Sigmund Freud was born in 1856, before the
advent of telephones, radios, automobiles, airplanes, and a host
of other material and cultural changes that had taken place by
the time of his death in 1939. Freud saw the entirety of the first
World War–a war that destroyed the empire whose capital city was
his home for more than seventy years–and the beginning of the next.
He began his career as an ambitious but isolated neurologist; by
the end of it, he described himself, not inaccurately, as someone
who had had as great an impact on humanity's conception of itself
as had Copernicus and Darwin.
Freud's most obvious impact was to change the way society thought
about and dealt with mental illness. Before psychoanalysis, which
Freud invented, mental illness was almost universally considered
'organic'; that is, it was thought to come from some kind of deterioration
or disease of the brain. Research on treating mental illness was
primarily concerned–at least theoretically–with discovering exactly
which kinds of changes in the brain led to insanity. Many diseases
did not manifest obvious signs of physical difference between healthy
and diseased brains, but it was assumed that this was simply because
the techniques for finding the differences were not yet sufficient.
The conviction that physical diseases of the brain caused
mental illness meant that psychological causes–the kinds that Freud
would insist on studying–were ignored. It also meant that people
drew a sharp dividing line between the "insane" and the "sane."
Insane people were those with physical diseases of the brain. Sane
people were those without diseased brains.
Freud changed all of this. Despite his background in physicalism (learned
during his stay in Ernst Brücke's laboratory), his theories explicitly
rejected the purely organic explanations of his predecessors. One
of Freud's biggest influences during his early days as a neurologist
was Jean-Martin Charcot, the famous French psychiatrist. Charcot
claimed that hysteria had primarily organic causes, and that it
had a regular, comprehensible pattern of symptoms. Freud agreed
with Charcot on the latter point, but he disagreed entirely on
the former. In essence, Freud claimed that neurotic people had
working hardware, but faulty software. Earlier psychiatrists like
Charcot, in contrast, had claimed that the problems were entirely
in the hardware. As psychoanalysis became increasingly popular,
psychology and psychiatry turned away from the search for organic
causes and toward the search for inner psychic conflicts and early
childhood traumas. As a consequence, the line between sane and
insane was blurred: everyone, according to Freud, had an Oedipal
crisis, and everyone could potentially become mentally ill.
Psychoanalysis has had an enormous impact on the practice
of psychiatry, particularly within the United States, but today
it is regarded by most sources–medical, academic, governmental,
and others–as almost entirely incorrect in its conception of the
mind. This judgment is based on the crucial test of psychoanalysis: whether
or not it really helps patients with behavioral or psychological
problems. The consensus is that is does not. Psychoanalysis in its
many varieties appears to have little or no efficacy in treating mental
illness. In contrast, psychopharmacology and cognitive- behavioral
therapies (therapies that simply try to change what the patient
thinks and does rather than analyzing the causes of the behavior),
while far from perfect, do appear to help.
If this is true–and we have a great deal of evidence that
it is–why is Freud still so important? Why do we generally speak
of him as a great figure in Western thought, instead of as a strange
and misguided figure of turn-of-the- century Europe?
There are at least two reasons. The first is purely practical:
psychoanalysis has enormous historical significance. Mental illness affects
an large proportion of the population, either directly or indirectly,
so any curative scheme as widely accepted as was Freud's is important
to our history in general. The second, more important, reason is
that Freud gave people a new way of thinking about why they acted
the way they did. He created a whole new way of interpreting behaviors:
one could now claim that a person had motives, desires, and beliefs–all
buried in the unconscious–which they knew nothing about but which
nonetheless directly controlled and motivated their conscious thought
and behavior. This hypothesis, derived from but independent of Freud's
psychiatric work, was the truly radical part of his system of thought.
