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Psychoanlysis' demise is exagerated

Psychoanalysis has been getting a bad press for quite a while now. It is not uncommon to read about it as something that went out with the dinosaurs, as having no evidence base and as long past its sell-by date [1]. Working at the Tavistock Clinic, which continues to practice and teach about psychoanalysis, as well as other modalities, can leave one feeling somewhat under siege. What is maybe overlooked is how much evidence has recently come forward which bears out many of the ideas of Freud and his successors.

 

A typical example is a recent study  which showed that Freud was right about the link between depression and guilt., in that people who suffer from depression tend to also have exaggerated expressions of guilt and self-blame [2]  Brain scans showed that people with a history of depression showed different brain responses in relation to guilt and socially acceptable behaviour..As lead researcher Roland Zahn, M.D., from the University’s School of Psychological Sciences, said: “Our research provides the first brain mechanism that could explain the classical observation by Freud that depression is distinguished from normal sadness by proneness to exaggerated feelings of guilt or self-blame.

Similarly Michigan Professor Howard Shevrin found evidence for the Freudian concept of unconscious conflict in an examination of patients with anxiety disorders and phobias [3]. Here words capturing the nature of the unconscious conflict were selected from in-depth interviews and used as stimuli in a laboratory experiment. The researchers also selected words related to each patient's experience of anxiety disorder symptoms. These verbal stimuli were presented subliminally at one thousandth of a second, and supraliminally at 30 milliseconds. A control category of stimuli was added that had no relationship to the unconscious conflict or anxiety symptom. "Only when the unconscious conflict words were presented unconsciously could the brain see them as connected," Shevrin notes. "What the analysts put together from the interview session made sense to the brain only unconsciously."  Indeed even that a prominent critic of psychoanalysis and Freudian theory, Adolf Grunbaum, apparently  expressed satisfaction with these results which suggest that psychoanalytic concepts can indeed be tested.

This is of course not by any means the first of this kind of research. Mark Solms has been showing that contemporary neuroscience bears out many psychoanalytic ideas for quite some while, [4], developmental researchers such as Beebe [5], Stern [6] and Tronick [7] have long  been illustrating how psychoanalytic ideas such as about defences are backed by research, while psychoanalytic ideas are being tested in other therapies, such as in the allied field of mentalization [8]. Indeed much research about non-conscious and unconscious processes by leading researchers such as nobel prize-winner Daniel Kahneman [9], [10]. We are even seeing impressive results come through in some research studies. A recent study for example compared with psychoanalytic and psychodynamic therapy in the treatment of patients with a primary diagnosis of unipolar depression [11]. It  found that psychodynamic or psychoanalytic therapy was considerably more effective than CBT at 3 year follow-up. There are other studies coming through in the next few years with children and young people which might well yield similar results.

While I believe that psychoanalytic thinking, if it is to retain any place within therapeutic culture, needs to embrace other forms of research such as neuroscience and developmental thinking, it is also true that reports of its demise are still greatly exaggerated.

 

[1]          P. Salkovskis and L. Wolpert, ‘Does psychoanalysis have a valuable place in modern mental health services? No’, BMJ, vol. 344, 2012.

[2]          C. Zahn-Waxler and C. Van Hulle, ‘empathy, guilt, and depression’, Pathological Altruism, p. 321, 2012.

[3]          H. Shevrin, ‘Consciousness, states of consciousness, unconscious psychological processes, and psychological states’, Sensory Perception, pp. 265–273, 2012.

[4]          M. Solms and K. Kaplan-Solms, Clinical studies in neuro-psychoanalysis: Introduction to a depth neuropsychology. New York: Other Press, 2001.

[5]          B. Beebe and F. M. Lachmann, Infant research and adult treatment: Co-constructing interactions. New York: Analytic Press, 2002.

[6]          D. N. Stern, The interpersonal world of the infant. New York: Basic Books, 1985.

[7]          E. Tronick, The neurobehavioral and social emotional development of infants and children. New York: Norton, 2007.

[8]          A. Bateman and P. Fonagy, Psychotherapy for borderline personality disorder: mentalization-based treatment. New York: Oxford University Press, 2004.

[9]          D. Kahneman, Thinking, fast and slow. Farrar, Straus and Giroux, 2011.

[10]        D. Kahneman, ‘A perspective on judgment and choice: mapping bounded rationality.’, American psychologist, vol. 58, no. 9, p. 697, 2003.

[11]        D. Huber, J. Zimmermann, G. Henrich, and G. Klug, ‘Comparison of cognitive-behaviour therapy with psychoanalytic and psychodynamic therapy for depressed patients-A three-year follow-up study.’, Zeitschrift für Psychosomatische Medizin und Psychotherapie, vol. 58, no. 3, p. 299, 2012.

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Tuesday, 21 May 2019

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