The Freudian Schism

By WILLIAM SARGANT

PHE tremendous advances that have taken I place in psychiatric treatment in recent years should be better known to the general public. They should also know that Britain is now lead- ing the world in her all-round common-sense approach to the treatment of its mentally and neurotically ill. British mental hospitals, too, have changed out of all recognition. The majority of patients, especially those of good previous personality, only enter them on a voluntary basis, and are able to leave after treatment within weeks or very few months at the most, compared with the years and years of illness that were common- place twenty-five years ago. However, there is still a lot of confusion as to where the advances have originated.

One would hardly realise that this great pro- gress is being made from the books on psychiatry and psychology that are being pub- lished both here and in America at the present time. Various approaches which contribute the least to the present therapeutic revolution have their advocates, who see to it that lack of results in treatment is compensated for by a barrage of publicity. So much is this the case that, although there are in this country fewer that 300 medically qualified and lay psychoanalysts and over 2,000 general psychiatrists, using mostly other methods of treatment, too many people among the general public still think of psychiatric treat- ment as being synonymous with psychoanalysis, and psychiatrists are likely to become tarred with the same brush.

This schism within psychiatry still, unfortu- nately, remains a very wide one indeed for many reasons. Many psychiatrists entered this speci- ality from general medicine as philosophers in revolt against the crude but extremely effective physical and mechanistic treatments of modern medicine and surgery. But these philosophical refugees then suddenly found that modern psy- chiatry is only making its present tremendous headway by using just the same sort of empirical and mechanistic methods that have proved so successful in general medicine in the last fifty years. Protesting vociferously, they may retreat again into 'social' psychiatry, insisting that dis- turbance in the environment and the upbringing of children is much more important than in- heriting and trying to maintain a stable nervous system by physical methods of treatment. It may take some time for British psychiatrists to live down some of the utter nonsense talked at the recent muddle-headed International Congress of Social Psychiatrists in London. And they seem to forget that the last war showed one thing above all else, and that was how the most terrible stresses and conflicts could be dealt with by the brain when it was functioning well. Alternatively, some psychiatrists chose to pose as 'sensible and well-balanced' doctors, who decry all present treatment enthusiasms and do their best to show by a mass of statistics, studied away from the patient's bedside, that no treatment, new or old, helps very much in mental and nervous condi- tions, and nature is best left to take its course if environment cannot be altered.

Another refuge for the philosophical psychi- atrist is to resort to seeking the support of one or other philosophical dogma, such as the Freudian discipline. When this happens, indi- vidual criticism and judgment are likely to be abrogated in favour of blind faith. And now the fact, for instance, that depression is so easily relieved by a few electrical shock treatments, or by some of the new antidepressant drugs, makes no difference at all to the Freudian fol- lowers of, say, the late Melanie Klein. Many of these will still go on believing that depression is caused by breast frustration in infancy, and should also be treated along such hypothetical and generally impossible lines.

Hanna Segal's book* on the teachings of the late Melanie Klein, who was for some years before her death the medically unqualified leader of the Freudian analysts in the country, shows to what absurd lengths one can go in theory when faith and a dogma rather than testable hypotheses and actual treatment results dominate the picture. The book •shows, in fact, what hap- pens to concepts and treatments of mental illness when approached by somebody with no medical knowledge or training, and who refuses to accept the brain as the treatable organ of thought.

An Introduction to Psychotherapy,t by Sidney Tarachow, is at least written by a qualified

doctor. But again we see here that exact and careful diagnosis of all the many different types of mental illness and varied neurotic complaints, to which man has been heir for centuries, does not have very great importance; largely because there seems to be only one satisfactory treatment for most patients, namely, Freudian-aligned psy- chotherapy.

Heinz Hartmann's Essays on Ego Psychology$ stem from one of the leading minds in the inter-

national psychoanalytic movement. But again, how pedantic and limited this whole approach is, and still how dependent on Freudian authority of fifty years ago. And how little psychoanalysis can help most mentally ill patients, compared with the other much simpler advances in physical treatments, which Freud himself, as a neurologist at heart, always knew were bound to come, and which according to his writings he would have warmly welcomed and used had they been in existence in his day, On the other hand, L. S. Hearnshaw's history§ is an excellent account of British contributions to psychology and psychi- atric theory over the hundred years from 1840 to 1940, showing the tremendous changes that have occurred during this time. And one can see how foreign to us, as a nation of empiricists, are the European and American dogmas based mostly on speculation.

Years ago, Henry Maudsley said: 'The ob- servation and classification of mental disorders

have been so exclusively psychological that we have not sincerely realised the fact that they illustrate the same pathological principles as other diseases, are produced in the same way, and must be investigated in the same spirit of positive research. Until this be done, I see no hope of improvement in our knowledge of them, and no use in multiplying books about them.

(Goulstonian Lectures, 1870.) And how right he has proved! Lord Moran also said a few years ago: 'The physician of today is twice as well equipped in the war with disease as he was when I was a student. And . . . when he has'an effec- tive remedy in his hands he can cut the cackle. This is equally applicable to the psychiatric treatment of today.

* INTRODUCTION TO THE WORK OF MELANIE KLEIN.

By Hanna Segal. (Heinemann, 16s.) •

t AN INTRODUCTION TO PSYCHOTHERAPY. By Sidney Tarachow. (Hogarth Press, 35s.) t ESSAYS ON EGO PSYCHOLOGY. By Heinz Hart- mann. (Hogarth Press, 75s.) § SHORT HISTORY OF BRITISH PSYCHOLOGY (1840- 1940). By L. S. Hearnshaw. (Methuen, 35s.)