooting around for them in the murk of the unconscious. And new medications to treat mania, psychosis and depression were already replacing the hours of aimless chat prescribed by psychoanalysis. Freud began to look more like the founder of a religion than a scientist, and his followers like disciples zealously but fruitlessly interpreting his sacred texts. “Biomedical” psychiatry had seemingly triumphed; the real scientists would take over from here.

So it may come as a surprise that, decades after the study of the neuroses was replaced by that of the neurotransmitters, a prominent clinical psychologist has published a new book that includes a game attempt to make a scientific case for Freud. In Mortal Secrets: Freud, Vienna and the Making of the Modern Mind, Frank Tallis dares to take a harder line than most other Freudian holdouts. When their discipline came under siege from biomedical psychiatry, most psychoanalysts — turtlenecked figures who could quote Proust and Lacan but had never seen the inside of a lab — retreated to Hampstead, pulled up the drawbridge and turned inward. Adam Phillips, perhaps the most famous of them, now argued that Freud’s ideas cannot be false but, like poetry, only “more or less interesting, more or less inspiring”. Sounding like High Church mystics in the age of modern science, the psychoanalysts in effect helped downgrade their own field from a mighty branch of medicine to a (more inspiring, interesting — and expensive) rival to astrology.

By eschewing such relativism, Tallis may be out of step with contemporary psychiatry — contrast his subtitle with that of the 2006 work Freud: Inventor of the Modern Mind — but unlike Phillips et al., he at least takes Freud seriously on his own terms. After all, Freud fulminated against those like Jung who doubted the literal truth of ideas like penis envy and the oral and anal stages of sexual development. “We don’t reject Copernicus, Kepler or Galileo because they produced horoscopes,” Tallis points out. This is true, but some might object that there is rather more evidence that the earth travels around the sun than there is for the idea that the central trauma of a little boy’s life is his terror of being castrated by his father as punishment for wanting to sleep with his mother.

Boldly (or, perhaps, rashly) Tallis attempts a review of the science. Freud’s ideas, he assures us, have had unspecified “seismic after-effects” in the field of biology. There have been conferences of something called the International Neuropsychoanalysis Society (among whose attendees, we are gravely informed, was Oliver Sacks). In support of Freud’s claim that dreams represent symbolic wish fulfilment, Tallis quotes a neuroscientist who writes that “‘wishing’ might be subserved by the mesocortical-mesolimbic dopamine circuitry of the brain”. There is certainly a pungent, science-y whiff to all this. But readers will decide for themselves whether it adds up to what Tallis calls “Freud’s scientific rehabilitation”.

But perhaps instead a case can be made for the enduring relevance to psychiatry of Freud’s worldview without resorting to scientific credulity or postmodern mystification. Indeed, millions of readers are already familiar with it by way of bestselling books based on a growing body of research on the effects of trauma. When Bessel van der Kolk argues that the human body “keeps the score” of the mind’s suffering, or that “traumatised people have a tendency to superimpose their trauma on everything around them and have trouble deciphering whatever is going on”, he can sound uncannily like Freud (whose work he liberally quotes). Likewise the Canadian physician and intellectual Gabor Mate when he writes that our early experiences can leave us trapped in a “physio-emotional time warp”. Van der Kolk and Mate place strong emphasis on “attachment theory”, first developed by the psychoanalyst John Bowlby, which explores how the effects of our early entanglements reverberate through our lives.

What’s more, the claim that Freud’s notions are unsupported by science no longer cuts as deep as it once did — because, as it turns out, so are some of the fundamental assumptions of the “biomedical” psychiatry that supposedly usurped them. The decoding of the human genome, completed in 2003, did not show that mental illness is predestined but, rather, that hereditary vulnerability interacts with our environment in enormously complex ways. Optimism around psychopharmacology has waned, as new psychiatric drugs have failed to appear and doubts about the efficacy and safety of the old ones has grown. And hopes brain imaging would transform psychiatry have petered out, as new technologies like fMRI have so far shown no utility in the diagnosis or treatment of mental illness. In 2022, a new history of psychiatry gloomily concluded that “biology is a bet whose payoff has been far more limited than its architects promised”.

