Psychotherapy, science (and the real importance of Freud)

Is ‘Freudianism science? Probably not. But does that matter?

Is psychoanalysis a science based therapy? Probably not. But does that matter?

Was Sigmund Freud a ‘scientist. as we now understand the term? Probably not. But does that matter?

What I refer to as here as ‘language based, context-dependent’ psychotherapy, runs the gamut from psychoanalysis, through Rogerian talk-therapy, to behavior modification, as well as the common 12-Step program – basically any therapy primarily reliant on discussion with a therapist (or quasi therapeutic other) in a ‘safe’ environment, where the client’s historical behavior is addressed in terms of the context in which the client lives, usually in the form of re-interpretation of those behaviors in a manner that the client finds more satisfying, and which produces less tension in the given context.

Different people with differing complaints – and sometimes even different people with the same complaint – will respond well to different therapies. They all work, but none of them work for everybody.

In the early ’90s, I had cause to research studies on the effectiveness of various language based, context-dependent therapies, and found that – at that time – the recidivism rate for unwanted behaviors or experiences was roughly 60% across the board. That is, for any such therapy one chose to pursue – from behavior modification to group therapy – one had about 30%-40% chance of a lasting successful outcome. (Purely medical treatment, i.e., e.g., psychotropic medication, seemed to fare a little better; but the research on these was generally conducted under more stringently controlled clinical environments. *)

This doesn’t make any of these therapies poor choices. Regardless of scientific foundations, even language based, context dependent therapies have proven beneficial to somebody. I think it a mistake to say to someone who has claimed to have been helped by such a therapy that the weakness of the therapy’s scientific foundation means that it doesn’t work. It does work; it has worked. The only danger here is the occasional charlatan, who does more harm than good; but we have quite a number of watchdog agencies, both private and public, that can be engaged to address these.

My research was nearly twenty years ago, so matters may be different now; but I suspect not much. Most therapies are justified with case-study anecdotes or short range statistical studies. At the time I read up on this there were only a handful of long-term follow-up studies. Again, this may have changed; but I doubt it because 1) the kinds of complaints that bring people into therapy are wide-ranging, highly variable, and enormously complex; and 2) the bias in research in psychology tends toward short-range studies on limited populations, often in highly controlled situations.

This means that the science that would utterly invalidate an established therapy has be fairly strong to be convincing, and it’s unclear to me that such science has been fully grounded as yet.

My own opinion – unless shown the science just mentioned – is that whatever works for a large enough clientele without complaint, is worth pursuing.

The theoretical claims used to ground such therapies, on the other hand, lie within the domain of theoretical or philosophical psychology, and therefore open to criticism, both theoretical and scientifically measurable. (it should be remarked that many elements of such theories of psychology are sometimes simply outside of what can be properly measured – how does one measure an ‘archetype?’ And sometimes even theories with considerable clinical measurement as resource, fail to hold up under scrutiny over time, as happened with the pure form of Skinner’s behaviorism.)

Freud understood ‘science’ in a manner peculiar to German culture in the 19th century: a mixture of theoretical rigor and completeness, clinical repeatability, and casework compiling and analysis – a rough form of statistics. This ‘rough’ quality of the inductive portion of his method, combined with the speculative inventiveness needed to make his theories complete, undoes his work from the view of our contemporary scientific community. But I think this judgment, while well-grounded, risks ignoring what Freud actually did accomplish.

Regardless of the scientific validity of his methodology, Freud was, in his prime, an insightful and even courageous thinker, willing to challenge social shibboleths of his day in order to offer positive redress to chronic disorders, while developing a larger and more grounded theory of the mind of a particular animal, rather than of some embodied soul. The notoriety and controversy that surrounded these efforts had the effect of disseminating his work throughout the culture of the educated middle and upper lasses.

This dissemination has had some unhappy effects – for instance, a language of esoteric interpretation that can be used manipulatively rather than helping to improve and clarify communications. On the other hand, he developed interpretative strategies that have been found useful, especially in the arts.

