In a recent discussion at Perverse Egalitarianism regarding the relationship between ontology and politics, Asher Kay went off-topic to question the empirical validity of psychoanalysis. Asher had a book in hand casting strong doubt on the empirical basis for analysis. Bryan Klausmeyer countered by saying that clearly the unconscious exists, just as analysis asserts. Levi Bryant contended that the empirical support for psychoanalysis comes from clinical practice. Here’s my view of the situation, which I previously relayed to a few people via email.
There’s strong empirical support for the existence of the unconscious. This evidence isn’t generated only by analysts either. Social psychologists devise all sort of ingenious experiments for exploring ways in which our minds play tricks on us, where what people consciously say and believe are at odds with what they do and decide. Cognitive psychologists design problems intended to expose cognitive processes and intermediate results that happen in brains beneath the threshold of conscious awareness. Neuroscientists look at brain structures and functions that operate far beneath consciousness. Consciousness is just the tip of the iceberg of brain/mind activity, which is evident to all of us. E.g., what will I write in my next sentence? I don’t know yet: I’ll assemble it from components of knowledge and language that’s distributed in my brain but that I’m not consciously rehearsing. What was the name of my next door neighbor’s dog while I was growing up? I know it, but I have to retrieve it from unconscious memory in order to answer the question. As I wrote in a post a couple of months ago:
“Based on a count of receptor cells and their neural connections, neuroscientists estimate that the human sensory system takes in more than 11 million pieces of information per second. Based on studies of processing speed on tasks like reading and detecting different flashes of light, cognitive psychologists estimate that people can process consciously about 40 pieces of information per second. What happens to the other 10,999,960? It’s processed unconsciously.”
Is there empirical support for the metapsychology of psychoanalysis? Here I’m referring to things like the id/ego/superego distinction, the Oedipus complex, the oral/anal/genital/phallic stages of development, the divided self centered around lack, the imaginary/symbolic/real, the unsatisfiability of desire, and so on? I’ve not read A Final Accounting, the book Asher cited, but I’d agree with the author’s general conclusion that the evidence is either weak or nonexistent. For what it’s worth, psychoanalytic theory plays virtually no role in contemporary empirical psychology and its investigations of cognition, memory, the unconscious, personality, and even psychopathology. Awhile back I wrote a post critiquing Lacan’s supposed empirical support for a “mirror stage” preceding language acquisition leading to the development of the “specular image” of the self. This situation follows what seems to be the typical pattern: despite claims to evidentiary support for the theories, the evidence typically doesn’t hold up to closer scrutiny.
Regarding the therapeutic outcomes of psychoanalysis… I know, I know, analysis isn’t therapy. However, people tend to be motivated to come for analysis because they’re suffering from symptoms, and I daresay that they expect analysis to alleviate their suffering. Many empirical studies point to the same conclusion: pretty much any therapeutic intervention is far better than no intervention, but no particular technique seems to work any better than the rest. Also, the amount of experience on the therapist’s part seems to have no impact on outcome.
One implication of this finding of similar results across modalities is that all modalities achieve their effects pretty much the same same way. So even though psychoanalysis and cognitive behavioral therapy espouse different praxes and theoretical rationales, they might be wrong regarding the cause-effect connection. It seems likely that establishing and maintaining a supportive relationship between therapist and client is the most important criterion for obtaining good symptom relief.
It should be noted that cognitive behavioral therapy gains no greater empirical support for therapeutic outcomes than does psychoanalysis. The constructs of CBT seem fairly common-sensical, even managerial, which suits some people better than does the quasi-mystical language of analytic theory. And there is some empirical evidence that people who believe in the particular treatment praxis they receive are more likely to benefit from therapy.
* * *
Though I’m not persuaded by the empirical evidence supporting psychoanalysis, I find it more fascinating than ever. Empiricism in psychological research is mostly a matter of averages. But it’s a pretty squishy field of research, with even strong correlations between variables typically overwhelmed by the statistical variation. Clinical practice opens up the exploration of the variations, the individual differences that get lost in empirical averaging. Two people scoring the same on a depression inventory can have very different subjective experiences of their depression, different causal trajectories, different ways in which their symptom affects their lives, and so on.
