Opinions Please

Heya, Renee,

It is true that in the last 65 years, Freud's legacy many parts of Freud's original theories have not stood up well to scientific scrutiny. For example, Freud broke human development over the lifespan down into five stages: oral, anal, phallic, latency, and genital in what he termed "psychosexual development." For example, the phallic stage was marked by the Oedipal complex, in which the child wants to have sex with the parent of the opposite sex and may want to kill the parent of the same sex as Oedipus killed his father in the famous Greek plays. (I'm not joking.) Most modern researchers think that these theories overemphasize sex and don't find them helpful. Only a very small proportion of psychotherapists use Freud's original versions of his theories as the cornerstone of their day to day practice.
https://en.wikipedia.org/wiki/Psychosexual_development

Regarding Cocaine, it's also true that Freud was a major proponent of it's clinical use. For example, he convinced his best friend, a fellow doctor, to use cocaine to treat his friend's morphine addiction. The friend ended up dead seven years later. Similarly, in the words of CBS news, "Freud's first major addition to the medical literature dealt not with psychoanalysis but with cocaine. "Uber Coca," was an 1885 tract that erroneously argued that cocaine was so effective at treating morphine and alcohol abuse that "inebriate asylums can be entirely dispensed with.""
http://thechart.blogs.cnn.com/2011/07/22/sigmund-freuds-cocaine-problem/

So what do we make of all of this? I think that Freud was a product of his time* - late 1800/early 1900 Vienna - and wasn't as careful as scientists are taught to be today about making up theories. As a result, some of the conclusions that he came to may not be completely correct. His contribution, then, was drawing attention to the importance of unconscious factors and the role that "talk therapy" can play in bringing these issues to light. That's pretty much what Dr. Sarno uses him for. In terms of Freud's specific theories, I've spent a great deal of time researching them, and I'm not a huge fan. But, like Mike said, what Dr. Sarno did with them is absolutely amazing.

* Another example of a theory that was a product of this time period in Vienna came from another of Freud's best friends, Wilhelm Fleiss. Fleiss was known for his theory of 'nasal reflex neurosis.' In the words of Wikipedia, "The theory postulated a connection between the nose and the genitals and related this to a variety of neurological and psychological symptoms; Fliess devised a surgical operation intended to sever that link." Of course, this theory isn't taken very seriously today and are sometimes ridiculed - if someone has a mental health issue, we typically don't operate on their nose in an attempt to sever a hypothesized connection between nose and genitals. Here's more of what Wikipedia has to say about Fleiss:

On Josef Breuer's suggestion, Fliess attended several "conferences" with Sigmund Freud beginning in 1887 in Vienna, and the two soon formed a strong friendship. Through their extensive correspondence and the series of personal meetings, Fliess came to play an important part in the development of psychoanalysis.
...
Fliess developed several idiosyncratic theories, such as 'vital periodicity', forerunner of the popular concepts of biorhythms. His work never found scientific favor, though some of his thinking – such as the idea of innate bisexuality– was incorporated into Freud's theories. Fliess believed men and women went through mathematically fixed sexual cycles of 23 and 28 days, respectively.[1]

Another of Fliess's ideas was the theory of 'nasal reflex neurosis'. This became widely known following the publication of his controversial book Neue Beitrage und Therapie der nasaelen Reflexneurose in Vienna in 1892. The theory postulated a connection between the nose and the genitals and related this to a variety of neurological and psychological symptoms; Fliess devised a surgical operation intended to sever that link.

Freud referred occasional patients to Fliess for treatment of their neurosis through nasal surgery and also via anaesthetization of the nasal mucosa with cocaine. Together, Fliess and Freud developed a Project for a Scientific Psychology, which was later abandoned. Fliess wrote about his biorythmic theories in Der Ablauf Des Lebens.

