Brian Anderson: Welcome back to the 10 Blocks podcast. This is Brian Anderson, the editor of City Journal. Joining me on the show today is Jonathan Clark. He’s a lawyer, essayist, critic, and a contributing editor of City Journal. He’s written numerous stories for us on literature, sports, television, and more. Today we’re going to discuss his essay “What’s Left of Psychoanalysis?” which appears in our autumn 2023 issue and examines the value and limitations of psychoanalysis. So Jonathan, thanks so much for coming on 10 Blocks.
Jonathan Clarke: Thanks, Brian. It’s great to be with you.
Brian Anderson: Since its founding in the late 19th century by Sigmund Freud, psychoanalysis has been both influential and controversial. The true meaning, or the consensus meaning, about Freud’s work has always been a matter of debate. Doubts about his methods have arisen and persist, but still, psychoanalysis does remain a treatment for some for mental afflictions, and its influence on the humanities has been absolutely enormous. Certainly, that’s where I encountered Freud’s work is in philosophy departments when I was in graduate school. I wonder, can you give us an overview of the history of psychoanalysis’ development and where it stands today in relation to the problems of mental illness?
Jonathan Clarke: Well, in the United States, psychoanalysis didn’t really start to get much traction until after World War II. The Defense Department at the end of the war found itself confronted with many soldiers returning from theaters in Europe and Asia and North Africa, suffering from post-traumatic stress disorder, what we now call post-traumatic stress disorder, and they needed a way to treat these veterans and get them functioning again. And psychoanalysis became an option that the Department of Defense embraced. Psychoanalysis then, which it always had adherence in the United States and surprisingly, for a field that was developed in Europe, had always been well received in the United States. It started to grow enormously after the war and more and more psychiatrists began to choose psychoanalytic training as their preferred path into treating patients, especially in outpatient settings. And by, say, the middle 1950s, psychoanalysis was sort of the default treatment method in the United States, not for treating in the inpatient context for people with, say, florid schizophrenia, but for people with depression and anxiety and phobias and who wanted to be treated in an outpatient setting.
The dominance of psychoanalysis lasted into the late ‘70s and then finally ended I would say in 1980, with the publication of the third version of what is known as the Diagnostic and Statistical Manual or sometimes known as the DSM, which is the diagnostic bible for psychologists in the United States. Psychoanalysis was essentially written out of the DSM-III, and since then the field has suffered a decline and to a certain extent, even disrepute in the psychological mainstream in America.
Recently, though, say within the last five to ten years, there has been a revival of interest in psychoanalysis, a revival of intellectual interest, and then also a revival of professional interest as the demand for outpatient mental health service in the United States has increased dramatically because of the COVID-19 pandemic and other forces, which I’m sure we could talk about. So there is this rising tide of interest in a field that is still regarded with enormous skepticism in mainstream psychology. So I think that’s where we are now. People are curious again about Freud and the field is growing, but we’re not sure where it’s going to go.
Brian Anderson: You studied yourself for a time at a psychoanalytic institute and for a time you considered becoming a psychoanalyst, but while you found this world intellectually stimulating, you ultimately were not able, as you described in the essay, to embrace its main doctrines fully. Many of your fellow students, you note, professed great confidence in psychoanalytic methods, the talking cure, yet they couldn’t answer basic questions about the mind’s function. So I wonder, what was it like being a student of psychoanalysis? How does that work, and what were these limitations that you ultimately recognized in its approach?
Jonathan Clarke: One of the reasons I wanted to write the article was to work through some unresolved feelings that I had about my time training as a psychoanalyst, which as you say, I did not complete. Initially, it was very exciting. I’d been practicing law in law firms for a couple of decades. I come from a family of lawyers, I’m married to a lawyer, and so I had looked at the world through this single window for a long time. And the idea of being exposed to people from a variety of different fields, people of great intelligence and intellectual curiosity, it was enormously rewarding and stimulating at first. And what I found was over time, that as I began to pose what I thought were very basic questions to some of the senior members of the psychoanalytic institute where I trained, I was dissatisfied with their answers. And for instance, if I said to them, is schizophrenia fundamentally a biological problem or a psychosocial problem? They couldn’t give me a firm answer to a question like that.
I think this is a problem that afflicts not just psychoanalysis, but that afflicts psychology in general in the United States, that we simply don’t have a consensus model of how the mind works, of what the etiology and treatment of mental disorders ought to look like. We’re still in a benighted state in understanding the psychology of the human mind, and I’m afraid that’s a problem that afflicts the field generally.
Sometimes I found that, as I said in the article, psychoanalysts knew both too little in the sense that they suffered from an inability to answer these basic questions and too much in the sense that they had so much confidence in their treatment methods that they had a tendency to brush aside these questions as irrelevant or pedantic, which ultimately was what troubled me and caused me to stop my training.
Brian Anderson: At the top, we both mentioned that psychoanalysis is enjoying a revival of public interest, but as you’ve noted just now, the discipline does have shortcomings, but so do other prevailing treatments for mental illness. So psychiatric medication, which is seen as a kind of quick fix, sometimes it does bring undesirable side effects, as is also recognized.
Cognitive behavioral therapy is an approach which has become probably the dominant form of talk therapy now, narrative therapy, but its results have been mixed too, I think it’s fair to say, although perhaps there’s some promise there. But in your view, what is it that psychoanalysis is offering that these other alternative treatments might lack, and where does it fit into this spectrum of approaches to mental illness now?
