Psychotherapy's founders were wrong about human nature and the causes of mental illness. Modern therapy culture continues to promote pernicious myths about mental health.
Freud was arguably the biggest charlatan and pseudointellectual in human history, along with Marx.
Psychoanalysis and it's many spinoffs have pathologized life and Human Nature to a far worse degree than even the most nihilistic and anti-worldly religions ever did.
I worked emergency psych at a state institution - the violent, suicidal, and unable to care for themselves - for 42 years. I did work neuropsych, substance, forensic, adolescent, developmental, and geriatric populations at times as well.
You have hit some of the main points very well. Freud did set the field of psychology back decades, perhaps even a century. He gave Viennese society, and ultimately the whole intelligentsia, an excuse to talk about sex endlessly, which i why he was popular. (See also Alfred Kinsey) Psychiatric medications do sometimes have uncomfortable, even terrible side effects and sometimes the "improvements" in symptoms are the result of time more than anything else.
But you are otherwise flat wrong in what you are saying. No one does psychoanalysis anymore. There are some lurking Freudians and Jungians about these days, but not many. Much of therapy is more like coaching - doing homework and checking back, trying different responses to difficult loved ones - now. This has been true for forty years. You are attacking strawmen, at least in terms of those who deal with the most difficult clients, the schizophrenics, the serious affective disorders, the personality disorders. Medications can work powerfully for some of such folks.
Look, they die less often. What the hell do you want? We don't waste our time on the Worried Well, as they are called. We throw them some good advice and move on. The problem is largely the general public picking up an idea or two that they saw on a YouTube and applying that to their local middle school. I'm pretty sure that's not psychology's, and certainly not psychiatry's problem at that point.
I will laughingly but seriously say that the solution to everything in life is to read more CS Lewis.
As for the current state of talk therapy, I think Scott Alexander at Astral Codex Ten, plus his many very excellent commenters, is invaluable. He is a practicing psychiatrist who is rather obsessive about looking at data and evidence, but also an adventurous thinker. Go to his site and enter whatever you think you want to know about in his search bar: depression, psychedelics, trauma, EMDR, psychosis, anxiety - you will get some first-rate stuff.
If his priors matter to you, he is a humanist who left the New Atheist community in frustration, often quotes GK Chesterton, and says that he was "almost persuaded" by CS Lewis. Go figure.
Lewis is varied. He is best known for his speculative fiction, but also writes philosophy, apologetics, practical theology, literary criticism, and memoir. Some are essays, some are book length. Almost everything is still in print even though he died 60 years ago.
Just scanned the article. And want to read it when more time. But totally agree that "pscychoanalysis" is a paper-tiger. Basically, it is a small cult in parts of New York and in old Woody Allen movies. I think even Wikipedia considers it pseudo-science. And when it comes to money, most insurances and and public health schemes would never cover it - it's in the same group as crystal-healing and scientology.
Agree. Definitely has contaminated culture and life to some extent - as Fraud propably intended.
But I would still say that current use of "psychoanalysis" in science and as a therapy is limited. However, agree that on a mid-wit level some of the vocabulary and "theories" are in use. A lot of people in various languages even confuse "psychoanalysis" and "psychotherapy" (the latter which can be any kind/school of "talk therapy".
I think it was Scott Alexander who taught me that pseudo-science is science's control group.
I would really love to see a comparison between the effectiveness of the most extreme chicken bone waving, incense burning and ecstatic dancing voodoo Shamen against the most highly credentialed psychotherapists. But of course, each group would have to strongly believe in each therapy to get the placebo effect.
Please don't interpret any of this as a snarky dig against voodoo Shamen, I actually like and even respect those guys. Plus, apart from dispelling demons, they can predict the future and also do weddings and funerals, which is more than you are going to get from an Ivy League professor of clinical psychology and psychotherapy.
