Research has shown that psychoanalysis, in the form originally promulgated by Freud and his followers, is no more effective in relieving neurotic symptoms than other less demanding and less expensive forms of psychotherapy. Freud's theory of dreams, which he himself considered to embody his deepest insight, has not stood the test of time. Nor have his views on religion, anthropology, and art. Although many of his psychopathological interpretations are open to question, he was a great clinical observer and a great writer whose descriptions of obsessional neurosis and melancholia remain unsurpassed. In spite of the comparative failure of psychoanalysis as either a system of psychopathology or a technique of treatment, psychoanalytic ideas have caused a revolution in the way Western man thinks about himself, and have also had a major effect upon twentieth-century art and literature. Psychoanalysis has entered the language we use, and it would be difficult to discard from our writing and speaking such words as 'repression', 'sublimation', 'ego', 'id', superego', 'unconscious', 'projection', and 'defence mechanisms'. Freud's uncompromising reductive stance tended to explain human behaviour in terms of the lowest common instinctual denominator. One result has been to make us less inclined to take what were considered virtues at their face values. So altruism and self-sacrifice are interpreted as masochistic, and celibacy is considered a flight from sex or as masking perversion.
Although psychodynamic theories have made us more aware of the human tendency to self-deception, they have also made us more tolerant. Because Freud laid it down that neurosis has its roots in early childhood, psychiatrists and others working in child guidance clinics have studied the child's development within the family and based their treatment of the child's difficulties upon understanding family dynamics. Psychiatrists, hospital administrators, and others have become aware of the young child's need for secure attachment, and of the dire consequences which are likely to follow if such attachment is suddenly disrupted. For example, mothers and infants are kept together rather than separated whenever possible, even if one or the other has to be admitted to hospital.
Although we are no better at preventing crime or treating criminals than before the advent of psychodynamic theories, there is a greater appreciation among forensic psychiatrists that crime reflects alienation from society rather than innate wickedness, and a greater realization that savage penalties are ineffective.
Sexual diversity is no longer attributed to moral degeneration. Freud attempted to account for homosexuality and other forms of sexual deviance in terms of the vicissitudes of infantile emotional development. Although it is now believed that some varieties of sexual deviance are due to variations in the development of the brain in infancy, Freud's frank discussion of infantile sexuality did much to dispel the cloud of moral disapproval which had hitherto hindered our understanding of these phenomena.
Freud's employment of free association instead of hypnosis was referred to above. Freud's technique of listening to distressed people over long periods has had a profound and beneficial influence upon all techniques of psychotherapy derived from psychoanalysis. Psychoanalysis and its derivatives have in common that they are techniques of helping the patient to understand and help himself rather than obeying doctor's orders or carrying out instructions. In spite of this, Freud discovered that his patients tended to put him in the position of a father figure, an idealized lover, or even a saviour. Freud's discovery of what he called 'transference' has affected every subsequent type of analytical psychotherapy. Today, exploration and interpretation of the patient's changing attitude to the analyst is a major tool in enabling the patient to understand and improve his relationships with others in the world outside the consulting room.
Although psychoanalysis and its derivatives have not led us into the promised land for which Freud had hoped, the impact of psychodynamic theories has been considerable. Freud did cause a revolution in the way we think about ourselves. As Karl Popper claimed, our understanding of the world and of ourselves progresses by the refutation of existing hypotheses. Even if every theory which Freud put forward could be proved wrong, we should still be greatly indebted to him.
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