Freud vs. Prozac

The architect of the unconscious faces his greatest challenge

So when pop culture puffs up Prozac and neurotransmitters, what doesn't it want us to see? The obstinate irrationality of the human mind—in a word, the unconscious. "Sexuality and aggression explode very violently into our lives in ways that we constantly have to accommodate or clean up after," explains Roth. "And that's what makes people interested in Freud."

While Freud famously promised to restore neurotics to "ordinary unhappiness" and resolutely insisted on the unruly and savage nature of the unconscious, the pop Prozac myth promises equilibrium—and more. As Kramer writes, "With Prozac I had seen patient after patient become, like Sam, ‘better than well.' Prozac seemed to give social confidence to the habitually timid, to make the sensitive brash, to lend the introvert the social skills of a salesman." In its crudest form, this vision of neuroscience sees the mind as a chemical-reaction chamber with no unconscious and no emotion that cannot be adjusted into biochemical balance.

But denying the unconscious has profound consequences. It can blind us to the true emotional sources of authority, sap our personal power, and ultimately make us more vulnerable to political coercion and collective hysteria.

Of course, Freud's critics have long contended that he wielded a tyranny over people, and the very image of Freud—ice eyed and
cigar wielding—has become an archetype of a sinister authority: charismatic, shrewd, spellbinding. Though this image bears little resemblance to the average shrink, Freud's critics point out that psychotherapy requires transference, the powerful emotional bond that develops between patient and analyst. Chief Freud-basher Frederick Crews accuses therapists of fostering a "childish overinvolvement with the analyst, which will then take years to ‘work through."' Certainly, this emotional dependence could give an unethical (or incompetent) analyst virtually hypnotic power, forcing upon a patient false or harmful interpretations of his or her life.

But on the couch of any decent analyst, transference is simply this: The patient reacts to the therapist as he has to other important figures in his life. Maybe the patient falls in love with the analyst, replaying the way he has loved in the past, or he might get angry with the therapist, reenacting old resentments. But rather than use these intense emotions to brainwash the patient, a good analyst encourages the patient to pay attention to the man behind the curtain, thereby demonstrating how the therapist—and by extension other important people in the patient's life—are able to push emotional buttons and exercise undue influence.

"That's very different from just trying to gain equilibrium" through medication, says Roth. "I'm not saying that it's better to suffer," he adds. But "in a situation where you are not asked to question the authority of the person who's intervening in your life, you are more vulnerable. Much more vulnerable."

Of course, it's often best to treat psychological problems with both medication and talk therapy. So why has our culture pitted Prozac against Freud?

Partly, it's just the latest skirmish in the long war of nature versus nurture, body versus mind. But economic forces are skewing the debate. Noting that talk therapy is more expensive than prescribing drugs, NYU sociology professor Dorothy Nelkin says, ‘biological model fits in with cost-containment." It also fits the marketing plans of one of the world's most profitable industries, the pharmaceutical business, which heavily subsidizes academic science and lobbies for government research that might lead to the next blockbuster drug. No comparable funding source exists for talk therapy, with the result that the whole research community tilts toward thinking of psychology in terms of biology.

When that happens, says Nelkin, psychological troubles are located in the individual, but simultaneously the individual is absolved of all blame: "It's not my fault, it's a chemical imbalance." Society and culture, meanwhile, are "let off the hook completely."

Last month, a study in the prestigious Archives of General Psychiatry provided a glimpse into the power of culture to cause mental illness. The study compared the mental health of Mexican immigrants to U.S.-born Mexican Americans. Despite having much less money and access to health care, the recent immigrants had one-half the mental-health problems of their richer, more Americanized counterparts. "There's an exchange," says William Vega, the Berkeley professor of public health who conducted the study. "You get material benefits, but you're trading off emotional support and nurturance." Such "affluenza," as other researchers have dubbed this problem, can be tranquilized by medication but not cured by it.

Freud never ignored society. Civilization and Its Discontents postulated that the more sophisticated culture becomes, the greater the psychic toll it exacts. Even the Oedipus complex is a social disorder: The infant wants "to be loved alone," as the poet W.H. Auden put it, but, in the primal civilized act, realizes he must yield to his other parent.

The chemical view of mental illness renders the patient passive, whereas Freud insisted that individuals engage society and make an accommodation with it. "Freud's really great discovery is that the mind is active and imaginative in the creation of its own experience of reality," says Lear. "So people can feel as if the world is dealing them a bad hand and be completely unaware of how active they are in creating the dramas in which they experience themselves as a victim." This is a problem of meaning, not of biology. By framing it as a purely biological problem, we deny ourselves the power to shape our destinies.

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