For pretty much all of human history, when people were troubled they talked to their priest or an equivalent figure like a “bone waving shaman”, and it worked because these people were trusted advisors and skilled soothsayers just like a modern therapist. Now that people are becoming more secular they follow the religion of psychology
Well exactly, that Shamen/priest was an essential part of the community, they were keepers of traditions that bound the community together across time. Your psychic/spiritual/psychological difficulties are a communal difficulty with a communal solution.
BTW don't you think that the old story of Joesph interpreting the dreams of Pharoah (Genesis 41) is a weird ancient echo of a stressed-out CEO going to a (Jewish) psychotherapist?
Prof Peter Gøtzsche is also a very interesting person. Was a full professor and everything but then broke some taboos by critizising the the pharma-mafia in psychiatry:
Depression is the soul's way of letting you know that you are not on the right path, simple as that. All these quacks that practice psychiatry would have been right at home in Nazi Germany, their discipline is nothing but bullshit theories that have been used to medicate and deaden the human spirit. Best part of the antidepressant discussion is that the media never reports that almost every school shooter was jacked to the gills on Zoloft, Lexapro, Prozac, and, of course, Abilify(let's double up on prescribing antidepressants if the first doesn't work, fucking insane); the listed side effects of these poisons are homicidal rage and violent urges. If this were a sane world these quacks would be crucified for crimes against humanity.
This article is erudite, beautifully written and eminently sensibile
However it overlooks so much of America. More and more Americans are leading crasser and meaner lives, and most people are eons away from psychotherapy. Today, vast numbers of mentially ill people are being put in prisons where their bodies are brutalized and their brains are butchered
Not sure where the “science” lies now, but way long ago as an undergrad, Freudian analysis—pseudo science or not, loomed large. Very large—and not simply on campus, but in society as a whole. There are myriad movies from the 50’s and 60’s which depend on the audience not simply buying into Freud’s understanding of the human mind, but having a sophisticated understanding of his basic concepts such as repression, Id, Ego, Superego and the like.
Doubt me? Try dialing up the old sci-fi flick, Forbidden Planet. One of my more memorable moments in university was in class lecture by a faculty member in the History department. He reacted with glee whenever he mentioned “Sigmund Fraud”. Of course, the joke was on him since we all took his statement as an example of a “Freudian slip”! ;-)
I know your question was directed to the articles authors, Sarah, but if I can pop in an unrequested opinion, couples therapy is generally terrible. The very few cases where I've seen it do something useful was if the couple had a problem of miscommunication and needed a good translator between them.
Thing is, if it's hard to make a point in a way that would make one person listen, it's even harder to make it so that two would listen. Not only that, but despite widespread belief fomented by pop psychology, very rarely couples don't fulfill each others needs because of miscommunication.
Typical case: they stopped having sex, and the reason is because one doesn't find the other sexually attractive anymore. Usually the wife, as was the case for my parents. What the therapist would then do is put the husband through the ringer - because if they don't validate the wife's feelings they aren't gonna see the couple another time - and start him on a course of choreplay: "have you tried doing the dishes more", "maybe she needs to feel less stressed and more comfortable", "open up about your feelings without being accusatory".
This makes her feel righteous and indeed validated for a while - which again is what keeps both going - while also less and less respectful of her husband, who not only was so bad before to necessitate an external authority to do what she "wanted" him to do, but now also tries to negotiate her sexual desire.
This is my take. I'm aware it may not be unbiased, considering where I'm coming from. I also suggest you listen to Orion Taraban's short YouTube video "Why couples therapy almost never works". He makes a convincing case that, when things are so dire, the very maintenance of the relationship is often the worst thing for both partners; but when the relationship itself is "the client", one can't just say "you'd be better off just breaking up", and that puts the therapist in a really bad spot to make each of the two patients better off.
I think they can be helpful in some cases. For that matter, a therapist who focuses a particular problem can also be helpful. For example, “my boyfriend is an alcoholic, should I break up? “
Why did you not mention Durkheim (the father of sociology) as an answer to Freud (the father of psychology)? Anomie (people feeling alienated because of the breakdown of social bonds) vs. a more individual, sexual or chemical understanding of depression.
