How Well Does Freud’s Work Stand the Test of Time?

1. How Well Does Freud’s Work Stand the Test of Time? Allen Frances MD

2. Full Disclosure- I am not a specialist on: • Freud • Neuroscience • Cognitive psychology • Computer science • The social sciences • Art criticism • Philosophy • Intellectual history • I know almost nothing about everything and welcome contributions from the audience on all of these topics

3. Why Freud Counts • Complete model links brain and mind • Science and humanities • Medicine with evolutionary biology • Normal and abnormal psychology • Individual and group psychology • Past, prehistory, and modern cultures

4. Freud’s Contributions Hold Up Well • Mind can be studied scientifically • UCS determines much of what we do • Role of defense and psychic conflict • Bridge: Darwin to everyday life • Precursor of evolutionary psychology • Epigenesis, not degeneracy or genetics • The Kraepelin of outpatient diagnosis • Father of all modern talk therapies

5. Freud as a Reluctant Social Reformer • All speak Freud without knowing it • Furthers modernism, individualism, fem emancipation, and sexual revolution • Embraced by intellectuals in their opposition to Hapsberg status quo regarding church, politics, bureaucracy, and morality • But unlike Adler, Reich, Fennel, From, and Marxists, Freud was pessimistic regarding changing human nature and society

6. Second Greatest Psychologist After Darwin • M and N Notebooks (1838-1840) • On the Origin of Species (1859) • The Descent of Man and Selection in Relation to Sex (1871) • The Expression of the Emotions in Man and Animals (1872) • Biographical Sketch of an Infant (1877)

7. Darwin’s Contributions to Psychology • Human psychology from animal and retains much of our inheritance • Understanding baboons tells us more than reading Locke and the philosophers • Psychology can be an objective science amenable to observation and experiment • Materialist mind as a brain function: no vitalism or human exceptionalism

8. Darwin’s Contributions to Psychology (continued) • Natural and sexual selection lead to evolution of instincts, emotions, and intellect • UCS-major rule influencing behavior • Instinct interacts with environment • The child is father to the man • Everything has or once had a purpose

9. Darwin’s Methods • Compare animal and human behaviors • Survey human behavior around the world • Minute observation of child maturation • Reactions to facial expressions • Introspection and dream analysis

10. Darwin UCS vs. Freud UCS • Neither invented idea • By 1700 UCS conceivable • By 1800 UCS topical • 1870-1880 UCS fashionable • Darwin’s UCS is mostly adaptive, non-conflictual reflection of evolution • Freud adds dynamic unconscious-conflict between lusty instinctual wishes and repressive forces, some inborn • Hartmann adds conflict free sphere

11. Adaptive vs. Conflictual UCS Reflect: • Darwin entry point is normal function; Freud’s is the study of psychopathology • Darwin optimist; Freud pessimist • Darwin hates conflict; Freud relishes • Darwin establishment; Freud outsider • Darwin inborn moral sense to be good; Freud inborn punishing superego • Darwin cherished fruits of civilizing; Freud saw it as discontents

12. Freud Surfaced Many Intellectual Currents • Helmholz-brain; as electrical machine; see with out brains, not just our eyes • Meynert, Jackson- hierarchy of brain structure and fx; inhibition and regress • The sexologists: Moll, Ellis, Kraft-Ebbing • Archeology-dig for deeper UCS layers • Anthropology-universals in UCS content

13. Freud’s Philosophical Influences • Plato-reality under world of appearance • Kant-limits of reason and perceptions • Schopenhauer, Nietzche, Herbart, Hartmann- UCS sexual and aggressive forces influence behavior

14. Freud: A Crypto Aristotlean Via Brentano • Deductive model building not experimental model testing • A beautiful speculative model must be true-eghumoral, string, neurotransmitter • Becomes dogma-number of horses’ teeth • Freud an exquisite logician-errors come from false premises, not weak argument • Metapsychology is not a science-closes off refutation and inclusion of new data • Appeal to authority impedes progress • Lack of validators promotes schisms

15. Literary Influences • Sophocles • Bible • Shakespeare • Goethe • Dostoevski

16. Strengths • Bridges gap between brain materialism and psychological romanticism • Breath-brain anatomist, clinician, psychologist, anthropologist, art critic • Intellectual ambition-linking symptoms, personality, dreams, myths, literature

