PSYCHOANALYSIS TODAY

 

Stanislav Matacic
Croatian Psychoanalytic Society

Let us just imagine that Freud could rise up from the “eternal Unconscious” and regain his bodily form, and get interviewed by us today on his views on the present state of his major discovery – psychoanalysis. What would he say?

Would he be satisfied, or not?

He died at the dawn of WW2 that changed significantly the world in which he lived. Tired of all attacks on himself and depressed due to the long and heavy battle with cancer, at the end of his life he was not too optimistic about the future of his own child – psychoanalysis. But it survived Nazism, Communism, the militant second and third wave Feminism, and is now surviving technological revolution, free market economy, ultra liberalism and New Age mysticism. Psychoanalysis is alive and well, despite the pessimistic predictions and continuous attacks on it.

There are about 12 000  practicing analysts (more than ever before) and thousands of candidates around the world today, who are members of the 72 constituent Societies of the IPA – the main international association, founded by Freud in 1910, and the IPSO – association of psychoanalytic candidates.

Although some of his paradigms have changed, I presume that Freud would be satisfied with his successors.

I would like to offer you today just a brief look at the present state of psychoanalysis. It will be merely an essay by an insider who is, by chance, current President of the Croatian Society.  Perhaps you will be disappointed that I shall touch upon the topic of neuropsychoanalysis only tangentially, but we have the pleasure and honor to have its prominent representative speaker here with us today.

As in the old hit Wonderful World by Sam Cooke:  “Don’t know much about history, don’t know much biology…,” I must unfortunately admit that I don’t even know much about neuropsychoanalysis…  “But I‘d like to” … after almost 30 years spent living in it, however, I think I know something about the “wonderful world” of psychoanalysis that I could share with you.

WHAT IS IT, AND WHAT IS IT NOT?

Among many signifiers that can, with either positive or negative intentions, be attached to psychoanalysis, one that is surely not applicable is – Religion.

I believe Sigmund would be pleased with this statement.

If we consider religion to be “the common belief of a group of people in the absolute Truth that need not be questioned or replaced,” Freud’s own ever-changing and developing body of work as well as the further development of psychoanalysis serve as proof of its essentially scientific fundament. The problem is only that psychoanalysis is still rooted deeply in experience, in clinical wisdom rather than in experiment which is conditio sine qua non for present-day science. What cannot be measured can be considered irrelevant, or not existing at all. As psychoanalysis is the Science of the Unconscious, and mental life and unconscious cannot be measured, then psychoanalysis is not a science but rather a pseudoscience, and it should not be considered serious – says today’s science. Subjectivity is not a matter of scientific interest.

In the comprehensive Encyclopedia of New Religions (Partridge and Melton, 2004), in the section New religions of the Western World, the authors also mention the so-called “transpersonal psychology” as the foundation of modern psychology and psychotherapy founded equivocally but independently with the contributions of William James as well as Sigmund Freud, but they add that “it should be mentioned that transpersonal psychology in its foundations is applied science and not a religion.”

On the other hand, philosopher of science Karl Popper (1902 1994), professor at the London School of Economics, founder of the concept of Open Society and inspirational teacher of George Soros, in his puritan scientism, together with astrology and historical Marxism as a paradigm of pseudo-sciences, also mentions Freud’s psychoanalysis and Adlerian psychology as exemplary proof.

He writes the following (1963):

“The two psychoanalytic theories were simply non testable, irrefutable. There was no conceivable human behavior which could contradict them. That does not mean that Freud and Adler were not seeing certain things correctly. I personally do not doubt that much of what they say is of considerable importance, and may well play its part one day in a psychological science which is testable […] I thus felt that if a theory is found to be non-scientific or metaphysical, it is not thereby found to be unimportant or insignificant or meaningless or nonsensical.”

And in conclusion:

 “[…] thus the problem which I tried to solve by proposing the criterion of falsifiability was neither a problem of meaningfulness or significance, nor a problem of truth or acceptability. It was problem of drawing the line between the statements, or systems of statements, of the empirical sciences, and all other statements – whether they are of a religious or of the metaphysical character, or simply pseudoscientific.”

So much from Popper, but there are two problems with the statement in relation to psychoanalysis:

1) Popper considers it only as a unique theory, primarily Freud’s own one, and not as a method of investigation of subjectivity which is not falsifiable, and

2) To be considered today a “pseudoscience” is a death verdict for any psychological and therapeutic discipline.