More importantly, though, we must remember that Freud helped shape our understanding of the human animal as an animal. We now admit that this animal is driven by desires, anxieties, grudges; some inarticulate, often the result of memories, some of which we only half-remember.

Darwin’s human animal was a product of Victorian faith in progress – ever developing toward greater reasoning, deeper sympathies, more reasonable means of assuring an improved future for progeny. Freud’s animal is horny, angry, selfish, and scared – with tendencies towards sadism and masochism that, if uncontested and unconstrained, could well destroy us. It is with no irony of history that it was Freud, not Darwin, who would need to confront the irrationality, cruelty, and mob-mentality in the rise of Nazism.

I’m certainly not justifying continued adherence to Freudianism in the present day (although I still think some of its interpretative strategies useful). My purpose here is simply to remind us that, whatever flaws in Freud’s character, theories, or methodology, and whatever flaws that developed in the practice and theories of his heirs and professional descendents, Freud contributed a good deal to the culture in which we live, some of which has proven beneficial, none of which we can rid ourselves of, without some loss in our continuing efforts to understand ourselves.

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* As someone who has suffered from chronic, sometimes disabling, depression all my life, I guarantee that depression (the primary reason people enter therapy in the US, according to statistics) is not anything like clearly neurophysiological conditions like, say, epilepsy or autism.

I will also admit that, in therapy, I have tried anti-depressant medications of every type and stripe, without success. Indeed. sometimes the trials were disastrous.

It should be noted that, despite the public branding of such medications, there is no such thing as an “anti-depressant.” There are drugs that suppress certain neuro-chemicals, and there are drugs that enhance certain other such. The term “anti-depressant” refers, not to the direct effect of these drugs, but to the indirect behavioral expressions of individual responses to their effect. Grasping this changes one’s perception of the whole medical-psychiatric enterprise. (I have given up on chemistry; I am content now to find my solace in Buddhism and philosophy.)

Personally, I don’t think there’s going to be any science of psychotherapy at all. I think its entirely a social phenomenon, and can only be properly discussed sociologically. And sociology offers no certainties, only statistical probabilities.

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3 thoughts on “Psychotherapy, science (and the real importance of Freud)

  1. I think it is important to understand here that the German term “Wissenschaft” is much broader than the English term “science”. History, philology, history of arts and of literature, philosophy, etc. are all “Wissenschaft”, as is physics or chemistry (in the sub-branch “Naturwissenschaft”). There is also “Sozialwissenschaften” and “Kulturwissenschaften” etc. Translating the German term “Wissenschaft” as “Science” is simply wrong (and vice versa). I think there is no English term corresponding exactly to “Wissenschaft”. What Freud was doing was not science according to today’s standards and it was probably no science according to the standards of his time, but it might qualify as “Wissenschaft”.

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    • Although I may have phrased it badly, that’s really the point I was trying to make (but I didn’t want to get into the language issue, which raises some interesting questions most English readers would be unfamiliar with.)

      To his credit, Freud did try to pursue his studies as rigorously, using the methodology he had, as he could. (Indeed, as he began to train others, he grew rather tyrannical about it.)

      I don’t know if this was true in Europe, but it should be noted that in the US, psychoanalysts were for some time required to have MDs as well.

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  2. Freud tried to help alleviate patient suffering testing best-effort imperfect methods that did not require exorcism.

    Suffering and healing must have meaning and cause for both the secular and religious:

    https://www.psychologytoday.com/blog/evil-deeds/201209/devils-demons-and-dybbuks-possession-exorcism-and-psychotherapy

    Freud’s primal horde is the invisible 800-pound gorilla in the room taboo-repressed and obsoleted through the comfort-benefits produced by modern civilization. His speculation would have to be at least directionally correct, if evolution is correct and even if 3rd party invisible spirits were involved in prehistory. Nature unclothed only performs a few core functions.

    http://link.springer.com/referenceworkentry/10.1007%2F978-1-4614-6086-2_525

    Shamanism and the Evolutionary Origins of Schizophrenia

    I respect any involved in the imperfect art/science healing industries that seek to understand, help and not to harm.

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