Psychoanalysis and Faith
To the Editor:
It is unfortunate that Lillian Blumberg McCall chose to use her review of Dr. C. P. Oberndorf’s History of Psychoanalysis in America (April) as an occasion for petty self-pleading and captious criticism of psychoanalysis in general. In projecting her personal dissatisfaction with the results of psychoanalysis onto “anyone who has ever been analyzed” she reveals her bankruptcy as a serious critic.
Every psychoanalyst knows, and will unhesitatingly state, that there are many patients who like Mrs. McCall terminate analysis with the feeling of being “the same old you.” But every analyst and every analytically-oriented psychiatrist can point to many others who have emerged with quite different feelings, and whose change from “the old you” can be attested to not only by themselves but by those around them. That there are not more such is unfortunate, and indicates the existence of unresolved theoretical and practical problems. These problems will not be solved by imputations to analysts—medical analysts, of course—of motives of greed, dishonesty, and opportunism.
In her orthodox unorthodoxy Mrs. McCall casually dismisses certain technical rules of psychoanalysis as “matters of custom.” It does not seem to have occurred to her that the value of these “matters of custom” may have been repeatedly verified by empirical means, or that in cavalierly discarding them the “non-orthodox schools” may have thrown out the baby with the bath. The distinction between flexibility and doctrinaire anti-Freudianism seems to have escaped her.
Mrs. McCall is, of course, correct in her frivolous observation that there is no present evidence to prove that “five times a week is five times better than once a week.” Mrs. McCall knows perfectly well that quantifications of this kind are impossible of achievement, Most psychiatrists will agree, however, that the degree of therapeutic success varies distinctly, if not directly, with the frequency of sessions in most cases even when non-analytic techniques are used. If five times a week were only one and a half times as good as once a week, and the one-half were to mean the difference between success and failure, might it not then be justified?
The problem posed by Mrs. McCall’s review does not lie in her offhand attacks on particular “schools” or particular technical procedures. The problem is that of an irresponsible, personally motivated attack on a major scientific discipline which is itself making serious efforts to improve its techniques of self-observation and research methodology (see the recent work of Kubie, Escalona, Glover, et al). The case for psychoanalysis does not rest on “five times a week” or on the use or non-use of “the couch.” It rests on its incalculable contributions to the understanding of human behavior and its readily verifiable benefit to increasing numbers of patients who, even when treated by non-analysts, are the beneficiaries of the contributions of psychoanalysis to all modern psychiatric and psychological thought.
Dr. Oberndorf is indeed a man of candor, and his scientific skepticism and his demands for flexibility and constant self-criticism on the part of analysts have earned for him his place of honor in his profession. He has been ill served by Mrs. McCall’s embittered and patronizing review.
Aaron H. Esman (M.D.)
Takoma Park, Md.
Mrs. Mccall writes:
I’m getting tired of the heads-I-win-tails you-lose character of the Freudian attacks on me. The last time I wrote about psychoanalysis I didn’t mention that I’d been psychoanalyzed. It didn’t seem relevant because I was discussing the evidence of its clinical effectiveness as presented in the literature. It wasn’t then and isn’t now my fault that there is no evidence that the therapy works. However, because I didn’t mention that I’d been analyzed, my critics assumed that I hadn’t been and I received several nasty letters to the effect that anyone who hadn’t been analyzed was not competent to discuss the sacred subject. This time I confessed and what happens? I’m incompetent because I have been analyzed and take a dim view of the therapeutic effectiveness of psychoanalysis out of motives of personal revenge. As a matter of fact I am, after twelve years, still fond of my analyst. Why must psychoanalysts attack their critics instead of the arguments? Are we to assume that their failures are so many that they have become oversensitive? The business of personal motivation is a double-edged sword; psychoanalysts are not immune to the usual human frailties. They have been known to go mad and to commit suicide. I can only say, “Physician, heal thyself!” In any case, a “major scientific discipline” is suspect when it treats criticism as heresy. . . .
Dr. Esman doesn’t accuse me of error. He just thinks it is indelicate to discuss publicly what every psychoanalyst knows—that the system doesn’t work in practice as it is supposed to in theory. It is certainly something to consider if, as Dr. Esman says, “many patients” terminate treatment with the feeling that it has been a failure. How many? One out of ten? Five out of ten? Nine out of ten? Dr. Esman doesn’t say, but it doesn’t strike me that the question is “frivolous.” I agree that psychoanalysis poses many unsolved theoretical and practical problems. Should patients be asked to pay $75 and up a week for several years while the psychoanalysts try to solve problems that as far as they or anybody else can tell may be insoluble? If it is any comfort to Dr. Esman, I think that the only virtues possessed by the non-orthodox schools are negative: they are less expensive and time-consuming. Nobody has shown that they are less or more effective than the classical procedure. Dr. Esman is talking through his hat when he says that the technical rules of the orthodox procedure have been “repeatedly verified by empirical means.” Let him cite the evidence. “Most psychiatrists,” he says, “will agree, however, that the degree of therapeutic success varies distinctly, if not directly, with the frequency of sessions in most cases. . . .” I’d like to be around when two psychiatrists agree on anything. As Dr. Oberndorf pointed out, psychiatrists don’t agree on diagnosis, the purpose of the therapy, when to terminate it, or its results. Stekel, for one, believed that the degree of success could vary inversely with the length of treatment and frequency of sessions.
The “incalculable contributions” of psychoanalysis “to the understanding of human behavior” axe exactly that—incalculable. If its benefits are so readily verified how come they have yet to be verified? The fact that some people think the therapy has helped them doesn’t constitute proof of its effectiveness. Some people swear by chiropractic but that doesn’t make chiropractic “a major scientific discipline.” It only means—as any general practitioner can tell you—that faith is a powerful therapeutic factor.