Freud was a mega-genius; the ideas in his “Interpretation of Dreams” are a revolutionary analysis of the mind and a lucid description of how psycho-dynamic psychology operates. The idea that ‘society should be fixed first’ is completely absurd and contrary to your premise of the difficulty of life. Spiritual traditions exist to help us with the traumas and complexities of life, but they are not a replacement for modern science.
“We have reason to believe that the mismatch between modern society and our evolved brains is a prominent—though certainly not the only—reason for pervasive mental suffering. Often, the disease is not in the head, but in the society. And thus, even if psychotherapy were highly effective, it might be a dangerous distraction.”
Probably true. People seem to be happiest in societies with low Gini coefficients, i.e. less full-on capitalist, or high levels of religiosity. https://worldhappiness.report
Maybe it would help if emotion was more central in modern life. Unamuno’s The Tragic Sense of Life gets at this.
A separate question is whether therapy would be more efficient if therapists were better. I have heard one therapist, maybe it was Theodore Darymple, say that 90% of therapists don’t really know what they are doing.
Freud was arguably the biggest charlatan and pseudointellectual in human history, along with Marx.
Psychoanalysis and it's many spinoffs have pathologized life and Human Nature to a far worse degree than even the most nihilistic and anti-worldly religions ever did.
Freud was not a charlatan, but his views should be placed more in the realm of philosophy and anthropology than therapeutic science.
He was just as much of a charlatan in philosophy and anthropology as he was in science.
I worked emergency psych at a state institution - the violent, suicidal, and unable to care for themselves - for 42 years. I did work neuropsych, substance, forensic, adolescent, developmental, and geriatric populations at times as well.
You have hit some of the main points very well. Freud did set the field of psychology back decades, perhaps even a century. He gave Viennese society, and ultimately the whole intelligentsia, an excuse to talk about sex endlessly, which i why he was popular. (See also Alfred Kinsey) Psychiatric medications do sometimes have uncomfortable, even terrible side effects and sometimes the "improvements" in symptoms are the result of time more than anything else.
But you are otherwise flat wrong in what you are saying. No one does psychoanalysis anymore. There are some lurking Freudians and Jungians about these days, but not many. Much of therapy is more like coaching - doing homework and checking back, trying different responses to difficult loved ones - now. This has been true for forty years. You are attacking strawmen, at least in terms of those who deal with the most difficult clients, the schizophrenics, the serious affective disorders, the personality disorders. Medications can work powerfully for some of such folks.
Look, they die less often. What the hell do you want? We don't waste our time on the Worried Well, as they are called. We throw them some good advice and move on. The problem is largely the general public picking up an idea or two that they saw on a YouTube and applying that to their local middle school. I'm pretty sure that's not psychology's, and certainly not psychiatry's problem at that point.
What readings do you recommend?
I will laughingly but seriously say that the solution to everything in life is to read more CS Lewis.
As for the current state of talk therapy, I think Scott Alexander at Astral Codex Ten, plus his many very excellent commenters, is invaluable. He is a practicing psychiatrist who is rather obsessive about looking at data and evidence, but also an adventurous thinker. Go to his site and enter whatever you think you want to know about in his search bar: depression, psychedelics, trauma, EMDR, psychosis, anxiety - you will get some first-rate stuff.
If his priors matter to you, he is a humanist who left the New Atheist community in frustration, often quotes GK Chesterton, and says that he was "almost persuaded" by CS Lewis. Go figure.
Thanks. Yes I follow Scott, he is smart and a skeptic I think. CS Lewis I should read but not sure if I will like it.
Lewis is varied. He is best known for his speculative fiction, but also writes philosophy, apologetics, practical theology, literary criticism, and memoir. Some are essays, some are book length. Almost everything is still in print even though he died 60 years ago.
Just scanned the article. And want to read it when more time. But totally agree that "pscychoanalysis" is a paper-tiger. Basically, it is a small cult in parts of New York and in old Woody Allen movies. I think even Wikipedia considers it pseudo-science. And when it comes to money, most insurances and and public health schemes would never cover it - it's in the same group as crystal-healing and scientology.
