As Oliver Burkeman recently outlined, the therapy Freud invented, psychoanalysis, is at last gaining some much-needed empirical support, while at the same time the default treatment on offer in the U.K., quick fix, symptom-focussed cognitive-behavioural therapy (CBT), is increasingly looking like some sort of snake oil.
CBT appeals to our common sense. But common sense isn't as common as we'd like to believe.
Freud’s revelation was that we are not necessarily always logical, rational beings making optimal choices as we navigate through life’s vagaries, that we are in fact to a large extent strangers to ourselves.
A few years ago, a relative had a terrible holiday in Italy. On returning home, in retaliation, she boycotted her favourite local Italian restaurant and has not been back since. This marvelously illogical yet so very human protest is typical of how inventive and fluid our psychology can be.
Unlike my relative’s very deliberate restaurant boycott, however, Freud argued that much of what we do operates “under the hood,” out of awareness. Our conscious, stated desires can be different from or even completely opposed to our unconscious ones. We might say we want to give up smoking, or find a partner, or start (or finish) a big project, or do something bold and courageous, but somehow we find ways to ensure it doesn’t happen. We make mistakes, and we vow never to be so foolish again, but then we find ourselves doing the exact same thing. Over and over. Freud called this “repetition compulsion.” Britney Spears called it “Oops, I did it again.”
According to Freud, our unconscious motivations generally can be traced back to our formative years. We learned how to be in the world as children, and decades later this blueprint remains. Sometimes it’s as if we were insisting on still using a crutch long after our broken leg has healed. The blueprint includes an imperative to repress disturbing ideas, thoughts, emotions, events, memories and conflicts from long ago. But they are not so easily silenced—they retain some kind of energetic charge which can find all manner of expressions, sublimations, projections and other creative outlets.
One of Freud’s patients, five-year-old “Little Hans,” had an intense fear of horses—Freud said they represented his father. “Rat Man” had an obsessive, intrusive fear of torture involving rats and bottoms which Freud linked to early experiences of discipline and sexuality. “Dora” had a suicidal breakdown after being propositioned by a family friend because, claimed Freud, she was repressing a lesbian attraction for the man’s wife. Freud’s most notorious cases are summarized here.
Freud argued that neurotic symptoms, when unmasked, usually make some kind of sense. They have an intent, a meaning; they exist to resolve something or defend us from pain, guilt or shame. Merely removing the symptom without addressing the cause—the CBT approach—might just lead to another symptom.
And anyway, a symptom is not so easily removed. Since it serves a purpose, writes Freud, a patient will “make the most of it, and when it comes to taking it away from them they will defend it like a lioness her young.”
Freud defined his invention of psychoanalysis as “the science of unconscious mental processes.” The power of the unconscious is his greatest legacy.
Darwin told us about ourselves as members of the animal kingdom. Marx told us about ourselves as members of society. Freud told us about ourselves as individuals.
The battle within
A cornerstone of Freudian psychology is his 1923 structural model of the human psyche. The idea—which wasn't original: Plato proposed the same thing two millennia earlier—is that we have three parts to our interior system of government, which Freud called the id, ego and super-ego. The selfish, erogenous, childlike id seeks gratification. The autocratic finger-wagging super-ego by contrast is a sanctimonious, guilt-inducing presence, forever hectoring you about what you should be doing. Mediating in between is the harried, democratic ego, trying to keep everyone happy. It’s like having Caligula, the Pope and Bill Clinton sitting around the negotiating table. On different days, some voices are louder than others. Freud likened the internal conflict between the three constituents to a legendary 5th century battle between Attila and the Romans and the Visigoths.
The battle is as old as the hills and most people—and families, cultures, countries—generally have a default setting, either on the side of the super-ego, favouring restraint, prudence, safety and being “good,” or on the side of the id, living their lives with more freedom, spontaneity, creativity, passion and throwing caution to the wind. Many clients belong in the former category, paralysed by a brutally harsh inner self-critic. The more you try to please the super-ego by doing the “right” thing, the more demanding and punitive it can become. The super-ego usually has its origin with parents, but also can come from teachers, bosses, governments and religions. Freud writes that it “rages against the ego with merciless violence.” That violence can be the cause of much psychological and somatic distress.
Therapy is about shining a light on these and other haunted caverns of the unconscious, understanding them, accepting them—making the unconscious conscious or, as Freud put it, “where id was, there ego shall be.” To be enlightened is perhaps to have no fears, illusions or deceptions about one’s propensity for darkness.
• After a lifetime of short-term relationships with troubled men, Karen is lonely and desperately wants to settle down. She has a social life, she does various evening classes, she has joined a dating site. “But there are no good men out there,” she complains. Her checklist of criteria that must be fulfilled is so long that she has effectively ensured it will never happen. She is thus spared the pain of rejection. In therapy we learn that Karen’s father left the family when she was 10 and was barely spoken of again.
• Dave lives under a blanket of depression. He collects evidence everywhere for his worthlessness. Every chance remark, askance glance or unsuccessful outcome is added to the rap sheet and presented as evidence that there’s no point. He is thus relieved of having to take responsibility for his life and the possibility of real failure is averted. Dave initially dismisses the fact the he was born into an acrimonious divorce—which he feels was his fault—as irrelevant “ancient history.”
• Jessica is a workaholic with no time for relationships. She has risen to the top of two professions and is considering starting a third. She has a history of unexplained physical complaints and finally sought out therapy when one morning, on her way to work, she inexplicably burst into tears. She came to realize how as a teenager, after her father had died, she had become “the man of the house,” helping her depressed, bereaved mother, looking after her younger siblings, getting a part-time job to make ends meet. She held the family together; now she lives alone.
*These are fictionalized, representative stories; names and details have been changed
Freud’s influence was far-reaching and profound. But he was a flawed character. You get the feeling he started to believe in his own myth. Patients often had to fit into his theories rather than the other way round. Any dissent might be met by indignant harrumphing or an ended friendship. He was capable of exploiting his position as a white male authority figure for personal ends. His work was sometimes more to do with furthering the legend of Sigmund Freud than with healing.
Some of his ideas and speculative musings have great metaphorical and symbolic value, yet he invited ridicule by insisting on speaking in absolutes and the rigid certainties of hard science. He was somewhat obsessional, detached, and ironically perhaps not so much of a people person, once writing, “I have found little that is ‘good’ about human beings on the whole. In my experience, most of them are trash.” The best they could hope for was “common unhappiness.” In photographs, his facial expressions run the gamut from utter foreboding to grim disdain.
Freud claimed psychoanalysis worked. He would identify unconscious motivations and unhelpful patterns, explain them to the grateful patient and, thus fortified, the patient would make better choices going forward. Except that very often they didn’t.
Today’s therapists who work at any depth will, like Freud, want to uncover your blueprint, your patterns, your unconscious processes. They might explore your childhood, interpret significant memories, analyse your dreams, which for Freud were the “royal road” to the unconscious. But they know that, while self-knowledge is helpful, it only takes a client so far. Lasting change and healing comes from the heart as well as the head, through acceptance, support and love. Research shows it is the therapeutic relationship itself which heals.
Good therapists are not inflated with their own importance, nor blinded by their own certainties. They treat clients ethically, not just because there are codes of ethics to abide by, but because ethical therapy is inherently good therapy. Above all, they are fully engaged with the client, noticing what is happening between them, and always working in partnership with them, in their best interests, rather than lording over them as they lie on the couch, prostrate and exposed (whether as a client or a therapist, I prefer to sit chair to chair and eye to eye). A good therapist cares.
It’s not enough to know and be known. To thrive in this life it helps, too, to love and be loved.