Freud vs. Prozac
Michael S. Roth, curator of the hotly contested, long-delayed Sigmund Freud exhibition that opens this week at the Library of Congress, is talking with me about the hoary old Oedipus complex. In passing, I describe it as "wanting to sleep with your father and kill your mother." A flicker of surprise passes across Roth's face as he reminds me, "It's the opposite." So it is, I reply, startled and sheepish. Then I let Roth in on the fact that I'm gay. So was my Oedipus mistake a meaningless mix-up or a classic Freudian slip?
Freud bashers would insist such gaffes tell us nothing of the psyche. But even they couldn't help but suspect that such mistakes reveal something. And so, "We are all Freudians in our everyday thought," the psychiatrist Peter Kramer writes in the exhibition catalogue. Yes, the author of Listening to Prozac confesses that it was Freud who inspired him to go into psychiatry and Freud who continues to shape our conception of the psyche. "We worry," Kramer says, "about unconscious aggression, mother complexes, sexual repression, Freudian slips, and the like." The exhibition demonstrates how completely Freud pervades our culture by showing a delightful collection of video clips, from Popeye to The Simpsons, Dick Van Dyke to Murphy Brown.
Now is the perfect moment for an exhibition on Freud, not only because Monicagate is forcing everyone to ponder when a cigar is not just a cigar, but also because a new understanding of the mind is giving Freud his most serious competition ever. Roth has noticed that his 11-year-old son Max will make psychological jokesbut not Freudian ones. If someone is acting odd, he might say, "What, did you forget your medication today?" Freud, with his theories of libido and id and repression, has been forced to make room for the Prozac philosophy of mind as a soup of neurotransmitters.
Of course, Freud has long been under attack from many sides. Roth's exhibition, called "Sigmund Freud: Conflict and Culture," was scheduled to open two years ago. But more than 50 prominent figures, ranging from Gloria Steinem to Oliver Sacks, signed a petition protesting it as too laudatory. Biographers have shown that Freud lied, as in claiming to have cured patients when he hadn't. Freudian concepts such as as ego, id, and superego are dismissed by most brain researchers, and the idea that mental illness arises from infantile traumathe centerpiece of Freudian theoryhas, to put it charitably, not been validated. So from a medical and scientific standpoint, says Roth, there are "perfectly good questions about, well, does psychoanalysis work?"
But for most of Freud's readers, this question misses the point. Even for Freud himself, neurosis was the royal road to understanding normal life, and that, not a treatment model, is his lasting legacy. So while the attacks on Freud diminished him, they didn't replace his basic philosophy that humans are driven by unconscious desires that conflict with reality. Witness the feminist turn around: In the 1960s and '70s women writers lacerated Freud for his misogyny, but now many younger feminists have reappropriated his ideas, spawning a vibrant feminist psychoanalytic movement.
Prozac and neurobiology, however, have succeeded where other challenges failed: they offer a full-blown alternative theory of the mind, and Hollywood, always a reliable mirror of pop culture, reflects this duality. "You have your therapeutic Good Will Hunting, where repression in some loose way is the center of the story, and in As Good As It Gets, it's take your medication and you can have the girl," Roth explains. "People are going to weigh these against each otherthe model of the individual based on desire, repression, expression, deflection, all those Freudian things, versus a model based on chemicals, humors, balance, where issues of character and freedom must take a different form."
Of course, these views don't have to compete. Freud himself insisted that chemical interventions would someday remedy many psychological problems. As Oliver Sacks notes in a brilliant catalogue essay, Freud started his career as a neurobiologist and devised a model of the brain that foreshadowed our current conception of synapse networks. Moreover, because the talking curea general term for psychotherapy of all schoolsforges new associations and meanings, it almost certainly remaps those synapse networks. That's why Professor Joseph LeDoux of NYU's Center for Neural Science calls psychotherapy "just another way to rewire the brain." But once they enter mass culture, complementary theories tend to degenerate into warring campsand Freud and Prozac have become mortal enemies. "It's known I'm a defender of psychoanalysis and Freud," says psychoanalyst Jonathan Lear, author of Open Minded: Working Out the Logic of the Soul. "I can't tell you how many conversations begin with the assumption that, therefore, I must be against drugs, I must be against all this brain research." Of course, he isn't. "We should learn as much as we can about the brain and how drugs can cure certain kinds of pain and suffering," Lear says.
What alarms him is not neuroscience itself, but the way popular culture distorts and exaggerates its findings, enlisting them to prop up a simplistic biological materialism that claims brain research will reveal everything there is to know about being human. Lear draws an analogy to the way obsessional patients maintain their warped view of reality: "Everything they say will be true, but what they don't see is the use they're putting the truth to, which is that it's a way to block out other things that are also true."
