Unorthodox Freud: The View From the Couch

This book is written by two psychologists who seek to rehabilitate Freud as a therapist by presenting case material from five analyses spanning a 20-year period of Freud's life from age 65 to age 82; these analyses are thought to be “representative of Freud's final technique.” The authors are coming to the defense of a reputation that has been badly lacerated by recent, highly publicized, ad hominem disclosures and accusations calling into question Freud's veracity, motives, and character (1). These five accounts purportedly give us an “intimate view of Freud at work” from the patient's perspective and are “essential to an understanding of how Freud practiced psychoanalysis” (italics mine). The authors deem this important because “the contemporary ideal of mainstream analytic treatment, which is called classical and attributed to Freud, is actually a post-World War II invention.” This allegedly bogus Freudian style unhappily “operates not only as a powerful norm for students, the less experienced and the less original, but also as an inspiration for rebels.”

The authors' intention of resurrecting the real, unorthodox Freud as a corrective for current therapeutic technique sputters and misfires. In the five cases presented, one sees a Freud who is often impulsive, irritable, dogmatic, and disorienting, more concerned with theory than the patient's condition. As just one example, the authors themselves describe Freud's treatment of Wortis as a “wrestling match” in which analyst and analysand were immediately contentious, descending to “unseemly bitching at their lowest points.” Wortis concluded that Freud was “essentially negative and pessimistic in nature,” an opinion corroborated by review of other cases in this book. Freud is also seen to charge in with dream interpretations that are premature, seemingly arbitrary, and unsupported by the patient's associations. When Wortis objected to these “far-fetched” interpretations, Freud told him bluntly that he didn't care whether they pleased him or not.

This alienating style of analysis shows an apparent, if not actual, lack of empathy for the analysand's deepest wishes and needs. The Freud who emerges seems not to care for the patient as a total human being or even as an “integrated self,” in Kernberg's terms (2).

Although Lohser and Newton do not discuss it, one wonders, on the basis of these case presentations, to what extent Freud was imbued with what Ortega y Gasset (3) described as “contempt for the old monumental forms of the soul” in pursuit of an “inhuman attention to the microstructure of sentiments, social relations, [and] characters” so prevalent in the arts, music, and literature of the early twentieth century. This might explain Freud's brushing aside, for example, a patient's need to be thought well of by the great master and why, 30 years later, a new, reactive school of psychoanalysis would seek to patch up a patient's wounded “narcissism.” In any case, Freud's deconstructivist tendencies were clearly in evidence long before they became embodied in his “final technique.” An example of this was his battle cry, “Flectere si negueo superos, Acheronta movebo” (If I cannot bend the gods on high, I will at least set Acheron in uproar),” from the title page of Interpretation of Dreams. Certainly, Freud's heavy reliance on free association and dream interpretation, methods that the authors underscore, tended to bring the outskirts of subjectivity—the small, absurd, self-mocking, and confusing events of life—to center stage in his analytic procedure.

The authors' main targets for orthodoxy are the American medical establishment and Kurt Eissler and his 1953 paper on technique. They are psychologists, and it is no surprise that they do not like a marriage, however moribund, between psychoanalysis and the medical sciences. Regarding the selection of Eissler, they show a curiously limited and antiquated idea of which orthodoxy can be dispensed with. They totally omit discussion of what really became the defining focus of post-World War II conservative analysis, which had far-reaching effects on technique, much more so than any single paper on technique by only one of a galaxy of stars, that is, the establishment of the resolution of the “infantile neurosis” within the context of the transference neurosis as the principal goal and measure of a successful analysis (4, 5). In tandem with Anna Freud, Hans Loewald and the powerful Yale School were the chief exponents of this paradigm; Loewald's name and role are not even mentioned, and Anna Freud's name is mentioned only in passing. Anna Freud's regal stature and influence have been determinative not only in New Haven but in institutes all along the Eastern seaboard. One had only to witness the stir among the faithful her appearance caused in Philadelphia in the early 1970s to be convinced that she was the new orthodoxy defined. With respect to the “rebels,” it is odd that the “overly personal” therapy of Franz Alexander back at mid-century would be targeted when the chilling new orthodoxy in Chicago has its own heroic figure in the name and memory of Heinz Kohut (the specter of Alexander is a regretted footnote for the new orthodoxy).

The authors are to be commended for their scholarly questioning of mainstream psychoanalytic “values, politics, [and] careerism.” However, lionizing Freud the practitioner and egging on the divorce of psychoanalysis from medicine will not revitalize a dying discipline. New paradigms, however “rebellious,” are needed and available. For example, Fairbairn, Winnicott, Coppolillo, and myself, among others, have explored what is called the “third” or “intermediate” area of subjectivity (6–9). This new analytic way of looking at human experience has many connections with modern psychiatric diagnosis (9, 10), new psychotherapeutic strategies (reference 11, for example), and neurology and neuropsychiatry (references 10 and 12, for example). This paradigm holds the potential for reuniting ideas and the intellect on the one hand with affects and emotional feelings on the other, a marriage that Freud unwisely dissolved in his theory of the unconscious and in a deconstructivism run amok. Freud, who did not like music, failed to see that idea without feeling, particularly in the unconscious, is like a verse melody without the plumb line of the harmonic chord.