Reading a new book about Freud initially leaves a reader with a feeling much like entering McDonalds:  how can this meal be any different than the last?  While in McDonalds, this consistency is highly prized and expected, in the world of books, something new is expected.  Thus, for an author, even of Peter Kramer's caliber and reputation, to take on a request to write yet another book about Freud (as his publisher's "Eminent Lives" series requested), would seem a bit risky.

I did not expect Kramer to pull it off, and, when a friend wrote me that this book was full of new and intriguing material about how Freud had not really been what he has seemed to be — my first reaction was that it could not really be new material, or perhaps it was only new to those who had not read the work of those honest critics of Freud, who belatedly (decades after Freud's death) but not too recently (the honest critique of Freud began in the 1960s) had revealed what there was to know.

I was pleasantly surprised: expecting little new, I found much I did not know (and though not a Freud expert, I probably have read more than most psychiatrists, at least, about him); feeling settled as a critic of Freud, I found myself even more critical when all was said and done; thinking I knew the basics of Freud's famous cases, I found I had not fully appreciated how poorly they transpired.

Like a novelist, Kramer excels in the telling details.  George Orwell once wrote that all writing has to grow out of vision — that we should "see" what we want to say, and then find the words to say it.  Done well, this kind of writing is not only graphic and pleasing, but it leaves the reader with visual images as well — more powerful, and more easily recalled, than words.  After finishing this book, the overarching visual image that remains with me is of Freud's patient (the wife of his childhood best friend, no less) pitching herself over the long narrow spiral staircase of Freud's building (the kind of stairs that, in Europe, connect from the outside entrance to inner apartments at each level), falling downward as if in a spiral herself, until she lands in a bloody heap at the bottom floor.  I had never heard of such a suicide, such an aggressive self-murder, at Freud's door.  I recently asked a prominent psychoanalyst here in Atlanta (who also plans another Freud biography!) about the stairway suicide: Had he ever heard of it?  Yes, he nodded, a bit too knowingly.  Now I felt like my friend who had written about the new discoveries of the book.  How come I had never heard?  (Kramer's book is meant to be a concise biography, so it has no footnotes or specific references, which hamper verifying material like this report.  He appends an annotated bibliographic essay though).  All these years of studying with psychoanalysts, of conversing with them about Freud and his ideas, of gossiping about Freud's foibles and flaws, and talk of the suicides of his students and colleagues —  yet no one had mentioned Freud's own patient impaling herself in the stairwell. 

Perhaps it does not matter, so many years later. Indeed, it may not. Suicides occur for all clinicians; I have experienced one too.  The problem, instead, may be rather Watergate-like: it is not that something happened, it is that no one wants to admit it.

Overall, that seems to be the tone of Kramer's book. Freud was a great man, a brilliant man, etc. etc.  There is really no need to add to the string orchestra of superlatives that has played for almost a century.  The arias of acclaim have had their day.  Indeed, for all I know, Freud deserves most of it.  But he clearly was not a divinity.  So let's hear about his flaws too.  It could be he only has a few, far outweighed by his virtues; but let us judge.  I speak here to psychoanalytic mavens who seem to protect the old Viennese neurologist as if he were signing their paychecks weekly (indeed in a way he is), and also to those who have wanted to preserve a divine aura at all costs (like his daughter Anna Freud's coterie).  It may be in fact that his virtues grew out of his vices, and thus the one cannot be understood without the other.

Freud's main vice was his dogmatism.  The man would not brook disagreement, at least about his main ideas.  In fact, letters exist between Freud and Stanley Hall (president of Clark University who had invited Freud to the US in 1909) in which Hall takes Freud to task about this habit (the letters were exchanged in the 1920s after the excommunication of Jung) and Freud defends his strict attitude.  Indeed, the virtuous flipside here is that Freud knew how to take a stand; he was courageous and clear about his ideas, a wonderful quality when one is right, a massive weakness when one is wrong.  The level of dogmatism that Freud bequeathed to psychoanalysis as a tradition was deadly from the start:  So certain that their truth was the only one, or at least better than all the rest, psychoanalysts took over psychiatry (in the US at least) as if they were enlightened colonizers sent to the bush to save the natives.  As later psychiatric critics put it, case conferences became intolerably boring in the hands of psychoanalysts:  the end could always be predicted at the beginning, and all cases ended up in the same place – repressed unconscious sexual instincts, the Oedipus Complex or some variation thereof, and infantile wishes.  (Kramer cites a parody in a play by Moliere:  "If the patient loved his mother, it is the reason for this neurosis of his; and if he hated her, it is the same reason for the same neurosis.  Whatever the disease, the cause is always the same.  And whatever the cause, the disease is always the same.  And so is the cure: twenty one-hour sessions at 50 Kronen each." p. 110))

