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THE OPEN MIND
Psychoanalysis, Blind Alley or Key to Mental Health?
Sunday, May 26, 1957
MODERATOR: Richard D. Heffner
GUESTS: Mike Gorman, Dr. Sandor Rado
Announcer: The Open Mind, free to examine, to question to disagree. Our subject today, “Psychoanalysis, Blind Alley or Key to Mental Health?” Your host on The Open Mind is Richard D. Heffner, author and historian.
Mr. Heffner: Last week on The Open Mind we began a series of programs on mental health. Now we on The Open Mind have received a good many letters in the year and more that we’ve been on the air, but I don’t think that we’ve ever received as many letters as during this past week. Letters were in two parts, let’s say, one commenting on last week’s program, which was a general survey of mental health; and the others commenting on the program for today, which is on psychoanalysis.
Quite obviously a good many people in our country today are very much involved in the problems concerning psychoanalyst and I think it interesting to note that a good many of the letters were rather hostile in tone; a good many of the letters asked questions about the costs of psychoanalysis, which is, well to a lay person such as I am, an extended period of treatment, It means an extended period of treatment.
A good many people asked about the availability of analysis; and in line with this note of hostility I’d like to quote for a moment from an article that appeared in the New York Sunday Times some months ago.
Commenting on the indictment of psychiatry and psychoanalysis made by a number of people the author said that for the most part psychiatrists don’t examine minutiae. They spin metaphysical theories of behavior. They don’t don the white coat and creep humbly into the laboratory. They don cutaways and orate at town hall on the phallic significance of junior’s thumb-sucking.
Another quote: “As any science writer knows, you need a key to Greek mythology to cover the semi-annual ruminations of the American Psychoanalytic Association. Without a score card how can you tell which complex is being liberated? Narcissus, Oedipus, Electra, or what have you?
Then again on the next page, continuing these criticisms:
The cultivation of a special language has been accompanied by the creation of psychoanalytic institutes where the psychiatric novitiates are instructed in the rites and mysteries of the inner temple. These institutes once ruled from Vienna are now the self-appointed guardians of the psychoanalytical grail. Doctrinal deviations are punished by expulsion. For example, if you don’t believe that every little boy harbors a secret desire to kill daddy you don’t understand the Oedipus complex and you might as well become a general practitioner.
Well now suppose we turn to our guests today and introduce them? One of them is the author of these hostile statements. The author of these statements which I at least consider hostile, is Mr. Mike Gorman who is the Executive Director of the National Association Against Mental Illness.
My other guest is Dr. Sandor Rado of the American Academy of Psychoanalysis, Professor of Psychiatry, and the Director of the Graduate School of Psychiatry of the State University of New York’s Downtown State Center, and the author of many books and articles on psychoanalysis.
Well suppose I begin our discussion today by asking you, Mr. Gorman, what the source of these rather hostile evaluations of psychoanalysis is? What is the source of these evaluations?
Gorman: Well I would answer very simply, Mr. Heffner, by saying that the most critical people in regard to analysis are sometimes some of the most distinguished analysts themselves; m if I might just quote from Dr. Karl Menninger, who many regard as one of the outstanding analysts in America, now he says in a recent speech which he delivered in London that analysis has serious drawbacks both for the physician and for the public. It restricts the experience of the physician to a very small number of patients.
As one young doctor put it, “I hate to face the prospect of spending the rest of my life treating an average of four patients a year.” That is, eight patients a day seen daily for an average period of two years. It is a disadvantage for the public in that it makes for a situation in which a private patient is either considered a proper subject for psychoanalytic treatment or else a case for someone else. And on and on.
In other words, what I would say is this, I don’t like the word hostile really because I think analysis has made a tremendous contribution not only in the writings of Freud, but in the writings of my distinguished friend on my left, Dr. Rado, and many others. I only deplore the fact that it has developed cults and rigid types of thinking you see which have restricted it.