17. Strengths (continued) • Smartest person in room-not always right, but never wrote or said a dull thing • No one idea entirely new-UCS in the air, two books in Vienna in 1890’s; sexology was hot new science • But brilliant in putting it all together in one integrated and plausible model • Literary gifts- reaches general audience and leaders of all academic disciplines

18. Freud’s Epistemological Weakness • Talmud: We don’t see things as they are, we see them as we are • Kant/Comte: Beware observer bias-impossible to remove subjectivity • Relation of observer to the observed • Umpire 1: Call them as they are • Umpire 2: Call them as I see them • Umpire 3: They don’t exist till I call them

19. Basic Issues Haunt Psychoanalysis • Subjectivity and projection • Circular reasoning-sought confirmations of theories that could not be disproved • Descriptive reified as explanatory • If you disagree, must be your neurosis

20. Freud’s Methodological Weaknesses • Small n study-20 hysterical patients • Contempt for statistics and experiment • Subjective: Darwin looked as babies, studied primitive men, Freud inferred secondhand from reconstruction • Focused mostly on intrapsychic life- downplays interpersonal causes

21. Freud’s Methodological Weaknesses (Continued) • Ignores great role of suggestion in theory confirmation and treatment cures • Moll- ‘Freud’s theory accounts for clinical hx; histories don’t prove the theories’ • Inheritance of acquired characteristics

22. Freud’s Personal Weaknesses • Freud: “I inherited the defiance of our ancestors defending the Temple” • Breuer: “Freud is a man given to absolute and exclusive formulations” • Fleiss: “The reader of thoughts reads his own thoughts into other people”

23. Freud’s Personal Weaknesses (continued) • Liepmann: “Ingenious artist of thoughts triumphs over the scientific investigator” • Bleuler: “Prickly skin-for or against us” • Jung: “One repays a teacher badly if one remains only a pupil” • Freud: “The goody-goodies are no good and the naughty ones go away”

24. Borrowings-Not Always with Attribution • Breuer: UCS/talking cure/catharsis • Fliess: infantile and bisexuality • Jung: UCS complexes/myth • Stekel: death instinct • Adler: aggression/mastery/ego psych

25. Borrowings-Not Always with Attribution (Continued) • Groddeck: the ID • Rank: signal anxiety/separation anxiety/termination/mother transference • Ferenczi: transference/countertransferen • Alexander: correction emotional experience • Reich: analyze character resistance first

26. Blind Spot: What Do Women Want? • No coherent psychology of femininity-Freud’s boy’s eye view of girls • Castration complex, penis envy, clitoris vs vagina, masochism, passivity • Conventional views of women as neurotic, irrational, undeveloped men

27. Blind Spot: What Do Women Want? (Continued) • Object of desire, not subject of empathy • Downplays role of mother/child bonding • Horney- much fuller female psychology

28. But Positives Too • His influence greatly liberated women • Encouraged female analysts • Strongly influenced by women • Better father figure to female followers

29. Promising Career as Brain Anatomist • Neuron-cell body plus fibrils • Importance of contact barrier • Mediating vs. moderating synapses • Evolution: neurons similar across all species-crab, lamprey, mammal

30. Promising Career as Brain Anatomist (continued) • Development in pups, kittens, fetus, kids • Cells migrate and connections get more complicated, but early structures persist • Gold chloride stain-reported in brain • Types of neurons-Phi for perception, Psi for memory, Omega for Cs

31. But Freud Has a Career Dilemma • Ambition thwarted-how to be great when funding is lost and want to marry? • Viennese dim view of clinical practice • Virchow- “the academic physician can do nothing; the practitioner knows nothing” • Solution-apply scientific, observational, theoretical, literary skills to achieve greatness for clinical not lab work

32. Promising Career as Clinical Neurologist • Agnosia- deficits with intact perception • Cerebral palsy • Aphasia • Cocaine as psychotropic drug

33. Early Steps Toward Psychoanalysis • Translates Charcot and Bernheim; practices and writes on hypnosis • Collaborates with Breuer and has specialty practice focused on hysteria • Attempt to transcend cathartic and suggestion models for psychotherapy • Free association to provide a study tool based on faith in psychic determinism

