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In psychiatry, as in medicine throughout its history, theories of cure and the prevailing theory of etiology are always intertwined. Galdston divides the etiological theories of psychiatric illness in the past one hundred fifty years into eight categories. He then correlates the dynamics of the cure with each theory of causation.
The major portion of this paper, however, is devoted to a critique of the period since the introduction of psychoanalysis. Repression and free association are the foundation stones of the psychoanalytic theory of neurosis and psychoanalytic therapy. Both concepts are 'brilliantly conceived' and are valid in many instances, but they may lead to pitfalls. Free association is not a unique process of mentation but is 'in essence no more than the basic processes of thinking and recall, exercised in an extraordinarily permissive atmosphere'. Free association is misunderstood, has become 'a shibboleth in psychoanalysis … [and] is responsible for much drag and lag in therapy, … and the loss of precious time'. There is a magical expectancy 'that if the patient recumbent