Unfortunately, many psychoanalytic ideas still permeate the culture, e.g., the notion that "repressing" one's sinful impulses is a bad thing.
Agree. Definitely has contaminated culture and life to some extent - as Fraud propably intended.
But I would still say that current use of "psychoanalysis" in science and as a therapy is limited. However, agree that on a mid-wit level some of the vocabulary and "theories" are in use. A lot of people in various languages even confuse "psychoanalysis" and "psychotherapy" (the latter which can be any kind/school of "talk therapy".
I think it was Scott Alexander who taught me that pseudo-science is science's control group.
I would really love to see a comparison between the effectiveness of the most extreme chicken bone waving, incense burning and ecstatic dancing voodoo Shamen against the most highly credentialed psychotherapists. But of course, each group would have to strongly believe in each therapy to get the placebo effect.
Please don't interpret any of this as a snarky dig against voodoo Shamen, I actually like and even respect those guys. Plus, apart from dispelling demons, they can predict the future and also do weddings and funerals, which is more than you are going to get from an Ivy League professor of clinical psychology and psychotherapy.
For pretty much all of human history, when people were troubled they talked to their priest or an equivalent figure like a “bone waving shaman”, and it worked because these people were trusted advisors and skilled soothsayers just like a modern therapist. Now that people are becoming more secular they follow the religion of psychology
Yes, and priests were much better at being priests than the psychiatrists are.
Well exactly, that Shamen/priest was an essential part of the community, they were keepers of traditions that bound the community together across time. Your psychic/spiritual/psychological difficulties are a communal difficulty with a communal solution.
BTW don't you think that the old story of Joesph interpreting the dreams of Pharoah (Genesis 41) is a weird ancient echo of a stressed-out CEO going to a (Jewish) psychotherapist?
That's such an interesting parallel. I would have never thought about it that way
Readers might enjoy 'The Myth of Psychotherapy: Mental Healing as Religion, Rhetoric, and Repression,' by Thomas Szasz.
Too bad substack app doesn't allow to copy
Screenshot the comment and use an app like Google Lens to copy the title of the book.
I don't like that he was an anti psychiatrist but the title looks interesting
Prof Peter Gøtzsche is also a very interesting person. Was a full professor and everything but then broke some taboos by critizising the the pharma-mafia in psychiatry:
https://www.youtube.com/watch?v=_9cfjKOmPF8
Depression is the soul's way of letting you know that you are not on the right path, simple as that. All these quacks that practice psychiatry would have been right at home in Nazi Germany, their discipline is nothing but bullshit theories that have been used to medicate and deaden the human spirit. Best part of the antidepressant discussion is that the media never reports that almost every school shooter was jacked to the gills on Zoloft, Lexapro, Prozac, and, of course, Abilify(let's double up on prescribing antidepressants if the first doesn't work, fucking insane); the listed side effects of these poisons are homicidal rage and violent urges. If this were a sane world these quacks would be crucified for crimes against humanity.
You haven't the faintest idea what you are talking about. You grabbed a few anecdotes and called the gospel, Reverend.
Can I guess you don't like that someone prescribed for you, cupcake?
exactly right.
This article is erudite, beautifully written and eminently sensibile
However it overlooks so much of America. More and more Americans are leading crasser and meaner lives, and most people are eons away from psychotherapy. Today, vast numbers of mentially ill people are being put in prisons where their bodies are brutalized and their brains are butchered
https://davidgottfried.substack.com/p/the-new-moral-turpitude-prison-for
Appreciate the article.
Not sure where the “science” lies now, but way long ago as an undergrad, Freudian analysis—pseudo science or not, loomed large. Very large—and not simply on campus, but in society as a whole. There are myriad movies from the 50’s and 60’s which depend on the audience not simply buying into Freud’s understanding of the human mind, but having a sophisticated understanding of his basic concepts such as repression, Id, Ego, Superego and the like.
