Madness on the Couch: Blaming the Victim in the Heyday of Psychoanalysis by Edward Dolnick

Madness on the Couch: Blaming the Victim in the Heyday of Psychoanalysis Reviews

• 
  Mary

  Both as fascinating as it is disturbing, this is the SEVENTH book I have read by Edward Dolnick and, as was the case with all the others, it is highly recommended.
• 
  Dennis Littrell

  Fascinating demolition of psychoanalysis
  
  The madness in the title more properly should be assigned to the chair behind the couch. That is Dolnick's point: the shrinks themselves were mad. In their madness they blamed the parents for the illness of their children, particularly the mother. How did the schizophrenic get that way? He had a "schizophrenogenic" mother, typically a loveless woman who rejected the child while dominating it psychologically. How about autism? The victim of a "refrigerator mother" who withheld love from the child. The obsessive-compulsive disorder? Ditto, although here the patient was also singled out since the patient knew what he was doing, but just would not change.
  Dolnick does a great job of chronicling the delusive mind set of the shrinks who fought tooth and nail against any sort of biological explanation of mental illness even though the evidence was clear. They clung like barnacles to their delusions that these diseases were psychological because, should they admit that they were physical illnesses, caused by something physically wrong in the brain, their fraudulent "talk therapy" would be seen as it really was, useless, and their entire professional lives would be exposed as a waste.
  
  Dolnick begins with a studied demolition of Freud and psychoanalytic psychology. He exposes Freud's delusions about the causation of mental disease, about the nature of dreams, his obsessive belief in "symptoms as symbols," and especially his arrogant lack of scientific method. Dolnick shows how the "great" man bamboozled the psychiatric profession with his almost magical way with words, turning yes's into no's and vice versa as the situation required. The Freudian canon that sex was at the heart of every neurosis was so broad and varied that almost any convenient explanation could be found within. Soldiers suffering from shell shock would seem to be an exception, but no. Dolnick quotes Freud as arguing that "Mechanical agitation...[the hellish roar and rumble of trench warfare] must be recognized as one of the sources of sexual excitation." (p. 37)
  
  Freud's ability to delude both himself and his colleagues is exemplified in the notorious case of Emma Eckstein who was operated on by Freud's friend, Wilhelm Fliess. She was suffering from "stomach ailments and menstrual pain" and "had problems walking." Fliess performed a nose operation but it did not go well. For one thing Fliess left some surgical gauze in Eckstein's nose. As she continued to hemorrhage Freud observed, "she became restless during the night because of an unconscious wish to entice me to go there; since I did not come during the night, she renewed the bleedings, as an unfailing means of rearousing my affection." (p. 47)
  
  The crux of Dolnick's book, though, is not about Freud but about his followers, especially the psychoanalytic psychiatrists from what he sees as the heyday of psychoanalysis, roughly the middle third of the twentieth century. He expresses the central delusion of the therapists in these words, "The ranting of the schizophrenic on the street corner, the retreat of an autistic child behind invisible walls, the endless hand-washing of an obsessive-compulsive were not simply acts, but messages. They were, the therapists fervently believed, desperate if inarticulate cries for help. And now, for the first time, those cries could be decoded."
  
  This self-serving delusion on the part of the shrinks is Dolnick's target and he hits it well, again and again. His technique is to describe in detail the latest Freudian disciple and his particular method of "treatment," how it is ballyhooed and how the psychiatrist himself is caught up in yet another wave of excitement and personal exultation. And then Dolnick gives the grim details, exposing the fake cures and nonexistent breakthroughs. Bruno Bettelheim in particular, who for decades covered up his lack of success in treating autism with attacks on parents ("All my life I have been working with children whose lives have been destroyed because their mothers hated them." p. 216) is exposed as a violent and hypocritical man obsessed with protecting and maintaining his turf.
  
