Sigmund Freud was born in Frieberg, Moravia (now in the Czech Republic) 150 years ago on 6th May 1856 and died in Hampstead, London in September 1939. His writings, along with those of Darwin and Marx, constitute one of the three grand narratives that dominated 20th-century thought. Freud greatly admired Darwin—but thought little of Marx and Marxism. He deplored Marx's failure to give credit to psychological factors in human nature and said of the goals of the Bolshevik revolution, "A transformation of human nature such as this is highly improbable." Someone said to him that the Russian revolution would involve great distress followed by great happiness. He replied that he half agreed.
Freud did not set out to work in psychology. He wanted to pursue a career as a research scientist in neuroanatomy and neurophysiology, did laboratory work in Vienna after his medical training and wrote many purely scientific papers. Indeed, his first extensive treatise (unpublished) was an attempt to express psychology in neurological terms, and his first book, On Aphasia (1891), was a neurological treatise . But a Jew could not make a living in neurological research, so Freud turned to clinical work, taking on the cases other doctors could not help. He and his mentor, Josef Breuer, applied various nostrums, including hypnosis and electrotherapy, but mostly they listened and began to make interpretations about the sexual fantasies of their patients. This material proved too much for Breuer (or, more accurately, for Mrs Breuer), who abandoned this line of work. Freud persevered, eventually coming to attribute neuroses to unconscious sexual impulses and conflicts. He initially stressed sexual abuse but moved on to attribute neuroses to both actual and fantasied sexual distress.
The result was, in the first instance, Freud and Breuer's Studies in Hysteria (1895) and then Freud's masterpiece, The Interpretation of Dreams (1900), which had this motto, from Virgil: "If I cannot bend the higher powers, I will stir up the lower depths." The latter sold only 351 copies in the six years after its publication, but eventually came to be seen by some as one of western culture's great works. Freud also wrote some popular works— The Psychopathology of Everyday Life and Jokes and Their Relation to the Unconscious—and was not above the odd populist potboiler to help the psychoanalytic press keep solvent. His complete psychological works make up 24 volumes, but at the heart of it all is the role of sexuality, interpreted very broadly, in human nature and of the unconscious in human motivation. He argued that by far the largest portion of our thought processes are unconscious, and that unconscious motivation is by far the most determinate part of our minds. His discoveries in this area place him in the tradition of ideas that diminish human arrogance and status. In this his work follows the Copernican dethronement of the Earth from the centre of the solar system, the Darwinian removal of humankind from a special place at the peak of living nature, and the Marxist assertion that economic causation lies at the heart of human arrangements and culture.
Freud's concept of the ubiquity of sexual energy, or libido, has been broadened further in more recent work. In particular, Melanie Klein, Donald Winnicott and Wilfred Bion place "object relations"—our relations with the objects of our love and hate—at the base of human feelings and interactions. The claims about the role of the unconscious have also been broadened to say that the inner world is more determinate than the outer world of who we are and how we act. This is not to say that the outer world is ineffectual, but rather that our early experiences of care and upbringing set the tone of how we feel and react for the rest of our lives.
Freud's influence grew apace. Psychoanalytic training schools and institutes were set up all over the world and continue to train psychoanalysts, while psychotherapy trainings have also prospered. He won the Goethe prize for his writings, and he was made a corresponding member of the Royal Society of London when he immigrated to Hampstead just before he died.
When I was a university student in the 1950s, psychoanalysis was at the peak of its influence, and many posts in medical schools were held by psychoanalysts. But Freud and psychoanalysis have always had their detractors, particularly among traditional psychiatrists or the new generation of psychopharmacologists who aspired to treat mental illness by drugs. There was a concerted counterattack on psychoanalysis by the traditional psychiatrists in the 1970s that centred on the editorship of the Diagnostic and Statistical Manual of the American Psychiatric Association, the main textbook of student psychiatrists and reference work for practitioners throughout the world. A professor at Columbia, Robert Spitzer, was approached to edit a revision of the manual. He said he would accept on the condition that he could determine the board of editors and that they could expunge all trace of psychoanalytic and psychodynamic thinking from the revised edition. And so it came to pass. There was a standing ovation at the meeting when this coup was announced. (For a moving account of the deleterious effects of this wrench on the training of mental health workers, see TM Luhrmann's Of Two Minds).
This period saw another institutional attack on psychodynamic therapies. The insurance companies that pay for psychotherapy became reluctant to fund open-ended psychological treatments, preferring short-term interventions and ongoing drug regimes. Even though prolonged drug treatments have since been discredited for most conditions, this view remains to the present day. Most people cannot afford private psychotherapy, much less psychoanalysis four or five times a week. Some countries, like Germany and Canada, enjoy state funding of such treatments. The latest appeal in Britain, by Richard Layard, an LSE economist and adviser to No 10, calls for 10,000 more therapists to treat the large number of people suffering from depression and anxiety, but Layard advocates the use of cognitive behavioural therapy (CBT), decidedly un-psychodynamic. CBT is useful in its place, but it is psychoanalytic psychotherapy that reaches the parts other therapists do not reach.