Doubt me? Try dialing up the old sci-fi flick, Forbidden Planet. One of my more memorable moments in university was in class lecture by a faculty member in the History department. He reacted with glee whenever he mentioned “Sigmund Fraud”. Of course, the joke was on him since we all took his statement as an example of a “Freudian slip”! ;-)
What are your thoughts on the efficacy of a competent therapist for couples or families?
I know your question was directed to the articles authors, Sarah, but if I can pop in an unrequested opinion, couples therapy is generally terrible. The very few cases where I've seen it do something useful was if the couple had a problem of miscommunication and needed a good translator between them.
Thing is, if it's hard to make a point in a way that would make one person listen, it's even harder to make it so that two would listen. Not only that, but despite widespread belief fomented by pop psychology, very rarely couples don't fulfill each others needs because of miscommunication.
Typical case: they stopped having sex, and the reason is because one doesn't find the other sexually attractive anymore. Usually the wife, as was the case for my parents. What the therapist would then do is put the husband through the ringer - because if they don't validate the wife's feelings they aren't gonna see the couple another time - and start him on a course of choreplay: "have you tried doing the dishes more", "maybe she needs to feel less stressed and more comfortable", "open up about your feelings without being accusatory".
This makes her feel righteous and indeed validated for a while - which again is what keeps both going - while also less and less respectful of her husband, who not only was so bad before to necessitate an external authority to do what she "wanted" him to do, but now also tries to negotiate her sexual desire.
This is my take. I'm aware it may not be unbiased, considering where I'm coming from. I also suggest you listen to Orion Taraban's short YouTube video "Why couples therapy almost never works". He makes a convincing case that, when things are so dire, the very maintenance of the relationship is often the worst thing for both partners; but when the relationship itself is "the client", one can't just say "you'd be better off just breaking up", and that puts the therapist in a really bad spot to make each of the two patients better off.
I think they can be helpful in some cases. For that matter, a therapist who focuses a particular problem can also be helpful. For example, “my boyfriend is an alcoholic, should I break up? “
Why did you not mention Durkheim (the father of sociology) as an answer to Freud (the father of psychology)? Anomie (people feeling alienated because of the breakdown of social bonds) vs. a more individual, sexual or chemical understanding of depression.
Freud was a mega-genius; the ideas in his “Interpretation of Dreams” are a revolutionary analysis of the mind and a lucid description of how psycho-dynamic psychology operates. The idea that ‘society should be fixed first’ is completely absurd and contrary to your premise of the difficulty of life. Spiritual traditions exist to help us with the traumas and complexities of life, but they are not a replacement for modern science.
Another very interesting presentation about the origin of DSM 3:
12 chosen people just chit-chatting and flipping coins to decide if a diagnosis/illness excist or not. Not much science behind it:
https://www.youtube.com/watch?v=6JPgpasgueQ
https://www.youtube.com/watch?v=_f2WFFwBZPc
"Some sort of psychiatric jargon you've picked up from the Reader's Digest."
“We have reason to believe that the mismatch between modern society and our evolved brains is a prominent—though certainly not the only—reason for pervasive mental suffering. Often, the disease is not in the head, but in the society. And thus, even if psychotherapy were highly effective, it might be a dangerous distraction.”
Probably true. People seem to be happiest in societies with low Gini coefficients, i.e. less full-on capitalist, or high levels of religiosity. https://worldhappiness.report
Maybe it would help if emotion was more central in modern life. Unamuno’s The Tragic Sense of Life gets at this.
A separate question is whether therapy would be more efficient if therapists were better. I have heard one therapist, maybe it was Theodore Darymple, say that 90% of therapists don’t really know what they are doing.
Oh my goood… my trauma sacs… they’re inflaming!! OH MY GOOOOOOD WHERE IS MY ZOLOFT!!! I’m gonna veeeent!!!
It might be that they're measuring the wrong thing. If people believe it helps them, I would take these personal experiences over statistics.