Freud’s work took place at a particular contextual time and place – the sexually repressive context of nineteenth-century middle-class Vienna. His views were seen as radical at the time, as they challenged the prevailing assumptions about the nature of personality and psychological suffering. His ideas have become part of Western cultural heritage. However, Freud’s theories have been criticized widely, the most frequent being that they are not scientific (Eysenck and Wilson 1973, Steele 1982 and Sutherland 1998).
Both the theories and therapies based on the psychodynamic model have been criticized for their lack of scientific rigour. For example, Steele states:
Unfortunately, Freud’s belief that his work was science, and as such discovered the truth, and his stance that either someone was for or against him created a dogmatic system. He had not developed the critical consciousness necessary to see that psychoanalysis was a method which constructed a causal historical narrative, but that other methods . . . could formulate different and equally plausible scenarios. His insistence on orthodoxy kept his approach to enquiry from being either truly scientific or truly hermeneutic. (Steele 1982: 360) Critics argue that Freud’s theories are too vague to be put to the test of science (Fisher and Greenberg 1996; Sutherland 1998). The scientific process is based on the concept of falsification (Popper 1959). Thus scientific hypotheses should be formulated in a way that they are capable of refutation, that is, can be shown to be false. Although some psychoanalytical conjectures can be tested scientifically many of the concepts are complex and do not easily lend themselves to the process of falsification. However, just because an idea cannot be tested scientifically this does not mean that it is not true, only that it is not possible to provide evidence in support of it.
Evidence for the efficacy of therapeutic techniques developed out of psychodynamic approaches to psychopathology is equivocal. Some researchers point out that the scientific evidence is not convincing, and that findings are typically based on the study of a limited number of people (Eysenck and Wilson 1973). Even if there are other studies that appear to provide some evidence for the efficacy of brief psychodynamic therapies (Malan 1979; Crits-Christoph 1992; Anderson and Lambert 1995), these do not prove the validity of the psychopathological models that underpin them.
A second criticism of the psychoanalytical model is that it is mechanistic, individualistic and is tied to its medical roots. Admittedly the model takes an opposite stance to biological psychiatry, but whereas biological psychiatry tends to reduce psychological phenomena to biology, psychoanalysis tends to make everything a psychological matter – whether describing the biological or the social as well as the purely personal. For many people, there may well be Oedipal conflicts and their attendant neuroses underlying their distress but as the social cultural model of psychopathology highlights, the concerns of everyday life may have far more effect on people’s mental health. The theory and practice of psychoanalysis ignores a consideration of social realities. A third criticism is that the psychoanalytical model does not address the effect of personal futures. This excludes a field of enquiry that may exert a profound influence on human conduct and distress experienced in the present. Much empirical research points out how our expectations and aspirations influence our present conduct. The psychoanalytical model has been generally criticized for being reductionist as it reduces multiple realities experienced within complex social relationships, in the present and past, to one understood within a tightly limited version of hermeneutics. Although psychoanalysis has provided an illuminating and enriching variety of views and insights into the human condition within a hermeneutic framework, nevertheless the theory is always given precedence over the patient’s own view about themselves and their experiences of their world. The patient’s own constructions tend to be viewed as, for example, unanalysed conscious reflections and therefore, inadequate, incomplete or incorrect. Precedence is given to the analyst’s viewpoint and interpretations. The analyst of whatever specific psychoanalytical school has a set of prepared theoretical constructs or hermeneutic formats that are imposed on clients. Psychopathology appears to dominate. This not only applies to Freud’s classical psychoanalysis but also to later developments. Guntrip, for example, takes an essentially reductionist stance when he reduces homosexuality and prostitution to schizoid defences. The varied and interacting uncertainties of life tend to be reduced to single variable explanations. This criticism of reductionism can also be made of the behavioural model.
Some psychoanalysts have refuted this criticism. For example, Casement (1985) emphasizes the importance of resisting preconceptions, and cautions against the psychoanalyst imposing interpretations upon patients. He notes how Bion advised that each analytical session should be approached ‘without desire, memory or understanding’ (1985: 17).
The implicit superiority of the psychoanalyst is very different to the therapeutic position of person-centred therapy that involves being with, empathically and non-judgementally listening to and engaging with the unique experiences of patients. To allow each new patient to have a unique self-constructing story might lead to psychoanalysis turning into a form of phenomenology or existentialism, although some analysts have certainly taken this path, as seen for example in the work of R.D. Laing. Others, such as Lomas (1987), although retaining a broad allegiance to psychoanalysis, criticize its interpretive imperatives and emphasize direct knowledge of people through their unique narratives.
Conclusion
It is impossible to draw definitive conclusions about psychopathology from a psychoanalytic perspective. The legacy of Freud is that we have an understanding that unconscious motives and defence mechanisms influence human conduct, and that early childhood experiences influence later experiences and influence adult personality adjustment. Although to varying degrees, most would agree with this general view, the devil is in the detail. These posts have inevitably had to compress extensive and complex discussions of the psychogenesis of different states of mind and presenting symptoms. The extensive body of psychoanalytical literature that addresses these issues suggests that, whatever the acknowledgement made to Freud in those enquiries, there are many ways of understanding human dilemmas and behaviours that go beyond his theories. Freud’s ideas, and those of many who have take them forward have attracted many followers as well as critics.
Many in the scientific community argue that psychoanalysis is not amenable to hypotheses testing criteria such as refutation inherent in the paradigm of traditional empirical research. Others view the empirical paradigm as an inadequate scientific model not appropriate for the study of subjective human experience. Although evidence suggests that psychodynamic therapy can be helpful, it is open to debate whether this is because psychoanalytic therapists convey valuable insights to their patients about what their suffering means, or because psychoanalysis acts as a flashlight enabling each therapist and patient to find a particular road. Psychoanalytical theory has had an important influence in a wider range of disciplines concerned with psychopathology. It has inspired many developments in the study of psychopathology, one of which we examine in rather more detail in the next posts.
Tags: person-centred therapy, psychodynamic approaches, psychodynamic model, psychodynamic model theories therapies, psychogenesis of different states of mind, scientific hypotheses