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Burying Freud

[ Burying Freud Homepage | Freud's Seduction Theory Homepage ]

I haven't read this [Edward Erwin] but its likely to follow similar lines to many of the others of its kind (Crews? ). They all seem to hinge on the mistaken view that so-called scientific evaluations of psychoanalysis are value free and objective. They generally make the claim that there is no evidence that psychoanalysis and its derivatives "work". They offer nothing in its place. "They" usually view psychoanalysis as a kind of psychic surgery which can and should be evaluated much like any other medical practice.

People who come to see me come asking for help want help with their lives in a much broader sense than this: they don't usually just want a particular thought cutting out, nor alleviation from some circumscribed "psychic pain", or indeed requesting a psychic antibiotic. They come because they feel out of control usually across the broad range of human experience. It usually affects most aspects of their lives by the time they come to a psychiatrist or a psychotherapist, and their problems have been subject to a wide range of both personally planned and unintentional/contingent influences.

As such I have not been able to help someone (either in psychiatry or in psychotherapy) through "pulling a psychic tooth", "setting a psychic fracture" or through giving a pill, except as a means of relieving pain and anxiety, or reducing unpleasant (or pleasant but socially unacceptable) symptoms temporarily. It takes so much more to really help somebody whose life is in turmoil and torment. And to evaluate "outcomes" here is no simple matter; and it is a myth to suggest this could be done in a value-free scientific way.

The arguments from the Crews camp (to make it them and us to simplify the argument) tend to assume that psychoanalysis should be assessed like other medical treatments - scientifically. Sadly, many psychoanalysts think of what they do as somehow scientific (just as Freud said). I think this approach is mistaken. Psychoanalysis and psychoanlytic psychotherapy are 'techniques of the self' (of self modification and self change), acheived through ones voluntary subjection to another (the analyst/therapist). In this regulated context, a process takes place which invariably involves a fairly full range of ones life experiences (love, hatred, anger and destruction, sex, self worth/love, ones moral values etc, etc) as these interact with each other.

In addition, this the process of psychoanalysis always involves ones relationships with people of the same sex, people of the opposite sex and one's relationship with oneself; how we understand how each of these interrelate, past and present; and most importantly how we value different parts of our conduct and our experiences in the context of these relationships. And if I am describing something in a language Freud did not use that is of little consequence.

Put (albeit too briefly) like this I would hope makes it obvious that psychoanalysis needs to be evaluated rather more like child rearing, and rather less like engineering or medicine. There are clear similarities with education too; a process that is at its heart not value free and cannot be evaluated in any simple 'objective' way. In education and child rearing one can make a rough and ready evaluation of the degree to which a pupil or child has internalised the values and knowledge inculcated: this is not too difficult and appears "objective". But this would make no evaluation of the value of inculcating these values or this or that knowledge. Nor does this approach take into account that children, even pupils, are not simply empty vessels passively absorbing facts and values. They have loves, hates, pasts and hopes for the future, views of themselves and are already, at least to some degree, moral agents in their own right. They are able to interpret and evaluate what we intend to inculcate into them, and this may end with a very different "outcome" to the ones we are even attempting to measure.

Psychoanalysis is nevertheless, different from pedagogy (etc); different in that although it is a fundamentally ethical practice, the inculcation of others' values is intentionally kept to a minimum (suggestion is not wholly avoided, and psychoanalytic practice is normalising, although in a more subtle and limited way). However, the ethics of the relationship in psychoanalysis are absolutely central to the project of any psychoanalysis since it is the way that the relationship is conducted that is primary to personal change for the client (transference-countertransferance and its interpretation, and the basic rules governing the conduct of this relationship).

I am therefore suggesting that:
1. we need a much more complex, qualitative and quantitative, historical and case historical, ethical approach to the evaluation of psychoanalysis and its derivatives. Simple outcome measures are wholly inadequate to the task.
2. That we need not keep fighting the battle of scientific vs not scientific, unless what is scientific is more broadly concieved; quite what this would mean/do I am unsure.
3. That those generating critique recognise the pain and suffering that is involved in more than just a limited part of someone's life for those who seek help from psychoanalysis: this might make the debates less ideological and rather more ethical (and for me more valuable).
4 Anti psychiatry may have had some important points to make, but it put change in psychiatry backwards because its protagonists put winning the argument through whatever means before changing the minds and practices of other psychiatrists so as to improve the lot of patients. Will Anti-psychoanalysis do the same?

