In Defense of Psychoanalysis (Psychiatry Talks, April 2019, San Antonio)

Uploaded 8/5/2019, approx. 26 minute read

My name is Sam Vaknin, and I am the author of Malignant Self-Love, Narcissism Revisited, and other books about personality disorders. I am a visiting professor of psychology in Southern Federal University in Rostov-on-Don, the Russian Federation, and a professor of finance and a professor of psychology in SIAS-CIAPS, the Centre for International Advanced Professional Studies.

Today I would like to discuss psychoanalysis.

There is no social theory that has been more influential and later more revived than psychoanalysis.

Psychoanalysis burst upon the scene of modern thought, a fresh breath of revolutionary and daring imagination, a herculean feat of modern construction, a challenge to establish mores, morals and manners.

But psychoanalysis is now widely considered nothing better than a confabulation, a baseless narrative, a literary exercise, a snapshot of Freud's tormented psyche, and thwarted 19th-century Middle-Europa middle-class prejudices.

Most of the criticism hurled at psychoanalysis is by mental health professionals and practitioners with large axes to grind.

The truth is that few, if any, theories in psychology are supported by modern brain research. All therapies and treatment modalities, including medicating one's patients, all of these are still forms of art and magic rather than scientific practices.

The very existence of mental illness is in doubt, let alone what constitutes healing. So psychoanalysis is in bad company all around.

Some criticism is offered by practicing scientists, mainly experimentalists or neuroscientists.

This in the life and exact physical sciences. Such diatribes frequently offer a sad glimpse into the critics' own ignorance. They have little idea what makes a theory scientific and they confuse materialism with reductionism or instrumentalism, a confused correlation with causation. Few physicists, neuroscientists, biologists and chemists seem to have ploughed through the rich literature of the psychophysical problem.

As a result of this obliviousness, they tend to prefer primitive arguments long rendered obsolete by centuries of philosophical debates.

Science frequently deals matter-of-factly with theoretical entities and concepts, considering for example, works or even some forms of black holes.

These constructs, these concepts have never been observed, measured or quantified. This should not be confused with concrete entities. They have different roles in the theory.

Yet when they mock Freud's trilateral model of the psyche, the id ego and superego, his critics do just that. They relate to his theoretical constructs as though they were real measurable concrete things.

The medicalization of mental health hasn't helped either.

Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain or they are ameliorated with medication.

Yet these two facts are not ineluctably facets of the same underlying phenomenon.

In other words, that a given medicine reduces or abolishes certain symptoms does not necessarily mean that these symptoms were caused by the processes or substances affected by the drugs administered.

Cowization is only one of many possible connections and change of events.

To designate a pattern of behavior as a mental health disorder is a value judgment or at best a statistical observation.

Normal, abnormal. Such designations affected regardless of the facts of brain science.

Moreover, correlation, as I said before, correlation is not the same as causation. This is a very important distinction that very often is lost on the critics of psychoanalysis.

Deviant brain or body biochemistry, once called polluted animal spirits, these do exist. But are they truly the roots of mental perversion?

Nor is it clear which triggers what. Do the aberrant neurochemistry or biochemistry, do these cause mental illness or is it the other way around?

The mental illness caused the biochemistry.

That psychoactive medication alters behavior and mood is indisputable. So do illicit and illegal drugs, certain foods and all interpersonal interactions. That the changes brought about by prescription are desirable, is debatable and involves total logical thinking.

If a certain pattern of behavior is described as socially dysfunctional or psychologically sick, clearly every change would be welcomed as healing and every agent of transformation would be called a cure.

It's a cyclical argument. The same applies to the alleged heredity of mental illness.

Single genes or gene complexes, gene arrays, are frequently associated with mental health diagnosis, personality traits or behavior patterns.

But too little is known to establish irrefutable sequences of causes and effects. Even less is proven about the interaction of nature and nurture, genotype and phenotype, the plasticity of the brain, epigenetics and the psychological impact of trauma, abuse, upbringing, role models, peers and other environmental elements.