And just one further point, to explain my orientation, because I don’t want to be misunderstood. I’m interested both in my position and from the point of view of my enzymes, in the tax load of patients, of 700,000 hospitalized patients, of several million additional people who go to clinics who cannot either afford psychoanalysis or there aren’t enough doctors to give the three or four hours a week.
This is so common right here in New York City. I was born in Yorkville and I will talk later I think about some surveys that have been made in Yorkville as to the availability of psychiatric treatment.
Heffner: Dr. Rado, do you want to pick up the cudgels here?
Rado: I certainly would like to. First of all I should like to clarify our topic. What are we talking about?
Heffner: Well let me say that we’re asking whether psychoanalysis as claimed by some people is rather much of a blind alley in a time when there is a mass need for therapy?
Rado: Now in my feeling the word psychoanalysis covers two very different topics. Psychoanalysis to my mind is a branch of human biology. It is a medical science, and investigative procedure, and a means of therapy.
As distinguished from scientific psychoanalysis you have public popular image of psychoanalysis which is a romanticized image; the same way as you have the surgeon romanticized as the man in white there is an image of a psychoanalyst wrapped in mythology.
These two things have very little to do with each other. So I am in no position to defend or even to argue about what the popular image of psychoanalysis is because I have very little interest in it.
Mr. Heffner: Well would you say that you think Mr. Gorman is talking mostly about this popular image or about the first category of psychoanalysis.
Rado: Well you see everybody is entitled to discuss the popular romanticized image of psychoanalysis because it is a fact of present day society, but from the point of view of fight against mental illness this is not the decisive point of view.
Heffner: Well, let me say this, that some of the letters I’ve received this week obviously say, come from people who have sought help but who have been told that the help that they need can come only through an extended period of analytic treatment, and they write with considerable hostility, if I may use that word again, about a form of therapy that requires tremendous sums of money and a great deal of time. Now how do we answer these criticisms?
Gorman: Could I comment on this briefly?
Heffner: Yes, please do.
Gorman: Dr. Rado, I’d like to say this; I have no phantasy or interest in the romanticized conception of analysis. I have in the last thirteen years had a good familiarity with it and with its major protagonists. I would say this, that from your point of view I respect deeply your point of view because you’re interested in both the biological and psychogenetic aspects of schizophrenia.
I would say that 95% of analysts are not, on the contrary are exceedingly dogmatic in their opposition and hostility to biochemical approaches, to it. I don’t want to read a litany of these people but they would include the major, I think, analysts in this country today.
Now for instance, again just to quote from Karl Menninger, talking about the scientific attitude, which is not developed by analysis– for example, there’s been no really scientific study of the process of analysis; there’s been no really scientific study of the end results of psychological therapy, as Earl Ubell pointed out in the New York Herald Tribune last Sunday.
There is still not one scintilla of evidence that psychotherapeutic intervention has any influence one way or other on the course of schizophrenia. Now this is over a period of 60 years. And Karl Menninger in talking to the London Psychiatric Society says: “Psychoanalysis has definitely impaired descriptive clinical observation. The young physician intent on understanding and explaining symptoms on the basis of a hypothesis is less inclined to be interested in learning to describe accurately what the patient seems to be experiencing and manifesting. An attitude of patronizing indifference toward the acquisition of systematic historic material is justified by the glib excuse that since the patient has probably forgotten or repressed the most significant incidents in his life it is a waste of time to collect conscious memories. Now this is a typical quote. I could quote you Kenneth Appel.
Heffner: Dr. Rado.
Rado: There now you see the difficulty we are having here is that we are throwing one generalization against the other. If we come down to facts and see a constructive evaluation of what contribution psychoanalysis has already made, and may be expected to make in the future, then I would say briefly this: The diagnosis of behavior disorder, also called emotional disturbance, or mental disease, always is based on the observation of the behavior of the patient which is altogether a psychological procedure. It is impossible to diagnose mental disorder or as I call it, behavior disorder to check upon the progress or non-progress brought about by any method of treatment unless you have a refined technique of psychological observation.