Vice number two (Kramer brings this out clearly): he was extraordinarily ambitious.  Kramer describes how Freud seemed to go from idea to idea in his early medical career, seeking to hit a lottery ticket for fame; it did not seem to matter if the magic numbers alighted on the id or on cocaine: whatever made for fame was what Freud wanted. Now there is nothing wrong with wanting fame; we all dream of such acclaim (at least in adolescence).  But there are some risks, too, in sacrificing to what William James called "the bitch-goddess, Success."  Freud was even willing to sacrifice his students' lives, if one takes the example of Victor Tausk.  (This is perhaps a bit too well-known for Kramer to spend much time on it. In a way, I was pleased by this, for I had thought that the Tausk affair was about as sordid as Freud's life got, and I was not going to be impressed by a rehashing of it; but Kramer went for more fresh material, like the stairway suicide. But, for the purposes of review, it may be worth revisiting the case first broken into the open by Roazen in his book Brother Animal (1967): Tausk had manic depressive illness, was hospitalized in asylums, and came to Freud as a medical student. Upon learning of Freud's ideas, he naturally wanted to apply them to understanding depression and mania. Freud pre-empted him by publishing his own sole work on depression "Mourning and Melancholia", before Tausk could write anything; Freud then began to ostracize Tausk, pushing him off onto others for analysis and supervision, ultimately ending in Tausk's suicide).

Vice number three and we will stop here:  Freud broke all his own rules.  Psychoanalysis is a trade with many rules for the analyst:  sit behind the patient, don't reveal much about yourself, establish transference, interpret resistance, etc.  It is all a rather boring affair, in many ways, at least for patients who want much reaction from their doctors. But Freud was anything but boring. The real Freud was quite human and interactive with his patients.  He would let his dog into the room to sniff around; he gave advice freely (too freely at times, enjoining divorce or adultery in some cases — as Kramer shows); he let his opinions be known.  After historians revealed Freud's actual methods (in recent decades — almost half a century after his rise to fame), psychoanalysts responded that the founder of the field could break the rules, but his followers needed to adhere to them. Again the odor of divinity: what is allowed to the gods mere mortals cannot bear.  Yet this vice is more virtue, I think: Freud was perhaps the greatest psychotherapist — too bad he tried to keep others from following his example, rather than his texts.

         

The friend who wrote me about this book asked a good question: If Freud was so flawed, how did he manage to fool so many people for so long?  One thought is that he really did not fool anyone who did not want to be fooled.  In other words, people want dogmas; people like dogmas; we want to be told what is right, without worrying about what is wrong; Freud's dogmatism fills a human instinctual wish, if you like. But there are plenty of dogmas, why this one?  Perhaps because his vices were also virtues. Indeed, I recently read another review of this book in a mainstream psychiatric journal in which the reviewer ends, after a mostly positive review, by saying that this book reminded him so much of Freud's value that he decided to pay a visit to the statue of Freud that stands at Clark University, whereupon he squatted next to the marble man, looked up, and whispered: "Thank you."  I could not be sure that we had read the same book, because my instinct would have been instead to knock on the statue to see how hollow it was. But be that as it may, there is something about his work that has had an impact, that has probably tapped into some deep truth. Perhaps it is, as Freud himself put it (somewhat grandiosely) the removal of man from the center of his mental universe (the emphasis on emotions rather than reason), which Freud analogized to two other great ego-deflating revolutions (Copernicus removing the earth from the center of the physical universe, and Darwin removing humanity from the center of the biological world).  Freud of course was not alone in this insight:  In my mind, William James did it just as well (and needless to say less dogmatically) in his Principles of Psychology and in his overall philosophy.  Freud will do for some; James for others.  I am willing to give them both room to shine, Freudians have, in contrast, tended to see only one light in the darkness. 

