In Defense of Psychoanalysis July 24, 2010
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No social theory has been more influential and later more reviled than psychoanalysis It burst upon the scene of modern thought a fresh breath of revolutionary and daring imagination a Herculean feat of modelconstruction and a challenge to establish
No social theory has been more influential and later more reviled than psychoanalysis It burst upon the scene of modern thought a fresh breath of revolutionary and daring imagination a Herculean feat of modelconstruction and a challenge to established morals and manners It is now widely considered nothing better than a confabulation a baseless narrative a snapshot of Freuds tormented psyche and thwarted 19th century Mitteleuropa middle class prejudices
Most of the criticism is hurled by mental health professionals and practitioners with large axes to grind Few if any theories in psychology are supported by modern brain research All therapies and treatment modalities including medicating ones patients 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 Psychoanalysis is in bad company all around
Some criticism is offered by practicing scientists mainly experimentalists 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 and correlation with causation
Few physicists neuroscientists biologists and chemists seem to have plowed through the rich literature on the psychophysical problem As a result of this obliviousness they tend to proffer primitive arguments long rendered obsolete by centuries of philosophical debates
Science frequently deals matteroffactly with theoretical entities and concepts quarks and black holes spring to mind that have never been observed measured or quantified These should not be confused with concrete entities They have different roles in the theory Yet when they mock Freuds 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 things
The medicalization of mental health hasnt helped either
Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain or are ameliorated with medication Yet the two facts are not ineludibly facets of the same underlying phenomenon In other words that a given medicine reduces or abolishes certain symptoms does not necessarily mean they were caused by the processes or substances affected by the drug administered Causation is only one of many possible connections and chains of events
To designate a pattern of behavior as a mental health disorder is a value judgment or at best a statistical observation Such designation is effected regardless of the facts of brain science Moreover correlation is not causation Deviant brain or body biochemistry once called polluted animal spirits do exist but are they truly the roots of mental perversion Nor is it clear which triggers what do the aberrant neurochemistry or biochemistry cause mental illness or the other way around
That psychoactive medication alters behavior and mood is indisputable So do illicit and legal drugs certain foods and all interpersonal interactions That the changes brought about by prescription are desirable is debatable and involves tautological 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
The same applies to the alleged heredity of mental illness Single genes or gene complexes are frequently associated with mental health diagnoses personality traits or behavior patterns But too little is known to establish irrefutable sequences of causesandeffects Even less is proven about the interaction of nature and nurture genotype and phenotype the plasticity of the brain 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 clearcut Words and the interaction with the therapist also affect the brain its processes and chemistry albeit more slowly and perhaps more profoundly and irreversibly Medicines as David Kaiser reminds us in Against Biologic Psychiatry Psychiatric Times Volume XIII Issue 12 December 1996 treat symptoms not the underlying processes that yield them
So what is mental illness the subject matter of Psychoanalysis
Someone is considered mentally ill if
His conduct rigidly and consistently deviates from the typical average behavior of all other people in his culture and society that fit his profile whether this conventional behavior is moral or rational is immaterial or
His judgment and grasp of objective physical reality is impaired and
His conduct is not a matter of choice but is innate and irresistible and
His behavior causes him or others discomfort and is
Dysfunctional selfdefeating and selfdestructive even by his own yardsticks
Descriptive criteria aside what is the essence of mental disorders Are they merely physiological disorders of the brain or more precisely of its chemistry If so can they be cured by restoring the balance of substances and secretions in that mysterious organ 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 brought on by abusive or wrong nurturance
These questions are the domain of the medical school of mental health
Others 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 the patient in his or her entirety as well as his milieu
The members of the functional school regard mental health disorders as perturbations in the proper statistically normal behaviors and manifestations of healthy individuals or as dysfunctions The sick individual ill at ease with himself egodystonic or making others unhappy deviant is mended when rendered functional again by the prevailing standards of his social and cultural frame of reference
In a way the three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant Still they share not only their subject matter but to a counter intuitively large degree a faulty methodology
As the renowned antipsychiatrist Thomas Szasz of the State University of New York notes in his article The Lying Truths of Psychiatry mental health scholars regardless of academic predilection infer the etiology of mental disorders from the success or 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 The theory must be allinclusive anamnetic consistent falsifiable logically compatible monovalent and parsimonious Psychological theories even the medical ones the role of serotonin and dopamine in mood disorders for instance are usually none of these things
The outcome is a bewildering array of evershifting mental health diagnoses expressly centred around Western civilization and its standards example the ethical objection to suicide Neurosis a historically fundamental condition vanished after 1980 Homosexuality according to the American Psychiatric Association was a pathology prior to 1973 Seven years later narcissism was declared a personality disorder almost seven decades after it was first described by Freud
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