To begin with psychoanalysis offers an important set of tools for this particular purpose. In this sense no contribution to mental health — and many will be needed can even be evaluated without using some of the tools that psychoanalysis has put at the disposal of the psychiatrist. This is where the whole story begins.
Heffner: Well I think this is a very fair—
Gorman: With this I agree.
Heffner: –statement, fair evaluation, but what about the criticism that the many schools of psychoanalysis have stood in the way of the development of therapeutic processes that are not of such long length and are not as expensive as the traditional analytic one?
In other words, it is one thing to say that psychoanalysis has made the contributions you list but the question comes up as to whether — some people have raised the question as to whether psychoanalysis or maybe even just the myth of analysis, doesn’t stand in the way of the development of therapeutic procedures which will meet our mass needs today?
Rado: Well I cannot represent here everybody and all the people who do psychoanalysis. Still less can I sit judgment here. All I have to say in fairness is that psychoanalysis to my knowledge has never prevented anybody from trying any kind of investigative or therapeutic method.
I also know that I myself happen to have a part in that. Psychoanalysis has established free clinics. So the economic question has thereby been excluded as much as humanly possible.
Heffner: Well at this stage as much as is humanly possible is very little, isn’t it? What are the facilities available?
Rado: This is very little; it is very little; just as little as all the support psychiatry receives from society — psychiatry way beyond psychoanalysis.
Heffner: Well could I ask this question, Dr. Rado?- In general it may be a very difficult question to answer but in general — would you say that psychoanalysis is a therapeutic tool that can and should be used in most cases of psychological illness or psychological need, or in some, or what?
Rado: Well you see this is again too general a question.
Heffner: How would you refine it?
Rado: My feeling is that the method of observation, of examination and diagnosis — psychoanalysis is today an indispensable part of such procedure. As to the therapeutic process, that depends upon the nature of the disorder.
Nor do I think that psychoanalytic treatment procedure, per se, excludes additional procedures of a physiological nature. Nobody has ever suggested such a thing, nobody whose scientific responsibility can be accepted.
Heffner: Well to make therapy available to a good many more people would you accept the notion that the principles of psychoanalysis can be applied on a larger level, on a mass level in other kinds of therapy?
Rado: You see the principles of psychoanalysis, or rather the science, the working of the mind which psychoanalysis has developed and there is today not one such theory but there are several — is the basis for a variety of therapeutic procedures.
Gorman: This is generally true, I think that Dr. Rado’s point is awfully well taken, that no psychotherapist practicing today does not owe something to the seminal discoveries of Sigmund Freud and to the application of psychodynamics;
and I’d like to just throw this discussion on a more positive level rather than flailing the witch of analysis which I think gets us nowhere, to point out that Dr. Rado is one of the pioneers in an attempt to combine both the psychological factors in schizophrenia and the biochemical factors, which is the real answer, and I think Dr. Rado as he pointed out in an article in a symposium “Anxiety,” wrote that we have to have biochemical methods to get at the primary or basic disease of schizophrenia; and one of his pupils, Dr. Rubert Heath at Tulane, has I think given UG in this very brief definition a great challenge which combines both the psychological and biochemical process. He writes in the book “Studies in Schizophrenia”: “To us the conventional psychoanalytic framework for the integration of the mind was not a satisfactory working hypothesis. The formulations that we found most useful were the concepts of Rado and others who stressed the importance of basic deficiencies in feeling from early infancy. Rado postulates that subsequent alterations in behavior arise primarily from a basic deficiency in pleasure.”
Now putting it very simply as I put it in this little book I did last year, I think that many people can gain insight through analysis into the twisting and turnings of their personality, but if they do not have the metabolic strength they cannot rise out of the pit of despond and of stress. I think there is a combination of factors involved. Now I think that’s one aspect of it, and I’m not in any sense anti-analytic, and I received a great deal of benefit from my own analysis.