Emma Eckstein (1865–1924) had a particularly disastrous experience when Freud referred the then 27-year-old patient to Fliess for surgery to remove the turbinate bone from her nose, ostensibly to cure her of premenstrual depression. Eckstein haemorrhaged profusely in the weeks following the procedure, almost to the point of death as infection set in. Freud consulted with another surgeon, who removed a piece of surgical gauze that Fliess had left behind. Eckstein was left permanently disfigured, with the left side of her face caved in. Despite this, she remained on very good terms with Freud for many years, becoming a psychoanalyst herself.

Fliess also remained close friends with Freud. He even predicted Freud's death would be around the age of 51, through one of his complicated bio-numerological theories ("critical period calculations"). Their friendship, however, did not last to see that prediction out: in 1904 their friendship disintegrated due to Fliess's belief that Freud had given details of a periodicity theory Fliess was developing to a plagiarist. Freud died at 83 years of age.​

It must have been quite a heady time in turn of the century Vienna when people could make up theories like that, start teaching them, and have patients referred to them. These days, people would demand scientific studies to demonstrate the scientific validity of a treatment before referring people. This is referred to as "Evidence Based Medicine." My father was a doctor and hearing him talk about evidence based medicine, you know he has extremely strong feelings about it. He thinks, as most doctors do, that Evidence Based Medicine is crucial for delivering the best care to patients.

I mentioned the story of Freud's patient, Emma, because I find it a bit horrifying. Here is a woman who comes to Dr. Freud with premenstrual depression (PMS?). He talks to a buddy of his who says that the problem has to do with a connection between her nose and her genitals and that he wants to cut her open to remove a bone from the side of her nasal cavity. A modern doctor would have demanded scientific evidence that the treatment would work, but perhaps Freud just relied on the fact that his friend was very confident in the theory he had concocted (alternatively, perhaps the theory just made sense to him?). Of course, people can be very confident and still be wrong, so the operation presumably didn't help Emma. Worse, he leaves some surgical gauze inside the wound that almost kills her and leaves her permanently disfigured. It just raises the question of how, with the tremendous responsibility conferred by his medical authority, was Dr. Freud confident enough to tell Emma to go under the knife?

As medical science has progressed and doctors demand scientific evidence to support various treatment methodologies, it has turned out that Freud's original treatment ideas haven't held up terribly well compared to things like changing one's thoughts and behaviors like we do when we create an evidence sheet or resume normal activities in TMS treatment. (Meditation has also done extremely well in scientific studies.) The therapists who use a methodology most inspired by Freud's (but usually inspired by many other writers since) are usually referred to as psychoanalysts. The psychoanalysts that I have met have been extremely well trained and I've been quite impressed by their sensitivity, erudition, and sophistication. However, psychoanalytic treatment also tends to be quite expensive, and can last for decades or more.

In contrast, therapists who consider unconsious thoughts and emotions to be very important but aren't quite as closely connected to Freud are referred to as "psychodynamic" (dynamics is a word taken from physics, so psychodynamics means something similar to "psychological forces" - physics was incredibly successful and Freud saw himself as creating a physics of the psyche.) Because there is comparatively little scientific evidence supporting psychodynamic approaches, universities tend to teach evidence based approaches and it is becoming harder to find psychodynamic therapists. As a result, most TMS therapists pursue an "eclectic approach," involving both psychodynamic work and more modern approaches like CBT (which is about changing one's thoughts and behaviors). When I have organized seminars for TMS Therapists, I haven't found the ones in which psychoanalysts have presented to have been terribly well attended.

So, in summary,

• Freud was a product of his time. In the late 1800s/early 1900s in Vienna, people didn't require extensive medical evidence and as a result, many of Freud's theories, such as his endorsement of cocaine as a way to overcome addictions or his referral to have a bone in the nose removed to heal PMS, may have not been correct.
• Likewise, some of his psychological theories might have not been completely correct. However, despite this, he was the first person to popularize talk therapy focused on unconscious emotions to treat various non-psychotic psychological (i.e. "neurotic") conditions.

