Freud’s legacy

Freudian psychoanalytic theory was the basis of the whole notion of  “the talking cure” – what we now know as psychotherapy. But many of Freud’s ideas have been discredited and none (to my knowledge) have stood up under the lens of scientific scrutiny. This doesn’t necessarily mean that they have no utility, just that they can’t be proven. I’m not suggesting that nobody has benefitted from psychoanalytic therapy, but its techniques and benefits haven’t been empirically validated.

The first two editions of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) were largely written by psychoanalysts, and analyzed mental illnesses through Freud’s theoretical lens. (Both editions labeled homosexuality as a mental disorder, a grave error corrected in the third edition.) Subsequent DSM editorial committees saw fit to question the utility of Freudian concepts such as neurosis and hysteria, and to focus instead on identified symptoms in establishing diagnostic criteria. Most of Freud’s psychoanalytic concepts have proven superfluous to our understanding of the pathologies, or unfounded.

Freud attributed most psychopathy to unconscious and unresolved infantile or early childhood issues and conflicts, especially those conditions he characterized as “hysterical” or “neurotic.” He posited that the Oedipus Complex was a universal experience for little boys: the unconscious wish to kill Dad and have sex with Mom. The Electra Complex was the female analogue of this Freudian notion, which no longer seems to have any utility. The concept of female “penis envy” also appears to tell us more about Freud’s psyche than about the human condition.

While there may be some metaphoric validity to the idea that some people are “accident prone” or have a “death wish” due to unresolved unconscious conflicts, there’s no real evidence for these propositions. Conversion disorders – the loss of some physical or sensory capability for psychogenic reasons – are still in the DSM, but calling them “hysterical” in origin contributes nothing to our understanding of the condition.

There’s been a steady decline over the years in people who undergo the rigorous training required to become a psychoanalyst, and its theory and techniques haven’t been validated by research. The technique of “free association” (saying the first thing that comes to mind, in response to serial stimulus words) can reveal interesting mental associations, but there’s no scientific evidence of its effectiveness as a therapeutic technique. Dream analysis can be fascinating, but it’s not a magical key to insight.

I’ve already written a post in which I presented Freud’s concept of defense mechanisms as a useful tool in psychotherapy. But what other Freudian notions have stood the test of time? In my opinion, his popularization of the concept of unconscious motivations has contributed significantly to our understanding of human behavior. Sometimes people do things for reasons they don’t consciously understand. This idea has taken root in modern life.

The personality structure of superego, ego and id still has some metaphoric validity, and was revived in Transactional Analysis as parent, adult and child. The way I used the metaphor in therapy went something like this: “It’s as if we had three aspects to our personalities, the parent, the adult and the child. Children operate on the pleasure principle – I want what I want right now! One of the tasks a child needs to master on the journey to adulthood is learning to delay gratification, to be willing to do needful things now, in anticipation of future reward.”

Another Freudian concept that still makes sense to me is that of transference and countertransference. It describes emotional dynamics within a therapeutic relationship. Freud said that patients tend to unconsciously transfer feelings for significant others (like Dad , or a lover) onto their therapist. A therapist who is aware of this dynamic in the therapeutic relationship, and who isn’t unconsciously affected by countertransference (her feelings for the patient), can use transference to the patient’s benefit in therapy. A client falling in love with his therapist or a therapist falling in love with her  client (it happens) can also be understood through this Freudian lens.

But it seems to me that Freud’s most enduring legacy (influenced by his mentor, Joseph Breuer) was his concept of “the talking cure,” the idea that talking about your problems with an attentive and caring therapist can be healing. This may seem obvious to many of us today, but without Freud’s contribution, contemporary psychotherapy as we know it wouldn’t exist.

Bonus recommendation: If you want to read an excellent novel about the genesis of “the talking cure,” I highly recommend Irvin Yalom’s When Nietzche Wept. Freud isn’t the main character, but the novel imagines a friendship between Joseph Breuer and Friederich Nietzche, and how it affects the lives of both men. Don’t waste your time on the movie adaptation.

 

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