Freud, Schmeud

If you were to take a cultural tour of New York today, you’d think Sigmund Freud were as relevant to society now as Mark Zuckerberg or Steve Jobs. Everywhere you’d turn, from Broadway to the movies, you’d find the father of psychoanalysis holding a prominent place. He’s the main focus of David Cronenberg’s film “A Dangerous Method”; the Off-Broadway play “Freud’s Last Session” is having a successful run, and his name pops up throughout the one-acts plays by Woody Allen and Ethan Coen in the Broadway show “Relatively Speaking.”

But just beneath the cultural flotsam, you’d find Freud’s reputation seriously embattled. In psychiatry, where he once mattered most, his theories have never been more in question. Among historians of medicine, his significance has taken a serious beating. And even among Jewish scholars, questions about his views on Judaism remain as fresh as ever.

“Freud has virtually vanished from science and from psychology,” said Edward Shorter, a professor of medicine and psychiatry at the University of Toronto. “It’s not that Freud’s ideas have been improved upon either,” he added. “They’ve been entirely thrown out.”

Not every historian puts it so strongly, but most concede that Freud’s central ideas, from the id to the Oedipal complex, have far less influence in science than they do in the culture at large.

The reasons they give for Freud’s demise among doctors and scientists are straightforward. Most important, in the last three decades, psychiatry has focused on neurobiology and pharmacology as the most scientific way to manage mental disorders. Before then, the dominant treatment had been talk therapy, which has its roots in Freudian psychoanalysis.

To be sure, studies increasingly show that talk therapy is just as, if not more, effective than pills in treating common psychiatric issues like depression or anxiety. Yet the type of psychoanalysis Freud championed — based on the idea that neuroses were rooted in childhood sexual experiences and conflicted relationships with one’s parents — has been virtually abandoned.

“The theoretical side and the sexual stuff bothered a lot of people” in his own lifetime, said Hannah Decker, a medical historian at the University of Houston, who also teaches a history course to psychiatry residents at the Baylor College of Medicine.

Next year, Decker will publish a history of modern psychiatry by Oxford University Press that discusses the demise of Freudian psychoanalysis. A pivotal moment in the shift away from Freud’s ideas in psychiatry, she argues, came in 1980, with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM III.

The manual is the authoritative guide to mental issues for psychiatrists, and that year it abandoned many of Freud’s central ideas, like his theory of the unconscious and certain “complexes.” Because Freud’s ideas were almost impossible to test, and because scientists had a much clearer grasp of the chemistry of the brain, the DSM listed illnesses only if they had a clear set of common symptoms.

Yet the reason Freud had such a powerful influence on psychiatry is equally important. Decker argues that, in the United States, psychoanalysis flourished only after Freud’s death, in 1939. The Second World War resulted in an unprecedented number of soldiers returning with mental disorders, and the military relied heavily on the practices being espoused in Europe — namely, psychoanalysis — to treat them.

Prominent European psychiatrists, all trained in psychoanalysis, had immigrated to the U.S. during the war and had been given appointments in leading medical schools. So it was their ideas — most of them based on Freud’s — which came to dominate psychiatry till at least the 1970s, and the rise of neurobiology.

Despite Freud’s waning influence on psychiatry today, however, the importance he once had should not be dismissed, said Decker. “You can’t throw him under the bus even if you can’t prove his theories empirically,” she said.

Like several historians interviewed, she said Freud’s legacy lives on in the proven efficacy of talk therapy, even if his own style of psychoanalysis has been largely abandoned.

Still, psychiatrists have been neglecting all forms of talk therapy for decades, in part because insurance companies offer less money for reimbursements, and non-medical health professionals, like psychologists and social workers, do it for much cheaper. A government study from 2005 found that only 11 percent of psychiatrists offered talk therapy to all their patients.

As for psychoanalysis itself, which is only one, very intensive, type of talk therapy, a 2008 study by the American Psychoanalytic Association found that the practice is hardly taught at all in psychology departments. When the term “psychoanalysis” was used in college course descriptions, for instance, 86 percent of the time it was for classes that had nothing to do with psychology.

Of course, Freud’s ideas about the mind went well beyond psychoanalysis. And he still has a prominent place among some intellectuals who defend his legacy both as a scientist and a general thinker.

Sander Gilman, a prominent medical historian and professor of psychiatry at Emory University, says Freud’s fundamental insights about the human mind are still ubiquitous in psychiatry and other fields, like political science and economics, even if many of his particular theories are now discredited.