A colleague recently asked me why I am so critical of Freud.  In my view, one is obligated to critique when others are not; where obeisance is the rule, rebellion is enjoined. In contrast,  an unpopular thinker does not deserve more dirt; his virtues needs to be reasserted. Freud remains popular, despite his critics: hence criticism is still required.  To take the other kind of thinker: Karl Marx has been beaten down plenty in recent decades, and with no Soviet system to prop him up (unlike the psychoanalytic institutes which continue to venerate Freud), the old socialist has few defenders. But he was a brilliant thinker too, with many useful ideas, which, like those of Freud, have become incorporated into modern thought.  Yet as it would be folly to pretend that economics (or even part of it) can be replaced by Marxism, so it is folly to think that most (or even part) of psychiatry (or psychology) can be reduced to psychoanalysis. Few self-respecting economists believe the first lie; many psychoanalysts still seem to believe the second.  

I'll end with where my friend Paul Roazen ended just before his death two years ago.  Paul was a pioneer in the history of psychoanalysis in the 1960s.  Yet, he soon conflicted, despite his sympathy for psychoanalytic thinking, with the Freudian establishment. Intrepidly obtaining the first oral history of psychoanalysis (based on interviews of most of his living followers and patients), he discovered, and then began to make public, secrets which Freud and his followers had tried to suppress:  Tausk's suicide, the fact that Freud had psychoanalyzed his daughter Anna, various sexual liaisons between famous analysts and patients (a major breach of medical ethics), interpersonal conflicts of various kinds, attempts to demean certain figures (like Jung or Otto Rank) who disagreed with Freud, and so on.  Roazen spent most of three decades trying to discover and tell the truth, at the price of being seen as an enemy by leaders of psychoanalysis (Anna Freud once said: "Everything Paul Roazen writes is a menace.").  Yet, at the end of his life, when he collected decades of essays in a final book (The Trauma of Freud: Controversies in Psychoanalysis), Paul wrote a final chapter in which he reminds us that critique is in the service of truth, not simply to attack.  And there is much that is useful, perhaps even truthful, in Freud's work. 

Some psychoanalysts are turning these days away from any talk of truth. They have turned to social constructionism, and postmodernist lingo, in an attempt to poke holes in their opponents' (mostly biological) theories (schizophrenia and bipolar disorder are not diseases; they are not any more real than Oedipus Complexes; it's all social construction).  This is mere desperation.  Perhaps Freud needs to be saved from the Freudians:  it is not that his ideas are just as made up as anyone else's; rather, there are truths there, mixed up with errors, which are worth discovering and preserving. 

Here is how Roazen puts it:

"I remain optimistic about what the next phase in the story of psychoanalysis might be like.  I have suggested that in the United States clinicians will no longer be attracted to the field for the sake of mere careerist considerations; since departments of psychiatry are so hostile to all psychodynamic thinking, those who go into the field will have to do so for some of the idealistic purposes that Freud's original followers had.  People who are natural outsiders are abound to be more creative than those motivated by the conformist pressures that in the 1950s and 1960s were so striking in American analysis….As long as orthodoxy, sectarianism, and fundamentalism can be kept at bay — which is by no means easy — psychoanalysis has immense possibilities for expanding the horizons of laymen, physicians, as well as academics."

After so many me-too works of hagiography, Kramer has done Freud a service by seeking the truth about him, despite the dirt involved, so that we might clean up the mess that his followers have made, and learn anew what the old man had to teach.

         

© 2007 Nassir Ghaemi

Nassir Ghaemi, M.D., M.A., M.P.H., Associate Professor, Department of Psychiatry and Behavioral Sciences; Director, Bipolar Disorders Program, Emory University School of Medicine. Dr. Ghaemi is author of The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness, Johns Hopkins University Press, 2003.

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Categories: Psychoanalysis, Memoirs