Nor is the distinction between psychotropic substances and talk therapy that clear-cut. Words and the very interaction with the therapist also affect the brain, its processes, structure, chemistry and neural pathways.

Admittedly talk therapy does it more slowly and less discernibly, but perhaps also more profoundly and irreversibly.

Medicines, as David Kaiser reminds us in Against Biologic Psychiatry, it's an article published in Psychiatric Times, Volume 13, Issue 12, December 1996.

David Kaiser writes that medication treats symptoms, not the underlying processes that yield them.

So what is mental illness? What is the subject matter of psychoanalysis?

Someone is considered mentally ill if one's conduct rigidly and consistently deviates from the typical average behavior of all other people in the person's culture and society that fit his profile.

Whether this conventional behavior is moral or rational is not material.

The second requirement is that the person's judgment and grasp of objective physical reality is impaired.

The reality test is impaired.

The third requirement is that his conduct is not a matter of choice, but is innate and irresistible.

The fourth condition is that the person's behavior causes him or her or others discomfort and is therefore the fifth condition dysfunctional, self-defeating, self-destructive, even by the person's own yardsticks and standards.

Descriptive criteria aside, what is the essence of mental disorders is still dubious.

Are these merely physiological disorders of the brain or more precisely of the brain's chemistry?

If so, can mental disorders be cured by restoring the balance of substances and secretions in that mysterious organ?

These are echoes of the Middle Ages or even the ancient world.

The humors, the four humors.

And once equilibrium is reinstated, is the illness gone or is it still lurking there under wraps waiting to erupt?

Are psychiatric problems inherited, rooted in faulty genes, though amplified by environmental factors or are they brought on by abusive or wrong nurturers?

These questions are the domain of the medical school of mental health.

Other practitioners cling to the spiritual view of the human psyche. They believe that mental ailments amount to the metaphysical discomposure of an unknown medium, the soul.

Theirs is a holistic approach taking in both the patient in his entirety as well as his medium.

The members of the functional school of mental health regard mental health disorders as perturbations in the proper statistically normal behaviors and manifestations of healthy individuals.

In other words, as dysfunctions.

The sick individual is with himself, egodystonic, making others unhappy, deviant. The sick individual is mended, fixed, when rendered functional again by the prevailing standards of his social and cultural frame of reference.

In a way, these three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant.

Still, they share not only the subject matter, the aforementioned elephant, but to a counter intuitively large degree, a faulty methodology.

As the renowned anti-psychiatrist Thomas Sasse of the State University of New York knows in his article, The Lying Truths of Psychiatry, mental health scholars, regardless of academic predilections, infer the etiology of mental disorders from the success of failure of treatment modalities.

This form of reverse engineering of scientific models is not unknown in other fields of science, nor is it unacceptable if the experiments meet the criteria of the scientific method and above all falsifiability.

The theory must be all inclusive and analytic, consistent, falsifiable, logically compatible, monovalent, or harmonious, and so on.

Psychological theories, even the medical ones, for example, the role of serotonin and dopamine in mood disorders, psychological theories are usually none of these things. They do not satisfy the basic criteria of scientific theories.

Psychoanalysis is not an exception. The outcome is a bewildering array of ever-shifting mental health diagnoses expressly centered around Western civilization and its standards.

For example, the ethical objection to suicide or to homosexuality or to sadomasochism.

Neurosis, a historically fundamental condition, vanished after 1980. Homosexuality, according to the American Psychiatric Association, was a pathology prior to 1973 and totally accepted practice afterwards. Sadomaso, sadomasochistic sex, became legitimized in 2013 with the latest edition of the Diagnostic and Statistical Manual. Seven years later, seven years after 1973, in 1980, Marxism was declared a personality disorder almost seven decades after it was first described by Freud.

Anna Freud said, the more I became interested in psychoanalysis, the more I saw it as a road to the same kind of broad and deep understanding of human nature that writers possess. And that is true.

Dostoyevsky was, in many respects, one of the greatest psychologists ever.