Chief among them, he argued, is Freud’s theory of the unconscious. Freud’s basic insight was that human behavior is dictated by motivations deeply embedded in our unconscious mind. And it is because we have an unconscious mind that we often act in irrational ways. To see how influential those ideas still are, Gilman said, you need look no further than Daniel Kahneman, the Nobel-winning psychologist and economist, who has shown how irrational ostensibly “rational markets” are.

Freud may be wrong about the contents of the unconscious, like the idea that sexual repression and Oedipal struggles were integral parts. And he may have been wrong about how to bring the unconscious mind to the surface — by analyzing dreams and slips of the tongues, for instance. But, Gilman said, “that we have an unconscious life that affects our conscious behavior” is still an idea subscribed to by legions of psychiatrists, intellectuals and the general public.

No one seems quite sure what to make of Freud’s relationship to Judaism these days, either. In the film, “A Dangerous Method,” based on a history of Freud titled “A Most Dangerous Method,” by John Kerr, Freud is paranoid that his theories will be discredited simply because he is Jewish. And indeed, almost all historians today note that psychoanalysis was originally disparaged as a “Jewish science” in the early 1900s, when Freud was trying to establish the field.

Jay Geller, a professor of religion and modern Jewish culture at Vanderbilt, who has written extensively about Freud’s ideas about Judaism, said that Freud was indeed worried by how anti-Semitism might affect how his work was received. That explains why, in 1905, the year Freud tried to establish international branches of his Viennese psychoanalytic society, he began erasing all references to the fact that many of his patients and fellow practitioners were Jews. “He did not want psychiatry to be viewed as a ‘Jewish science,’” Geller said.

Unlike many other Jews from assimilated European backgrounds, Freud never renounced his Judaism. But he often distanced himself from Jewish beliefs to a degree that has led some prominent scholars to question his motives. It was not only that Freud was an outspoken atheist that makes some question his loyalty to his fellow Jews and his Jewish identity. It is that he was so adamant in his rejection of all religious belief, and some fundamental Jewish tenets in particular, that some find deeply troubling.

With regard to all forms of religious belief, Freud argued that they were essentially a collective mental illness. Belief stemmed from acute psychological needs, he said, not otherworldly experiences. And while he stayed silent on his particular thoughts about Judaism for much of his life, toward the end, in the 1930s, he began putting them in print. His most famous treatise, “Moses and Monotheism,” was published in 1938, a year before he died, and has confounded readers ever since.

The book appeared to both demean Judaism as well as applaud it. On the one hand, Freud argued that Judaism laid the groundwork for all abstract thought, which was critical to the development of Western civilization. On the other, he revived obscure and discredited ideas about the historical origins of Judaism. For instance, he argued that Moses wasn’t really a Jew at all, but an Egyptian who worshipped a typical tribal sun god, called Aton. Moses did in fact admonish his followers for abandoning laws he received from this sun god — the “Golden Calf” story — but after he did so, his followers killed him, according to Freud’s account.

Those followers then followed another leader, also named Moses, but over centuries, as the biblical story of Moses got written down into the biblical form all Jews now use, the two Moses figures were conflated into one. In addition, Aton was remembered as an abstract, singular god, thus giving birth to Judaism as we know it — a monotheistic faith, with Moses as the lawgiver.

Why Freud, who had just fled Nazi Austria and was acutely sensitive to anti-Semitism, would publish such a provocative thesis at that time has no clear explanation.

“Freud’s relation to Judaism was complex,” Frederick Crews, a prominent critic of Freud and a longtime literary scholar at Berkeley, wrote in an e-mail. “Scholars have debated why Freud took that strange step, but it showed insensitivity, to put it mildly, to the situation of Europe’s Jews.”

But not everyone agrees. Eliza Slavet, author of “Racial Fever: Freud and the Jewish Question,” published in 2009, argues that Freud was actually trying to understand how he, and many secular Jews like him, could still fundamentally feel Jewish even if they thought so much of the faith was false. His historical explanation of the religion’s development may have been provocative, but it was not a repudiation of Judaism itself, she argued.

“In some sense,” she said, Freud is “defending Judaism even as he is also concerned with shedding light on the problematic and uncomfortable aspects of Judaism.

“What Freud was getting at,” she continued, “was the very real, very intense sense of Jewishness that is inalienable, ineluctable.”