For anyone who regularly reads this forum, I'd encourage you to read and learn more about the history and the evidence out there. Not only is it fascinating, but it will definitely inform your thinking when people come here for advice. For anyone who would like to learn more about Freud and his development, there's an excellent and very watchable miniseries created by the BBC in the 80s:
http://dvd.netflix.com/Movie/Freud/70133102
However, there is also a tremendous amount of information available via Google. In addition, I'll paste in an excellent blog post about "Why Freud Still Matters, When He Was Wrong About Almost Everything" in a follow up post.

 

Here is the blog post that I mentioned. It comes from io9, one of the first very successful blogs. I think it does a good job of trying very hard to be balanced in a subject that stirs up such very strong emotions.

Why Freud Still Matters, When He Was Wrong About Almost Everything

George Dvorsky
8/07/13 2:02pm
Filed to: Daily Explainer

He’s been dead for nearly 70 years, but Sigmund Freud’s provocative theories are still a huge part of psychology, neuroscience, and culture — this despite the fact that many of his ideas were mindboggingly, catastrophically wrong. Here’s why Freud just won’t go away.

Love him or hate him, there’s no denying that Sigmund Freud was a giant in his field. When it comes to his influence on psychology, psychoanalysis, and our theories of mind, he’s often credited for kindling a revolution; with Freud, it’s kind of a before-and-after thing.

Freud’s Century
Indeed, the 20th century has often been called Freud’s century. His books landed with the subtlety of hand grenades, featuring such seminal titles as The Interpretation of Dreams (1900), The Psychopathology of Everyday Life (1901), and his Introductory Lectures on Psycho-Analysis (1915-1916).

​

Freud’s legacy has transcended science, with his ideas permeating deep into Western culture. Rarely does a day go by where we don’t find ourselves uttering a term drawn from his work: Mommy and daddy issues. Arrested development. Death wishes. Freudian slips. Phallic symbols. Anal retentiveness. Defense mechanisms. Cathartic release. And on and on and on.

As psychologist and Freud critic John Kihlstrom himself admits, “More than Einstein or Watson and Crick, more than Hitler or Lenin, Roosevelt or Kennedy, more than Picasso, Eliot, or Stravinsky, more than the Beatles or Bob Dylan, Freud's influence on modern culture has been profound and long-lasting.”

An Outdated Paradigm
But his legacy is a shaky one. Freud has, for the most part, fallen completely out of favor in academia. Virtually no institution in any discipline would dare use him as a credible source. In 1996, Psychological Science reached the conclusion that “[T]here is literally nothing to be said, scientifically or therapeutically, to the advantage of the entire Freudian system or any of its component dogmas." As a research paradigm, it’s pretty much dead.

Many of Freud’s methodologies, techniques, and conclusions have been put into question. Moreover, his theories have even proved damaging — and even dangerous — to certain segments of the population. His perspectives on female sexuality and homosexuality are reviled, causing many feminists to refer to him by a different kind of ‘F’ word. Some even argue that his name should be spelled “Fraud” and not Freud.

“Freud is truly in a class of his own,” writes Todd Dufresne, an outspoken critic. “Arguably no other notable figure in history was so fantastically wrong about nearly every important thing he had to say. But, luckily for him, academics have been — and still are — infinitely creative in their efforts to whitewash his errors, even as lay readers grow increasingly dumbfounded by the entire mess.”

Without a doubt, many of these criticisms and valid and totally justified. But a renewed look at his legacy shows that Freud’s contribution is far from over — both in terms of his influence on culture and science.

Yes, even for a guy who died in 1939, his work is incredibly out of date. We’ve learned much about the human brain and the way our psychologies work since that time — but he got the ball rolling. Much of today’s work is still predicated on many of his original insights. Some areas of inquiry have been refined and expanded, while others abandoned and dismissed altogether in favor of new theories. This is good. This is how science advances.

