Book Review: Burgo on Defences

Burgo, J (2012) Why Do I Do That: Psychological Defense Mechanisms and the Hidden Ways They Shape Our Lives. Chapel Hill, NC: New Rise Press.

Joseph Burgo, psychotherapist and expert blogger, has written a readable, informative, and above all, useful account of our psychological defences - the lies we tell ourselves to avoid emotional pain. He has a gift - you can see it in his blog - to engage with the reader and tranform complex psychological phenomena into understandable and recognisable everyday human processes. This is a good trait in a psychotherapist. In a writer it means the insights of psychoanalysis are available to the reader and he or she can use the book's contents and exercises to begin some self-analysis. The book has helped me to understand the unhelpful ways I protect myself from emotional pain and the costs involved. It offers the possibility of choice - more enriching ways of relating and being in the world, ways that are more in touch with reality.

The defence mechanisms are unconscious and repeating patterns that keep our experience of self and others predictable and safe. Burgo writes about denial, splitting, idealisation and projection as means by which pain is avoided and distressing reality kept at bay through dissociation or by locating it elsewhere, particularly in others.

The book begins with a quiz inviting the reader to explore their own psychological make up and the defences that might accompany the different ways of being. After each chapter there are exercises to help the reader identify how each defence might be being deployed in his or her life. I have found it useful to keep a journal whilst reading the book, for my observations and as a place to do the exercises. As a result I have discovered interesting things about my own defences and learnt to be even more curious about the defences employed by my clients. Like Burgo I believe defences are a part of everyday life, to be expected, even appreciated, after all their intention is a positive one: learnt at times of great stress to keep us functioning; but at a cost and ultimately defences get in the way of seeing and engaging with the world as it really is.

So I can happily recommend Joe Burgo's book, without, I hope, idealising either the book or Joe!

Book Review: In the Freud Archives by Janet Malcolm

Last week I wrote a short review of Psychoanalysis: the Impossible Profession by Janet Malcolm. This week I finished reading another of Malcolm's books, In the Freud Archives. An enjoyable read,  finished in a couple of sittings, though I appreciate the book may not have broad appeal. It's about two Freud researchers, Jeffrey Masson and Peter Swales, and their encounter with the psychoanalytic establishment in the USA. It's a fascinating tale and high-class gossip!

The first researcher we meet is Jeffrey Masson, a professor of Sanskrit and unsuccessful therapist, who seduces the eminent psychoanalyst and long-time secretary of the Freud Archive at the Library of Congress, Dr K. R. Eissler. Very quickly Masson is appointed as Eissler's replacement and tasked with editing a complete edition of Freud's letters to his friend Wilhelm Fleiss. An excellent job Masson does too! 

But whilst working in the archive Masson looks for evidence supporting his view that Freud's initial understanding of the etiology of hysteria was correct, that his patients had indeed been sexually abused. He argues that Freud abandoned this 'seduction theory' because of the hostility of his fellow medical professionals. Wow! The whole basis of psychoanalysis, the Oedipus Complex and Freud's theory of childhood sexuality, questioned by the new keeper of Freud's archive. Masson published his views in a national newspaper and was subsequently removed from his post as secretary of the Freud archive. Masson promptly sued Eissler for $13 million, settling for $150,000. 

Of course it's not the sequence of events that's interesting but rather the personalities involved. Masson comes across as confident and charming, but above all - due to his frankness during interviews - narcissistic. And for that unwanted portrait Masson sued the author of the book - an unsuccessful court case that lasted ten years. Eissler comes across as totally devoted to his beloved Freud, but naive and easily duped. I'm reminded of the priest played by Richard Burton in the 1978 film Absolution: a pious man whose rigid beliefs are no defence against the wickedness of a murderous boy he teaches.

Masson went on to write two incendiary books: a hatchet job called The Assault on Truth about Freud's abandonment of the seduction theory; and Against Therapy which is an attack on the unethical practice and power crazed therapists Masson finds in every field of psychotherapy.

