In the past, mental disorders were thought to be caused by hereditary or degenerative changes in the brain. The psychiatrist’s task was primarily to diagnose and, if possible, provide treatment using methods available at that time.
Sigmund Freud, a neurologist and researcher, began listening to his patients’ stories to link them to their hysteria, anxiety, depression, compulsive behaviors, etc. His notion that humans have an unconscious mental life alongside their daily thoughts and feelings was not new. However, when he linked it to the emergence and treatment of mental illness, it revolutionized psychiatry. He changed the view of the patient from being seen as an example of a particular diagnosis to being treated as a completely unique individual with his or her own special history.
Today, psychoanalysis is criticized for being unscientific, vague, outdated, and based on the analyst’s personal biases. In fact, psychoanalysis has always been criticized according to the prevailing zeitgeist. Let me briefly address today’s criticism:
UNSCIENTIFIC: Psychoanalysts base their comments to the patient on their dialogue, personal experiences, and knowledge of psychoanalytic theory. They follow a tradition from German philosophy (Dilthey), which argues that humans seek to understand the world and themselves through dialogue with others. It begins between the infant and the parent and then develops further, including into psychoanalytic conversation. Psychoanalysis theory is extensive and constantly evolving. It rests on the so-called hermeneutic tradition, which is also found in nursing research, law, sociology, etc. Therefore, psychoanalysis is not a natural science, just as the aforementioned hermeneutic traditions aren’t. Analysts do not measure or weigh the patient or conduct examinations outside the consulting room. They rely on what the patient communicates, how they are affected by such communications, how they can link it to their knowledge of themselves, the patient, and the theory – before providing any comment to the patient.
VAGUE: When a lawyer discusses a legal text, a journalist analyzes a political statement, a priest converses with a person about a moral dilemma – they are about as “vague” as the analyst in conversation with the patient. For if they can link the event to a larger and understandable occurrence, we call them interesting and not vague. So, a reasonable expectation you can have of your analysis is that it should be interesting and meaningful!
OUTDATED: Psychoanalysis theory and practice have changed enormously over a hundred years. It now also treats adults with severe mental disorders and children. PDT, psychodynamic psychotherapy, and short-term therapy have been developed to provide more treatment options. The theory has deepened in the description of children’s development and how our early relationships affect us as adults today. The treatment has also become more dialogue-oriented. Of course, the analyst-patient relationship is “asymmetric” because the patient seeks help from the analyst and not the other way around. But today’s more “democratic” view emphasizes that patient and analyst together explore new perspectives. The analyst does not know the “truth” about the patient’s inner self, and we are aware that both participants have their “blind spots.” A well-known analyst (Bolognini, 2024) emphasizes that in psychoanalysis, both parties “must coexist mentally for the time needed, share experiences, and allow a common path to develop, in short: to give time to time.”
Psychoanalysis continues to fascinate, irritate, and provoke. It’s an unusual form of treatment. I dedicate space here because it’s one of the therapy methods I practice. Furthermore, psychoanalysis and its theory are the “parents” of most psychotherapy methods.