So when pop culture puffs up Prozac and neurotransmitters, what doesn't it want us to see? The obstinate irrationality of the human mindin 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 equilibriumand 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 Freudice eyed and
cigar wieldinghas 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 therapistand by extension other important people in the patient's lifeare 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.
Paradoxically, reducing mind to body alienates us from our bodies. Freud certainly thought biology influences the mind"anatomy is destiny," he postulated, propping up sexism. But the essence of his belief is that our lived experience of the body is what's important. In short, Freud was earthy. He argued, for example, that we get pleasure from defecating. But far from banishing this pleasure to the realm of the trivial or dirty, Freud posited a real psychological cost to society's restrictions on shitting: forcing babies to defecate only at certain times and placesnot to mention making them regard the whole process as shamefulprovokes a rage that we never overcome but merely repress into our unconscious.
How different is the pop-Prozac account of how the body influences the mind! There, consciousness is a blend of chemicals that needs to be calibrated into balance by medical experts, and our lived experience is discounted in favor of laboratory assays. "The personality-altering pill is high technology, something unknowable, foreign," writes Kramer in Listening to Prozac. Though he generally supports its use, Kramer warns that the drug "may be experienced as self-alienating even when, in particular instances, it restores people to themselves. Having diminished the power of psychoanalysis, we are all the more at the mercy of professional knowledge."
Our mind stripped of the power to shape its destiny and our bodies handed over to the medical-industrial complex: That's a caricature, but it's merely the flip side of the smiley, sunny images used in ads for antidepressive drugs. The very fact that these absurd images are pitted against the Freudian conception of a cryptic and conflicted psyche strongly suggests that Lear is right and the legitimate findings of neurobiology are being exaggerated to obscure other truths. And Lear thinks the target, the thing that is being hidden, is the unconscious.
The unconscious not only frightens us as individuals, it also threatens political authority. Authority sets the terms of the debate, deciding which arguments are legitimate and which are not. But seeking out unconscious motives means probing behind these terms, smoking out hidden agendas. Even if Freud hadn't been Jewish, the Nazis would have hounded him out of Austria because his theories undermined fascism. After all, if psychoanalysis questions the authority of the analyst, it certainly couldand didquestion the authority of the demagogue.
McCarthyism, the Lewinsky scandal, child-abuse panicssuch events grip us in ways that border on hysteria. "It's not that we can always figure out what's unconscious and therefore never get caught up in a drama we don't understand," says Lear. "But the difference between assuming we already know what the issues are and more humbly assuming that we don't understand everything that's going on can have tremendous consequences." Merely by accepting that there are unknown and unknowable motivations inoculates cultures against "being gripped by the next wave of things to fear."
It can also inoculate us against political tyranny. Communism was the result of thinking the mind is all nurture, a tabula rasa on which society could imprint civic virtue and class solidarity to create Socialist Man, while Nazism emerged from the opposite philosophy, that biology and genetics were all-important and that anyone who wasn't born into the "master race" was irredeemably inferior. In truth, humans live between biology and spirit, and when a society tilts too far toward one view or the other, tyranny often follows.
While Freud is being attacked and talk therapy truncated by HMOs, one-sixth of America's gross national product goes to health care. Congressional Republicans, spurred by the biotech lobby, have called for doubling the federal government's already huge biomedical research budget. And ever more human behaviorfrom addiction to intelligence to antisocial behavioris being attributed to DNA and brain biochemistry.
The cumulative effect of this biological materialism is to discredit humanism. From Socrates through Freud, the imperative was to examine your life, know thyself. But now society is veering toward a view that an unexamined life can be quite worth living, thank you, just as long as the serotonin is flowing.
Already, certain crucial questionssuch as why our culture makes us so ill that we need psychiatric drugsare being relegated to almost trivial status, mainly because they lend themselves to political answers, not biological ones. The study about immigrant mental health, for example, disappeared with barely a media ripple, though it certainly raised profound and urgent questions.
Biocentrism routinely shrugs off such issues as how we should we organize society and what is the purpose of life, leaving them to get answered in the darkness of our collective unconscious, where we are at the mercy of unseen forces, such as economic greed, political power-lust, and cultural aggression. Or, when it doesn't ignore political and social questions, biocentrism recasts the debate in biological terms by, for example, defining the body politic as just thata body, a bioentity that obeys the same natural laws as, say, ant colonies. In this view, social Darwinism makes perfect sense, though now society throws a pharmaceutical lifeline to some of those who don't fare so wella pill that can make you "better than yourself."
What's missing from the biocentric image of humanity is the idea of people as makers of meaning, as unique creatures capable of living not only in a physical world but in a world of dramas and myths that, consciously and unconsciously, we create. Freud's enduring truth is simply this: No matter how many pills we take, we will continue to shape such dramas. The question is whether we will try to understand them and set a more deliberate course, or whether we will let them carry us where they will, aiming only to tolerate whatever they bring.
Research assistance: Meredith Yayanos
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