“Our suffering has a story, and it makes sense.”

None of this means that the Gothic edifice of Freud’s theories, with its vaults and gargoyles, is about to be rebuilt. But a sober assessment of what modern psychiatry can and cannot tell us suggests that, in broad outline if not in many of its details, his approach continues to hold much value. Our past loves and terrors can haunt us in the present. We are often opaque to ourselves, riven by conflicts we only half understand, our passions barely kept in check by external constraints. If we can be helped to overcome the thousand ways we protect ourselves from self-knowledge, we may see that our distress is not some random affliction but a meaningful response to the conditions of our development. Our suffering has a story, and it makes sense.

Freud once likened the way we repress unwanted thoughts to the ejection of a disruptive audience member from an academic lecture so that the event can continue smoothly. Now 30 years after Freud himself was manhandled from the podium of psychiatry and shut out of the lecture hall, the authorities who replaced him are faltering — and he can still be heard, banging on the door outside. Even if, as Auden wrote, “often he was wrong and, at times, absurd”, his voice cannot altogether be silenced. Perhaps the most canny assessment of him came from his wronged patient Horace Frink, who when Freud was dying was asked if he had any words for his former idol. “Tell him he was a great man,” said Frink, “even if he did invent psychoanalysis”.


Matt Rowland Hill is the author of Original Sins and his Substack is Bibliopathology 


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Lancashire Lad
Lancashire Lad
4 months ago

One issue not addressed in this essay is the current penchant for aspects of cognitive development and growth being described in terms of mental illness. This has been categorised as the “mental industrial complex” and if biomedicine has helped cure or alleviate many of our physical ailments, psychiatry is having the opposite effect of pathologising as many of us as possible.

Post-Freudian psychiatry then, isn’t working so it’s perhaps unsurprising that his theories might be revisited; after all, it was his work which pathologised all our early childhoods and brought modern psychiatry into being.

The internet of course is a phenomenon which can be described as “holding a mirror up to ourselves” and will therefore necessitate a rethink as the extent of our human psychology starts to take on this new dimension: a Jungian “collective unconscious” made conscious to us all, with greater or lesser degrees of awareness or recognition.

For these reasons, i think we’re entering new territory. This article is welcome as a reminder of how human psychology began to be more fully explored with the rise of the industrial world and mass communications.

The existence of a ‘soul’ is also posited, most recently in terms of gender (as well as in the more traditional sense) as a kind of epiphenomemon of our biology. All of this entreats us to proceed more carefully. The classical imperative to “know thyself” becomes ever more relevant; having others do it for us isn’t necessarily the best route to mental health.

peter lucey
peter lucey
4 months ago

“Freud began to look more like the founder of a religion than a scientist”. Well put. Freud was a glorious, and extremely successful, shaman – or confidence trickster, if you prefer.
I can recommend anything by Prof Fred Crews, especially his collection of articles “Follies of the Wise”, where he passes a skeptical eye on the various beliefs we are sold (Theosophy, the Roschach Test, aliens, Zen Bhuddism, and of course psychoanalysis and it’s obsession with the “unconscious”.).

But, amusement aside, Freud’s theories have caused terrible suffering. “Repression” has enabled the fake satanic abuse plague, and I shudder to consider all the poor women whose sex lives were confused by Freud’s theory of clitoral to vaginal orgasm transference…

Charles Stanhope
Charles Stanhope
4 months ago
Reply to  peter lucey

Perfectly put Sir! Thank you.

AC Harper
AC Harper
4 months ago

“Bits of the Truth” can be found, if you look closely through squinty eyes.
But by the same inspection perhaps we should also re-assess Jung, James, Montaigne, Epicurus, etc. There will be some nuggets of truth to be recovered along with a big spoil heap of waste material.