Jonathan Clarke: Cognitive behavioral therapy was actually founded by disenchanted psychoanalysts, I think it’s fair to say, and many of the basic premises are the same, and I do think the evidence shows that CBT is effective in certain contexts. It’s effective in treating post-traumatic stress disorder sometimes, it’s effective in treating certain kinds of phobias or obsessive-compulsive disorder. It’s effective in treating what’s sometimes thought of as ordinary depression, although the study suggests it’s less effective in treating major depressive disorder, which is depression but on a different level of severity and persistence. So if cognitive behavioral therapy is fairly effective in these fields, why do we need psychoanalysis? I think the claim for psychoanalysis is partly that it’s seeking more durable change in the patient, that it is less focused on symptoms and more focused on allowing people to tolerate suffering generally and to make suffering a feature rather than a bug of their experience.
And once we accept that suffering is part of human life, then maybe it makes us a little braver and a little bit more resilient and maybe we can live a little bit more fully. We can whistle through the graveyard of suffering, if you will. That’s the promise or the claim of psychoanalysis, I think. I also think that because of the duration of psychoanalytic treatments, which often go on for years and years and years, I know many people that have been in training with the same analyst or with two analysts or three analysts for a decade or more.
There is a kind of bearing witness that goes on, I think. In a culture where people find themselves increasingly alone and where they’re not buttressed by church attendance or by strong community ties or a strong sense of ethnic or cultural identity, there is a role for the psychoanalyst to play in simply being there week after week and holding your story in their mind and making the experience of living in a very lonely, and atomized society, a little bit less lonely and a little bit less atomized. And so that’s not symptom relief and that’s not transformation of personality, but it may be kind of service to the patient of its own. So that’s what I see. The length of treatment possibly offers benefits that a short symptom-focused treatment like CBT simply can’t offer.
Brian Anderson: You rightly recognize that Freud was an anti-utopian, and that is underscored by your comments about suffering. There is a current of the profession, though, that took on for a time, a kind of spirit of liberation. I’m thinking of Freud’s influence in the ‘60s and ‘70s, which in the work of people like Marcuse and others, took on a very different cast, a kind of radical political cast that Freud himself would’ve been horrified by, I think.
So in the current enthusiasm for, or perhaps that’s too strong a word, in the current growth of interest again in psychoanalysis, is it this kind of stoicism, or this recognition that suffering is indeed something we have to understand and make part of our lives? Is that part of its appeal? Has the liberationist side been completely left behind?
Jonathan Clarke: No, and in fact, I think the liberationist side continues to be the dominant strain in psychoanalysis, but this battle goes on, and in fact, it’s not entirely resolved in the minds of individual analysts. I think in the treatment room, the idea of teaching people to bear their suffering is still very much alive as a concept, but as psychoanalysis turns outward to the world, then this utopian cast, this leftist political cast is more and more evident. So I think that there’s to some extent a split, almost, that if you read the psychoanalytic journals, you would see a strong embrace of fashionable critiques of capitalism and critiques of Western ideology and critiques of race and gender and these sort of things.
But then when you get in the treatment room, I wonder how present all of that stuff is. I think there are still people who might be open and even embracing of the utopian Freud who actually practiced more in the anti-utopian tradition. As I wrote in the essay, the anti-utopian tradition is very much the one that appeals to me. What I found in the psychoanalytic institute where I trained was often, at least on an intellectual level, the more utopian cast, which I found discouraging.
Brian Anderson: A final question, Jonathan. This is something I hadn’t really followed. It was interesting. Psychoanalysis traditionally is a narrative-based understanding of the mind that we script our lives in a way based on these unconscious, unresolved sexual experiences in our youth. But it’s fair to say, I think, that the psycho approach has traditionally been in tension with a biological approach to human psychology, although there was a biologist in Freud too. But recent efforts to balance psychoanalysis with science have produced something called the neuropsychoanalysis movement, which seemed quite interesting to me, and I didn’t really know that much about this. So I wonder, could you describe that a little bit, and how do you assess its potential?
Jonathan Clarke: I was not very much aware of this movement. And then as I began to conduct interviews for purposes of writing this essay for City Journal, the work of a man named Mark Solms was more and more urged upon me. Solms is a South African neurobiologist who’s also a Freudian-trained psychoanalyst, and he’s the leader of this neuropsychoanalysis movement, and unusually I would say, he publishes both in psychoanalytic journals and in mainstream psychological journals. And the core tool of neuropsychoanalysis is brain imaging. And what Solms is attempting to do is to take these MRIs and what we can learn about the functioning of the brain through direct observation and map it on to basic Freudian concepts of the unconscious and the sort of structure of ego and superego that we still sometimes think about. And Solms claims that actually Freud’s ideas consort very comfortably with what he sees on MRI scans.
I find myself a little bit out of my depth in assessing whether that’s a promising area of study or not, but people much smarter than I am, like the famous psychiatrist Oliver Sacks, British psychiatrist Oliver Sacks, whose work is well known in the United States. He felt that it was potentially a breakthrough in the understanding of the mind, and so we’ll have to see where that goes. Neuropsychoanalysis is something that people who work in analytic institutes and see patients all day point to, I think, as a way of resolving this tension between biological and phenomenological approaches to the mind that has dominated, this division has dominated American psychology for a long time. So maybe this is a way to break through the impasse.
Brian Anderson: Well, thanks very much, Jonathan. The essay is called “What’s Left of Psychoanalysis?” You can find it on our website. It was in our autumn issue. Don’t forget to check out Jonathan’s work on the City Journal website. That’s at www.city-journal.org. We’ll link to his author page in the description. You can find all of that work there. You can also visit his website, jonathanclarkewriter.com. That’s jonathanclarkewriter.com, and you can also find City Journal on X @CityJournal and on Instagram @CityJournal_mi. As usual, if you like what you’ve heard on today’s podcast, please give us a five-star rating on iTunes. Jonathan Clarke, thanks very much for coming on.
Jonathan Clarke: Thanks, Brian. I enjoyed it.
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