Please note that, where applicable, links have been provided to original texts which these letters address. Also, your thoughts may be sent via the online Letters to the Editor section.
Editor's note: "Where Will Psychoanalysis Survive?" by Alan A. Stone, M.D., provoked dozens of letters. Excerpts appear here. Several correspondents challenged Stone for failing to substantiate his arguments; since his original address was condensed for publication, interested readers may wish to read the full text, available here on the website. You may also obtain a copy by writing to Stone at Hauser 400, Harvard Law School, Cambridge 02138.
I have just read Alan Stone's puzzling article on Sigmund Freud--puzzling because I know Stone to be a thoughtful person and yet this article seems so oddly uninformed about both Freud and modern psychoanalysis. In fact, it seems downright--well--unscientific.
Stone seems to have been seduced by a narrow view of science as utterly rational and objective, such as can be found in statistical analyses and double-blind studies. Certainly, fields that depend upon systematic and rigorous observation such as sociology or anthropology would be cast out, along with psychoanalysis, by such a knowledge-impoverishing definition.
Such a mechanistic approach eliminates what is surely one of the most exciting areas of exploration that has been opened up by neurobiological studies and psychoanalysis--the mind-brain interface and how each sphere influences the other. Mind seems to have been entirely sacrificed to brain in Stone's scheme.
Concerning Freud's view of himself, as with so much in the article, Stone is simply wrong. Freud viewed himself first and foremost as a scientist, a seeker after the great secrets of nature, a solver of the "riddle of the Sphinx." In discovering the unconscious, Freud wrote Fliess that he felt he had stumbled onto "something from the very core of nature." A neuroanatomical scientist, trained in the tradition of Helmholtz, Freud hoped to understand the biology of the mind through clinical investigation. His "Project for Scientific Psychology" was one of the earliest attempts at trying to evolve a biological theory of mind. His early work "On Aphasia" was in a similar vein.
One portion of Stone's criticism is valid. Psychoanalysis had, to some degree, allowed itself to become separated from the mainstream of the scientific thought of other disciplines. This is rapidly being corrected.
Stone's description of the clinical practice of psychoanalysis is hardly recognizable, except in a historical context. His description of practice is identical to that of 25 years ago when he and I were both in training at the Boston Psychoanalytic Institute. I wonder how much he has remained involved in the clinical and scientific advances of psychoanalysis over the last several decades. The scientific and clinical research that he suggests does not exist has produced enormous changes in psychoanalytic technique. The psychoanalytic and psychodynamic treatment of today has become a vigorous and effective treatment for the relief of human suffering.
Robert L. Pyles, M.D. '62
President-elect, The American
Wellesley Hills, Mass.
Oh! Dr. Fraud!
There once was a Sigmund named Fraud
who set up the Male as a god;
he won fortune and fame
running down Woman's name--
and called that a Science! How odd!
When the Almighty brought forth a Man, Like all builders He built from a plan.
He'd ruled that Bad Deeds
be buried like weeds
in a nook of one's brain, under ban.
For when Life deals a soul-crushing blow
yet one gets through its dangerous low,
Our Maker had bidden
its mem'ry be hidden
so one could still go with the flow.
What's really, of all, the most strange
Is how eager this Doc was to change
this sensible act
based on subconscious fact
into something he swore was deranged.
Exhuming these defects long nursed,
Sigmund showed you yourself at your worst:
with nary a squint
he dared you to hint
his verdict not worth your whole purse.
All he said was--"You yearned for your mother."
So, remember, whatever you'd ruther,
his treatment was fraud;
he was messing with God!
Believe him? He'd tell you another.
Ms. H.W. Edwards '36
Stone's sympathetic critique of psychoanalysis is misguided because he assumes the psychoanalytic theory of treatment must rest on the psychoanalytic theory of neurosis. The latter has, indeed, been dealt mortal blows, and I agree that Freudian theories of neurosis "lose much of their explanatory power." Lacking a scientific etiological theory, Stone despairs of developing effective psychoanalytic treatment: "I do not believe psychoanalysis is an adequate form of treatment." That inference does not follow. Clearly, no etiological knowledge is necessary for effective treatment. The etiology of hypertension remains unknown, but highly effective treatments exist. Whether psychoanalytic treatment is effective is an empirical, not a theoretical, question.
Previous psychoanalytic theories of technique, based on the psychoanalytic theory of neurosis, utilized a one-person model of treatment that required the analyst to be abstinent, neutral, and anonymous to facilitate examination of the patient's psychic reality. New theories of technique, increasingly independent of earlier theories of etiology of psychopathology, utilize a two-person model with abstinence, neutrality, and anonymity getting short shrift. Building upon the early, fundamental discoveries of psychoanalysis, the importance of unconscious thoughts and feelings, and the role of defenses, the interpersonal, intersubjective domain of patient-analyst interaction is being avidly explored. These radical changes in theories of technique promise powerfully enhanced therapeutic efficacy.
Joseph Schacter, Ph.D. '55, M.D.
As co-editors of the Journal of Clinical Psychoanalysis and as psychoanalytic practitioners for 30 years, we dispute the assertions that psychoanalysis is a failure as science and useless as therapy. Stone presents his case in the one-sided fashion of a lawyer: he just omits evidence to the contrary. Readers who wish a more balanced appraisal of psychoanalysis will find it in "Why Freud Isn't Dead," in the December 1996 Scientific American.
Stone has managed to convert Freud himself into a friendly witness for the prosecution by ignoring in his citations the many passages in which Freud makes clear his conviction that he was an empirical, psychological scientist--a conviction which he asserted and reasserted to his dying day. Further, Stone admits into the courtroom only vague reference to the "available evidence," which convinces him that mental illness is purely chemical or genetic, neither psychological nor developmental. And this despite the voluminous evidence to the contrary, not to mention the fact that to date, in not one single instance has the solely chemical or genetic origin of a mental condition been satisfactorily proven.