Another researcher graces the pages of this book. Peter Swales is a complex man with an encyclopaedic knowledge of Freud and the origins of psychoanalysis. He calls himself a 'guerilla historian of psychoanalysis'. He too won the confidence of Eissler, who arranged for the Freud archive to gift him $4000 to enable him to continue his research. What Swales comes up with is the closely argued theory that Freud had an affair with his sister-in-law, Minna Bernays, that she became pregnant and that Freud arranged for a termination. So here we are again, Dr Eissler using the Archive's money to fund research intended to harm the reputation of Freud and psychoanalysis.

So for those Freud anoraks out there I can highly recommend Janet Malcolm's book. Beautifully written, full of wry humour and a nice partner to her other volume, Psychoanalysis: The Impossible Profession..

Book Review: Psychoanalysis: The Impossible Profession by Janet Malcolm

I recently spotted a tweet from my Twitter pal @RuthNinaWelsh saying she'd just bought Janet Malcolm's book, Psychoanalysis: The Impossible Profession. Before I knew it the very same book was in my Amazon basket, along with another by Malcolm, In the Freud Archives, my next big read. I've a weakness for pretty dust jackets and books about psychotherapy and with the help of Amazon I've been able to fill two rooms at my house and office. The Marsden Therapy library! It will certainly fill a large skip when I'm dead and gone.

Janet Malcolm's book fooled me a little. This latest edition was published in 2012, but the book was first published in 1981. Very dated then. It started as an article in The New Yorker, where Malcolm has been a contributor since 1963, and it's been expanded to 168 pages with detours into Freudian theory and practice. 

At the heart of the book is an extended interview with psychoanalyst "Aaron Green", a 'forty-six-year-old psychoanalyst who practices in Manhattan in the East Nineties' (3). The book is fascinating when it describes the views and experiences of Green, this 'slight man, with a vivid, impatient, unsmiling face' (3). 

To increase the word count (I suspect) the opinions of Green become departure points for fairly esoteric discussions of Freudian theory and technique (transference, analyzability) and the competing revisions of post-Freudians. In the face of all these revisions Green remains completely loyal to Freud's original conception of psychoanalysis, articulated for Green by his contemporary, Charles Brenner. 

The first chapter of the book is something of a potted history of Freud's discoveries, but after that the book becomes much more interesting. The interview with Green casts light on the politics of the New York Psychoanalytic Institute, the eccentricities of the New York Psychoanalytic Society, the manoeuvres and bids for power and status of America's leading analysts in the '70s and '80s. There are insights too - on therapy, on Freud and on human nature - so I'm looking forward to reading my other Malcolm purchase, In the Freud Archive, about Jeffrey Masson, who did us all a great service as the editor of the Freud-Fliess letters and then did a hatchet job on Freudian studies and the field of psychotherapy with his two books, The Assault on Truth and  Against Therapy

Janet Malcolm, Psychoanalysis: The Impossible Profession, London, Granta. Available from Amazon

Film Review: A Dangerous Method

You can see from the picture above just how much Mortensen and Fassbender look like Freud and Jung. There are uncanny moments in the film, when one or the other turns his head, and the resemblance is striking. I particularly enjoyed the sight of Mortensen/Freud lighting his cigar and Fassbender/Jung tamping away at his pipe - there must be some symbolism here!

Choosing the above picture is no slight on Kiera Knightly, whose performance as Sabina Speilrein gives this period drama some much needed emotional intensity. Everything else is starched collars and buttoned up emotions - which beautifully captures the period and the personalities of Freud and Jung, but makes for a rather slow and stilted film. Having said that the film is lovely to watch, at one point Jung and Speilrein are aboard a steamboat, which reminded me of the Esmerelda in Visconti's Death in Venice - nothing quite as luxurious here but beautiful nonetheless.

In this film, the director David Cronenberg, suggests that Jung's encounter with his patients, Sabina Speilrein and Otto Gross, leads to his sexual, emotional and philosophical development and ultimately to the break with the dogmatic Freud. But there is enough evidence in the Freud/Jung Letters to suggest that two such powerful personalities were inevitably going to disagree. I don't believe that Speilrein and Gross performed the crucial roles assigned to them in this film. What we know of as Analytical Psychology emerged following Jung's break with Freud: out of the psychosis that the break-up precipitated and the recovery that Jung was able to achieve. I don't think we can give too much credit to Speilrein and Gross.