I think this to be true though, I don’t accede to the popular outcry against things either — I think most of the popular outcries are largely misunderstanding and superficial or they come from reading very sloppy articles in ladies’ magazines. I think this, though, that for instance in Yorkville which is my native habitat, Dr. Thomas Rennie, the late Dr. Thomas Rennie, of Paine Wetney, did a survey there of how many people needed psychiatric treatment and how many received it; and it was a door to door survey conducted over a period of five years, a very intensive and excellent epidemiological survey.
Now the essence of it is this, that about three in every ten whom they contacted had very serious emotional problems, and that less than two per cent, less than two per cent of those thirty per cent felt that psychiatric treatment was even for them. They had this feeling: “Oh, this is only for rich people. You have to go west of Park Avenue to get this type of thing.”
Now there’s a certain validity in this because we have to develop methods by which the average person can receive some type of psychotherapeutic benefit.
Rado: Mr. Gorman, if you permit me to break in here?
Rado: We are moving happily from one subject to the next. Now how many people need psychiatric treatment and how many do actually receive psychiatric treatment is a very important question, but a very different question, just like how many people do need surgical treatment and how many actually receive surgical treatment.
Heffner: I say it is a different question but I wonder really whether it is? Now Gorman writes his book, “Every Other Bed,” and he says every other hospital bed in the United States is occupied by a mental case. He writes this article in the New York Times. Now it’s not a ladies magazine and it is not a sloppy article.
Gorman: No, it’s a very good article.
Heffner: I agree. But I think that you would have to agree that whether you like the word or not there is some hostility here and it is aimed at, directed at psychoanalysis, and it does to me seem to come from putting these two questions, together: (1) the question of the validity of psychoanalysis; and (2) the question of how many people need treatment and how many people are getting treatment.
Rado: Mr. Heffner, this hostility is the price of popularity. Would psychoanalysis not be so popularized as it had been it would have never come into the position to become the target of so much hostility. I am insisting that these phenomena of the marketplace must be kept separate from a scientific evaluation of psychoanalysis as a tool of investigation1 as a scientific theory, and as a means of taking it.
Now Mr. Gordon has referred to certain views about the most widely spread and most important mental illness, schizophrenia. May I add to that that what he said about schizophrenia applies to all behavior disorders. Let me explain that in a simple way” If you go through a village with a photographic camera then you will have all the visual images you care to fix. If you go through a village with a Soundscriber then you will have all the noises. The photo camera cannot give you the noises; the Soundscriber cannot give you the sights.
The human organism in health and in disease must be examined with all the methods at our disposal. One of the methods is psychological; the other is physiological.
Psychological methods, when we use psychological methods we look into ourselves and listen to the other person telling us what he finds when he looks into himself.
Physiologically you just inspect. The inspective and introspective pictures must complement each other. If they don’t something is wrong with the method.
Heffner: But in treatment don’t you emphasize the one or the other and aren’t we then getting back to the evaluation of psychoanalysis as a therapeutic tool?
Gorman: Well I think this, Mr. Heffner, these questions get very complex, although they seem to me rather simple. Psychoanalysis has an enormous contribution to make as a theoretic discipline and as an understanding of behavior, this starting with Freud and going on through.
Freud himself admitted that it had little therapeutic potency in relation to schizophrenia. In fact he said at one time the classic story of the young doctor who was going to America and was going to do a survey of how psychoanalysis helped schizophrenics; he said, “Well write your answer on a post card” — one point, may I? this point — that’s the therapeutic validity, although it has I think some great benefits in the neuroses, in the disabling neuroses. Schizophrenia is a disease about which we know very little, and I think the only area of complaint I have, and it’s certainly not with Dr. Rado or his school or with the Academy of Psychoanalysis which is attempting to integrate the psychological and physiological aspects of schizophrenia; it is with those analysts who say, “Well, this is a totally psychological process”; and the further argument, the only other argument I have with them really
— and these arguments are not based upon any degree of personal hostility — is that for years they think they attempted to build institutes divorced from the main stream of medical schools and medical education.