Paddy Taylor
Paddy Taylor
4 months ago

Still one of my favourite definitions:

A Freudian Slip – saying one thing when you mean amother

Mike Downing
Mike Downing
4 months ago

I was a kind of lazy acceptor of Freudian ideas in my yoof; it was just in the ether and lots of the theories were talking points among people although we didn’t really understand it in depth (like trans issues now I suspect).

Then one day in the pub I was saying something to a female acquaintance and she smiled at me skeptically and explained that she didn’t see any real evidence at all of the existence of this thing called the subconscious.

Since then, I’ve watched the forward march of all kinds of therapy and self-help with bemusement and I’m more and more convinced that, apart from some really screwed up folks, most of us are better keeping away from all of it.

Go for a run, a swim, read a novel, do something, make something and leave your money and time in the bank.

I notice Labour have started talking up the ‘Crisis in Masculinity ‘ whose remedy will no doubt include more of this rubbish and the further compulsory feminisation of ‘toxic’ male behaviour. No mention of jobs of course let alone meaning (apart from self obsessing) but more men-only spaces (previously destroyed by the Feminists).

edmond van ammers
edmond van ammers
4 months ago

Wittgenstein famously said that when you attend a talk given by Freud “you should hold on tight to your brain”

Phillip F
Phillip F
4 months ago

Wittgenstein extensively praised and criticized psychoanalysis, as he did most foundational and important ideas. There are several books and much scholarship describing his long engagement with Freud, psychoanalysis and psychoanalytic therapy.

Aphrodite Rises
Aphrodite Rises
4 months ago

Freud was part genius part charlatan. Jung was pure genius.

Wilfred Davis
Wilfred Davis
4 months ago

I don’t know whether you have read ‘The Aryan Christ: The Secret Life of Carl Jung‘ by Richard Noll (1997).

I would be interested to learn whether after reading that anyone would be prepared to say Jung was pure genius.

Aphrodite Rises
Aphrodite Rises
4 months ago
Reply to  Wilfred Davis

I haven’t but being a genius is very different from being a saint. I make no moral judgement if that is what you are alluding to.

AJ Mac
AJ Mac
4 months ago

Many who treat him like a witch doctor or mere fabulist overlook the degree to which he combined real science with real vision, not fetishizing one or the other.

Aphrodite Rises
Aphrodite Rises
4 months ago
Reply to  AJ Mac

Agreed. In fact to deny Jung could be said to deny science. A little Wikipedia cut and paste:
In 1932, physicist Wolfgang Pauli and Jung began what would become a long-spanning correspondence in which they discussed and collaborated on various topics surrounding synchronicity, contemporary science, and what is now known as the Pauli effect
Wolfgang Ernst Pauli (/ˈpɔːli/;[5] German: [ˈvɔlfɡaŋ ˈpaʊli]; 25 April 1900 – 15 December 1958) was an Austrian theoretical physicistand one of the pioneers of quantum physics. In 1945, after having been nominated by Albert Einstein,[6] Pauli received the Nobel Prize in Physics for his “decisive contribution through his discovery of a new law of Nature, the exclusion principle or Pauli principle“. The discovery involved spin theory, which is the basis of a theory of the structure of matter.

Steve Houseman
Steve Houseman
4 months ago
Reply to  Wilfred Davis

To this I would add R. Noll’s book ‘The Origins of Jung: A charismatic Cult Movement’ 1994. Strange character Jung.
But as far as F. Crews story of Freud there’s numerous books available and all good. Strange character Freud.
Also Dagmar Herzog “Cold War Freud’ 2017 is a must especially the origins of post traumatic stress disorder. Fascinating.