For me watching the film was a little like watching Freud and Jung's greatest hits: there is the thirteen hour discussion when they first met, the cracking of the bookshelves whilst Freud discouraged Jung from writing about parapsychology, the refusal of Freud to 'risk his authority' and tell Jung his dreams and Jung's "death wish" which caused Freud to collapse on a couple of occasions. I recognised these episodes as they came along, all well known biographical details. Interesting to watch and it's great to see Freud and Jung up there on the big screen, but in the end, no cigar!


Director David Cronenberg, with Viggo Mortensen (Sigmund Freud), Michael Fassbender (Carl Jung), Keira Knightly (Sabina Spielrein), Vincent Cassel (Otto Gross) and Sarah Gadon (Emma Jung)

Book Review: An Anatomy of Addiction by Howard Markel

My favourite book this year turns out to be An Anatomy of Addiction: Sigmund Freud, William Halsted and the Miracle Drug Cocaine by Howard Markel. Such an enjoyable read: a good story, well written with humour and insight from a doctor and professor of the history of medicine.

Markel provides some entertaining chapters on the discovery and early use of cocaine. It was used as a pick-me-up added to soft drinks and wine, as a cure-all for the depressed and liverish and as a local anaesthetic that revolutionised surgery. By the time cocaine's addictive and destructive properties were recognised thousands were addicted to the drug.

Markel's account of Freud's cocaine use is fascinating, fair and balanced, an antidote to E.M. Thornton's tendentious Freud and Cocaine - also reviewed on my blog here. He describes Freud's early research into the drug's medicinal properties, including the disastrous treatment for morphine addiction of his friend, Ernst von Fleischl-Marxow. Despite his friend's double addiction to morphine and cocaine and resulting death, Freud became an advocate of cocaine and used the drug himself for around ten years. It is fascinating to consider how much cocaine influenced Freud's ideas in the 1890s, including his Analysis of Dreams.

William Halsted was a contemporary of Freuds. He has been called the father of modern surgery. He advocated the antiseptic approach of Lister, and at a time when surgeons operated in dress coats, insisted his staff wear surgical garb, scrubbed their hands and don rubber gloves. He developed new operations and new treatments and yet throughout his career he was addicted to morphine and cocaine. Halsted's cocaine addiction began when he started testing the drug's anaesthetic qualities, injecting himself under the skin and cutting himself to see how deep he could cut without pain. Soon he was addicted. His friends and colleagues attempted to rehabilitate Halsted whilst preserving his reputation. Thus they sent him on a sea voyage to wean him off the drug and when this failed he was sent to a mental hospital where he was prescribed morphine in order to manage the symptoms of cocaine withdrawal. Halsted was addicted to drugs for the remainder of his life but managed to control his drug use (but with frequent relapses) thanks to a huge effort of will. After some years working in the pathology lab at the new Johns Hopkins University Medical School he was appointed to a professorship and continued to advance the profession of surgery until his death in 1922.

Markel's book provides an entertaining account of the lives of these two great Victorians, advancing the cause of medicine whilst battling their own demons and the problems of drug misuse and dependency. An excellent read!

Marg Simpson Sees a Therapist for Her Flying Phobia

First click of play gives you a pop up, which you close, second click gets you the movie at which you can laugh!

Today @Shrink_at_Large Tweeted the link to a funny Simpsons video in which Marg sees a therapist to cure her flying phobia. In true Freudian style Marg lies on the couch and free associates. With the “help” of her therapist she’s able to trace her anxiety to a time when she caught her father working as a stewardess on a passenger jet. I say in true Freudian style because one of Freud’s most famous cases, The Wolf Man, was neurotic, according to Freud, chiefly because he’d intruded on his parents having sex. In fact Freud himself wrote about seeing his mother naked on a train, an image the young Freud found both disturbing and memorable. As with a great deal of Freud, what begins as theory turns out to be autobiography.

