Dismissing Freud 2.0

2544

It happens every few years: historians, psychologists, journalists and investigators find “new” material to dismiss and discredit the work of Sigmund Freud. Since his passing in 1939, the man, who is often mythologized, has undergone numerous character assassinations. Many have said his work is both unscientific and offensive, while others have labeled him a racist and a sexist. Most recently, his work and its lack of empirical research, has been cause (somewhat fairly) for concern about the effectiveness of psychoanalysis. In his new book, the British author and critic Frederick Crews continues his take down of the late Freud. The book, “The Making of an Illusion,”  focuses on Freud’s shortcomings as a man and a professional, and rails against a form of treatment that created a “cult of personality” in the late 19th and early 20th centuries.

Freud’s most notable dissenters have spent years rejecting his theories on penis envy, the Oedipus Complex and the core concept of the sexual drive inherent in all humans. His experimentation with cocaine has poured into mainstream culture. But the main problem with dismissing Freud outright is the lack of understanding of the value of psychoanalysis. At its core, psychoanalysis is a talking cure (coined by Josef Breur in 1895). Patients are able to therapeutically process emotion, content, disturbances and conflicts. The contemporary relational psychoanalyst Susie Orbach said “Psychoanalysis is the study of human subjectivity. It is a clinical practice. It theorises the vicissitudes of human attachment, of the psychological development of mind and body that occur within a relational, cultural field.” She is correct. Furthermore, psychoanalysis proper is rarely practiced today because of the “need” for brief, concrete and managed mental health treatment.

Swept up in the Freudian revisionism is a more common problem, which is the dismissal of the magnitude his ideas have had on the field of psychology for 100 years. Freud’s groundbreaking understanding of transference and countertransference, along with his working model of the mind, are still understood and used today. Psychiatric assessments refer to “attitude toward writer,” which can be linked to a patient’s transferential projection onto the therapist. Because of Freud, we now understand the omnipotence of defense mechanisms and the unconscious motives of our drives.

Freud normalized sexuality for men and women. The ability to relate sexuality to early childhood experiences is a sensitive issue, but one that needs exploration in the therapeutic setting. Today, we have a greater appreciation for attachment theory, psychosocial development and the ego because of Sigmund Freud. The problem with the argument that Freud’s work was not empirical rests on the idea that therapy is strictly a science. Cognitive behavioral approaches, along with other standardized modalities are ubiquitous, but their long-term efficacy remains unknown. Behavioral interventions negate defense mechanisms, unconscious conflicts, inhibition, drive and attachment.

The mind is still a largely unknown construct. Psychoanalysis has allowed therapists, physicians and lay people to inch closer to understanding its processes. Replacing this with psychopharmacology and shallow methodologies of treatment that rely on labels and symptoms fails to grasp the rewards of the subjective therapeutic experience.

 

Advertisements

Understanding anger

anger-management-manchester      Can you name a society or culture where aggression is not present? Somewhere where the need to express aggressive drives, whether physically or verbally ceases to exist? The answer is you cannot, because aggression is ubiquitous. When Freud came up with his aggressive drive, he was writing from a biological perspective. For him, aggression was a human drive that we all had in us. This is a good start, but aggression takes on a more important, more consequential form when we look at one’s character development, i.e. personality.

While it is true that the aggressive drive in us needs to be released, whether through argument, fighting or exercising, how we come to understand, know and deal with anger is more complicated. What is less understood is that not all aggressive expressions are a result of anger. Children often times are scorned or punished for “acting out.” This is routinely seen as aggression in our society. But, what if the acting out is caused by something unknown or uncomfortable to the child? What if the child is suffering from anxiety or a fear that cannot be verbalized? What if the child feels an innate sense of helplessness? This all leads to an outward expression of the emotions, but the emotions are caused by anxiety, not anger. As a result, the child is yelled at and disciplined for misbehaving. His symptoms scream anger, but his underlying character is anxiety.