Towards the end of the 19th century, the new discipline of psychology became entrenched in both Europe and America.

The study of the human mind, either to the preserve of philosophers and theologians or novel writers, this study became a legitimate subject of scientific, or some would say pseudocytically, scrutiny.

The structuralists, Wilhelm Wundt, Edward Bradford Tichenor and others, embarked on a fashionable search for the atoms of consciousness, physical sensations, affections, feelings, images in both memories and dreams.

Functionalists, headed by William James and later James Angel and John Dewey, functionalists derided the idea of a pure elemental sensation. They introduced the concept of mental association.

Experience uses associations to alter the nervous system they hypothesized correctly, as we discovered.

Freud revolutionized the field, though at first his reputation was limited to the German-speaking parts of the dying Habsburg Empire.

Freud dispensed with the unitary nature of the cycle. Instead, he proposed a trichotomy, a tripartite or trilateral model, the id, the ego and the superego.

He suggested that our natural state is conflict, that anxiety and tension are more prevalent than harmony.

Equilibrium, compromised formation, is achieved by constantly investing mental energy, hence psychodynamics, echoes or physics.

Most of our existence, Freud, is unconscious. The conscious is but the tip of an ever-increasing iceberg.

He introduced the concepts of libido and thalatos, the life and death forces, instincts, thrbid or drives in German, drives in English as well.

The somatic, erotogenic phases of psychic personality development, trauma and fixation manifest in latent content and dreams.

Even his intellectual adversaries use this vocabulary, often infused with new meanings.

The psychotherapy Freud invented, based on his insights, was less formidable than the theoretical construction. Many of its tenets and procedures had been discarded early on, actually, even by its own proponents and practitioners.

The rule of abstinence, the therapist is a blank and hidden screen upon which the patient projects or transfers his repressed emotions. This was dispensed with free association, as the exclusive technique used to gain access to and unlock the unconscious.

He's no longer thus.

Dreamed reputation with mandatory latent and forbidden content, symbolically transformed into the manifest.

All these have literally vanished within the first decade or decades of the practice.

Other postulates, most notably transference and counter transference, ambivalence, resistance, regression, anxiety and conversion symptoms, all these survive to become cornerstones of modern therapeutic modalities, whatever their origin.

So did, in various discusses, the idea that there is a clear path leading from an unconscious or conscious conflict to signal anxiety, to repression and to symptom formation, the neurosis, noted in current deprivation, or psycho-neurosis, the outcomes of childhood conflicts.

The existence of anxiety-preventing defense mechanisms is also to be widely accepted.

From its initial obsession with sex as the sole driver of psychic exchange and evolution, it has earned him the derision and diatribe aplenty.

Clearly, a child of the repressed sexuality of Victorian times and the Viennese middle class, Freud was fascinated with perversions and fantasies. Oedipus and electro complexes are reflections of these fixations, but their origin in Freud's own psychopathologies does not render them less revolutionary.

Even a century later, child sexuality and incest fantasies are more or less taboo topics of serious study and discussion.

As Chris said in 1947, but psychoanalysis is nothing but human behavior considered from the standpoint of conflict. It is a picture of the mind, said Chris, divided against itself, with attendant anxiety and other dysphoric effects, with adaptive and maladaptive defensive and coping strategies, and with symptomatic behaviors of the defense phase.

But psychoanalysis is more than a theory of mind. That is the secret of its endurance.

It is also a theory of the body, and of the personality, and of society. It is a social sciences theory of everything.

It is a bold and highly literate attempt to tackle the psychophysical problem and the Cartesian body versus mind, Fernando.

Freud himself noted that the unconscious has both physiological instinct and mental drive aspects.

Freud wrote, the unconscious is a concept on the frontier between the mental and the somatic, as the physical representative of the stimuli originating from within the organism, enriching the mind.

Psychoanalysis is, in many ways, the application of Darwin's theory of evolution in psychology and in sociology.

Survival is transformed into narcissism, and the reproductive instincts assume the garb of the Freudian sex drive.