In that sense, in a debate with Mark Solms on Freud’s Dream Theory at the University of Arizona in Tucson in 2008, Harvard professor of psychiatry J. A. Hobson said something along the lines of “Popper proved that psychoanalysis is a pseudoscience, and the entire Freud’s dream theory (and complete psychoanalysis as well) is therefore unscientific, misleading and should be abandoned”.

This is a predominant contemporary point of view. But is it a strong argument?

Even worse – in 1984, physicist, philosopher and professor of psychiatry Adolf Grunbaum, a “specialist for anti-Freudianism,” attacked Freud for abandoning the initial intention to position psychoanalysis as a natural science in 1896, when Freud decided not to publish his Project for a Scientific Psychology and turned instead to the analysis of dreams and metapsychology. He even attacked Popper and two other philosophers, Paul Ricoeur and Jurgen Habermas, who, from his point of view, did not understand Freud’s “escapism.” Since Freud dared to abandon the real science even before he built his own way of thinking, his complete conceptuality and philosophical discourse should be abandoned as unscientific. Therefore all hypothesis of psychoanalysis should be abandoned because its clinical method is just a fraud based on placebo effect. That was Grunbaum’s point of view.

In that same Orwellian year, 1984, American academic scholar and then-IPA candidate Jeffrey Moussaieff Masson, who collaborated on the publication of complete Freud-Fliess correspondence, published the best-seller book The Assault on Truth in which he accused Freud for abandoning seduction theory in favor of fantasy and Oedipus complex due to cowardice. That means that the turmoil experienced by his female hysterical patients was the result of real sexual assaults in childhood by real patriarchs, their own fathers. Without any real arguments, Masson put himself in a role of the “wild psychoanalyst” toward the archetypal Father Freud, and hypothesized that Freud abandoned seduction theory to conceal real sexual molestation of him and his sisters by their own father Jacob. Militant ideological feminists and all other enemies of psychoanalysis in the United States were delighted. It was “the final fall of the Freudian empire,” claimed New York Times. War against psychoanalysis with ad hominem attacks on poor dead Freud began.

In December 1995, when the Library of Congress in Washington (the possessor of Freud’s Archive) tried to organize the exhibition Freud: Conflict and Culture, 42 independent American scholars signed a petition against it and marked the beginning of the millennial anti-Freudian hysteria. All of Freud’s adversaries, including Grunbaum, united against psychoanalysis, accusing Freud without any proof that he had sexually abused his sister-in-law Minna and that he was a liar and a charlatan, and therefore his entire body of work should be considered a lie and deceit.

In his 1990 novel “Immortality,” Milan Kundera wrote the following: “The whole moral structure of our time rests on the Eleventh Commandment: Tell the truth.”

To prevent misunderstanding about what truth means to the commissars of the new Truth, it is not, as Kundera points:

“the question of God’s Truth for which Jan Hus was burned, or the Scientific Truth for which Giordano Bruno was burned, but the Truth of the lowest ontological level, the so-called Factual Truth: What Mr. F. did yesterday, what he was really thinking in the deep of his heart, what he talked with Miss D. yesterday, or what he did with Miss M.

This is the truth of the media-ridden society in these Internet times. The gossip truth became relevant even in evaluating one’s scientific importance, not one’s body of work.

In the 1970s, the new wave of feminism inspired by Simone de Beauvoir and originating in France, primarily represented by the work of Helene Cixiuos and Catherine Clement, spread across American academia that gave rise to gender and queer theories in the 1990s; it indicated our poor Sigmund as the advocate of the so much hated Patriarchy, abuser of poor female patients, in one word – an almost Genghis Khan-like archenemy. The “nonsense machine” works loudly these days.

On the other hand, Eric Kandel, Nobel Prize winner in biology and admirer of psychoanalysis, wrote the following (1999, 2012):

“Most importantly and most disappointingly, psychoanalysis has not evolved scientifically. Specifically, it has not developed objective methods for testing the exciting ideas it had formulated earlier. As a result, it enters the 21st century with its influence declining. The decline is regrettable, since psychoanalysis still represents the most coherent and intellectually satisfying view of the mind.”

He advocates the new marriage of psychoanalysis as science of the mind and subjectivity with pure science of the brain, neurobiology and, in our century, neuroscience and neuropsychoanalysis, which I see, although smitten as psychoanalyst practitioner by the beauty and art of the process of healing, as a real promise for the future of psychoanalysis and its return as a respectable scientific discipline.

THE ART OF MEDICINE

To become psychoanalysts in the full sense in terms of professional identity, my generation had to choose between an institutional academic career and outsiders’ status, becoming the “resistance” or “partisans” fighting for psychoanalysis – as I like to say – outside of the cannon of technology-based and Big Pharma medicine that rejects completely the art of medicine, the Hippocratic art of healing.

