The declining influence of psychoanalytic thought and the decrease in the practice of psychoanalysis in our American cultural milieu is increasingly evident. The proximate causes of this decline are multiple and well known. Among them, the rising use of pharmaceutical agents and economic forces favoring short-term therapies.
In the following thought experiment, I shall add another less well appreciated cause resulting from the idiosyncratic nature of history. I shall argue that Sigmund Freud was born too soon—50 years too soon for psychoanalysis to become a viable field today, not only for individuals, but also for families and society generally. One would not think that Freud's birth in 1856 significantly shaped the trajectory of psychoanalysis. But in fact the scientific and cultural changes over the first half of the 20th century were such that had Freud been born in 1906, the trajectory of psychoanalysis might have been more practice friendly today.
Fifty years more or less would have made little difference in the emergence of the Copernican and Darwinian revolutions that preceded the psychoanalytic revolution.
Born in the midst of 19th century positivistic science, Freud was influenced by psychologists and biologists such as Charcot, Bernheim, Janet, Meynert, Brucke, and Breuer, to name just a few. During this era when hysteria was widespread, Freud, to put it simply, discovered that hysterics suffered from repressed “reminiscences.” At the start, the big question that Freud faced was whether these reminiscences were, as he first thought, due to traumatic events, or as he later came to write in 1897, these reminiscences were inextricably bound up with infantile sexual fantasies and conflicts. This eclipse of the seduction theory gave rise to ego psychology, which highlighted these intrapsychic conflicts and dominated psychoanalysis in the first two-thirds of the 20th century.
Fifty years more or less would have made little difference in the emergence of the Copernican and Darwinian revolutions that preceded the psychoanalytic revolution. The discoveries of the earth revolving around the sun and our being descended from our cousin apes would have been discovered by later scientists, such as Galileo and Alfred Russell Wallace, already working in these fields. The psychoanalytic revolution, on the other hand, in the absence of Freud's unique genius, would not likely have occurred. Given his genetic makeup, his self-analysis and his having matured in the period of Newtonian physics, the discovery of psychoanalysis was, as Ellenberger and Makari have demonstrated, the synthesis of one man influenced by 19th century science and psychology.
The first sentence of Freud's The Interpretation of Dreams begins “In the pages to follow I shall bring forward proof that there is a psychological technique which makes it possible to interpret dreams…” This opening sentence to Freud's most well-known book reflects the zeitgeist of 19th century certainty. This declarative statement mirrored that certainty in the face of his founding a completely new science.
The question arises, are we calling psychoanalysis a “science” because it arose in a medical scientific context? Rather we may see Freud as a transitional figure with one foot in 19th century science and as a visionary who, 50 years later, was also seen as having contributed to a “hermeneutical discipline,” with “a whole climate of opinion,” in the 20th century. Though he himself was an atheist, he wrote with the certainty that paralleled later and now as well, the culture's belief in the existence of God and its faith in the certainty of science. Though science has provided us with undreamt of possibilities, faith in both religion and science are no longer certainties that we rely on for meaning in the 21st century. Our search for meaning remains in the light and shadows of the dialogue, or controversies, between scientific and religious thought.
When Freud found himself at the crossroads of his seduction theory and his theory of infantile sexuality he took the “less well traveled road” or the 19th century route searching for the “truth,” which was either/or rather than both/and. The iconic couch became the microscope of the field even as it eventually expanded to a number of schools of psychoanalysis that, in their own way without acknowledging it, tried to revive an interpersonal trauma theory as, for example, self psychology. Though misrepresented as a one-person psychology the use of the couch further consolidated the intrapsychic, as distinct from the interpersonal focus of the seduction theory.
From the start some of Freud's followers began directly or indirectly to challenge the exclusive intrapsychic model. Beginning with Ferenczi on to the more recent “relational”
Fred M. Sander, M.D., an associate clinical professor of psychiatry at the Weill-Cornell Department of Psychiatry, has taught psychoanalysis and family therapy in many settings. His book “Individual and Family Therapy: Toward an Integration,” can be downloaded free at .
and Boston Change Group analysts, the exclusive use of interpretation was questioned as ideas such as Franz Alexander's “the corrective emotional experience” were introduced to treat psychic deficits as well as intrapsychic conflicts.
While intrapsychic conflict largely circumscribed by ego psychology was the predominant model in the first two-thirds of the 20th century, a sea change in physics (quantum mechanics) and, later, in biology (the discovery of the genome and the structure of DNA) occurred in the hard sciences. Einstein's theory of relativity and then Heisenberg's “principle of uncertainty” called into question the certainties of Newtonian physics. The seduction theory and the theory of intrapsychic factors depended on one's point of view just as quantum mechanics taught that whether a subatomic particle behaved as a particle or wave depended on one's point of view.
Had Freud been born 50 years later rather than being influenced by the biologists and psychologists of the 19th century, he might have seen that the seduction theory and the theory of infantile sexuality were not mutually exclusive. Depending on the method of inquiry, the study of an individual on the couch differs from the same individual observed within the family unit, subject to the unconscious conflicts of important others in the family. But, you may say, the unconscious had yet to be discovered.