  In a particularly chilling chapter Dolnick recalls the progression of treatments from induced fever to electroshock to lobotomies. He describes the work of Dr Walter Freeman, who specialized in ice pick lobotomies in which an ice pick or similar tool is poked into the brain via the eye socket. Dolnick comments, "This was not merely driving without a map but barreling down the road with the windshield painted black." He quotes Freeman as asking a patient on the operating table, "What's going through your mind now?" The patient replied, "A knife." When the improvement of his lobotomized patients was short-lived, Freeman observed that "many patients had been too far gone to help. He had been wrong to call lobotomy a last resort; he realized now that it had to be used before it was too late." (p. 147)
  
  In a final chapter on "Placing the Blame," Dolnick compares "the therapists [who] had only the best intentions...[to] American communists in the forties and fifties who sincerely wanted a better world but refused to acknowledge Stalin's crimes..." (p. 278) He asserts that "beyond hubris" the fault lay in two factors, one, the sense that when psychoanalysis failed it was "somebody's fault" unlike the sense in conventional medicine that when it failed it might be nobody's fault; and two, "a lack of respect for science." He adds that the therapists were simply "ignorant and disdainful" of science. (p. 286)
  
  This "smugness and intellectual complacency" was "the besetting sin of psychoanalysis," according to Peter Medawar, who was astonished to find that psychoanalysts "seemed free of all such doubts" as most scientists in other disciplines normally encounter. (p. 287) I would add that psychoanalytic theory was like a new religion in the making. The analysts had experienced revealed truth and there was no confusing them with the facts. The sad result was "a tragedy" that "abounded in grief needlessly inflicted." (p. 278)
  
  --Dennis Littrell, author of the mystery novel, “Teddy and Teri”
  
• 
  Daniel Watts

  In one of the many diversive yet fascinating footnotes of this book there is a wonderful anecdote of a rather unusual scientific experiment. A religious student wanted to test if her prayers affected the rate at which plants grow. Like a good scientist she set up a control group and began to do her experiment (i.e. began play for her plants in the test group)... and found that prayer had had no effect. Her conclusion? The plants she had been praying for failed to grow because she had not been in a state of grace while praying.
  
  To us of a secular or critical bent the flaws in her reasoning are obvious, yet she did use controls and statistical analysis, all essential components of the intellectual apparatus of modern science. For the majority of psychiatrists operating in the United States in the two decades after the Second World War, the subject of [i]Madness on the Couch[/i], even this modicum of rigour was not adhered to. For they, they believed, already knew the truth of mental illness and that lay in the teachings of that great exponent of romantic melancholy Sigmund Freud. Armed with battered copies of Freud and a bulk of anecdotes and case histories full of colour and life but little statistical power, Psychoanalysts rose to become the dominant factor in American psychiatry for twenty years. They promised great wonders of curing patients of Schizophrenia and OCD by just [i]talking[/i] to them. What could be more humanistic? What could be a better use of human empathy? Yet the result was less than spectacular. Instead of cures they in effect engaged in a campaign of vilification against the parents of sufferers of mental illness who they blamed for causing the disease and even the patients themselves, whose failure to cure they blamed on, in a piece of brilliant circular reasoning, on their neurosis and unwillingness to open up to the analyst. Rather than the cathartic release promised psychoanalysis was little more than victim blaming in modernist trappings.
  
  This is an in depth intellectual history of this Freudian moment in American thought when the reach of the Viennese founder of psychoanalysis was not only predominant in hospitals and mental health clinics across the United States, but psychoanalysts ranked among America’s top public intellectuals and Freudian notions – such as the idea of an ‘anal’ personality – seeped into public discourse about the mind. The author Dolnick, a brilliantly clear writer with an engaging style who is strong on Freud’s intellectual appeal to Eisenhower’s America, begins with the man himself. For Freud, as he famously remarked, there are no accidents, everything from injuries to bleeding to the delusions of a schizophrenic to the obsessions of an obsessive had a symbolic meaning, a meaning elusive to the sufferer but could be coaxed out by the analyst, using impressive intellectual gymnastics, to indicate that something really meant something else. The inactivity of a hysteric was [i]really[/i] indicate that she was sexual repressed, the obsessive washing of an OCD sufferer was [i]really[/i] a sign that he had not been toilet trained properly. The world was written in code and it required a trained analyst to decipher it, to see behind the surface to see all the sexual and childhood anxieties that [i]really[/i] lay underneath.
  