For us, psychoanalysis was the missing link between the scientific technological and pharmacological approach in Psychiatry of the present time and “the art of medicine” that connects us with the birth of our clinical discipline of medicine in the Ancient world. The so-called psychodynamic psychiatry is still the savior and carrier of the old humanistic tradition of medicine, I think.

As one of the cleverest voices in psychoanalysis today, Thomas Ogden has written the following (This Art of Psychoanalysis, 2005):

“Psychoanalysis is a lived emotional experience. As such, it cannot be translated, transcribed, recorded, explained, understood or told in words. It is what it is.”

Nevertheless, the effects of its unique, subjective and unrepeatable experience can be objectified in scientific terms, despite all adversaries.

Since the pioneering work of Lester Luborsky in the 1940s, psychoanalytic research “has over many years developed a host of the new insights into mental functioning articulated into various strands and schools of psychoanalysis. Further scientific research has set out and succeeded to show via comparative, long-term and follow-up studies the efficacy of psychoanalysis and psychoanalytic psychotherapy. Various elements of the cure like the style of interventions, the frequency of sessions, the relationship between the patient and the analyst or the applicability for the psychoanalytic treatment to different kind of mental pathologies have been scientifically studied, and finally new researches aiming to understand the interaction and interdependence of mind and brain functioning.”

THE EFFICACY OF PSYCHOANALYTIC THERAPIES

Contrary to propaganda from the side of the so-called psychotherapies based on evidence, the body of scientific evidence on the efficacy of psychoanalytical therapies are vast and impressive. John Cornelius (2014) made a presentation of the recent studies, follow-ups and meta-analyses: A Case for Psychoanalysis: Exploring the Scientific Evidence (YouTube, IPA Website, CPS Website). The studies mainly consisted of evidence of efficacy of psychodynamic psychotherapies in the following: anxiety disorders, somatizations, affective and personality disorders, in comparison with CBT and antidepressants.

The main parameter was the so-called Effect Size: 0.2 as low, 0.5 as middle, and 0.8 and over as high efficacy. For short therapies (40 sessions) E.S. is in all categories except depression, where it is in the middle. Compared to CBT and medication, in short-term therapies there are no significant differences between CBT and psychodynamic therapies, but both are better than medication only. The studies of long-term psychodynamic psychotherapy, including classical psychoanalysis (at least 150 sessions), show a different picture. Antidepressant medication and CBT both have more or less similar results – about 71 per cent of patients experience a relapse of symptoms within a period of one year, with the average time of relapse being 4 months; that means that the efficacy of both is short-timed.

On the other hand, studies showed significant increase of the efficacy of psychodynamic therapies with the passing of time (at the end of the study, 1, 3, 5 and more years later). So we can conclude that, if we consider psychoanalysis to be purely a theory, we could claim that its basic concepts cannot be quantified, measured or manipulated with in experiments either to confirm or falsify them, but the magnum crimen of contemporary scientism is to therefore consider psychoanalysis as completely obsolete and misleading as the Science of the Mind, and not wanting to have anything to do with “this pseudoscience” considered to be charlatanism, changing the paradigm for the understanding of the Mind completely towards cognitivism or behaviorism. The entire scientific body of evidence show us that the scientific method applied to the study of psychoanalysis as therapy, which is its origin and essence, give us the impression of psychoanalysis as a potent therapeutic method with long-standing outcome.

According to Cornelius’s presentation, we could conclude that psychodynamic psychotherapies including classical psychoanalysis are a treatment of choice for the majority of neurotic disorders with long-term effectiveness, and that they are superior to any other technique for the treatment of personality disorders (borderline patients) with increasing efficacy over time, and are absolutely a treatment of choice.

In that sense, we could dismiss claims on the part of short-term or instant-effect psychotherapies that psychoanalysis is a treatment of the past, not suitable anymore for the subject of this postmodern world; that it takes too long and is cost-ineffective and, above all, ineffective as a therapy, which is the pure and simple propaganda in the battle for their own “place under the sun” on the free-market of psychological treatments, repeated mantra-like over and over again in the media.

Psychoanalytical therapies are a synthesis of the scientific approach to treatment with the “art of medicine” from Hippocrates to Ogden.

