Books : One View to Psychiatric Couch

Understanding Psychotherapy: The Science Behind the Art by Michael Franz Basch (Basic Books: $19.95; 329 pages)

Let me put my cards on the table: I saw psychiatrists for many years, and I got nothing out of it. It was a waste of time and money.

I lay on a couch, I sat up straight, I talked and I talked, and I free-associated and I free-associated, and nothing happened. I kept waiting for “The Breakthrough,” but the breakthrough never came.

Psychiatrists take this as proof of how repressed I am. I take it as proof that psychiatry is not all it’s cracked up to be. Take your pick.

Books by psychiatrists that purport to explain how it works, such as “Understanding Psychotherapy” by Michael Franz Basch, are typically full of success stories. Basch’s book is no exception.

A Series of Case Histories

Basch, a professor of psychiatry at Rush Medical College in Chicago as well as supervising psychoanalyst at the Chicago Institute for Psychoanalysis, here relates a series of case histories, full of the give and take of actual patient sessions, that proceed more or less smoothly from communication to insight to change (with an all-important stop at transference along the way).

Guided by the psychiatrist, Basch’s patients work back to the traumas of their childhoods, re-experience them and are then freed of their debilitating effects.

“In 4 1/2 years of once-weekly psychotherapy,” Basch writes of one patient, “Jim Zurf progressed from a confused 16-year-old who could only defend himself angrily against his longing for human contact and affection, to a young man who could not only tolerate but successfully solicit meaningful affective responses.”

To his credit, Basch does at least mention unsuccessful treatments, and he even briefly describes one. But in psychiatry, if the doctor is a failure, it’s the patient’s fault, which is how Basch explains that case.

Extravagant Claims

Indeed, Basch, like psychiatrists I have known, makes extravagant claims for the method of Freud. He writes: “The therapist who applies Freud’s method, guided by his theory of how and why a neurosis develops, will produce exactly the results he promised. It never ceases to amaze and delight me how, when I am thoroughly confused by a patient, I can--like a pilot making an instrument landing in a dense fog--do what Freud said should be done, and eventually bring the analysis to a satisfactory conclusion.”

While psychoanalysts share this view, not everyone else does. The biologist P. D. Medawar, for example, called psychoanalytic theory “the most stupendous intellectual confidence trick of the 20th Century.”

Frederick Crews, the literary critic and one-time proponent of psychoanalysis, sums up research findings as follows:

“Existing studies, even when they have made no allowance for the vastly longer duration of Freudian treatment, have failed to note any meaningful advantage of that treatment over its myriad competitors. . . . If all psychotherapies were to be judged about equally effective, psychoanalysis would rank as the least efficient of therapies, bar none.”

Of course, Medawar, Crews and other critics of psychoanalysis are probably just repressed and defensive.

A Self-Contained System

Like all belief systems, psychoanalysis is self-contained and impregnable. Argue with a Marxist and he will tell you that you have been co-opted by capitalism. Argue with a theist and he will tell you that you have not received grace. Argue with a Freudian and he will tell you that you are defensive. The more you argue, the more it proves their point. It’s a neat trick.

Belief systems always have a way of showing that opposing ideas result from delusion.

None of this is to deny that some people experience improvements in their lives after psychotherapy. Whether this is the result of the treatment is not at all clear. Since there is no way to do a controlled experiment, it’s impossible to know what would have happened in the person’s life if he hadn’t been treated.

I have no reason to doubt the case studies that Basch presents, though I do wonder what “science” is referred to in the subtitle of his book, “The Science Behind the Art.” The first chapters contain a discussion of “the developmental spiral” and “the self system,” which Basch then uses in discussing his patients. But they fall short of being a full-blown theory.

Like most psychiatrists, Basch appears to be a warm, understanding person who cares about the well-being of his patients. In describing his cases, he writes clearly about the thoughts that he had at each stage of the analysis and about the techniques that he employed.

He deals creatively with each patient, never allowing doctrine to overwhelm the specifics of the human patient before him.

But the fact that the patients “got better” does not prove that the therapy did it. Crews notes that even Freud recognized that there were cures at Lourdes. But he did not conclude that they resulted from Christ’s mercy.