Freud, the Making of an Illusion, by American literary critic and UC Berkeley emeritus professor Frederick Crews, offers spellbinding writing and musters compelling evidence and scientific reasoning. His verdict in his latest book on Freud is devastatingly negative: Freudian psychoanalysis offers us neither a tenable theory of mind nor a proven psychotherapy. Crews considers Freud’s Dora case study to be “the product of a mind that conjoined illogical and bizarre ideas with misogyny, prurience, and cruelty” (613). Dora was an eighteen-year-old girl with voice loss who Freud “analyzed” for eleven weeks during the year 1900. About a quarter of the book offers outcome data (often newly available) describing most of the other patients Freud treated in the later nineteenth century, during which he announced his most important discoveries. Crews concludes that Freud failed to achieve any corroborated cures of patients and that he falsified clinical observations to justify specious theories. He claims that Freud’s daughter Anna and his official biographer, the English neurologist Ernest Jones (in his hagiographic The Life and Work of Sigmund Freud published in the mid-1950s), concealed the negative outcome of Freud’s analytic treatments.
The author quotes extensively from a treasure trove of recently released private letters Freud wrote to his fiancée, Martha Bernays. These indicate that his cocaine dependence was more severe and far longer-lasting than previously known. It significantly affected his writing, marriage, moods, and treatment assessments. And his mistaken conviction that cocaine was an antagonist of opioids led to the almost fatal mistreatment of an addicted colleague and friend, Ernst Fleischl.
Vigorous opposition to Freud began during the first half of his long lifetime (1856–1939). Such antagonism could not be discounted as rampant anti-Semitism, dislike of his atheism, or puritanical discomfort with his finding of sexuality in all psychopathology. The counterattack that his many critics suffered from “resistance” and “unconscious counter-transference” was never open to disproof.
Historians can learn much from Crews’s vivid recreation of the years when psychiatry was inseparable from psychoanalysis. He makes clear that Freud was misled by hero worship of nineteenth-century physicians such as Wilhelm Fliess and Jean-Martin Charcot, the founder of French neurology. Hippolyte Bernheim recognized that Charcot’s experimental results on hysteria were severely contaminated by suggestion, but Freud did not accept this. Neither could he accept Charcot’s explanation that psychosomatic symptoms were hypnotic stigmata associated with a proclivity toward degeneracy, female hysterogenic zones, and male “quasi-ovarian zones.” Therefore, he posited a potent pathogenic invisible and unmeasurable energy hidden in an “unconscious” region of the psyche. Freud’s postulation of this unsubstantiated energy later was transformed into the familiar if imaginary forces—“libido” (sexual), “destrudo” (aggression), and “thanatos” (death)—widely used to “explain” human behavior by psychoanalysts during the twentieth century. These concepts and terminology applied to psychopathology were hardly an improvement over the ancient belief that a wandering uterus produced disabling psychological symptoms in women.
But such Freudianism was transplanted across the ocean to America. Until recently, psychiatric nosology was still dominated by Freud’s formulations. The Diagnostic and Statistical Manual of Mental Disorders (DSM) edition I (1952) featured the terms dissociative reaction, conversion reaction, and anxiety hysteria; DSM III retained the terms conversion disorder and somatization disorder. Finally, the 2013 DSM-5’s Somatic Symptom Disorder included only the word conversion. Escape from the psychoanalytic frame of reference has improved our diagnostic precision.
But how were we psychiatrists (including the current reviewer who was a psychoanalyst) deceived for so long? Freud at times could be a splendid writer as is shown in his eloquent descriptions of mourning for the dead and in his moving 1915 war essay On Transience. Crews considers Freud’s The Interpretation of Dreams to be an ingenious hybrid text, comparable to the Ulysses of James Joyce. At best his fabricated case histories resemble Sherlock Holmesian narratives. But for psychiatrist-analysts, the heavy investment of time, energy, and money in a personal psychoanalysis and the years of study required to become a career analyst constituted strong incentives to defend the analytic ideology.
Many of today’s psychiatrists accept Crews’s negative views of Freud but maintain that his outdated theories and therapy have been better elaborated by fellow travelers such as Carl Jung and Melanie Klein. Several American psychoanalysts have advocated replacing depth psychology with empirical descriptions closer to everyday experience. The contributions of Erik Erikson and Heinz Kohut have proved far more applicable for treatment. A variety of other more contemporary versions of analytically informed treatment (“psychodynamic psychotherapy”) continue to be widely used by both American and continental psychiatrists. For this reviewer, who tries to ameliorate mental conditions following severe emotional trauma, psychodynamic psychotherapy still appears to be as efficacious as prescribing medication or using Prolonged Exposure and Cognitive Behavioral therapies. Some of Freud’s clinical descriptive terms seem to have become permanently embedded in the consciousness of most of us who try to understand and help patients through talking to and about them. But Crews has convinced me to question or jettison most of Freud’s spurious contributions.