The Limitations of Lying on the Couch

Human Givens, Vol. 9, No. 2, Summer 2002

I want to recount my experience of psychoanalysis in the hope that I can determine exactly how effective and therapeutic it was for me. Did it alleviate my mental distress? Did it make me feel less miserable? Did it make me happier? I do not conduct this inquiry solely in the spirit of a former patient’s rebellion against his analyst. I am not just writing to make trouble with him and the psychoanalytic institution. Rather I make this examination because I believe that this psychological process, like any other, ought to be scrutinized and contemplated. It should be able to withstand the critic’s eye, and even the contrarian’s challenge.

If I conclude that psychoanalysis did not help me, then I would hope that its practitioners – some of who might be reading this – would ask the crucial question: does psychoanalysis, as a psychological approach and method, contain flaws both in its understanding of mental functioning and its treatment of mental disturbance?

In this article, I propose that psychoanalysis is intellectually aloof, that it demands a near-religious dogmatism from its practitioners, that it is too concerned with the self rather than the rest of the world. Personal knowledge and insight are not everything. The world goes on around us irrespective of our mastery of our unconscious selves.

The powerful establishment of psychoanalysis, with all its intellectual pomposity – if only it were as clever as it considered itself to be – must be held to account if it provides ineffective treatment for its patients (as opposed to ‘clients’), and even worse, if it actually increases the suffering of these individuals.

Entering analysis
I was in psychoanalysis for three years. I entered analysis (or ‘psychoanalytical psychotherapy’, as some refer to it in its less intense incarnation) when I was 26. After the break-up of a relationship both my anxiety and my depression became more and more unmanageable. They started to interfere with my day-to-day life, my ability to work and to socialize. Then they began to affect my personal relationships.

It became increasingly painful and difficult to spend time with the people I care for, the people I love. I went on to lose my appetite for food and my ability to sleep. I started to wake early, at half past four in the morning, and lay there tossing and turning, full of dread at the prospect of getting up and going out. Before long I was permanently confined to my bed, in a desperate state.

I saw my GP and was prescribed anti-depressant and anxiolytic medication. To compliment the drug treatment she referred me to a counsellor who worked for the practice. The NHS provided a weekly one-hour session for ten weeks, after which time I could decide whether I wanted to continue treatment with another practitioner. The counsellor introduced me to the various different psychotherapies, offering me a brief outline of how each one worked, and finally referred me to a psychoanalyst. After consultation with my GP, I stopped taking medication and entered analysis.

The psychoanalytic process
Freud offered, for the study of the mind, a concatenated model – id, ego, superego – which facilitated systematic study of causes and symptoms, symptoms and causes. Through this psychological process I hoped to rid myself of the anxiety and depression, which caused me so much pain and distress. I would enter into an intense relationship with the analyst, and become very dependent on him. He would guide me as I penetrated my unconscious and dug deep inside it. He would help me remember and identify specific earlier traumas, which had been repressed. He would encourage me to re-live them and he would interpret them. And through this painful and rigorous process, of Memories, Dreams, Reflections, I would gain a new understanding and insight, which would put an end to my ‘neurotic symptoms’, as Freud would have me call them. In short, this method of digging up and unraveling my past experiences would make me better.

So where was I after the first nine months of therapy? Was I less depressed and less anxious? Well, not exactly. In fact, not at all. Far from making a recovery, I had another mental collapse: I was in a state of crisis again. My then relationship suffered terribly during this time. My GP referred me to a psychiatrist, who was not so concerned with my symptoms’ aetiology, but rather with their prognosis and containment. He diagnosed depression and OCD (obsessive compulsive disorder), and prescribed a combination of medication (paroxetine, commonly known as Seroxat) and CBT (cognitive behavioural therapy). I only had three sessions of CBT, and now wish that I’d had more.

Throughout this period of crisis I continued to see my analyst. Unfortunately, it is only with the benefit of hindsight that I can appreciate how ill-equipped psychoanalysis is when it comes to dealing with serious emotional distress. Freud always maintained that his would-be science responded best to neurosis, the less serious forms of emotional suffering. Well, he was right about this. ‘Some neurotics have remained so infantile that in analysis… they can only be treated as children,’ he’d remarked. Perhaps I was such an infantile patient? God only knows what criteria he applied to make the value judgement of ‘infantile’. His definition seems nothing more than an act of pedagogic discipline. According to him, it would seem that anyone is weak and puerile if they do not respond, as they should, to the therapeutic powers of his method, and sicker still, if they challenge his will and his method.