Before we take a look at where Freud was right, let’s consider where he went wrong.

Freudian Fallacies
The primary trouble with Freud is that, while his ideas appear intriguing and even common sensical, there’s very little empirical evidence to back them up. Modern psychology has produced very little to substantiate many of his claims.

For instance, there’s no scientific evidence in support of the idea that boys lust after their mothers and hate their fathers. He was totally, utterly wrong about gender. And his notion of “penis envy” is now both laughable and tragic.

There’s no proof of the id, ego, or superego. There’s also no evidence to support the notion that human development proceeds through oral, anal, phallic, and genital stages. Nor that the interference, or arresting, of these stages leads to specific developmental manifestations.

For example, he theorized that homosexuality was a failure to reconcile the anal phase, or the Oedipal phase. Which is nonsense. He also argued that only “mature” women could orgasm from vaginal sex, and that women who could only climax via clitoral stimulation were somehow stunted, stuck at a latent phase. Again, nonsense.

Indeed, as feminist Lili Hsieh points out, he had some very strange ideas about gender and sexuality:

Much of the critique of psychoanalysis as phallocentric or heterosexist is tied to the unfortunate conflation of femininity and sexuality; therefore, it is important to review the slippage in Freud's theory between femininity as the repertoire of sexed life and that as the logical complementarity to the universal sexuality. Freud's view of femininity leans predominantly toward the latter, as he decides in his early theorization that there is only one kind of libido, i.e., the masculine one. By masculinity of the libido, Freud means mainly activity, hence he equates femininity with passivity.

Although boys are caught in the constant threat of castration, girls on the other hand are in this sense already castrated, and thus are faced with an irreparable damage — ‘they feel seriously wronged … and fall victim to “envy for the penis”’...Freud suggests that for women there are two possible ways out of penis envy — besides the more strenuous ways such as neurosis or ‘masculinity complex’ — one of them is a ‘capacity to carry on an intellectual profession’...the other is having a baby. Both are thus substitutes for the penis.​

There’s also no evidence that Freudian psychotherapy (including psychoanalysis and “free association”) is any better than others, including Skinnerian behavioral therapy (which is diametrically opposed to Freudianism in terms of methodology), systematic desensitization, or assertiveness training.

The Unconscious Mind
Okay, sure, Freud’s got some problems. But he also nailed a few things.

For example, Freud was startlingly correct in his assertion that we are not masters of our own mind. He showed that human experience, thought, and deeds are determined not by our conscious rationality, but by irrational forces outside our conscious awareness and control — forces that could be understood and controlled by an extensive therapeutic process he called psychoanalysis.

Freud didn’t discover the unconscious mind, of course. That distinction goes to French psychiatrist Pierre Janet. Freud was also influenced by his professor Jean Martin Charcot, a famed neurologist who dabbled in hypnosis. But it was Freud who took the concept to the next level by breaking it down even further — and by applying it to psychotherapy and “free associating,” where patients would openly talk about their feelings and experiences regardless of how irrelevant, absurd, or upsetting it sounded.

Today, very few would argue against the idea of the unconscious mind. Freud’s claim for the central role of the unconscious mind in human actions was recently explored by experimental psychologists in a collection of essays called Frontiers of Consciousness.

For sure, we now know that the unconscious brain doesn’t exist or function in the way that Freud suggested — but we know it does in fact exist. The brain performs a myriad number of tasks in the background, particularly in managing our autonomous bodily processes, the way it affects our conscious, cognitive functioning, and how we interpret our surroundings.

“He says human beings can keep no secrets,” says Michael Roth, an expert on Freud. “They reveal their innermost selves with their clothes, with their twitches, with their unconscious mannerisms; that whatever we do, we're expressing things about ourselves, for people who have eyes to see and ears to hear. And I think that this is really the fundamental orientation of Freud.”