34. Causes of Hysteria • Early-misled by simple Koch causality • Into a series of blind alleys • Inborn degeneration • Current sexual frustration • Early sexual seductions • Stimulation by caretakers • Stimulation but only by father • Repression of inborn sexual instinct • Later-complementary epigenetic interaction of instinct with experience

35. Why Stuck on Sex as Universal Cause • Excitement regarding Darwin sexual selection • Sexology brings scientific legitimacy • Staging explains choice of neurosis • Libido is missing link mediating brain biology and mental functioning • Interaction nature/nurture • Conflict over instinctual wish fulfillment seems to explain everything

36. Steam Engine Metaphor • Brain as hydraulic power plant • Sexual libido is power source • Symptoms due to discharge, build-up, or transfer of libidinal energies • Neurasthenia-too much masturbation • Anxiety-toxic undischarged stimulation • Neuroses-psychic conflict/repression

37. Symptoms Related to Libidinal Stages • Autoerotic stage-schizophrenia • Narcissistic stage-delusional disorder • Oral stage-depression • Anal stage-obsessive/compulsive • Phallic stage-hysteria

38. Vicissitudes of Libidinal Stages • Regressions • Fixations • Repressions in neurosis • Expression in perversions • Also determine character

39. From Exciting Model to Procrustean Bed • Premature closure/incomplete facts • Deductive theory of everything • Way too rigid-everything is sex instinct • Ignores other instincts-aggression, attachment, status, mastery, altruism • Ignores neural network dysfunctions • Ignores context/interpersonal issues • Freud’s humoral theory

40. Modern Cybernertic View • Brain as computer • Information processing, not energies • Symptoms the result of hardware and software malfunction

41. Dreams-Royal Road to the UCS • Kant and Schopenhauer-dreams as brief madness/madness a long dream • Freud-mind a creative dream machine • Insights from dreams explain not only symptoms but myth, art, literature, and psychopathology of everyday life

42. Dreams as a Research Tool • Allow scientific study UCS process • Reflect lawful connections of all mental functioning-nothing is random • Instincts less repressed revealing primary process and contents of UCS • Free association to interpret content and determine latent content

43. But UCS is Elusive • Associations may be secondary elaborations, not key to latent content • Dream may be no more that Rorshach • No gold standard for interpretation • Wish fulfillment-random pontine firings? • Dreams tell us a lot, but not everything about human nature

44. Why Do We Dream? • Still a mystery • We now know when dream, but not why • Role in memory/homeostasis

45. Topographical Model • Borrowed from Fechner, Jackson, Darwin • CS tip of iceberg; most behavior UCS • Different rules govern different levels of psychic functioning • Freud adds method of study, instinct, regulation by censor, primary and secondary process • Stands up well to modern cognitive science and brain imaging

46. Structural Model-A Freud/H Hartman • Self-preservative and self-evaluating instincts in part inborn and largely UCS • General psychology that anticipates cognitive psychology • But ego psychologists are theorists, not experimenters, so doesn’t advance field • Useful description, not explanation

47. Libido theory a great burden on psychoanalysis • An ingenious but wrong 1890 neuroscience model that restricted its openness to including emerging brain and cognitive science • Freud somewhat corrects imbalance with aggression and the “I” and the “It” • Followers extend further with attachment theory, ego psychology, role of interpersonal factors, conflict free

48. Theories of Everything Bound to Fail • Brain too complex for simple models • Newton: “I can calculate the movement of stars but not the madness of men” • No Newton, Darwin, or Einstein of mind • Ambition spurs insights-but premature models can’t possibly answer all questions and don’t wear well

49. Localization by Brain Imaging • ID- limbic system/brain stem • I-dorsal prefrontal/somatosensory • Over I-ventromedial frontal • Anxiety-amygdala

50. Brain Plasticity • Psychotherapy change brain fx-reduced amygdalar firing in panic pts • Cortical control-can’t deconditionamygdalar responses unless cortical connections intact • Mirror neurons explain empathy for other’s emotions-inferior front gyrus connected to amygdala via insula