Is Freud Finished?

By John Elson

He is rightly regarded as the father of modern psychiatry -- as revolutionary a thinker as Darwin, as daring an explorer of the interior world as Columbus was of the exterior. Sigmund Freud not only developed the most profound theory to explain the workings of the human mind, but he also devised much of the terminology -- from Oedipus complex to penis envy -- that has become part of the language. The discipline he founded, psychoanalysis, became the world's most famous technique for helping the troubled come to grips with the demons haunting their minds.

But with the advent of new drug therapies, Freudian analysis has become almost irrelevant to the treatment of severe depression and schizophrenia. Granted, even the most pharmacology-minded of experts agree that the drugs work best in conjunction with some form of therapy. Yet psychiatrist Samuel Perry of Cornell University Medical College estimates that less than 1% of depression sufferers in the U.S. are being treated with traditional psychoanalysis -- that is, a long-term series of regular sessions with a psychiatrist. Though this technique is still considered suitable for treating neurotics who have trouble coping with everyday stress, not even the most fanatic Freudians believe psychoanalysis alone can cope with severe cases of schizophrenia or severe depression.

Relatively little of Freud's voluminous work is devoted to the empirical study of clinical depression. His writings discuss only four patients who were known for certain to have suffered from major depression, and he published only one paper on the subject -- "Mourning and Melancholia" (1917) -- which contrasted ordinary grief and acute depression. He wrote somewhat more extensively about schizophrenia, which he called "paraphrenia." But he was always doubtful that psychoanalysis would be of much help in treating it. The schizophrenic's lack of interest in the external world, Freud wrote, made him inaccessible to transference. That is the key psychological process by which a patient redirects unconscious feelings retained from childhood toward an analyst. It was Freud's later disciples, rather than the master himself, who popularized the use of psychoanalysis to treat depression and even schizophrenia.

Feminists complain that Freud's view of women, as mercurial creatures with a deficient sense of moral standards, was downright misogynistic. Even some orthodox Freudians concede that his emphasis on sexuality as the root cause of all neuroses was too narrow. Nonetheless, Freud's ideas still have impact. Says Arnold Cooper, past president of the American Psychoanalytic Association: "You and everybody you know is a Freudian, and they probably don't even know it. We have all drunk in basic Freudian tenets." Freud was a pioneer in mapping the unconscious mind and theorizing how it could be reached and interpreted. He was the first to speculate that traumatic events of childhood could influence the way adults see the world. And he was the first also to postulate that patients in psychoanalysis, rather than the doctor, could direct therapy and contribute to their own cure.

"Freud took two pieces of Vermont folk wisdom and turned them into a science," says psychiatry professor Thomas Gutheil of Harvard medical school. "The first was, 'There's a whole lot more to folks than meets the eye.' This became known as the theory of the unconscious. The second was, 'Keep your mouth shut and you might learn something.' He changed the position of the doctor from that of an authoritarian giving orders to a more receptive role. Freud said, 'Let the patient talk and tell the story.' "

In that sense, all forms of talk therapy can be considered a Freudian legacy. Even the sex obsession of today's society can be read as evidence that contemporary culture indirectly reflects Freud's deepest concerns. Perhaps W.H. Auden got it right after all in his poetic tribute to the Viennese master, written a few months after Freud's death in 1939:

If often he was wrong and at times absurd,

To us he is no more a person now

But a whole climate of opinion

Under whom we conduct our differing lives.

With reporting by Janice M. Horowitz/New York