The Mind Consists of Parts
Another astounding revelation offered by Freud is the idea that the brain can be compartmentalized. Brain function, both in terms of its biology and the emergent mind, can be broken down into individual parts. His take on this, of course, was incredibly primitive. Freud spoke of the ego, id, and superego — ideas we don’t really accept any more.

But his larger idea has gone to influence such thinkers as the cognitive scientist Marvin Minsky, who talks about the society of mind, and philosopher of mind Daniel Dennett, who argues on behalf of the idea that there are multiple models of consciousness working in parallel.

Memories, Defense Mechanisms, and Dreams
Freud’s take on memories continues to be interesting — particularly suppressed memories. We now know that memories are selective, and that they’re constantly being rewritten each time they’re recalled. People retain memories of events not as they happened, but rather in the way they are active when memories are being reformed.

And Freud's take on defense mechanisms still holds relevance. Few people, including psychologists, would deny that we all too regularly employ such defenses as denial, repression, projection, intellectualization, and rationalization. The same can be said for his ideas on transference and catharsis.

What’s more, as regards Oedipal and Electra issues, few would deny that there’s at least some modicum of truth to the idea that many of us carry so-called mommy and daddy issues. Human psychology is a very complex and fuzzy thing, and it’s not always easy for science to definitively prove or compartmentalize something that just feels right.

And though we no longer subscribe to Freudian dream interpretation, some of our dreams are so blatantly driven by our conscious and subconscious desires and fears that it’s obvious Freud was onto something. To deny this would be hallucinatory, ludicrous — and completely unfair to his legacy.

Context Matters
It’s also important to keep some of his ideas in context.

Take his views on homosexuality, for example. Though many critics are loathe to admit it, he was actually very progressive for his time. Unlike most of his peers, Freud believed that homosexuality resulted from arrested development — but he refused to characterize it as an illness, and did not believe that it should be criminalized.

In a letter written to an American mother who asked him for advice about her son’s homosexuality, Freud wrote:

Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by a certain arrest of sexual development. Many highly respectable individuals of ancient and modern times have been homosexuals, several of the greatest among them (Plato, Michelangelo, Leonardo da Vinci, etc.). It is a great injustice to persecute homosexuality as a crime, and cruelty too.​

Tell Me About Your Mother
As for Freudian psychotherapy, it lives on — but barely. These days, only 1 in about 20,000 Americans still use it. But that’s not to imply it doesn’t work, or that it’s not valued by those who depend on it. Elyn Saks, a law professor who suffers from schizophrenia, says that without it, her mental health would be seriously compromised.

It’s also important to remember that we live in the age of Prozac; it’s much easier to send a patient home with a bottle of pills than to talk things out.

It’s also important to remember that psychoanalysis is not about making patients normal, or even about curing them. Rather it’s about revealing deeper insights into a person’s psyche. Then, armed with that information, they can make desired changes. It’s as the old adage says, “Know thyself.”

Psychologist Drew Westen describes his experience with psychotherapy:

People do sometimes describe feelings or behaviors in therapy that conform remarkably to aspects of Freud's psychosexual theories (such as a patient of mine with erectile problems whose associations to a sexual encounter led to an image of having sex with his mother, followed by some unpleasant anal imagery). Nevertheless, psychotherapists who rely on theories derived from Freud do not typically spend their time lying in wait for phallic symbols. They pay attention to sexuality, because it is an important part of human life and intimate relationships and one that is often filled with conflict.

In summation, Westen says there are five broad areas in which the work of Sigmund Freud remains relevant to psychology: the existence of unconscious mental processes, the importance of conflict and ambivalence in behavior, the childhood origins of adult personality, mental representations as a mediator of social behavior, and stages of psychological development.

[Sources not cited: “Is Freud Still Alive? No, Not Really,”John Kihlstrom; “The Scientific Legacy of Sigmund Freud,” Drew Westen; “Psychoanalysis Is Dead ... So How Does That Make You Feel?,” Todd Dufresne; “Freud: He Wasn’t All Wrong,” Robert Matthews; Finding Out, Meem et al.]