In many cases, one’s own anger presents a great deal of conflict. Anger has a unique relationship to sex, depression, our idealized sense of self and relationships. Sometimes, the anger within cannot be consciously accepted. As Karen Horney writes in The Neurotic Personality of Our Time, “The main reasons why awareness of hostility may be unbearable are that one may love or need a person at the same time that one is hostile toward him, that one may not want to see the reasons, such as envy or possessiveness, which have prompted the hostility, or that it may be frightening to recognize within one’s self hostility toward anyone.” These three points are all conflicts that one must confront. As a rhetorical question, how many of you have been in a relationship where suddenly you are overcome with feelings of anger or hostility toward a partner’s remarks or actions, but know you cannot react, because you are dependent in some way on the relationship?

Aggression or hostility is present in the bedroom as well. I am not talking about whips and chains, but more in terms of one partner routinely dominating the other, usually out of the need to humiliate or punish. This is aggression. Often, this aggression will lead to neurotic formations in one’s personality. It can be viewed as a power struggle, although both parties are unaware of this.

If one were to analyze him or herself, there are certain areas of anger to explore that include the possibility of anger within (anger directed at the self), jealousy, events in the past and childhood experiences. We tend to think of anger turned inward as depression (This is what Freud said), but it is the result of a conflict. One can be angry at himself for failing to compromise, failing to love or failing to live up to his idealized self. The symptoms might be helplessness, sadness and a lack of motivation, but the real problem is one of anger, one of resentment.

Anger has many forms, and most are nonverbal. The passive aggressive can do as much harm to a relationship as physical actions. Aggression in adults can lead to over-assertivness in the workplace, poor boundary setting and hostile friendships. As I have written before, these personality traits are rooted in our unconscious neurotic conflicts and can create serious relational issues if left unexplored.

Developing in the 21st century

identityAt what point can culture, societal norms and the environment become as influential as our inherited traits and predispositions in defining how we identify? It seems apparent that outside forces have had a lasting impact on Generation X (also referred to as the millennials) in terms of how each person chooses to identify. Once thought of as static labels, identifiers such as gender, sex and political preference now have more options than Baskin Robbins. Earlier this year, Facebook revealed that users can choose from 51 different gender options, and that still does not cover gender identity in its entirety. Other characteristics, such as occupation and social status  are as important as sex and gender in terms of identity and personal development.

Identity has long been a hot topic among psychologists and developmental theorists. Erik Erikson, perhaps the most famous developmental psychologist (and my favorite) outlined eight stages of the  psychological life cycle that I think are still relevant today. According to Erikson, one passes through the following stages:

1. Trust vs. Mistrust (occurs at birth)

2. Autonomy vs. shame and doubt (approx. 18 months old)

3. Initiative vs. guilt ( 3 years old)

4. Industry vs. inferiority (5 years old)

5. Identity vs. role confusion (13 years old)

6. Intimacy vs. isolation (the 20s)

7. Generatively vs. stagnation ( the 40s)

8. Integrity vs. despair (…the 60s!)

Before you jump to reject this old model, let me defend its practicality and how it is still relevant in the 21st century.

The changing economic and political landscape in America has altered our psychological development. Due to a shortage of jobs, rising costs of living and stagnant wages, more young adults are finding themselves “stuck” and feeling unable to progress. Although the stage of “autonomy vs.  shame and doubt” was theorized to apply to 18 month old babies, it can now be applied to twenty-somethings. The inability to find work or move out of your parents’ house can definitely lead to shame and/or embarrassment, despite its commonality. Progress can be stifled, and one can become depressed, anxious or angry.

Stage six of Erikson’s model, which covers intimacy vs. isolation, is as relevant now as ever before. Intimacy has been pushed aside or delayed due to the demands of a 21st century economy. In many cases, intimacy has fallen by the wayside due to society’s demands of a perception of independence, where there is little time to get to know somebody, start a relationship from scratch and develop together. Despite people saying they choose to be alone, it is hard to believe that someone chooses to navigate life without any companionship or love. Think about people you know (and perhaps even you) who have sacrificed love for work, all in the name of…still to be determined.