We find it hard to understand, moreover, Stone's intellectual progression from believer to nonbeliever. How is it possible at one time to believe that a discipline is scientific, and at another time no longer to believe it? Whether or not a discipline conforms to the methodology of science is in itself a matter of objective, scientific judgment. It cannot be a matter of "belief" won or lost. Here we can't help but notice that Stone describes his early training as "reverential." This suggests to us that Stone was never scientific in his thinking about psychoanalysis, but was rather devout, or conformist, then and now. In fact, we would characterize his progression from his early reverent belief to his current total recantation more as a spiritual development than as the evolution of a dispassionate position based on scientific reappraisal.
Herbert M. Wyman '57, M.D.
Stephen M. Rittenberg, G '58, M.D.
New York City
I'm sorry to find my old friend and fellow-trainee in psychoanalysis subscribing to the canard that "the scientific center of psychoanalysis has crumbled." By now, most people, even psychoanalysts like Stone, seem to accept as a truism that there is no experimental backing for psychoanalysis. That is simply false.
The most comprehensive summary of the experimental literature appeared in 1996, Seymour Fisher's and Roger Greenberg's Freud Scientifically Reappraised: Testing the Theories and Therapy. If you combine this book with their 1977 study of the same field, they have surveyed more than 2,500 experimental studies of Freud's ideas. They speak of "the incredible amount of effort that has been invested in testing Freud's ideas fairly." In quality, they say, these studies "probably compare well with the accumulated studies relevant to any other major area of psychology."
Interestingly, this large body of experimental evidence confirms just that piece of Freud's thought that Stone thinks most doubtful, his account of childhood development. Oral and anal characters are strongly confirmed. Adult oral character correlates with needs for dependence and nurture, with pessimism and depression, and with oral gratifications like eating and smoking. Similarly, experiments show the familiar cluster of anal traits, notably negativism and obstinacy and what we now call Type A behavior. The experimental literature also supports an oedipal stage in childhood and oedipal fantasies about the body. Freud's story of superego development is not confirmed, however. As Stone notes, Freud's picture of female development has received little support.
The literature confirms Freud's etiology for depression, but one must allow, as he did not, for other causes. Freud's account of paranoia as caused by repressed homosexuality also holds, and experiments now extend this theory to women. Again, however, one must consider the possibility of other variables, although Freud did not.
Freud thought insight the basis for therapeutic change. The literature says that psychotherapy is more complex than that. Neither psychoanalysis nor any other therapeutic technique shows the superiority Freud claimed for psychoanalysis.
At best, the literature partly confirms Freud's dream theory. The major hole is the strong finding that the manifest dream has easily accessible, "transparent" content. If so, then our dreams do not conceal in the way that Freud thought they did. Psychoanalytic theorists Erik Erikson and Charles Rycroft made this point some years ago.
Fisher and Greenberg conclude that one should think of Freud as developing, not a grand, integrated structure--Stone's sunken "cathedral"--but a series of mini- theories. Some check out. Some do not.
Most psychoanalytic thinkers have adopted Stone's stance, that psychoanalysis is only an interpretive system, good only for short-term therapy. That's too bad, as is Harvard Magazine's enthusiastic presentation of his too-easy surrender of a proud and promising heritage.
Norman N. Holland, LL.B. '50, Ph.D. '56
This is a comment from someone who is currently in psychoanalysis on Stone's central, exploratory thesis that "we have no reason to assume that a careful historical reconstruction of...developmental events will have a therapeutic effect."
I had two 18-month, two-session per week, face-to-face psychotherapies (not psychoanalyses) with two intelligent psychotherapists. One had been analyzed, and the other had been analyzed, analytically trained, and was also well-known.. We dealt with my symptoms; each hypothesized that they were the consequence of developmental experiences I had had and explicated their reasoning. Although I thought their hypotheses about the relationship between my development and my symptoms were logical, and remembered events of my childhood which supported their hypotheses, many of my symptoms persisted. The cognitive overlay they gave me of historical interpretation did not alleviate my symptoms. The second psychotherapist helped because of his skills in interpreting aspects of my transference toward him (the truly psychoanalytic element of this therapy), and because he convinced me that he cared about me.
Many of my symptoms persisted, however, and new symptoms also emerged, the results of a mediocre first treatment and a flawed second treatment.
A career disappointment and my subsequent inability to move beyond it, despite having a career that continued to flourish, prompted me to seek treatment again eight years after the second psychotherapy, with a psychotherapist who was an experienced psychoanalyst. This therapy became a four-session-per-week psychoanalysis. The analyst induced a lot of regression. It was only as I regressed, reexperienced physiologically, emotionally, and cognitively my early development, understood for myself how my development influenced and was influencing my thinking and ways of relating to people now, and actually felt how my development was physically influencing me, that I could verify the truth or the falsity of my previous psychotherapists' and current psychoanalyst's interpretations, further grow, and be relieved of my symptoms.
When discussing the extent to which historical reconstruction of development alleviates symptoms, one must be careful to differentiate between the kind of hypothetical and intellectual exercise engaged in by psychotherapists and the kind of reconstruction made possible by an analysand's reexperiencing, during regression with his or her psychoanalyst, the emotional, physiological, and cognitive experiences of early childhood, adolescence, and young adulthood. The first kind of historical reconstruction may not alleviate suffering; it didn't in my case. The second kind, made possible through regression and growth in psychoanalysis, did.
Name Withheld, Ph.D. '79
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