Thursday, November 4, 2010

Is psychoanalysis still valid?

Freud is dead. His views are antiquated. His theories of women are sexist. His ideas about homosexuals are homophobic. He has nothing to say to us now. He lived in the Victorian era and we live now.

These are just a few of the things one hears about Freud and psychoanalysis these days. To many people psychoanalysis is no longer valid, either as a system of thought or a form of psychotherapy.

As a licensed psychoanalyst, I often find myself having to justify using psychoanalytic theory or therapy, and I gladly do so, for I think both are indeed still valid. I say, “Let’s not throw the baby out with the bath water.”

Freud made many monumental discoveries that continue to be important and valid. He discovered the unconscious mind and, by implication, nonverbal communication. He discovered the unconscious defense mechanism such as repression, projection, denial, and compensation, which are now part of our everyday speech. He discovered transference and resistance and he was a pioneer in the study of narcissism, both in individuals and groups.

Psychoanalysts today have made many modifications, especially in how we do therapy. We no longer see patients 6 days a week, as Freud did. I currently see many patients twice a week, once in individual therapy and once in group therapy. Nor do we use psychoanalysis for every patient. Each patient dictates his or her own interventions. Cognitive or behavioral therapy is more successful with some.

In Freud’s day, patients came for a year, six days a week, and then were pronounced cured. Today patients continue in treatment for years, and there is no finite end to the therapy. Patients terminate therapy not because they are “cured,” but because they decide, along with the therapist, that they have found enough balance and inner strength to function successfully in their personal and professional lives.

The most valid thing, and the thing that makes psychoanalytic therapy stand out from other therapies, is the therapy relationship. In psychoanalytic therapy, the therapy relationship is seen as the key to progress.

A patient can talk about what’s going on in his life, but that is second hand. When he talks about his thoughts and feelings about the therapist, he is being more direct. Often, the biggest turning points come when the patient develops a transference neurosis. For example, he unconscious sees his therapist as a demanding parent who is trying to control him. He starts threatening to quit the therapy, making up excuses about not having money. The therapist bides his time. One day the patient angrily says he is quitting. The therapist says that will be fine.

“So you’re not even going try to talk me out of it!”

The patient suddenly becomes incensed. “You’re just like my father. He didn’t care about me and you don’t either!” The therapist waits. Right then, at that moment, he finally becomes clear about something.

“The anger that I’ve been feeling toward you is really meant for my father,” the patient finally admits. And he is able to make an important distinction, in therapy, and then out of therapy.

Do babies born in winter fare worse?

Children born in the winter months already have a few strikes against them. Study after study has shown that they test poorly, don't get as far in school, earn less, are less healthy, and don't live as long as children born at other times of year. Researchers have spent years documenting the effect and trying to understand it.

Recently a new study by two professors at the National Bureau of Economic Research theorizes that babies born in winter fare worse because their mothers are poorer and less educated.

"What we're actually doing is asking how children born at different times of year might be different at birth, said Kasey Buckles, one of the authors of the study. "And we think an important way that they're different is that they're born to different types of families."

"Past studies have argued that children born in the winter have lower wages because they get less education," said Dan Hungerman, the other author. "We're showing that children born in the winter are often born to women of a lower socioeconomic status and that fact might explain both the education result and the wage result."

To do the study, the authors collected data on over fifty million births from all parts of the United States. "Women who give birth in the winter are more likely to be without a high school degree, they're more likely to be non-married, they're more likely to be teenagers than other women," concluded Hungerman.

When you read their research more closely, you find out that women who give birth in winter are 10% more likely to be without a high school degree and also about 10% more likely to be teen-aged mothers. This seems like a small fraction on which to base their conclusions. However, it must be noted that both are economists so, naturally, their focus is primarily on socioeconomic factors.

However, economic factors do not explain all aspects of the research. For example, how does the fact that mothers are teenagers and less educated explain research showing that babies born in winter have shorter life spans?

What they ignore are the psychological factors. It has been well established by research that there is more depression in the winter months as well as a higher suicide rate. It would seem to follow, then, that mothers who give birth in winter are more likely to suffer from depression. The question then becomes, how much does a mother’s depression affect the child in her womb as well as the baby after birth?

Also well established is research that shows that children of depressed mothers do not perform as well as other children in school, due to the fact that depressed mothers are too distracted by their depression to pay adequate attention to their kids. And the neglect of depressed mothers translates into lowered self-esteem of their kids, which does not bode well for their functioning as adults.

Yes, economy may well be a factor in the diminished functioning of winter babies, but psychology may be a bigger factor. But in today’s climate, the psychological factor is often swept under the rug.