Freud’s Practice of Psychoanalysis

To the Editor: I wish to comment on the article by David J. Lynn, M.D., and George E. Vaillant, M.D. Drs. Lynn and Vaillant use historical sources to illustrate that Freud promulgated techniques of psychoanalysis that diverged from those he used with his analysands. Why do Drs. Lynn and Vaillant make this foray into the past? Since “Sigmund Freud’s technical recommendations and theoretical contributions have retained an important influence in American psychiatry,” it appears self-evident to the authors that psychiatrists “will benefit from an understanding of the relationship between these contributions and Freud’s actual clinical experiences.” Yet the contemporary reader would remain confused about the precise nature of this relevance. The study falls short where it could contribute to current psychiatric knowledge, and it settles instead for an ideological indictment of Freud’s character and work.

Why does Freud’s “sovereign readiness to disregard his own rules” matter to the readers of the Journal in 1998? Hypothetically, exposing that Freud never tested the ideas he promulgated could alert readers to gaps in our knowledge about psychotherapy. This investigation could encourage psychoanalytic researchers to examine more closely those elements of Freud’s theories that have not been adequately studied in the clinic. Freud’s experience may even give insight into how such studies could be conducted. A study like that of Drs. Lynn and Vaillant could, in fact, encourage research into psychoanalysis and elucidate where that research ought to center today. Drs. Lynn and Vaillant, though, choose not to contribute to such debates, and their historical study dressed as contemporary science fails on both counts.

In the first place, their historical reconstruction serves as an opportunity for attacks on Freud’s character. Exposing Freud as, somehow, a bad researcher is problematical history. It is not clear that Freud intended his analyses to serve as trials of his recommendations, and contemporary researchers cannot hold him responsible for deviating from a protocol that he never intended to follow. Furthermore, the criteria that constitute “adequate proof” are historically based, and the standards of scientific psychiatry are not fixed but evolve. The authors would have to examine the standards of proof contemporaneous with Freud to investigate his efficacy as a researcher. He could not be expected to adhere to research habits that were codified after his time, and any indictment of his “test” on these grounds would be ahistorical. To the extent that they obscure the historical context of scientific investigations, misinterpretations of the past give a false impression of what guides psychiatric research today.

Similar anachronisms are employed when Drs. Lynn and Vaillant imply that Freud acted unethically because he was indiscreet with information from his patients’ analyses on occasion without their consent. One must admit that current standards of confidentiality are not timeless, and Drs. Lynn and Vaillant cannot legitimately paint Freud as unethical because he did not adhere to our own contemporary notions of an ethical practice. Such an indictment is anachronistic and unhelpful to clinicians attempting to practice ethically in a different historical moment.

However, even granting the (ahistorical) argument that Freud was an inadequate researcher, Drs. Lynn and Vaillant could, from this vantage point, evaluate the status of current research into the utility of psychoanalytic techniques. However, to do so, they would have to mention the studies of Freud’s recommendations conducted since Freud’s time, for if his recommendations have been adequately tested since he outlined them, the fact that Freud himself did not test them seems hardly relevant. Instead, they hint, inappropriately, that the techniques he recommended never have been substantiated by concluding that they “deserve to be scientifically tested.” Or they imply that Freud’s theories have been disproven, noting that “Freud’s recommendations to maintain an uncontaminated transference through anonymity have by no means been unanimously endorsed by subsequent contributors.” They do not cite a single study or current theorization of Freud’s psychoanalytic techniques—in spite of the fact that an extremely cursory review of the literature from 1997 alone locates three articles on anonymity in analysis. In short, they do not allow their study of Freud to contribute to or improve our understanding of psychoanalytic technique or psychotherapy research.

This lapse, though, would not be inconsistent with the orientation of the Journal. The research published in the Journal addresses questions some distance removed from psychotherapy research or psychoanalytic theory. The 1998 and 1997 issues of the Journal contain no articles on psychoanalysis, no references to Freud, and only one article describing research into supportive psychotherapy for schizophrenia. The Journal publishes exceedingly few articles intended to further the evidentiary basis of the psychotherapies in psychiatry. Drs. Lynn and Vaillant’s article is no exception, and its polemics serve to indicate that such preferences are justified when the quality of Freud’s contributions is reexamined.

Therefore, it is curious but not surprising that Drs. Lynn and Vaillant find substantiation for contemporary ideas in Freud’s practice. Since Freud’s actual techniques “may more closely resemble the techniques that current psychotherapy research has demonstrated to be most effective,” they conclude that “perhaps each outcome should be attributed more to these interactions and their qualities—warmth, support, acceptance, trust…—than to insights achieved through an interpretive exploration of the transference,” which Freud himself advocated. When researchers find proof in the past for their own ideology, one can be sure that they have not removed their blinders.

Drs. Lynn and Vaillant’s most consistent arguments are that Freud was unscientific and ethically dubious and that his entire corpus has been replaced by something better. The relevance of the article is all too clear: to paint psychoanalysis as a pseudoscientific fad now replaced with something more scientific. Their article constitutes a poor addition to the current debate about the place of psychoanalysis in psychiatry, and it presents little knowledge that could be helpful to contemporary practitioners. The study does not encourage relevant research into psychoanalysis; it does use ahistorical interpretations to reassure us that current research interests are justifiable in light of the past. Unfortunately, Drs. Lynn and Vaillant’s past is a false construct designed to justify the preferences of the present.