  This seems a strange doctrine to come to dominate a profession that was supposedly in thrall to science like psychiatry but by the time of the Second World War biological theories were fading fast from credibility with scarce progress and medical treatments, lacking modern medications, were horrific procedures like lobotomies that cured the patient by destroying him. Plus in 1950 anything that mentioned genes and behaviour had more than a whiff of Nazism about it, in contrast psychoanalysis was a type of humanism which treated all peoples as equal, all sufferers from the trauma of life. Dolnick then goes onto chart how psychoanalysts tried and failed to treat three conditions: Schizophrenia, Autism, and Obsessive Compulsive Disorder. It is the discussion of these that makes up the bulk of the nearly 300 pages.
  
  It is the first and second of these sections which are strongest as Dolnick has clearly done a great deal of research into the nature and history of these conditions which can be contrasted to the struggles of the psychoanalysts in trying to understand them. In discussing these Dolnick gives us the grand tour of the psychoanalytic treatment, including some of the most respected scientists of the age. These stretch from the well-meaning humanist Freida Fromm-Reichmann, who sat for hours on end listening to the delusions, insanitariness and even verbal and physical attacks of schizophrenics yet coined the term ‘Schizophrenogenic Mother’ to describe the supposedly unloving and cold nature of the mothers of schizophrenics who by being cold and unloving gave the disorder to their children, to the bullying and authoritarian Jon Rosen, once one of the most respected psychiatrists in America, whose technique of ‘direct analysis’ was in effect an attempt to force the schizophrenia out by insulting and attacking the patient.
  
  The story of Autism is similar albeit dominated by one man, Bruno Bettelheim who comes off in this book as a complete fraud and monstrous hypocrite. Freud did not speak on Autism (Indeed, the term in its modern usage only dates to after Freud’s death in 1943) but Bettelheim, holocaust survivor and one of psychiatry’s most public faces in post-war America, did forcefully and with conviction. In looking at children with autism he saw not difference but child abuse and flung the blame at the mother, again, calling them ‘Refrigerator Mothers’ lacking in warmth and affection for their children, even comparing them to guards at a concentration camp. According to Dr. B only a regime of round the clock love and compassion - at Dr. Bettelheim exclusive and highly expensive special school, naturally - could cure it and ‘rescue’ the child for his autism. The evidence for this theory was laughable yet it did not prevent it for being taken seriously from some of the serious minds of the day (and some not so serious in the Media). There is a lesson here.
  
  The section on OCD is more cursory and is the weakest of the three. As opposed to looking at psychoanalytic treatment in post-war America Dolnick mostly shows what Freud said on the condition and how what he said has been completely superseded by other, later researchers. In this Dolnick is overly dependent on the work of one contemporary psychiatrist and pays little attention throughout to the development of theories on OCD. This puts into focus one of the books problems – the overly uncritical, if understandable given the context, attitude towards contemporary (as of 1998) biological psychiatry. For given the obvious weaknesses of theories in the past (and the psychoanalysts always liked to claim how modern they were) what will the future reveal of the present? Given psychiatry’s never-ending ability to attract controversy on these issues, one cannot treat these issues as a closed case, especially given all that is known.
  