But Freud went a daring step forward by suggesting that social structures and internalized by the superego are concerned mainly with the repression and redirection of natural instincts.

Signs and symbols replace reality and all manner of substitutes such as money. These substitutes, these signs, these symbols, stand in for primary objects in our formative years.

To experience our true selves and to fulfill our wishes, we resort to fantasies, for example, dreams, screen memories, where imagery and irrational narratives, displays, condensed, rendered visually, revised to produce coherence, and censored to protect us from sleep disturbances.

These visual, irrational imagery represent our suppressed desires.

Current neuroscience tends to refute this dream work conjecture, but its value is not to be found in its veracity or lack thereof.

These musings about dreams, slips of tongue, forgetfulness, the psychopathology of everyday life, and associations were important because they were the first attempt at deconstruction, the first in-depth insight into human activities such as art, myth-making, propaganda, advertising, politics, business, and warfare, and the first coherent explanation of the convergence of the aesthetic with the ethic, the socially acceptable and the socially condoned.

Ironically, Freud's contributions to cultural studies may far outlast his so-called scientific so-called theory of the so-called mind.

It is ironic that Freud, a medical doctor, neurologist, the author of a project for scientific psychology, should be chastised this way by scientists in general and neuroscientists in particular.

Psychoanalysis used to be practiced only by psychiatrists up to a certain point, but we leave it an age when mental disorders are fought to the physiological, chemical, genetic origins, almost exclusively.

All psychological theories and talk therapies are disparaged by hard, exact scientists.

Still, the pendulum has swung both ways many times before.

Hippocrates ascribed mental afflictions to balance of bodily humors, blood, flagon, yellow, and black bile. This balance was supposed to be out of kilts.

So did Galen, Bartholomewus, and Licus. Johann Wehr, Taraxelus, and Thomas Willis all attributed physiological disorders, psychological disorders to functional fault of the brain.

The tie turned with Robert Burton, who wrote Anatomy of Melancholy and published it in 1621. He forcefully propounded the theory that psychic problems are the set outcomes of poverty, fear, and solitude.

A century later, Francis Gold and Sprozheim traced mental disorders to lesions of specific areas of the brain, the forerunner of the now discredited discipline of phrenology.

The logical chain was simple. The brain is the organ of the mind, thus various faculties can be traced to its parts.

Morel in 1809 proposed a compromise, which has since ruled the discourse.

The propensities for psychological dysfunctions, he suggested, are inherited, but they are triggered by adverse environmental conditions.

A Lamarck, Morel was convinced that acquired mental illnesses are handed down the generations.

Esquirol, concurrent in 1845, as did Henry Maudslay in 1879, and Adolf Mayer soon thereafter. Heredity predisposes one to suffer from psychic malaise, but psychological and moral social causes precipitate.

And yet, the debate is far from over.

Wilhelm Geisinger published The Pathology and Therapy of Mental Disorders in 1845. In it, he traced the etiology of mental disorders to neuro-pathologies, physical disorders of the brain. He allowed for heredity and environment to play their parts, though.

He was also the first to point out the importance of one's experiences in one's first years of life.

Jean Martin Charcot, a neurologist by training, claimed to have cured hysteria with hypnosis.

But despite this demonstration of non-physiological intervention, he insisted that his steroid symptoms were manifestations of brain dysfunction.

Warren Mitchell coined the term neurosthenia to describe an exhaustion of the nervous system, today we call it depression.

Pierre Janet discussed the variations in the strength of the nervous activity and said that they explained the narrowing theme of consciousness, whatever that meant.

None of these nervous speculations were supported by scientific or experimental or what we would call today medicinal evidence. This was not evidence-based medicine.

Both sides of the debate confined themselves to philosophizing and to ruminating.

Freud was actually the first to base a theory on clinical observations.

Gradually, though, his work, buttressed by the concept of sublimation, became increasingly metaphysical.

Its conceptual pillars came to resemble Bergson's Elan Vital and Schopenhauer's will.

French philosopher Paul Reicher called psychoanalysis, depth psychology, the hermeneutics of suspicion.

