The Only Cure by Mark Solms – Has Modern Neuroscience Proved Freud Right? | books

VVladimir Nabokov rejected the “vulgar and cheap medieval world” of the ideas of Sigmund Freud, whom he called “the witch doctor of Vienna.” Many have shared his negative judgment in the nearly 90 years since Freud’s death. His post-war rise in reputation has been followed by a downfall, at least in scholarly circles, but there are signs of a newfound respect for his ideas, including among those who once flatly rejected him. Mark Solms’s latest book, This wide-ranging and interesting defense of Freud as a scientist and therapist is a startling contribution to the reappraisal of the thinker described by WH Auden as “now no longer a person but a whole climate of opinion.”

It would be difficult to improve on Solms’ qualifications for the task he has set for himself. He is a neuroscientist, expert in the neuropsychology of dreams, author of numerous books on the relationship between the brain and consciousness, a practicing psychoanalyst, and editor of the 24-volume revised standard edition of Freud’s complete works. He is also a wonderfully intelligent and articulate writer.

I read The Only Cure through the lens of its bold—perhaps too bold—title. It contains two claims. The first: Psychoanalysis is a treatment in the sense that its benefits are permanent, and may continue after the completion of treatment. Second, it is the only treatment because competing treatments – most notably drugs – may lose their effect when they are discontinued because they do not address the underlying causes. Solms cites overviews of clinical trials that he believes support these claims. The story he tells seems very encouraging, unless, like me, you are obsessive enough to read the newspapers he refers to.

Solms opens his defense by citing a review that combines psychological, educational, and behavioral therapies. It is not clear how this explains the specific benefits of psychoanalysis. Furthermore, the response to this review from an impressive source considers that the various treatments are no more effective than placebo.

When Solms addresses the evidence supporting what he calls “good old psychoanalysis,” he cites the positive results of an authoritative systematic review, but neglects to mention the final lines of the paper, which caution against drawing hasty conclusions and call for “larger studies of higher quality.” A more recent systematic review was published in The Lancet Psychiatry He was similarly cautious. Admittedly, the treatment schedule was short. Perhaps most important is to examine the effectiveness of long-term psychoanalytic therapy (at least 50 sessions over a year). This appears to show a clear benefit, but again the authors advise caution “given the low quality of available evidence.”

In fairness, researchers in this field face enormous problems. The gold standard clinical trials are double-blind (meaning that neither the patient nor the doctor knows what type of treatment the patient is receiving until the end of the study); include an appropriate proxy by which to measure the effect of the treatment being tested; It requires a well-defined, even homogeneous, patient population; Have objective and measurable measures of outcomes, and control for other relevant variables. These criteria cannot be met for psychotherapy.

Thus, the jury is still out on whether or not psychoanalysis is a treatment, let alone the only treatment. At best one can conclude that it is as effective as other psychological treatments such as cognitive behavioral therapy, which requires less effort.

Toward the end of his life, Freud believed that better treatments than psychoanalysis could be discovered when we understood more about how the brain worked. Did this hope come true? Here we may look at medications such as antidepressants, anxiolytics, and antipsychotics. Solms agrees that these treatments can complement or complement psychological treatments, but he argues that since they do not address the underlying causes of mental health conditions, they are palliative rather than curative. It compares prescribing medications to using painkillers instead of surgery to treat angina due to a blocked coronary artery.

However, Solms does not reject a neurological understanding of mental illness. This would, in any case, be at odds with his admirable and laudatory account of the early Freud as a serious contributor to neuroscience, and with Freud’s belief that there would eventually be a convergence between functional models of the mind and physiological models. By highlighting Freud as a neuroscientist, Solms distanced him from the image of a charlatan whose theoretical claims were unscientific, not least because, as Karl Popper claimed, they were unfalsifiable. This charge lies at the basis of the oft-quoted joke about the patient who protested to Freud that his dreams were often terrible, thus refuting the psychoanalytic doctrine that dreams are the fulfillment of desires. Thus, Freud answered that terrible dreams fulfill the patient’s desire to disturb his therapist.

Solms rejects much of Freudian orthodoxy, loosening some of the connections between the more well-known and weaker theoretical foundations of psychoanalysis and its clinical application. “We do not need to rehabilitate every idea Freud had,” he writes. Articles of faith such as the sexual basis of all pleasures, the death drive, penis envy, and id are ignored. He also treats with skepticism the carnival of figures – among them the shrinking Jacques Lacan from hell – who have developed their own grotesque versions of psychoanalysis.

However, Freud’s central insight has been preserved: the long-term and profound effects of early life experiences. These are stronger for burial. In modern society, an individual’s emotional needs may go unmet for long periods of time, meaning “we can spend our lives under the intoxicating influence of context-inappropriate emotions.” Solms illustrates this through deeply moving case histories of patients who were prisoners of unresolved issues from their past, as well as a description of his psychoanalysis. These cases show that the essence of psychoanalytic practice is empathy that enables patients to detoxify their experiences by allowing them to talk about them to a sympathetic and intelligent listener. His description of psychoanalysis as a “process of re-education” captures his humanism.

One particularly compelling story opens and closes the book. Teddy B is a doctor whose professional and personal life disintegrates after his mother’s sudden death. Severe depression, memory loss, sleep disturbance, occasional loss of consciousness, headache, muscle pain etc. attract different diagnoses, prompting a host of ineffective treatments whose side effects add to his problems. Over the course of four years of therapy, Solms helps Teddy B unearth his loveless early life and subsequent internalization of the aggressive impulses he originally felt toward his emotionally unavailable mother. We learned of his eventual recovery, which led to a happy marriage and a life of work.

Extrapolating from successful cases to defend a psychoanalytic approach reminded me of the old saying “data is not the plural of anecdote.” Solms’ claim to combine “the best of modern neuroscience” with “the fundamental insights of psychoanalysis” remains a promissory note.

Despite persistent doubts about the evidence for the unique clinical effectiveness of its treatment, Solms pushed this skeptic’s attitude toward Freudian (or Freudian-inspired) psychoanalysis from contempt to agnosticism. I am willing to acknowledge its clinical role, although more research would be welcome. What therapy achieves in practice will of course depend on the personal qualities – above all acumen and integrity – of the therapist.

Professor Raymond Tallis is a clinical neuroscientist and philosopher.