Marxism had been another traditional source of critiques of psychoanalysis—most Marxists mocked psychoanalysis as subjectivist, accusing it of ignoring material conditions. There have been notable exceptions—Wilhelm Reich's sexual libertarianism, for example. Reich believed that neurosis could be eliminated by removing sexual repression, as described in his The Mass Psychology of Fascism and The Function of the Orgasm. Herbert Marcuse attempted to integrate Marx and Freud in Eros and Civilization. He believed that repression was necessary for civility but distinguished biologically necessary repression from that which was specific to different historical periods, like the capitalist era. More recently, Victor Wolfenstein, who is both a political scientist and a psychoanalyst, has made imaginative integrations of psychoanalysis and Marxism in his The Victims of Democracy: Malcolm Xand the Black Revolution, which I consider to be the best psychobiography there is, and Psychoanalytic-Marxism: Groundwork.
There have also been swingeing attacks on psychoanalysis in the broader culture—the so-called "Freud wars." The best known was launched by Frederick Crews, a Berkeley professor of English literature and a former adherent of psychoanalysis, in the New York Review of Books. A philosopher, Adolf Grünbaum, has launched an attack from the standpoint of philosophy of science, and there have been a number of lightweight critiques. Jonathan Lear's Love and Its Place in Nature is one of the stronger responses to these attacks. As he writes: "'How shall we live?' is, for Socrates, the fundamental question of human existence—and the attempt to answer that question is, for him, what makes human life worthwhile. And it is Plato and Shakespeare, Proust, Nietzsche and, most recently, Freud who complicated the issue by insisting that there are deep currents of meaning, often cross-currents, running through the human soul which can at best be glimpsed through a glass darkly."
But for the most part, the psychoanalytic community has not given a very good account of itself. I find this failure to rebut the critics of psychoanalysis somewhat odd. Part of the problem is that it is increasingly felt that truths about human nature are truths of the surface, that the human spirit is, as it were, passé. Behaviourists and Darwinian psychologists share a contempt for explanations in terms of unconscious motivation and opt instead for habits and genes as the determinants of human behaviour. And yet it is psychoanalysis, with its dynamic view of the complexities of human motivation, that resonates with literature, drama, fine art, film and music, including folk, country and pop. Moreover, there are fine writings based on a psychoanalytic reading of literature, such as The Chamber of Maiden Thought: Literary Origins of the Psychoanalytic Model of the Mind by Meg Harris Williams and Margot Waddell.
The increasingly negative attitude to psychoanalysis sometimes strikes me as a miasma, sapping people's better judgement. There is a shrinkage of patients, trainees and practitioners, though all agree that the amount of psychological distress remains high and is growing. The elite psychoanalytic training institutes have put their wagons in a circle and have created a caste hierarchy. Internal squabbles in and between psychoanalytic institutions abound, some doctrinal, some the result of group dynamics. These squables are perhaps no worse than in other professional subcultures, but, as with the clergy, one hopes for better from supposed experts in human relations.
After decades of experience, first as a patient and then as a psychoanalytic psychotherapist, I still feel that psychoanalysis and psychoanalytic psychotherapy work. They did for me, for people close to me and for almost all of my patients and my supervisees' patients. I have known people to move from death's door to fulfilled lives as a result of psychoanalytic treatment. I have seen it alleviate severe self-criticism, being "empty of oneself," alienation, creative blocks, depression, eating disorders, psychosomatic disorders, perversion, depression, anxiety and trauma. Drugs and behavioural therapies have their place, but they are less searching, less soulful.
Many have called Freud a pessimist. I find him and the leaders of the next generation of psychoanalytic thinkers to be realists. They have fully acknowledged our dual nature—love and hate, constructive and destructive, caring and aggressive—and the need to acknowledge the full range of feelings and motivations that drive us. Unless we acknowledge them properly and find ways of containing and detoxifying the negative side of our being, what hope is there for humankind? Freud's is the only general psychology we have that touches the depths of human nature and husbands the values that enlightened people cherish. It is also the only one that sheds light on the baleful and destructive aspects of human nature and offers ways of mitigating them. It speaks to the human condition in our very distressing times. As we take note of the 150th anniversary of Freud's birth, let's see if we cannot reverse the unmerited decline in his reputation and make more use of his insights and of those who have continued to develop psychoanalytic theory and practice.