The purity of analysis
I was reluctant to come off the medication again until I felt ready. I recently read an article in The Observer newspaper in which Lewis Wolpert, the Professor of Biology as Applied to Medicine at University College, London and author of Malignant Sadness: the Anatomy of Depression said, ‘People say to me, “Is the Seroxat helping you now?” But how the hell can I know? I stick with it because I’m too nervous to stop.’ Like him, I was terrified of the return of another depressive episode. My analyst agreed to continue seeing me, but we would work towards me coming off anti-depressants.

There are some analysts who refuse to see patients who are either on medication or receiving behavioural therapy. According to them drug treatment and behavioural therapy act as a smoke screen. They dampen down the emotions of the patient, and hence hinder him or her getting to the root of the problem. According to analytic theory neuroses need to be uprooted at the core. Painful experiences must be remembered, reflected upon and interpreted. Only then is significant characterological change possible. Implicit in this ‘hypothesis’ – let us give it its proper status as an assumption or proposition rather than a scientific truth – is the idea that the patient’s symptoms such as depression, severe anxiety or obsessional behaviour are the ‘expressions of highly charged conflicting impulses and fears’. Man is viewed in rather bleak terms as a cesspit of seething affect and sexual drives. If these are confronted and understood – revealed and ‘confessed’ to the analyst – then the patient shall ‘thereby [gain] relief and enrichment in [his or her] personal and intellectual life’. The patient must give himself over to the process. The patient must work hard and be rigorous with him or her self. Only then shall the patient gain relief, and become the true master of his unconscious. These are the rather dogmatic and educative rules of the psychoanalytic game: to make the unconscious conscious. All emotional conflict is interpersonal or person-centred, to use modern terminology. The rest of the world is not so important. Hence, genetic, biological, gender, environmental, economic, cultural, religious and racial concerns do not figure at the roots of mental distress. One need look no further than oneself and one’s own mother and father.

In search of a non-deterministic view
I must question this theoretical assertion and practice, particularly in light of recent advances in neuroscience. Depression and anxiety disorders have recently been attributed to low serotonin (one of several neurotransmitter chemicals that nerve cells in the brain use in communicating with one another). Anti-depressant medication works by slowing the reuptake of serotonin by the transmitting cell, thus making it more available to the receiving cell and prolonging its effect on the brain. Hence, if someone is biologically predisposed to depression and/or anxiety, rooting about in their past will not reverse this chemical imbalance, their inherent brain chemistry. Likewise, if someone is subjected to serious racial abuse and discrimination in the area in which they live, what will help this person is not a lengthy process of self-reflection and analysis but rather a change of environment or an appeal to the police. Only the abuser can change his or her own behaviour. That is unless he or she is forced to by the rule of law. No amount of personal knowledge and insight by the victim will halt the perpetrator’s abuse. These biological, hereditary, racial and environmental explanations of the causes of mental distress demonstrate the narrow scope and limited perspective of psychoanalytic theory. Trouble also comes from the real world, not just from within.

I spent the next year and a half in analysis building up to the point where I felt confident about coming off the medication. I hoped that the psychoanalytic process of rooting about in my unconscious would provide me with the inner resources to handle another depressive episode if, God forbid, another one crept up on me. My increased insight would give me the necessary strength. But it did not.

Biological madness
When I came off the medication I felt myself spiraling out of control. Self-knowledge didn’t seem enough. However, my analyst assured me that courage was required to avoid medication again, and that my current mental distress could be worked through. But I felt the chemistry going, that I was crossing the line into madness. My anxiety and depression had their own force and momentum, and I could not halt their relentless course. I yearned for practical coping strategies and tools to manage the anxiety. I desperately tried to recall what I had learnt in my few sessions of CBT. These practical behavioural approaches ran contrary to the ideas of psychoanalysis. My analyst perceived these methods as just ‘bloody management’, which fail to get to the root of the problem. They are temporary, shallow and artificial devices that do not set out to ‘cure’ and ‘heal’, but rather to ‘dampen down’ and to ‘manage’. Eventually I returned to my psychiatrist, who prescribed medication again.

Andrew Solomon, in his book The Noonday Demon, refers to his depressive breakdown as the point where ‘once you cross over, the rules all change. Everything that had been written in English is now in Chinese’. After nearly three years of lying on the couch, I might have possessed a greater intellectual understanding of the aetiology of my mental distress, but my symptoms still persisted, and with the same vigour and menace. I lay on the couch, in the midst of a panic attack and feeling suicidal, and sadly, all my analyst could offer me in terms of support was yet another interpretation. ‘You must examine again your early relationship with your mother.’ He said this with conviction, as if it provided the answer to all my distress, as if this insight would relieve me of my suffering. And at that moment I knew that analysis could not offer me anything else.