So the scene in which Marg intrudes on her father serving drinks has a pedigree. Interestingly Marg also remembers other train related trauma, such as the engines of her toy plane bursting into flames or being machine gunned by a crop duster whilst walking past a field of corn. These are discounted by her therapist in favour of the more significant trauma of seeing her father working his way along the aisle. Marg’s phobia only becomes apparent to us when the Simpsons are given free air tickets. These are to buy Homer’s silence after he crashes a plane whilst pretending to be a pilot (which he does to get a drink in a pilots only bar). Maybe it’s this parallel that leads to Marg’s crisis: all her life the phobia had served as a defence, enabling Marg to avoid planes and airports - and ultimately the memory of seeing her father serving cocktails on an economy airline.

Book Review: Freud and Cocaine: the Freudian Fallacy by E.M. Thornton

My beliefs about Sigmund Freud have been severely challenged by reading E. M. Thornton’s blistering attack on the founder of psychoanalysis. I’d considered Freud one of the greatest thinkers of the Twentieth Century. If anything, I imagined him to be a victim of his own success - so many of his ideas are a part of mainstream culture that Freud has become associated only with the eccentric and unacceptable leftovers.

I think Freud represents a paradigm shift in how we think about the mind and human motivation. We accept the notion that individuals are driven by unconscious wishes and the idea that the mind can cause physical illness. But for E.M. Thornton, these are just two examples of the false beliefs that underpin psychoanalysis. Her argument is that Freud’s theories are a product of his cocaine addiction. She also argues that Freud’s case studies, on which the whole edifice is built, are more likely to be suffering from temporal lobe epilepsy than hysteria. She argues that a great deal of time has been wasted by physicians who could have been working on physical medicine and neurology rather than the drug induced fantasies of Freud.  Towards the end of her book she goes so far as to describe Freud as 'a man of pathological preoccupations' (291).

The early chapters of Thornton’s book are a disappointment, focused too much on medical history and hardly at all on Freud. She writes about Freud's early encounter with cocaine following its recent discovery and importation into Europe from South America as a new cure-all. Freud took it, recommended it to friends, prescribed it to patients, supplied his fiancé and published an article on its medicinal qualities, recommending it as a cure for opiate addiction. In his affection for coca Freud was joined by a great many others, particularly in America. Thornton calls this the great cocaine epidemic and provides an interesting account of cocaine use in the late Nineteenth Century, before cocaine was eventually outlawed in the United States in 1902. Initially it was seen as a wonder-drug and widely prescribed, even introduced into soft drinks; but over time the case against cocaine and its dangers emerged. Individuals, especially doctors, became addicted and developed an insatiable need for the drug. Side effects included paranoia, violence, hallucinations, egomania and physical effects such as heart problems and impotence. Addicts described obsessions with sex and had sexually explicit hallucinations, they believed they were in possession of a great truth and simply had to share it with others. Later on of course Thornton will argue that Freud suffered from these symptoms of prolonged cocaine use and that cocaine produced not just a runny nose but the Standard Edition of the Complete Works.

Thornton is claiming that just at the time Freud developed his most contentious theories, such as the Oedipus Complex, he was misusing and suffering the symptoms of cocaine addiction. How else, she argues can we explain Freud's belief in the sexual origins of the neuroses. My understanding is that Freud had come to the seduction theory because that is what his patients had been telling him and that Freud's reading and research in the late 1880s at La Salpetriere, which pointed to high levels of sexual abuse in French society, had made more believable the disclosures made by his patients.

Thornton reminds us that the patients treated at La Salpetrier by Freud’s mentor, Charcot, were more likely suffering from temporal lobe epilepsy than hysteria. She certainly paints a grim picture of the Salpetrier and its mainly female patients, performing for doctors and medical students from around the world, all attending to hear Charcot’s lectures and see demonstrations of hypnosis. She goes on to argue that because of their epilepsy these patients were susceptible to hypnosis, indeed that hypnosis is actually only possible with patients suffering from this pathology because hypnosis is a form of temporal lobe seizure. She scorns Bernheim of the Nancy School of hypnotism for believing that most people are hypnotisable and claims that most of Bernheim’s patients were pretending to be hypnotised out of fear of upsetting him. As someone who has experienced and practised hypnosis and studied the work of Milton Erickson I have to disagree with Thornton's narrow definition of what constitutes hypnosis and the hypnotic state. In the end her critique of hypnosis serves one purpose, it is in furtherance of her attack on Freud, who learnt and briefly practiced hypnosis but decided he wasn't proficient enough and abandoned the technique. For Thornton all the trees in the forest must be cut down so she can swing her axe at the mighty oak.