Tim Kendall

 


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Ian Pitchford and Robert M. Young - Last updated: 28 May, 2005 02:29 PM

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Burying Freud

[ Burying Freud Homepage | Freud's Seduction Theory Homepage ]

I haven't read this [Edward Erwin] but its likely to follow similar lines to many of the others of its kind (Crews? ). They all seem to hinge on the mistaken view that so-called scientific evaluations of psychoanalysis are value free and objective. They generally make the claim that there is no evidence that psychoanalysis and its derivatives "work". They offer nothing in its place. "They" usually view psychoanalysis as a kind of psychic surgery which can and should be evaluated much like any other medical practice.

People who come to see me come asking for help want help with their lives in a much broader sense than this: they don't usually just want a particular thought cutting out, nor alleviation from some circumscribed "psychic pain", or indeed requesting a psychic antibiotic. They come because they feel out of control usually across the broad range of human experience. It usually affects most aspects of their lives by the time they come to a psychiatrist or a psychotherapist, and their problems have been subject to a wide range of both personally planned and unintentional/contingent influences.

As such I have not been able to help someone (either in psychiatry or in psychotherapy) through "pulling a psychic tooth", "setting a psychic fracture" or through giving a pill, except as a means of relieving pain and anxiety, or reducing unpleasant (or pleasant but socially unacceptable) symptoms temporarily. It takes so much more to really help somebody whose life is in turmoil and torment. And to evaluate "outcomes" here is no simple matter; and it is a myth to suggest this could be done in a value-free scientific way.

The arguments from the Crews camp (to make it them and us to simplify the argument) tend to assume that psychoanalysis should be assessed like other medical treatments - scientifically. Sadly, many psychoanalysts think of what they do as somehow scientific (just as Freud said). I think this approach is mistaken. Psychoanalysis and psychoanlytic psychotherapy are 'techniques of the self' (of self modification and self change), acheived through ones voluntary subjection to another (the analyst/therapist). In this regulated context, a process takes place which invariably involves a fairly full range of ones life experiences (love, hatred, anger and destruction, sex, self worth/love, ones moral values etc, etc) as these interact with each other.

In addition, this the process of psychoanalysis always involves ones relationships with people of the same sex, people of the opposite sex and one's relationship with oneself; how we understand how each of these interrelate, past and present; and most importantly how we value different parts of our conduct and our experiences in the context of these relationships. And if I am describing something in a language Freud did not use that is of little consequence.

Put (albeit too briefly) like this I would hope makes it obvious that psychoanalysis needs to be evaluated rather more like child rearing, and rather less like engineering or medicine. There are clear similarities with education too; a process that is at its heart not value free and cannot be evaluated in any simple 'objective' way. In education and child rearing one can make a rough and ready evaluation of the degree to which a pupil or child has internalised the values and knowledge inculcated: this is not too difficult and appears "objective". But this would make no evaluation of the value of inculcating these values or this or that knowledge. Nor does this approach take into account that children, even pupils, are not simply empty vessels passively absorbing facts and values. They have loves, hates, pasts and hopes for the future, views of themselves and are already, at least to some degree, moral agents in their own right. They are able to interpret and evaluate what we intend to inculcate into them, and this may end with a very different "outcome" to the ones we are even attempting to measure.

Psychoanalysis is nevertheless, different from pedagogy (etc); different in that although it is a fundamentally ethical practice, the inculcation of others' values is intentionally kept to a minimum (suggestion is not wholly avoided, and psychoanalytic practice is normalising, although in a more subtle and limited way). However, the ethics of the relationship in psychoanalysis are absolutely central to the project of any psychoanalysis since it is the way that the relationship is conducted that is primary to personal change for the client (transference-countertransferance and its interpretation, and the basic rules governing the conduct of this relationship).

I am therefore suggesting that:
1. we need a much more complex, qualitative and quantitative, historical and case historical, ethical approach to the evaluation of psychoanalysis and its derivatives. Simple outcome measures are wholly inadequate to the task.
2. That we need not keep fighting the battle of scientific vs not scientific, unless what is scientific is more broadly concieved; quite what this would mean/do I am unsure.
3. That those generating critique recognise the pain and suffering that is involved in more than just a limited part of someone's life for those who seek help from psychoanalysis: this might make the debates less ideological and rather more ethical (and for me more valuable).
4 Anti psychiatry may have had some important points to make, but it put change in psychiatry backwards because its protagonists put winning the argument through whatever means before changing the minds and practices of other psychiatrists so as to improve the lot of patients. Will Anti-psychoanalysis do the same?

Tim Kendall

 


human-nature.com
Ian Pitchford and Robert M. Young - Last updated: 28 May, 2005 02:29 PM

US -
 Search:
Keywords:  

Amazon.com logo

UK -
 Search:
Keywords:  

Amazon.co.uk logo

 | Human Nature | The Human Nature Daily Review | Psychiatry Research Online |