I found as a therapist that the empirical evidence had very little to do with the way I engaged with clients, because for the individual it’s the unique trajectory through life that’s important. At the same time, I have to acknowledge that after seeing multiple clients I found them all blurring together into something like an average client. Some therapists probably find that comforting: I know what to do with this case. My reaction was that I began losing interest, feeling unengaged and mechanical and distant in dealing with the clients. That’s why I quit doing therapy.
To illustrate the value of psychoanalysis, Levi Bryant described on Larval Subjects his experience of repeatedly breaking the chalk on the blackboard when he was a new teacher. His analyst’s intervention was to repeat a phrase that Levi spoke during a session, something about “pressure on the board.” The analyst’s restating of Levi’s remark triggered a cascade of insights, and shortly thereafter the chalk-breaking stopped.
What’s the common-sense response to this example? You’re tense. It’s natural to be nervous when you start out doing anything; most people fear public speaking; give it some time and you’ll start relaxing. And in most instances the common-sense response would be accurate: the nervousness would abate in time, the new teacher would stop pressing (literally and figuratively) so hard and relax into a comfort zone. One could imagine different sorts of interventions for accelerating the process. Relaxation exercises. Systematic desensitization — think about the chalk, pick it up and set it back down, pick it up and press it on the board and set it down, etc. CBT — it’s irrational to think that you’re less competent than your students, or that they care more about your performance than about their own grade in the class; become aware of your bodily and mental sensations leading up to the chalk-breaking and try to short-circuit the event by taking a deep breath and relaxing the hand holding the chalk; etc. We could even imagine a Freudian drawing analogies between the piece of chalk and the penis, handling the chalk and masturbation, breaking the chalk and self-castration for trying to take the place of the father in the classroom, and so on. Every one of these specific interventions might be useless in causing new teachers to stop breaking chalk, but the chalk-breaking would probably stop anyway over time. In all likelihood, though, Levi would attribute his lighter touch with the chalk to whatever sort of intervention technique he happened to undergo. And empirically speaking, just having someone there to support him would likely have reduced Levi’s anxiety more quickly than if he’d just dealt with it on his own.
But Levi’s analyst encouraged him to deal with the chalk-breaking symptom not just as something to overcome but as a sort of exploratory window. Looking through the window, Levi was able to see various ways in which this chalk-breaking symptom might relate to other experiences in his life, other symptoms, past experiences that caused similar reactions. The loosening of rational consciousness thought encouraged by the psychoanalytic context opened up the window even wider, bringing in less obvious, less well-rehearsed interconnections in memory and affect. The analyst’s interventions serve not to foreclose further exploration through expert judgment but to loosen the strictures even further, to deterritorialize the neural net with little schizzy interruptions in the usual flow of associations. Levi might have stopped breaking chalks at about the same time if he’d gone for CBT instead, but almost certainly he wouldn’t have had as rich and unique an experience along the way.
To me this is the great thing about psychoanalytic praxis: it regards symptoms as opportunities to open up windows rather than as cracks in the walls that have to be patched up. The kinds of discoveries a client might make are liable to be some combination of the ordinary and the idiosyncratic, just like all human experience tends to be. But for that particular client the discoveries add depth and texture and meaning to life. In this sense analysis is more like watching a great movie, or perhaps like writing a novel, than like going to a repair shop. What are the measurable outcomes of reading Crime and Punishment? You might pass a knowledge test, you might write a good interpretive essay, but ultimately it’s some sort of (trans)formative experience that contributes something intangible and distinct to who you are and how you experience the world.
* * *
Is psychoanalysis worth the money? I suppose the question is: compared to what? It seems self-indulgent, but so is buying a new car every few years or remodeling the kitchen. Those shopping-cart comparisons point to something fairly obvious: it’s hard not to think of analysis as a bourgeois luxury good. And yet, even in the go-go borrow-and-spend years leading up to the latest meltdown, those who could afford analysis rarely made that purchase. Is it because of the lack of empirical support? Doubtful. After all, consumers know that a new car loses a few thousand dollars in value the minute you drive it off the lot. There’s just something sort of decadently impractical about analysis. Besides, who intentionally wants to pick at the scabs of old wounds and open up cans of worms?