I recently went to a lecture by psychiatrist Allen Frances MD in which he argued that Sigmund Freud was half right and half wrong. And just because half of his ideas aren’t right it doesn’t mean that we should throw out the rest, as is popular these days.
Interestingly, Frances asserts that Freud didn’t come up with many original ideas, rather he was excellent at bringing together the latest ideas into an overarching and coherent model linking the brain and the mind. In particular he took Darwin’s work and popularised it. The excessive sexualisation within Freud’s work comes from the idea that natural and sexual selection “leads to the evolution of instincts, emotions and intellect“. What this means is that psychological behaviour is informed by sexual selection, i.e. we try to be more attractive. And therefore in Freud’s mind, the key link between the brain and the mind is the libido. He used the analogy of the brain as a hydraulic power plant, and the libido as the power source. As such, issues with the mind are due to build up, discharge or transfer of this energy.
From Darwin he took the ideas of “instinct interacting with the environment” and “everything has or once had a purpose“, ideas still alive and well today. He also took “introspection and dream analysis“: dreams “explain not only symptoms, but myth, art, literature and psychopathology of everyday life“. He saw the unconscious as having a major role in influencing behaviour. Dreams therefore are a great research tool as a window into the unconscious. However the jury is still out on what dreams & sleep are really about, though there is a clear link between them and memory and psychological stability.
Freud also took from Darwin the idea of comparing animal and human behaviours. He challenged human exceptionalism, that being the idea that we humans are somehow above all the other animals. I’ve written about this before, and it’s clear that we can learn much about ourselves by studying other animals, such as the bonobo ape. This was quite revolutionary thinking at the time – Frances called this “the most amazing discovery in the history of psychology“.
Also controversial at the time was his materialist view of human nature. No Cartesian dualism for him.
While he is most famous as the father of psychoanalysis he “began his professional career as a neurologist and made several notable contributions to the fields of neurology, neuropathology, and anesthesia“. He had the “ability to observe and describe a variety of disease processes“. He predicted epigenetics and pushed forward our understanding of neurons with his experiments. He did a lot to help further understanding how brain nerve cells worked and communicated.
Prior to Freud people were really writing about how the mind works from a first person perspective, and what Freud introduced was a slightly more empirical approach. He did this by looking at other people, even his own children. However, “he didn’t have much respect for experimental psychology, and certainly not for statistics“. So his approach was more rationalist than empirical: he would build up a convincing sounding theory but then not bother to do experiments to verify them.
This was one of his big blind spots: he was unable to keep followers that disagreed with him so couldn’t benefit from criticism. In fact he maintained that his detractors were neurotic! Frances claimed that what he saw in his patients were in fact his own modes of thinking he was protecting onto others. He wasn’t aware that someone could see things differently if they had a different set of experiences.
Sadly, Frances says, this still goes on today, with various groups and institutes having their own grand theories, and so closing their ears to new theories and research.
Francis added other defenses of Freud’s contributions, the big one being psychoanalytical practice – he can be considered the father of all modern talk therapies. He came up with the idea that psychosis is just carrying dreams in to waking state so the subconscious is not repressed. This clearly fits with the data today and means the condition is much easier to understand. He made the amusing observation that economists are just coming up with the idea that humans are not rational actors – if they’d have read Freud they might have come up with this earlier. I disagree with this – just because we don’t always understand our motivations, it doesn’t necessarily imply a lack of rationality.
One thing Frances didn’t mention was Freud’s negative view of the unconscious. He considered it to contain thoughts and urges that are unacceptable to society: dark and immoral desires. Hence Freudian slips, and so on. It was, in his mind (pun intended), something to be controlled and kept at bay. Some have said that this held back research into the mind for decades.
However we now see the unconscious as something valuable, full of black box functions that allow us to do things without thinking. For example, I’m not thinking about the keys I’m pressing, the letters, morphemes or structure of this sentence. I’m simply considering the meaning I’m trying to convey and the rest is taken care of for me by my unconscious mind.
He summed up saying that we still understand so little about the brain and how it links to the mind, and consciousness. Brain imaging (fMRI) doesn’t say as much as we think – it’s way oversold. Plenty of people have commented on this saying that neuroscience is in its infancy. However we now have a much better model of the mind, that being the computational one: it’s about information processing rather than energies, and symptoms are a result of either hardware of software malfunction.
Addendum – Psychiatry In Crisis
Allen Frances is a sound chap. He is a psychiatrist who “was the Chair of the Task Force that prepared the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), often called the bible of the American psychiatric profession. However, he has been a vocal critic of the new DSM V, condemning what he calls its diagnostic hyperinflation. His new book, Saving Normal, explores why psychiatry has always been subject to so many fads, while deploring the medicalisation of everyday human experience and the excessive use of psychiatric medicine“. Given that overview I was sold.
During questions he opened up on the idiocy of much of modern psychiatry. He is a psychiatrist and he says that big pharmaceuticals have taken over the profession, and pedaled the nonsense that biological changes can be made with drugs and so fix people’s problems due to their “chemical imbalances“. He says this has harmed people. The brain is a very sophisticated computer so yes we need to understand it’s biology, but we also need to understand its workings.
He says that DSM III was useful to give more standard accepted criteria by which to admit people to hospital, but the unintended consequence is that people now just get 10 minutes with a psychiatrist ticking off items on a DSM checklist and prescribing drugs. 80% of these mind-altering drugs are prescribed by GPs or psychiatrists in such short consultations. Now “the DSM is rushed to publication to make money, by a small American association with 35000 members“. He reiterates his point, saying it’s so dangerous because these new silly diagnoses mean more harmful drugs are given to people. He quoted one psychiatrist who says that she recognises herself in almost every condition in the DSM. Some people like labels: it helps them feel understood and part of a group. But people can feel permanently stigmatised, and too often is used to explain away behaviours or abdicate responsibility.
Everything we do in life has a psychological impact. The great thing is this means that psychotherapy changes brain functions. The theme he kept coming back to was that in psychological therapy, it’s the relationship that makes the difference.
He quoted Hippocrates who said “it’s more important to know the patient that has the disease than the disease that the patient has“.