I am postulating that Freud would still have found the role of unconscious mental life in the family, as he did earlier in his practice with patients like Dora and Little Hans. His self-analysis together with insights into patients and their families repeating conflicts within and across generations would have revealed to Freud, a broader scope for differing meanings in unconscious mental life and their treatment. To repeat, this would have led to an overarching theory of unconscious forces in everyday family life leading to indications for individual psychoanalyses of adults, child analyses, and seeing the collusive unconscious fit of couples and family members leading to analytic couple or family treatment.
A comprehensive array of approaches to a much larger range of patients would have resulted rather than the ever-decreasing number of individuals treated in orthodox psychoanalysis. Certainty in each of these separate spheres would have been illusory and helps explain why human conflicts (intrapsychic and interpersonal) were, as Freud put it, interminable as, for example, when children and spouses live out dissociated parts of a family member. Little surprise then that evidence-based objective findings remain elusive. For example, the results of individual therapy are ever limited by the impact of internal obstacles (e.g., an entrenched superego) and external family factors. As Freud put it in 1917, “the patient's closest relatives sometimes betray less interest in his recovery than in his remaining as he is.” Freud, by 1916, was taking patients who were sui juris, that is, “persons not dependent on anyone else in the essential relations of their lives,” hardly a realistic practice today.
Let us first ask, “What if Freud had not been born?” As I mentioned earlier the Copernican and Darwinian scientific revolutions were inevitable. Not so the Freudian, a not so scientific, revolution. It is highly unlikely that the systematic study of unconscious mental life would have evolved as it did over the past century without the genius of Freud at the intersection of his time and place in the history of psychology. Some fragments of an understanding of unconscious mental life would perhaps have emerged in the arts and humanities where unconscious mental life and creativity are so overlapping. Freud had already led the way in this sphere as early as his analysis of Wilhelm Jensen's novel Gradiva, in which dream interpretation was illustrated in a work of fiction.
In this thought experiment I am mainly changing one variable, Freud's birth in 1906 rather than in 1856. Born with the same genome, the same parents, an equivalent classical education, even without his confidant Wilhelm Fliess, there would have been some form of psychoanalysis. This would have been shaped not by the 19th century medical treatments of hysteria but rather informed by a quantum mechanical view of what is knowable and post-modernism's view of the varied constructions of reality, both affirming the indeterminacy of objective reality. This perspective would have been consonant with the centrality of one of Freud's earliest discoveries, psychic reality.
I am imagining that after Freud's birth in 1906 his father, eager to improve his family's circumstances, as he did in 1859, would have moved them to Berlin rather than Vienna where Freud would have found himself in the same type of gymnasium as he had attended in Vienna. In other words, he had a classical education with exposure to Greek mythology and Renaissance literature with Oedipus and Hamlet no strangers to him. As Peter Gay stated in his 1988 biography, “In truth Freud could have developed his ideas in any city endowed with a first rate medical school and an educated public large enough and affluent enough to furnish him with patients.”
The exclusive focus on the individual in medicine and psychiatry would have been the same as it has been throughout history. And yet Freud would have put forth his “seduction theory” as traumas in families have always existed. In other words, he would have begun as he did in the 1890s, noting the interpersonal determinants of symptoms and character traits. Interpersonal conflicts would have been seen as they were in the early days of psychoanalysis as internalized, repressed, only to return from the repressed unconscious in the form of neurotic conflicts. His main contribution would have been to help shift Kraepelinian psychiatry from its biological roots to a psychological plane. He would not have been alone in this endeavor as multiple schools of psychotherapy, depending mainly
on suggestion, i.e., support and guidance, would have flowered. Freud's further contribution in this second 50-year time frame would have been to understand why so many of these approaches, such as hypnosis, failed because of resistances and defenses. These concepts would have still found their place along with psychic reality and infantile sexuality in core psychoanalytic theory.
Freud's family would have experienced the same anti-Semitism his contemporaries had. By the time he completed medical training he would have made contact with some of the thinkers who were to become part of the Frankfurt School of Social Research (Adorno, Fromm, Horney, Horkheimer) who focused on social processes more than his mentors and colleagues in Vienna, for example in The Authoritarian Personality, the role of the father in German child rearing before WW II was explored.
No longer able to practice medicine as a Jew, after Hitler came to power, Freud fled Germany in 1938, which, as this narrative goes, is the same year he actually fled Vienna with the aid of his colleagues. However, in my reconstruction his aging parents would have passively remained in Germany devastated by the same fate of millions of other Jews who did not escape the Holocaust. In this context, I hypothesize that Freud, suffering from survivor guilt, would have begun his self-analysis (as he originally did after the death of his father in 1896) and without which psychoanalysis would probably not have been created.
His guilt resonated with the fates of Oedipus and Hamlet, tragic figures he had studied in the gymnasium and whose fates he was familiar with. Psychoanalysis shaped more by the influences of modern physics and post-modern literature would have led to a multifaceted, multilayered discipline, a truly broader general psychology. It would not have had the limitations caused by the replication and perpetuation of a century of orthodoxy in insulated training institutes, based, as they were, in 19th century Newtonian science.