Thornton's analysis of the Anna O case is an excellent read. She argues that Anna O was not hysterical but suffering from meningitis contracted whilst nursing her father who had died of tuberculosis. She charts the changes in Anna O's presentation and makes the case for an organic cause, principally brain lesions, where Breuer had ascribed a psychological cause. She makes use of research by Ellenberger (1972) who had discovered what happened to Anna O after her treatment ended. It turned out to be an orderly handover to other physicians rather than the story put about by Freud in which Anna O developed a hysterical pregnancy that caused Breuer and his wife to flee the country. Ellenberger discovered that Anna O had not been cured by Breuer and that the account of her treatment in Studies of Hysteria differed from the contemporaneous case notes made by Breuer and found with Anna O's medical file in the asylum at Bellevue. Thornton also suggests that another case of Freud’s, "Frau Emmy", was not suffering from hysteria but almost certainty a variant of Tourette's disease. She suggests that Freud was mistaken when he took mild tonic seizures to be evidence of the effectiveness of the cathartic method. Thornton also writes about Freud’s “pathological” treatment of 'Dora', another of his cases with epilepsy rather than hysteria. Freud analysed Dora and her dreams, and with an imaginative use of symbolism discovered a sexual cause to 'Dora's' neuroses but after three months 'Dora' discontinued her therapy.

After her chapter on Anna O, Thornton begins looking for evidence of cocaine use in Freud's letters to Fleiss. She argues that Freud’s heart condition, messianic traits, 'monotony of interpretation', headaches, nasal problems, depression, death anxiety and dysphasia all point to cocaine misuse and appeared after April 1894. The idea that Freud experimented with cocaine in the late 1880s and then stopped is disproved by the Fleiss letters. Later on she suggests that Freud’s preoccupation with 'irregular modes of sexual gratification' (241) is a result of his cocaine addiction. She also thinks that Freud's relationship with Fleiss had a 'homosexual element' and this too 'would be consistent with the other symptoms of cocaine usage' (242).

Thornton attacks Freud for criticising Charcot: "Such brash interpolations by a then little known neurologist in the work of a man of Charcot's eminence were undoubtedly the result of a cocaine effect" (209). At that point I wondered if Thornton might also be making “brash interpolations” and just as Freud everywhere saw sex as a cause of mental distress so Thornton sees cocaine use as the cause of psychoanalysis. Thornton (254) correctly states that Freud's self-analysis (1897 - 1900) was responsible for some of the most basic ideas in psychoanalysis. She criticises the subjective nature of this process and argues that it is particularly untrustworthy as a method because Freud's cocaine use was distorting his memories and creating vivid dreams. Freud's first full analysis of a dream was his 'Irma dream' on 24 July 1895. Thornton makes an interesting point when she suggests that vivid dreaming is a mark of cocaine misuse and that Freud’s patients were also having vivid cocaine sponsored dreams. So it was that dreams came to occupy a major place in the practice of psychoanalysis.

A final attack on psychoanalysis comes at the end of the book when Thornton makes the point that psychoanalysis has had a negative impact on research into brain disorders - organic brain disorders being the true cause of neurosis/psychosis for Thornton.  She argues that patients who could have had cures were instead given ‘hopeless psychoanalytical diagnoses’, including the catch all diagnosis of hysteria. Freud’s nemesis puts her pen down at the end of her book, arguing that as Freud’s later work rests on unsupported theories he developed during his cocaine years there is little point discussing them. Her assessment is damning: 'As we have seen, the foundations of this edifice were presented in a series of papers characterised by inconsistencies and circular arguments, with a total lack of evidence for the postulates they contained' (290).

  

Thornton, E.M., (1983). Freud and Cocaine: the Freudian Fallacy, London: Bond and Briggs