What also seems to be occurring is that millenials are moving through these stages out of sequence. Twenty-somethings are finding themselves in the “generatively vs. stagnation” stage- often referred to as the mid-life crisis phase- due to feeling unfulfilled with work, relationship statuses and overall wellbeing. This can very well be a result of culture’s most pressing characteristic: instant gratification. The saying “I want what I want when I want it” has never been more applicable than right now, where young men and women exude a sense of entitlement and power. Once reality hits, stagnation can set in.

These stages act as a roadmap for how we identify and develop both socially and psychologically. The focus should be on the stage characteristics, not the age. Although many developmental theorists believed one could not move  between stages at random, today’s societal norms have altered how Erikson’s model works in the 21st century.

Diagnosing America

 

dsm-grows

We are surrounded by neuroses, paranoia and delusions. Whether you’re at home, work, school, the gym or even in your own head, it seems impossible to escape the all-too-familiar neurotic individual. Forget the fact that every other person you meet has ADD, it also seems common to now be friends with the self-diagnosed narcissist, sex addict and manic depressive. Where did all of this self-diagnoses come from? Is it possible that because mental health has lost its stigma that more people are willing to seek help and treatment? Perhaps. After all, the field of counseling has made great gains in the public’s eye and has lost its negative connotation. But, I think there are other forces at play that have led to an over-diagnosed and over-pathologized country. That factor is culture.

For those of you who are unaware of how diagnosing works, there is a holy bible of sorts that outlines the clinical criteria for disorders and illnesses, the Diagnostic and Statistical Manual of Mental Disorders (DSM). While this manual plays an important role in how “illnesses” are defined, there are other factors in our diagnosing DNA.

If one were to analyze our country and its culture, you would see a country that has not progressed much in its use of defense mechanisms and, more importantly, a country that is bent on sending mixed signals. Let me explain. First, Americans love to use denial. Whether it is in our personal lives or in the political arena, we are reluctant to admit to having a problem. One great example is addiction. While you might be thinking drugs and alcohol, I am thinking oil, violence and fast food. We also love to use the defense mechanism of splitting, which is the failure to incorporate the bad and the good. It is black and white thinking. This can be seen in relationships, where breakups and divorces seem to always be the other person’s fault and in our foreign policy, where America is always the good guy. In addition to these two defenses, we also love to project. Again, thinking foreign policy, it seems so much easier to tell another country how to govern rather than look inward.

If this is not convincing enough, think about all the mixed messages that are inescapable. In relationships, we have been told that love outweighs money. But being broke is not worth the love. We tell addicts to quit using drugs, yet, we legalize marijuana (Yes, I am saying marijuana is a drug). We like to support the troops, yet only 1% of the country serves in the military. Teachers are training our “future leaders,” yet we pay them meager salaries. Why do I bring these examples up? Because they influence our relationship to mental illness in our country.

Women are much more prone to receive a borderline personality disorder label than men. This is because men are allowed to be sexually exploitive, daring, unwilling to commit and volatile. ADD is thrown around so loosely, I am shocked it is still holding firmly in the DSM. Having a bad day? You’re depressed! Do you  go on shopping sprees occasionally? Maybe you’re manic!

I say this  facetiously to underscore the over-pathologizing of our psyche. In recent years, psychologists and now psychiatrists, have begun to study the relationship between culture and mental illness. Most of these studies have focused on movies, music and dress. These are all important. My focus in this piece is to highlight those aspects of our culture that are out of our awareness and can affect our own well-being. This is a complex topic that involves the age old question of nature vs. nurture. That will be discussed in future posts.

