Sigmund Freud was by all accounts a difficult man who tended to be rather dogmatic about his ideas. At the same time, his ideas about the ways in which the mind is organized evolved throughout his life. He remains a giant because his attempts to understand and characterize the structure and workings of the mind continue to yield fruit long after his death, even though many of his original theories are now seen to be incorrect, incomplete, and overly simplistic.
Yesterday, Ronald W. Dworkin wrote a review of Peter Kramer's new book, Freud: Inventor of the Modern Mind. In his New York Sun piece, Freud's Will to Power, Dworkin focused heavily on what he understood to be flaws in Freud's methodology and conclusions. Dworkin, according to the information on the Amazon site for his book, Artificial Happiness: The Dark Side of the New Happy Class, is an Anesthesiologist, not a Psychoanalyst, but that does not stop him from commenting on Freud's theories and Freud's psyche:
Legend has it that Freud, although educated in the philosophies of his day, studiously avoided the work of Nietzsche to preserve the originality of his ideas against external influence. Nietzsche's analysis of the human psyche, how values were supposedly projections of people's unspoken jealousies and fears, ran dangerously close to Freud's idea (still a work in progress at the end of the 19th century) that the roots of conscious behavior lay in unconscious desires.
But after reading Dr. Peter Kramer's outstanding new biography of Freud (HarperCollins, 213 pages, $21.95), one wonders if Freud feared something else, not influence but self-knowledge, for Dr. Kramer's Freud is practically the living embodiment of Nietzsche's will to power. It's not simply that Freud was incredibly ambitious. (At age four, after soiling a chair, he reassured his mother that he would grow up to be a great man and buy her another.) Rather, it was Freud's determination to systematize the world, to bring order to chaos, and to impose his theory of life on life itself — a determination so intense that one of Freud's colleagues called it a "psychical need."
Dworkin accuses Freud of generalizing from small samples. He also caricatures his theories:
Freud built his theory of the Oedipus complex on an equally gross generalization, namely that all children want to kill their fathers and commit incest with their mothers. Yet a few questionable patient experiences hardly confirm a new truth about human nature.
From his reading of the book, Dworkin feels secure in his understanding of Freud and his continuing influence:
In real science, things are given names because they have value — hence the words "atom" and "molecule." In Freudian psychoanalysis, things have value because they are given names — "Oedipus complex," "castration anxiety" — and only because enough people have been convinced of their value. If scientists ignored atoms and molecules, these particles would still exist and exert vital effects. If Freudian concepts are ignored, their value, their very existence, is gone forever. Freudian analysis is not science; it is fashion, totally dependent on public acclaim.
Freud did not discover the unconscious. Other doctors had written on the subject before him. Nor did he discover phenomena like Freudian "slips," "displacement," and "transference." What he did was give these mental phenomena names, turn them into symbols, and then use these symbols to create road signs and boundaries in the vast infinite of the human mind. He was just one more man of letters who tried to tame that monster of energy: life.
Order out of chaos. Will to power. These may be the only truisms about human nature in the whole Freud saga.
I am too polite to point out that Dworkin seems to be generalizing from a small sample, not to mention caricaturing Freud's theories, but it is enough to make me wonder what Dworkin is so afraid of; if he doesn't see any value in Psychoanalytic ideas, he is free to ignore them. (I guess I'm not that polite.) The fact is that the more we learn about the structure of the brain, the more confirmation we find of many of Freud's basic ideas.
[I have written about the growing body of hard data supporting such theoretical ideas as the dynamic unconscious and evidence supporting the concept of the differentiation of the self. There is also a growing body of evidence on the importance of "mirror cells" in the brain, which likely form the basis of all object relations.]
In the October issue of the American Journal of Psychiatry is a report on a research study designed to look at the value of Transference interpretations. While the study is only available to subscribers, Glen O. Gabbard, MD, (a Psychiatrist, not an Anesthesiologist) reviews some of the results and their implications in When Is Transference Work Useful in Dynamic Psychotherapy?
Extensive research attests to the value of psychotherapy in an array of psychiatric disorders. However, when it comes to understanding how psychotherapy works, we must reluctantly acknowledge that we do not know as much as we’d like to know. Psychotherapists who ask their former patients to identify what was most helpful to them often find the answer disconcerting. What the therapist thinks was a magnificent interpretation based on a keen understanding of the patient’s psychopathology may be completely forgotten. The patient’s fondest memory may be the time that the therapist told a joke. If one asks a psychotherapist to identify the factors that produced improvement in a former patient, one will probably hear a response that reflects the personal theoretical biases of the therapist (and assures the maintenance of the therapist’s self-esteem). Hence, we are largely in the dark when we attempt to pinpoint the therapeutic action of psychotherapy. We have many theories but little data.
In this regard, the study reported by Høglend and his colleagues in this issue of the Journal arrives at an auspicious moment. The investigators provide meaningful data on one of the longstanding controversies in dynamic therapy, namely, the role that transference interpretation plays in the therapeutic action of psychotherapy. One point of view has been that a focus on the conflicts and themes that arise in the therapeutic relationship will illuminate the nature of problems in the patient’s relationships outside of therapy (1). An alternative perspective, especially in brief psychotherapy, is that too much attention to the transference may make patients inordinately anxious. In light of this concern, an alternative approach is to examine extratransference relationships and interpret patterns, conflict, and fantasies as they emerge in those contexts.
Of interest, the study shows that careful attention to the transference relationship between the Psychiatrist and the patient is especially helpful with people who have more significant problems of character. This probably has to do with the fact that such patients need a fair amount of work developing a therapeutic alliance before they can feel comfortable enough with a Therapist to risk the danger of revelation of the self to a stranger.
In many ways Dworkin is correct to question Freud's self-knowledge; none of us can ever know the full contents of our own unconscious minds. Yet the alternative, to act as if there is no dynamic unconscious leads to a kind of therapeutic nihilism that would be a disservice to our culture. At present, recognizing the gap between the rational and the irrational in our minds is the best way to enlarge our grasp of reality.
As for Dworkin: if you understand the Oedipus Complex in such simplistic terms as to mean that all young children want to kill their fathers and sleep with their mothers, of course it sounds silly. However, if you understand the Oedipus Complex to be short hand for the myriad difficult psychological and developmental processes that are involved in the young child partially renouncing his first, often conflicted, love of his mother, while negotiating rivalrous feelings with his father (and vice versa) conflated with multiple other trends, all of which are determinant of later Psychological and Characterological development, you might begin to understand where we have traveled since Freud's time.
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