The shadow of his legacy set back modern psychiatry for decades, but a reappraisal may be in order.
In October of 1900, an industrialist living in Vienna took his eighteen-year old daughter, "Dora," to see Dr Freud. Dora was acting peculiar and saying strange things. Could the good doctor restore her to reason? The case didn't seem particularly promising to Freud, just another garden variety hysterical woman, in his view, but his finances were none too secure and so he took her on.
A few days later, he wrote to a friend: "The case has smoothly opened to the existing collection of picklocks."
Freud had stumbled upon a strange new terra incognita he called the unconscious.
Under psychoanalysis, Dora told Freud of her family's closeness to that of Herr K, how her own father had been having an affair with Frau K and how Herr K was turning his attentions on her. Dora told the story of K's advances to her father, who rejected it as a sexual fantasy. Freud, however, accepted Dora's account, but wondered why his patient felt disgust rather than desire, and suddenly one of history's great Archimedes moments occurred - an aha! a Eureka!, an apple falling from the tree. Freud speculated that Dora UNCONSCIOUSLY desired Herr K. For good measure, he also claimed she lusted for Frau K.
Dora was not similarly impressed, She broke off her treatment, and we are left to contemplate whose uncouscious desire was really at work here.
Nevertheless, even Freud's most strident detractors could not shoot down the idea of the unconscious mind and its influence over our conscious actions. In one fell swoop, Freud put an end to the notion that we were rational beings governed by rational thinking. But he also held out hope, that the worst inside us could be stripped of its strange dominion simply by bringing it out into the open.
Out of this mysterious mindscape of the unconscious would emerge a veritable glossary of Freudspeak:
* Id - our lower nature, as opposed to our super-egos or higher natures.
* Repression - our means of keeping our lower impulses locked away from our conscious awareness.
* Projection - an unconscious passing of our thoughts and feelings to another.
* Neurosis and psychosis - various behaviors that result from the unconscious at work.
Then there was all the sex stuff - how boys unconsciously wanted to have sex with their mothers (Oedipus Complex), and how women deep inside envied men's anatomies (penis envy) - not to mention an equally powerful deathwish (thanatos) that engaged the id in an unconscious danse macabre.
Again, most of all this was just plain silly, based more on intuition and random observation than any scientific study. But to write off Freud as some kind of Viennese quack based on his penis envy nonsense and the rest would be like denouncing Aristotle as a second-rate philosopher because he didn't know the purpose of the brain.
What Freud succeeded in doing was bringing all our social taboos out into the open and making them appropriate topics for discussion, a cultural dam burst that would spill over into literature and the arts and across all disciplines. And by introducing us to the hidden world of the unconscious, Freud effectively showed us how we think. He demonstrated the huge impact our early childhoods can have on us as adults, and for good measure rescued the interpretation of dreams from the crystal ball category. Finally, his new technique of psychoanalysis promised to root out our hidden fears and desires and traumas and restore us to mental soundness.
His theories and ideas (much of it derivative of others and some outright plagiarized) would leave their imprint on every area of human activity - from parenting and education to social welfare to labor-management relations to marketing and advertising to the administration of criminal justice. He and his acolytes would literally create a new profession and spread the word across the planet. Even at his death at age 83 in 1939, Freud could be considered intellectually hot, and by the fifties and sixties no student could make it through college without being exposed to the Gospel According to Sigmund.
Make no mistake about it: We are talking about one of the two or three most influential figures of the twentieth century, if not in all history.
But Freud also left an extremely disturbing legacy. As his theories took root and were applied to practice, the biological basis of mental disorder was discounted, and the work of earlier clinicians forgotten and not built upon. Up until a very short time ago - thanks to Freudian psychology - schizophrenia was thought to stem from bad parenting, and those with bipolar disorder were written off as uncooperative behavior problems. Even simple depression was looked on as a neurosis.
The terrible result of all this was that for a good two or three decades following the second world war, money and resources that could have been devoted to finding proper treatments for these disorders - not to mention directed into more practical therapies - were diverted into other projects. According to E Fuller Torrey, author of "Surviving Schizophrenia":
"Talking to your therapist about your mother continues to be a national pastime, with or without federal assistance. And it continues to usurp an extraordinarily large share of professional resources that should be going to the seriously mentally ill."
Thanks in large part to the Freudian mindset of the psychiatric profession in the fifties and sixties, a simple common salt called lithium, found to be so effective in the treatment of manic depression, did not come into widespread use in the US until the mid-seventies, more than a quarter century after its efficacy had been discovered in Australia.
Still, one can no more fault Freud for the stupidities of his successors than one can blame Jesus Christ for all the holy wars that would later be waged in his name. Great minds like Freud open us to a realm of possibilities. But it is up to us to determine how to use these gifts to our best advantage. Sadly, all too often, we find ourselves having to rescue the legacy of a true visionary from the clutches of those who carry on in his name.
But it is difficult to keep a good man down for long. As the promise of a quick chemical fix for depression and other disorders fades, it appears that Herr Doctor may be experiencing a comeback of sorts, albeit in a slightly different reincarnation. Mental illness may be a biological phenomenon, but it occurs in an environmental context, with trauma and abuse linked to between 50 and 80 percent of people who are later diagnosed. For example, a Stanley Foundation survey of 631 bipolar outpatients found those who had a history child/adolescent physical or sexual abuse had an increased number of co-occurring disorders, including drug and alcohol abuse, a greater number of medical illnesses, earlier onset of bipolar illness, faster cycling frequencies, and a higher rate of suicide attempts.
A 2003 study found that depressed women with childhood trauma and abuse fared much better on short-term talking therapy than an antidepressant, On a seemingly unrelated note, the Toronto Star at round the same time ran a feature article, "Freud Goes Up in Smoke," with none other than Freud’s granddaughter, Sophie, a retired psychology professor, dismissing her iconic grandfather as a "false prophet." Ironically, although this study does nothing to rescue the Wizard of Id from penis envy and his other silly ideas, it compels us to give him his due for his core beliefs concerning unresolved trauma and listening to patients. Thank you, Sigmund, lots more studies, please.
Published 2000, reviewed Feb 2008
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