Beauty and the body

article-1041224-0228AC4600000578-286_634x942

I have written about narcissism and sadomasochism. At first glance, one might think that a young girl’s search for validation of her beauty (or lack there of) is a result of a narcissistic culture focused on outside prettiness. But, this is too simplistic. Yet again, we are reminded of the ever-present difficult and ambiguous relationship we have with our bodies. In this morning’s Times, the headline read, “Am I Pretty?” The story, brief in its analysis, focuses on middle-school aged girls who are regularly turning to the internet to ask an unknown, yet hypercritical audience the question of “Do you think I am pretty?”

As the author of the piece notes, many girls approach this platform with the position of: “Be honest and tell me if I am ugly or not…I can take it, but please don’t say really mean stuff.”  One does not have to be a father or have a sister to truly empathize with this situation. One can brush this off as a normal phase of development for 12 and 13 year old girls (and boys). But, there is more to this phenomena, and it lies in culture and the relationship we have with our bodies.

Nobody outlined the daily struggles we have with our bodies more clearly than Susie Orbach in her short, yet insightful book “Bodies.” Her general argument is that culture defines how we perceive our bodies and the second being that our bodies are being altered due to medication, technology and surgery. The actions taken by young girls to seek validation, acceptance or rejection from the internet is not an outlier.

Serious consequences can result from this behavior. For one, both young girls and older adults who turn to seeking validation for their physical characteristics might struggle with incorporating the physical and intimate aspects of a relationship. The focus is purely on the physical and sexual, leaving little room for intimacy. There is little or no focus on one’s personality. This is even more common in online dating, where both men and women are judged solely on their profile pictures. It is encouraged to only post the “good pictures.”

Second, a constant need to be reassured of one’s outside beauty can lead to crippling obsessive personality traits (I purposely refuse to say disorder) such as body dysmorphia , bulimia and anorexia. These obsessive acts can be the result of one striving to  control the body and unconsciously accept culture’s definition of “real beauty.”

This is by no means a female issue. Young men are under the same societal pressures to adhere to the norms of outside beauty. Walk around any New York City streets and you will find it hard to distinguish one man from the next, given the generic uniform of tight jeans, Nikes and fitted tees (myself included). Men also are victims of the selfie and the need for validation from the internet audience.

No, I do not think the trend of young girls turning to the internet to ask “Am I pretty?” is narcissictic. It is happening in the larger cultural context of the need to conform to projecting outside beauty. What is happening as a result is a disconnect between the individual and his or her body, and an ambivalence and struggle to live with one’s true body.

Living with our thoughts

internal thought

Where has introspection gone? Do we still reflect on our lives? Do we take five or ten minutes a day to allow for thought?  Recent research says no. Very few people want to spend time with their thoughts. In a Sunday morning story from the Times, Kate Murphy cited a remarkable study by psychology professor Timothy Wilson. She writes, “In 11 experiments involving more than 700 people, the majority of participants reported that they found it unpleasant to be alone in a room with their thoughts for just 6 to 15 minutes.” No, these were not  necessarily people with a traumatic past or unpleasant childhood. They were your everyday colleagues, friends and family members. Why are peoples’ thoughts so uncomfortable?

Before this question is explored, it is important to note how many distractions we have from our thoughts- Facebook, Twitter, Instagram and the like. How many times have you been in an elevator and someone whips out a phone, despite the lack of service? We have grown accustomed to not only ignoring others, but apparently, ignoring ourselves. In the old psychoanalytic model, silence was used as a technique to gauge the patient’s anxiety. While this technique is no longer used, its application surely applies to the aforementioned study.

What’s more is we no longer want  to live with our thoughts. We blackout to forget, pop pills to numb and project to place our own issues onto someone or something else. I was reminded of this the other day when a client stated he was nervous about transitioning to a new program and his first reaction was to get high. While this might be the typical reaction of an addict, it is important to note that this response is typical amongst us all. Why is feeling anxious or thinking about being anxious taboo? Why is anxiety bad?