Sigmund Freud wrote a letter to Fleiss in 1900 and he said, I'm actually not a man of size at all. I am nothing but a conquistador by temperament and adventure.

In the Gospel of Thomas, we find the saying, if you bring forth that which is in you, that which you bring forth will be your salvation.

And Sigmund Freud kind of echoes that. He says, no, our science is no illusion, but an illusion it would be to suppose that what science cannot give us, we cannot get elsewhere.

Harold Bloom called Freud the central imagination of our age.

That psychoanalysis is not a scientific theory, in the strict rigorous sense of the word, has long been established and I accept it.

Yet most criticisms of Freud's work by the likes of Karl Popper, Adolf Grunbaum, Havelock Ellis, Malcolm Macmillan and Frederick Cruz, most of the criticism pertained to his long debunked scientific potentials.

Today it is widely accepted that psychoanalysis, though some of its tenets are testable and indeed have been experimentally tested and invariably found to be false or uncorroborated, while psychoanalysis today is widely accepted as a system of ideas. It is a cultural construct and a suggested deconstruction of the human mind.

Despite aspirations to the contrary, psychoanalysis is not and never has been a value in neutral physics or dynamics of the site.

Freud also stands accused of generalizing his own perversions and of reinterpreting his patients' accounts of their memories to fit his preconceived notions of the unconscious.

The practice of psychoanalysis as a therapy has been castigated as a crude form of brainwashing within cult-like settings.

Feminists criticise Freud for casting women in the role of defective, naturally castrated and inferior men. Scholars of culture expose the Victorian and middle-class roots of Freud's theories about suppressed sexuality. Historians deride and decry his stifling authoritarianism and frequent and expedient conceptual reversals, and so on and so forth.

No one gives him a break.

Freud himself would have attributed many of these diatribes to the defense mechanisms of his critics, of course.

Projection, resistance and displacement do seem to be playing a prominent role.

Psychologists are taunted by the lack of rigor of their profession, by its literary and artistic qualities, by the dearth of empirical support for its assertions and fundamentals, by the ambiguity of its terminology and ontology, by the derision of proper scientists in the hard disciplines, and by the limitations imposed by their experimental subject matter, humans.

These are precisely the shortcomings that they attribute to psychoanalysis.

But as I said, they are common to all psychology.

Indeed, psychological narratives, psychoanalysis first and foremost, are not scientific theories by any stretch of this much-banded label.

They are also unlikely to ever become scientific theories because it's not possible to repeat the experiments and falsifiability, therefore, is excluded.

Instead, like myths, religions and ideologies, psychological theories are organizing principles of reality, of the world, theories of mind, if you wish.

Psychological theories do not explain the world. At best, they describe reality and give it true, emotionally resonant, heuristic and hermeneutic meaning.

They are less concerned with predictive feats than with healing, the restoration of harmony among people and inside people.

Therapists, the practical applications of psychological theories, are more concerned with function, order, form and ritual than with essence and replicable performance.

The interaction between patients and therapists is a microcosm of society and encapsulation and reification of all other forms of social intercourse.

Granted, it is more structured. Granted, it relies on a volume of knowledge gleaned from millions of similar encounters, and still the therapeutic process is nothing more than an insightful and informed dialogue whose usefulness is well attested to.

Both psychological and scientific theories are creatures of their times, children of the civilizations and societies in which they were conceived, context-dependent, culture-bound. As such, their validity and longevity are always suspect.

Both hard-aged societies and thinkers in the softer disciplines are influenced by contemporary values, mores, events and interpolations to use Alco's word.

The difference between proper theories of dynamics and psychodynamic theories is that the former asymptotically aspire to an objective truth out there.

While the latter emerge and emanate from a kernel of inner, introspective truth, that is immediately familiar and is the bedrock of their speculations.

Scientific theories, as opposed to psychological theories, need therefore to be tested, falsified and modified because their truth is not self-contained.

Psychoanalysis was, when elaborated, a cognine paradigm shift. It broke with the past completely and dramatically. It generated an ordinate amount of new, unsolved problems. It suggested new methodological procedures for gathering empirical evidence.

