Upublished Letter to the Editor of the New York Times by Henry J. Friedman
To the Editor:
As a practicing psychiatrist who utilizes psychoanalysis, psychotherapy and psychopharmacology in an effort to relieve the emotional suffering of my patients I feel a distinct need to respond to Scott Stossel’s review of Jonathan Engel’s book, “American Therapy: The Rise of Psychotherapy in the United States”. Stossel chooses to attack psychotherapy in general and psychoanalysis specifically despite the fact that Engel’s book, as described by the reviewer, is respectful of treatment and repeatedly cites psychotherapy research that supports the effectiveness of psychotherapy for a large percentage of patients. I can only wonder what motivates this reviewer to make unfounded statements, such as, “If it were to be conclusively demonstrated that therapy doesn’t work, therapists would be put out of business; that’s effectively what’s already happened to Freudian psychoanalysts.”. While it may be common parlance in uneducated circles to announce the death of Freudian psychoanalysis I would expect a more informed perspective in a review published in the Sunday Times Book Review. Stossel’s claims are entirely unfounded and appear to emerge from some hostility he feels about psychoanalysts and psychotherapists earning a living from the work that they perform with a wide variety of patients who are, indeed, helped to live with less anxiety and despair as a result of understanding the influence of their developmental and current life environments.
This review is riddled with inaccuracies both large and small. Its author might have benefited from doing his homework; the Vanderbilt University researcher he cites, named “Hans Krupp” is in reality Hans Strupp. Cognitive behavioral therapy is derived from Freudian psychoanalysis, a fact acknowledged by Beck who is a psychoanalytically sophisticated psychiatrist. His list of the most “eminent psychologists of the day” who “embraced and promoted Freudian theory” includes Adolf Meyer, who was adamantly opposed to Freud’s theories and Harry Stack Sullivan who created a competitive set of theories that he considered far superior to Freud’s ideas. These misstatements underline the sloppiness of this review but Stossel’s glib hostility to psychotherapy is the more regrettable element in what ultimately is an uninformed attack on psychoanalysis. While it can be argued that no one will be influenced by a review that persistently insists that psychoanalysis has been killed off and buried when, in fact, it is practiced by increasing numbers of clinicians both in the United States and Europe, there is simply something wrong with promulgating such a melange of misinformation.
Freud’s psychoanalysis is not only alive and well wherever intensive efforts are made to help individuals with anxiety and depression, it has also been added to and modified by psychoanalytic thinkers including Melanie Klein, Heinz Kohut, and Stephen Mitchell, each of whom have launched their own school of psychoanalytic theory and treatment. Furthermore, the arrival of Thorazine in the 1950’s, rather than being the “death warrant” for psychoanalysis as Stossel (and not Engel in the actual book being reviewed) claims made the treatment of schizophrenic patients with psychotherapy a possibility. This has been even more so with the advent of the SSRI’s as effective antidepressants that have made a widening scope of patients able to be in analytic psychotherapy and psychoanalysis as well. Perhaps Stossel’s hostility towards psychoanalysis that leads him to such inaccuracies of fact as well as of opinion comes from some part of his experience that would be better explored in a good analysis, Freudian or otherwise, to give him better insight into the how and why of his desire to bury Freud and psychoanalysis in a not so shallow grave. Maybe then he would no longer be “Still crazy after all these years”.
Henry J. Friedman, M.D.
Associate Clinical Professor of Psychiatry
The Harvard Medical School
6 Garden Terrace
Cambridge, MA 02138
617 876-4610