It’s also important to remember that we live in the age of Prozac; it’s much easier to send a patient home with a bottle of pills than to talk things out.

 

I'm really glad to hear you enjoyed the article, @mike2014 and @Renee! We would definitely love to have you stick around, Renee. I find it amazing how well read and well informed the people around here are as well.

@Simplicity, you might be interested in a story that I've been meaning to share. About a year and a half ago, two of the three psychologists that Dr. Sarno worked most closely with, Dr. Fran Anderson and Dr. Eric Sherman, introduced me to a medical doctor named Jay Rosenfeld. Dr. Rosenfeld had studied with Dr. Sarno in 1995 at Rusk and they wanted me to hook Dr. Rosenfeld into the resources that I run for TMS practitioners. In the process we had a 90 minute conversation during which he told me an about an article that he had read about neuropsychoanalysis. He was quite excited about it, believing that it is the future - a way to scientifically explore the hypotheses of psychoanalysis, deepening our understanding of the unconscious mind.

To someone who believes in its potential, neuropsychoanalysis is an unavoidable next step in the study of neuroscience and psychoanalysis. All unconscious thoughts and feelings exist in the brain and neuroscience is the study of the brain. As one article put it, "Psychoanalysis looks at the brain from the inside out: What does it feel like to be this thing? Neuroscience looks at the brain from the outside in, measuring its behavior, investigating its physical mechanisms. ... [Freud emphasized] that eventually, long after his own lifetime, the moment would come when brain science would be ready to fill out the psychoanalytic principles that he was busy laying down. [Neuropsychoanalysts] believe that moment is here."

This is why I think that the idea of neuropsychoanalysis, from the article that you shared, hits the nail right on the head. Freud only had introspection and his own interpretations to test his theories with, but now we have neuroscientific data. Specifically, we can use neuroscience to, as your article mentions, "ground the psychological in the biological."

Many of our unconscious emotions are located in the developmentally primitive parts of our brain known as our reptillian brain. We've all heard of the "reptilian brain" - the idea that our mind/brain is divided into multiple parts, some of which are highly advanced and rational and others that are older and deeper, which have more in common with animals. The part that is hyper rational like Mr. Spock from Star Trek is called the frontal cortex and is right behind your forehead (as many of you know). The older part of your emotional brain is located nearer the middle of your head, between your ears, and is sometimes called the limbic system.

Much of your conscious processing goes on in the rational frontal cortex. However, just as important is what is going on in the limbic system. Decisions are often made in the limbic system before you are even aware of them, and the conscious mind only picks up on those decisions later, at which point the rational frontal cortex attaches rational explanations to the emotional decisions we made. Sometimes those rational explanations are incorrect, and a lot of what we do in journaling or psychotherapy is figuring out how we really felt and what unconscious feelings led to the decisions that we thought we completely understood. It's pretty amazing, really.

 

For anyone who wants to learn more about Freud, I found a terrific documentary that presents a balanced view.

It's from PBS's science documentary series, Nova. It was produced in 1987, before people started becoming more seriously disillusioned with Freud. It's long, but it moves rapidly from topic to topic, so you keep learning new ideas and gaining exposure to important thinkers. The New York Times referred to the documentary as "a model of the expository documentary" for its watchability and balance.

My favorite part of the documentary was a part in which a historian of science from Harvard talked about Freud's concept of the unconscious mind. To Freud, the unconscious represents our instincts and animal evolutionary past. This is exactly what modern neuroscience is finding. Specifically, the part of the brain, known as the limbic system or paleomammalian brain, where our primitive instincts are found, is also where our emotions live. Coincidentally, much of this emotional processing is entirely unconscious.

Click here to go directly to that favorite part:
https://youtu.be/4RbusaCNYFI?t=24m44s

Or watch the entire very interesting video here:

​