In other words, it suggested research strategies.

Psychoanalysis was based on observations, however scant and biased. In other words, psychoanalysis was experimental in nature, not merely theoretical.

It provided a framework of reference, a conceptual sphere within which new ideas could be developed and experiments could be constructed.

That it failed to generate a wealth of testable hypotheses and to account for discoveries in neurology does not detract from the importance of psychoanalysis.

Both relativity theories were, and today strings theories are, in exactly the same position in relation to their subject matter physics.

In 1963, Carl Justice made an important distinction between the scientific activities of Ehrlich and Verstehen.

Ehrlich is about finding pairs of causes and effects. Verstehen is about grasping connections between events, sometimes intuitively and non-causally.

Psychoanalysis is about Verstehen, not about Ehrklaen. It is a hypothetical deductive method for believing events in a person's life and generating insights regarding their connection to his current state of mind and function.

And so, we come back to the core question. Is psychoanalysis a science? Is it a pseudoscience or is it a sui generis?

Psychoanalysis is a field of study, not a theory. It is replete with neologisms and formalisms, but like quantum mechanics, it has many incompatible interpretations.

It is therefore equivocal, but self-contained, recursive.

Psychoanalysis dictates which of its hypotheses are testable and what constitutes its own falsification.

In other words, it is a meta-theory. It's a theory about generating theories in psychology.

Moreover, psychoanalysis as a theory is often confused with psychoanalysis as a therapy.

Conclusively proving that the therapy works does not establish the very decency, the historicity, or even the usefulness of the conceptual edifice of the theory.

Furthermore, therapeutic techniques evolve far more quickly and substantially than the theories that ostensibly yield the practices.

Therapeutic therapies are self-modifying moving targets, not rigid and replicable procedures and rituals.

Another obstacle in trying to establish a scientific value of psychoanalysis is its ambiguity. It is unclear, for instance, what in psychoanalysis qualify as causes and what is their effects.

Consider the critical construct of the unconscious. Is it the reason for, does it cause, our behavior, conscious thoughts and emotions? Does it provide them with a racial explanation? Or are they, behaviors, conscious thoughts, emotions, are these mere symptoms of inexorable underlying processes?

Even such most basic questions receive no dynamic or physical treatment in classic Freudian psychoanalytic theory, so much for its pretensions to be a scientific endeavor.

Psychoanalysis is circumstantial and supported by epistemic accounts, starting with the master himself. It appeals to one's common sense and previous experience. Its statements are of these forms.

Given x, y, and z reported by the patient, doesn't extend to everyday reason that A causes X. Or we know that B causes M, that M is very similar to X, and that B is very similar to A.

Isn't it reasonable to assume that A causes X?

In therapy, the patient later confirms these insights by feeling that these insights are right and correct, that they are epiphanous and revelatory, that they possess retrodictive and predictive powers, and by reporting his reactions to the therapist interpreter.

This acclimation by patient sees the narrative's probative value as a basic, not to say primitive, form of explanation, which provides a time frame, a coincident pattern, and sets of ideological aims, ideas, and values.

Juan Rivera is right that Freud's claims about infantile life cannot be proven, not even with Gedanken experimental movie camera, as Robert Welder suggested.

It is equally true that the theory's ecological claims are epidemiologically untestable, as Grunbaum repeatedly says, but these failures miss the point and miss the aim of psychoanalysis to provide an organizing and comprehensive, non-tendentious, and persuasive narrative of human psychological development.

Should such a narrative be testable and falsifiable, and if it is not, should we discard it as the logical positive instances? I don't think so at all.

I think it depends if we wish to treat psychoanalysis as a science, or as an art form.

This is the circularity of the arguments against psychoanalysis. If Freud's work is considered to be the modern equivalent of myth, religion, or literature, it need not be tested to be considered true in the deepest, most profound sense of the word. After all, how much of the science of the 19th century has survived to this day anyhow?

Thank you for listening.

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