Playing devil’s advocate, it is easy to want to rid the mind of unpleasant thoughts. But the current quick-fix solutions are harmful. It is not just thoughts that people try to extinguish, but also emotions. Rather than explore feelings such as guilt or shame, it has become easier to suppress them. The end result is not healthy. Obsessive personality disorders, depression and addictions can be born out of a failure to explore one’s thoughts. Creativity is also born out of…thoughts!

How than do we learn to live with and understand our thoughts? First, try not running away from the unpleasantries. A thought does not imply an action. It is ok to think of something that is culturally and socially taboo. Thoughts are still legal. Second, try understanding what the thought means or where it is coming from. Be your own therapist. Obviously, this is easier said then done, but it still warrants mentioning. Third, explore your environment and surroundings when the unpleasant thought occurs. Did somebody remind you of a bad memory or someone you dislike? Perhaps. Be willing to challenge yourself and your inner-workings.

With the overall distraction of the need to stay busy 24/7, take a few minutes to just think.

 

Today’s sadomasochism

Im-Slightly-Masochistic

When the term sadomasochism is heard, one usually thinks of sex, chains, whips, and leather. But sadomasochism, which involves those who enjoy receiving pain (masochist) and those who enjoy being the punisher (sadist) is more complex and more common than you might think. Today, sadomasochism can be seen in almost every aspect of our lives. Think marathon runners who routinely take a beating to the body or MMA fighters who suffer concussions, bruisings and broken bodies. What about those who tattoo their entire bodies? These can all be seen as masochistic behaviors. Not all acts of giving or receiving pain should be viewed the same. Running marathons can be a cathartic experience.

Where sadomasochism becomes complex is when it is found in interpersonal relationships. We always hear about the self-sabbotaging and self-defeating individual who finds him or herself in relationships that are doomed for failure from the onset. Yet, the question is, why does this person continue down the same doomed course? I think there are certain explanations for this. One example, which can be viewed through the psychoanalytic lens, is that people create and enter into relationships that are filled with cruelty, manipulation and punishment because of a family history of sadomasochistic behavior. This can involve physical brutality or emotional scarring. Often times, if abuse on any level is witnessed at a young age, the individual (usually a male) begins to identify with the aggressor.

Second, sadomasochism can be viewed as a power struggle between two individuals. People from a dysfunctional family where unhealthy alliances, boundaries, roles and attachments were present seek out relationships where self-sabbotage and manipulation can be exerted. In other words, someone who grew up in a dysfunctional environment creates a new environment where he or she is now the individual in control.  The defense mechanism of displacement is used to literally “displace” aggression and emotion. This can be seen through decision making, extreme criticism, manipulation and emotional instability.

Masochistic tendencies are seen in the clients I work with. Individuals will share stories in group that they know will lead to harsh reactions that involve slurs, scoldings and name calling. Despite the evidence that positive feedback will not occur, these men continue to expose themselves to punishment. Why? One explanation that seems fitting is that any connection, positive or negative is welcome. For one individual who routinely (and most likely unconsciously) welcomes the criticism, he is able to seek a connection with other group members. For him, this could be a libidinal (emotional) expression. While it is hard to listen to as the group facilitator, I believe the masochist enjoys it.

As an aside, I reject the notion that men tend to be sadistic and women tend to me masochistic. If childhood trauma or conflict is an underlying reason for sadomasochistic behavior, women and men can be both the punisher and the punished.

With all this being said, I do not think all sadomasochistic behavior needs to be or should be pathologized. Somebody who enjoys rough, punishing sex can simply enjoy…well, rough, punishing sex. An individual who is covered in tattoos might really enjoy self-expression. Sadomasochism is also not the same as aggression. Self-defense is not the same as instigating a fight.

As you think about sadomasochism, you’ll realize how prevalent it is around you.  Our culture is filled with violence, sexual exploitation, power grabs and manipulation. Politics is now a sport, the movie industry is consumed with sex and violence and we legitimize sports where the objective is to “kill” or “crush” the opposition.