The impossibility of closure
When I announced that I wanted to terminate my therapy I was accused of being unwilling to fully commit myself to the process. My failure to completely let go, to fully trust in the analyst and his methodology, to open up, to expose all of myself, to relinquish my ego – I could go on – meant that my distressing symptoms would persist. My analyst cited that when I was particularly anxious, I used to charge straight into the toilet as soon as I entered the building and empty my bowels. Quite literally, I couldn’t contain myself. Now frustrated and angry, he declared that I unconsciously wished I could shit on him – according to his interpretation, this was my ultimate fantasy. If my anger were not repressed, if I were bolder, then I could speak instead of shit, I could confront him with words rather than faeces. According to this hypothesis, my depression was a kind of internalized violence. When my legitimate anger against others could not express itself, well … then it turned inwards, to self-contempt and self-destruction. This was his interpretation of my distress, which he assumed to be the root cause of my anxiety and depression, and he applied it rigorously. He knew what my shit really meant, and he told me so.

There was indeed some truth in my analyst’s explanation. I did feel angry. But I also felt very sad and confused. And these two feelings prevailed as my anger subsided. I asked myself, ‘How would this challenge to his dominance help me? Would it lift me out of my despair, just to enter into a conflict with him, to feel powerful?’ According to the rather brutal, pessimistic dog-eat-dog worldview of psychoanalytic theory, it would. This reminds me of the school bully, who having spent years being bullied himself, finally gets to the position where he can dominate others, where he can become the bully. And he takes up this role with relish. The analysand becomes the analyst. Now it’s his turn to be tough with his patients.

But when I did challenge his interpretation and deny the therapeutic value of his interpretation, my objection was not taken as a statement of truth but rather as a projection of my fantasy, an act of denial. The analyst alone, sitting aloof in his chair and looking down at his patient, can see the truth. He can be counted on to tell the patient what he or she really means. He is the best judge of what the patient is really thinking and feeling.

But how can this be? For what qualifies him to suddenly be in the position of authority. The psychoanalytic institution would respond, ‘Because he has been vigorously analyzed himself.’ But how can analysis be measured? Perhaps by the number of hours, or by the level of intellectual content, or by the number of tears shed? No, the process is too unique, too subjective. Every analysand’s experience is so different. Suffering cannot be universalized.

I was unsure what else I could do in analysis, what else I could gain from the process. I had entered therapy to relieve the burden of my memories and to be happy again. I had carefully reflected on my past experience as the process required. I had listened to the analyst’s interpretations, considered and incorporated them into my present life. I had made a systematic, concerted effort to make my unconscious conscious. According to psychoanalysis, if I took all these steps and pursued them with vigour and commitment, my suffering would be alleviated. And yet after my long and passionate commitment to a process, an ideology, an institution and a practice that I hoped could help me and lift me out of the dark, I was still deeply unhappy. I had put my faith in a psychological process that had failed to help me – though it would probably still maintain, even now, that this was my failure rather than its own.

I left analysis still suffering from bouts of crippling anxiety and depression. I left analysis still feeling emotions that often seemed completely senseless and unmanageable. It was a valuable intellectual exercise in self-awareness, but beyond this internal exploration of my unconscious it did not offer any practical solutions to my mental distress, it did not alleviate my suffering. It was not as therapeutic as it believed itself to be.

Believing in a more compassionate and humble approach
And now, a few months since I ended my analysis, I feel better, a whole lot better. Psychoanalysis insisted it could understand my experience in the format of theory alone. But to its great detriment, it did not meet my basic emotional needs and it did not nurture my built-in resources to help myself. It was unbending about the ultimate truth of its own approach. It was sure that it alone – as opposed to any other therapeutic method, faith, belief system or ideology – possessed the key to unlock the secrets of men’s and women’s hearts. It was blind to any other way of seeing the world. Human experience has shown itself to be too unique, varied, enigmatic and ambiguous. Life, at every corner, seems to resist definition and categorization. Different people need different things. Likewise, different theories and methods work for different people.

Freud, Sigmund. The Standard Edition of the Complete Psychological Works of Sigmund Freud. Trans. James Strachey. London: The Hogarth Press, 1964
Griffin, Joseph and Tyrrell, Ivan. Psychotherapy and the Human Givens. Human Givens Publishing, 1999
Hayman, Ronald. A Life of Jung. London: Bloomsbury, 1999
Masson, Jeffrey. Against Therapy. London: Harper Collins, 1989
Solomon, Andrew. The Noonday Demon. London: Chatto & Windus, 2001
Wolpert, Lewis. Malignant Sadness: the Anatomy of Depression. New York: Free Press, 1999

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