Dismissing Freud 2.0


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.



Hold off on transgender surgery

At a time when our society attempts to push for individual freedom and personal choice , let me give some push back to a growing trend in the United States: transgender surgery. A major ruling from the Obama administration came down at the end of May. For the first time, Medicare can pay for reassignment surgery (as it’s called). This was welcome news to the transgender community and symbolically, it was and is a victory for those individuals who do not identify with their biological sex. Despite the symbolic victory, reassignment surgery is not as advantageous as it is made out to be.

Paul McHugh, the former chief psychiatrist  at Johns Hopkins Hospital is one voice who is not in agreement with this decision. Writing in The Wall Street Journal, Dr. McHugh writes, “Policy makers and the media are doing no favors either to the public or the transgendered by treating their confusions as a right in need of defending rather than  as a mental disorder that deserves understanding, treatment and prevention.” I agree with Dr. McHugh’s first two assessments: understanding and treatment. However, I do not necessarily agree with the prevention piece. Let me explain.

Although it might sound like 19th century dogma, I do believe that there are natural gender feelings for men and women. Simply because somebody thinks he or she is of the opposite sex does not mean they are. The “fix” for issues surrounding feelings and thoughts of identifying with the opposite sex should not be surgery. As Dr. McHugh accurately points out, “Disorders of consciousness, after all,  represent psychiatry’s domain; declaring them off-limits would eliminate the field.” This underscores the larger problem with treatment today.

Too often, we want a quick fix to our problems, uncomfortable feelings and emotions. Americans are prescribed pills at alarming rates. Soon, the couch industry will become obsolete. I am not saying that those who truly identify as transgender are taking the easy way out with surgery. Quite the opposite. Many individuals have been shunned by their families and communities for their thoughts and feelings. But the science does not support reassignment surgery as the answer. A 2011 study conducted by the Karolinska Institute in Sweden showed the suicide rate for transgendered individuals who received reconstructive surgery rose “almost 20-fold above the comparable non transgender population.”  Furthermore, a Vanderbilt University study showed that 70-80% of children who had thoughts of identifying with  the opposite sex lost their feelings over time.

What seems clear to me is that larger psycho-social problems exist and should be explored. Issues surrounding gender and sexuality are complex and delicate and should not be dealt with surgically.  Once an individual has reconstructive surgery, there is no going back.

While I support many causes in the LGBTQ community, this is not one I am on board with.

Please share your thoughts.