SCHOOLS OF PSYCHOANALYSIS AFTER FREUD

On the other side, within the humanities, there is an understanding of psychoanalysis primarily as Freud’s personal philosophical theory, which neglects its development after him and its methodological and therapeutic value or, even worse, considers Lacanian school with its basic nonsense such as “the unconscious is structured as a language” to be synonymous with psychoanalysis. First of all, to us – practicing post-classical analysts – the unconscious is not structured at all, and its roots are not within the language as a collection of signifiers, but rather inside the mind of the subject, in deeper levels of brain activity. Once I heard a Lacanian analyst declaring “What does psychoanalysis have to do with brain? It is a matter of neurology, psychoanalysis only has to do with language.”  I could only conclude then that in this kind of psychoanalysis there may be language but no brain at all, both literally and metaphorically.

Which branches and schools are considered part of psychoanalytic mainstream today?

First, classical and modern Freudians

Second, Sandor Ferenczi and the Budapest School

Third, Ego-Psychology based on the work of Anna Freud and North American School of Hartmann, Kris and Loewenstein

Fourth, Classical and Contemporary Kleinians, followers of Melanie Klein, the second most important psychoanalyst, mainly in the UK and South America

Fifth, Bionian branch of Kleinian School, based on the work of British analyst Wilfred Rupert Bion

Sixth, Winnicottian branch of the Object Relation Theory, based on the work of Donald Woods Winnicott, pediatrician and the most important child analyst

Seventh, French School of Psychoanalysis (Lacanian not included) with Andre Green as its prominent figure

Eight, the so-called Self-Psychology, the North American school based on the work of Heinz Kohut

Ninth, Relational (Interpersonal) Psychoanalysis based on the work of Stephen Mitchell and Inter-Subjectivity (Atwood, Stolorow, Jacobs) in the USA

Psychoanalysis is still alive and well, and rich in the number and diversity of its schools that do not exclude or compete with each other, but rather represent various psychological points of view on the most sophisticated matter in Nature – the human mind.

PSYCHOANALYSIS IN CROATIA

Just briefly, a few words on psychoanalysis in Croatia.

The story of the Croatian Psychoanalytical Society began in Vienna somewhere between 1922 and 1924, when young physician Stjepan Betlheim, born in Zagreb in 1898, was on his psychiatry residency at the Wagner Jauregg Clinic where he met his mentor and first analyst Paul Schilder, who introduced him to Freud himself. Betlheim started his psychoanalytic training in 1925 in Vienna, and continued it in 1926 until the end of 1927 in Berlin. At the beginning of 1928, he returned to Zagreb and worked as psychiatrist, psychotherapist and psychoanalyst in private practice. At the beginning of 1941, Betlheim moved to Bosnia with his family, where he joined partisans in 1943 as a physician. After the end of WW2, he returned to Zagreb in 1946 and became the founder of medical psychology and pioneer of psychotherapy in the former Yugoslavia. In 1952 he became the first and only psychoanalyst recognized by the IPA in Yugoslavia.

Betlheim intended to establish a Psychoanalytical Study Group even back in the 1950s, but the political situation in the former state was not favorable enough, and later, at the second attempt in the 1970s, after his death, the IPA did not show much enthusiasm to support it. We had to wait until the fall of Communism in Eastern Europe in 1989 and the EPF’s move to the East, led by Han Groen Prakken.

In 1999, a core group of analysts – direct IPA members for the establishment of Study Group – was formed. Professor Eduard Klain was the first one to be accepted alongside the late professors Eugenia Cividini Stranić and Staniša Nikolić, with dr. Dragan Josić and, finally, prof. dr. Vlasta Rudan.

The Croatian Psychoanalytical Study Group was accepted at the IPA Congress in New Orleans in 2004. The sponsoring Committee of the IPA worked with us for nine years until the IPA Prague Congress in 2013 where we became the IPA provisional Society. Acquiring this status gave us significant impetus for the growth of our Society. In the last 5 years, the Society has almost tripled the number of its members, candidates, and analysands. Today we consist of 15 IPA members, 7 training analysts, 15 candidates and 12 analysands.

We are a rather young, lively and vibrant Society with a lot of activities that are going on at our residence on Strossmayer Square 1 in Zagreb. At the next IPA Conference in Buenos Aires in 2017, we will reach the status of the IPA Component Society, around 90 years after Stjepan Betlheim finished his training in Vienna and became the founder, father and grandfather of psychoanalysis in Croatia.

Let me finish with a small anecdote. Just after the fall of the Berlin Wall, when European analysts crossed for the first time the iron curtain of the past toward the East, one of the pioneers among them, Finnish analyst Eero Rechardt, was approached by the journalists at the airport in one of the Baltic countries with the question: “What is psychoanalysis?”  In a hurry and not very willing to talk to them, he answered: “Freedom of thought…”

For me, this is the shortest and most beautiful definition of psychoanalysis, and I would like to conclude with it.

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