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Psychoanalysis lacks an adequate etiological theory of the neuroses, and without this there can be no scientific treatment or evaluation of treatment. Etiological theory must explain satisfactorily both the typical features of neurotic syndromes and the individual differences; explain why one individual falls ill and another, under similar circumstances, remains healthy; explain factors underlying spontaneous recovery; show how to prevent neuroses, except in so far as they are due to constitutional factors; and cure neurotics or explain why it fails to do so. Neither the increase in length of training nor the prolongation of the patient's analysis seems to have increased the incidence of cure. Since we have adduced no thorough proof of the therapeutic superiority of our method, we have no right to be dogmatic either toward our patients or our nonanalytic colleagues as to the superiority of our technique or to maintain rigidly some of the rules of analysis such as the prohibition against making decisions during the analysis. Greater therapeutic freedom should be the right of the individual analyst as the need may arise. We must gather new observations, experiment with new methods, try to describe them in new terms, and build new theories. We have to re-examine many of the ideas that we have long held such as the value of insight or of lengthy treatment in the resolution of the conflict. The present tendency toward anarchy in psychotherapy is partly due to the lack of adequate knowledge of etiology and to many preconceived and probably unsubstantiated views concerning therapy, and also very essentially to a confusion of values and aims of therapy.
Dr. Schmideberg paints a picture somewhat exaggerated but well worthy of examination by complacent psychoanalysts, if such there still be.