  Also missing, although perhaps it would need another book, is any discussion of the great cultural shift that has taken place from the world of the psychoanalysts in which mental illnesses are caused by the traumas of existence to the world of antipsychotic drugs in which mental illnesses are caused by defects in the brain or chemical imbalances. Dolnick does indeed discuss the role of drugs and medication, the first for psychiatric illnesses went onto the market in the 1950s, but only in the context of how it led to the downfall of Freudian theories in American psychiatry and little on its impact on the wider American public never mind the World. There is a great story to be told there, but it is unfortunately missing from this book.
  
  When giving this book a star rating I flitted between giving it 4 or 5 stars. I decided on 4 for some of the reasons listed above yet despite this I do recommend this work to anyone with an interest in mental health or in 20th Century American Intellectual history. For this is a story full of people who meant well, who tried to deal with some of the biggest mental health issues that humans face with more than just hand waving and wishing for the best and many clearly deeply cared, the likes of Rosen and Bettelheim aside, for their patients. Yet they failed, the passions of the intellectual led to astray away from what could truly be helpful and into the realm of abstract and fundamentally unprovable theories. As I said earlier, there is a lesson here.
  
• 
  James Hansen

  This book is an extraordinary historical analysis of the rise and fall of psychoanalysis in the 20th century, particularly with regard to schizophrenia, autism, and obsessive-compulsive disorder. It is well-written, meticulously researched, and highly engaging. It is the best book on this subject I have read - highly recommended!
• 
  Sarah Hunter

  I have some mixed feelings about this book. On the one hand it is really readable and I definitely got into it. I connected with it partially because of my own skepticism for Freudian psychoanalysis and the way that it has been used to treat (or at least analyze) autism. I agree very much with Dolnick's overall point and I'm glad he wrote this book.
  
  But I found the section on autism itself really wanting. Dolnick criticizes Bettelheim as everyone does, goes too easy on Kanner (also like everyone) and comes to the conclusion that autism is a disability with biological origin that was not, in fact, caused by parents. All of this is true. But Dolnick's analysis of autism itself recycles a lot of old stereotypes- autistic savants, autistic people as being without emotion- that I think could have used a little more of the skepticism that he brings to Freud. I just don't think it is true that people with autism don't have emotions- there is far too much out there written by autistic people as well as by scientists that refutes that very simplistic (and epistemically violent) idea.
  
  The rest of the book I really liked; I know almost nothing about obsessive-compulsive disorder and all that I know about schizophrenia comes from my understanding of autism- but because the autism section sat so poorly with me, I began to doubt his analysis on these other issues. I'm not saying you shouldn't read this book, and I definitely agree with his central thesis, that Freudian psychoanalysis has been at best useless and at worst incredibly violent to people diagnosed with psychiatric illnesses. There are just little details that I'd want to do my own research on first (such as the connection between OCD and strep infections; he throws that out there as a way of understanding OCD as coming from a biological origin, but does not describe at all whether this is a commonly accepted fact or a hypothesis that is still being tested).
  
  Overall- I'd take some of the interesting facts and unusual connections with a grain of salt- we should make a regular practice of this actually- but overall this is a solid book that I found very engrossing.
• 
  Michael Connolly

  Dolnick criticizes the early theories for the cause of schizophrenia. Frieda Fromm-Reichmann coined the term "schizophrenogenic mother" and blamed the mother for the child that turned out schizophrenic. The anthropologist Gregory Bateson blamed the parents for putting the child in a no-win, "double bind" situation, where the child would be punished regardless of the choice the child made. Concentration camp survivor Bruno Bettelheim blamed "refrigerator mothers" for children who were autistic. These thinkers had little evidence to support their claims, but their theories caught on. It is not clear why. Perhaps simply due to the lack of good alternative theories. More recently, we have learned that genetics plays a major role in mental illness. What cannot be explained by genetics is no longer attributed to parents, but to unknown causes.
• 
  Read a Book

  A bit repetitive, but still an interesting look into psychological and therapeutic history that is often neglected and heavily understudied.
• 
  Stacy

  Toe-ing the line between textbook and entertainment, this was an interesting book even though I'm not interested in studying psychology.