AJ Mac
AJ Mac
4 months ago
Reply to  Steve Houseman

They both engaged in studies that were and sometimes remain taboo–not without defensible cause. (Reading Forbidden Knowledge by Roger Shattuck right now–think of Faust and Frankenstein). Freud had a habit of labelling and reducing what he found; Jung was often capable of illuminating mysteries of the psyche without pretending to fully comprehend them or itching to explain them away.
Where’s the proof? There isn’t any and never will be. Aside from the glimpses that, for some readers, illuminate many of his pages–and cause many others to mock his best work.

Richard Gipps
Richard Gipps
4 months ago

Why people keep writing about Freud like this – the reviewer or Tallis for that matter – beats me. Why not instead write about psychoanalysis? Why not tell the educated reader what actual clinical psychoanalysis is about? Freud had some great and some terrible ideas about the dynamic unconscious, just as Aristotle did about biological life. But psychoanalysis and biology both have moved on a lot. For anyone interested in what contemporary analysts think, I believe this is a good place to start: https://jonathanshedler.com/wp-content/uploads/2023/02/Shedler-2022-that-Was-Then-This-Is-Now-Psychoanalytic-Psychotherapy-For-The-Rest-Of-Us-1.pdf

Shrunken Genepool
Shrunken Genepool
4 months ago

And why we don’t – Phillip Rieff, Christopher Lasch, Abigail Shryer

Phillip F
Phillip F
4 months ago

150 years of psychoanalytic literature is, at its best, a recounting of the mistakes that arise when one individual attempts to make useful observations about the apparent conscious and unconscious motives of another. Over and under involvements are the frequent consequences of the patient’s compulsion to repeat their imperfectly recognized struggles. Those clinicians who undergo the long and expensive training to become psychoanalysts are not immune to these complications of treatment, but they are arguably better prepared to face them than the many poorly trained therapists who fall into the same traps first faced by Freud and his early followers. That Freud did as well as he did without training, supervision, or even the benefit of his own analysis is rather remarkable. That he filled thirty volumes with ideas based on his close examination of the process of his clinical encounters is more than many of us could manage. That he, as an accomplished neurologist whose initial project was a biological model of the mind, recognized the limitations of his tools to do so and turned to psychology, shows a certain humility even in a man of enormous ambition. Over-estimating the significance of the historic fashions that labeled psychoanalysis a panacea and then a fraud obscures the clinical good accomplished by the modest labors of the many psychoanalysts still trying to offer useful observations in consulting rooms today.

Steve Jolly
Steve Jolly
4 months ago

When I took my first psychology class in high school and learned about Freud, I didn’t need several generations worth of accumulated criticism to tell me his views were absurd. I didn’t really need much other than my own common sense and Freud’s ideas themselves actually. Freud made what I easily identified to be absurd leaps of logic that defied reason. Almost none of it matched my own observations or sense of reason. As I grew older and I learned more history and about how people are affected and defined by their social environment, I came to the idea that Freud’s ideas were culturally bound. Everything was about sex and sexuality because in the culture of Europe in the mid 19th century, sex was culturally taboo and sexual desires were enormously stressful and often unwanted in that cultural context. As the culture changed more and more over time, the more ridiculous Freud’s ideas looked even to the layperson. As the author points out, the more purely scientific approaches since Freud have only been marginally more successful. I wonder if a version of psychotherapy grounded in our current culture might be at least as useful as the pharmaceutical approach, but perhaps that already exists in an informal way through the hundreds of thousands of therapists in hospitals, schools, and in private practice throughout the world.

AJ Mac
AJ Mac
4 months ago
Reply to  Steve Jolly

I’m in general agreement. But I think works like The Interpretation of Dreams and his essay “The Uncanny” contain imaginative power and useful insights. If they are not treated like oracles or established fact.

Madas A. Hatter
Madas A. Hatter
2 months ago

Re Gabor Mate, I was urged by a devoted fan to view one of his videos. Literally the first thing he said was demonstrably, scientifically false. And his ego shone through like the beam of a lighthouse. My attempts to dis-illusion my enthralled friend, alas, were all in vain.