I make the point in the Times article, and I’ve made it elsewhere, that they do not allow their theories to be tested in the laboratory. You see this is a criticism I have heard from so many medical educators.
But these are only — every discipline has its weak points. I think with the physiological people –
Rado: Mr. Gorman -·-
Gorman: Could I just finish this sentence, Dr. Rado? Just this one point. I think with the physiological people the great trouble today is that they are shooting from the hip. That much that’s being hailed every week in the press is not the answer for schizophrenia, that we’re still fumbling in the dark, but I want a total holistic approach to this problem and I do want personally and from the point of view of what I do, a therapy and a method of bringing this to thousands of people who are now disabled, and I cannot see that analysis in its present form and concept can do this for the people I know in Yorkville.
Heffner: Mr. Rado?
Rado: There are, to sum up, two problems. One is a scientific function of psychoanalysis; and the other is administration of psychoanalytic treatment procedures.
So far as the scientific function of psychoanalysis is concerned, in my opinion psychoanalysis is an indispensable component of the comprehensive dynamics of human behavior that must include physiology and genetics. There is no doubt in my mind about this proposition and hasn’t been for a very long time.
As to the application of psychoanalysis by itself as a method of treatment, today the only thing that I can say is that this depends upon the critical judgment and scientific integrity of every individual therapist, and therefore is a problem of medical education. If medical education is so geared as to increase the independent critical judgment of every therapist and appeal to his scientific and therapeutic integrity that is your real guarantee against any possible abuse and nothing else can take its place.
Heffner: Well I think you’re answering really the question that I had wanted to ask because, Mr. Gorman, you talked in answer to my question about schizophrenia, and I wasn’t directing myself so specifically to that. My question to you was really the use of this method of treatment in general, and you brought it back to the question of schizophrenia.
Gorman: What’s your evaluation of it as a general tool of treatment. Well I would say this, that it is tremendously useful I’m sure in the handling of many neuroses and many disabling emotional problems, and I think particularly to those able to bring to it a great deal — I think you have to bring to analysis a great deal — that it has been a great contribution. Beyond that I cannot say because I think even analysts themselves have attempted to form, to shorten the process. Franz Alexander as an example, brief psychotherapy. They realize themselves that this is a time-consuming process.
If you educate a doctor, four years of medical school, many years of analytic training, and then he handles four to eight patient a year — I view it from the point of view of a democratic society and my orientation is maybe just a little different than Dr. Rado is because I’m thinking of the people in Yorkville; I’m thinking of the 700 thousand people in the hospitals and I’m thinking of the fact nothing has turned this around; and the development of new drugs while it offers symptomatic relief is still not getting at the basic problem I think of the biochemistry of much of mental illness, so there’s a challenge, and it’s further limited–just this one point, which I’ve made before, I guess–to the area of mental retardation.
There are four million people who are mentally retarded. Now analysis obviously cannot touch these people because they are deficient biologically and genetically, so that therefore men like Linus Pauling it seems to me offer the hope of future in that they are digging into the basic biochemical deficiencies of four million people. You see I view this in context.
Heffner: Dr. Rado, in one minute we have left.
Rado: I am a great admirer of Linus Pauling and there is absolutely no difference between us with respect to that. I would like to use this last minute to say that psychoanalysis as a treatment has often been defined as a process of re-education. It is much more than that. It wants to make people not capable of being educated capable of being educated by removing difficulties. No apparatus today can do such a thing.
Gorman: They have to have the money to be educated. They do not have the fifteen or twenty dollars an hour. Unfortunately in Yorkville they do not have it. They have the desire to be re-educated but not the fifteen or twenty dollars an hour.
Heffner: A health insurance plan study showed this recently. We’ve reached the end of our time. I’m sorry gentlemen but I think maybe right at the end here we come to the basis of a, not conflict, but difference of opinion. Thank you so much.
Next week on The Open Mind we’re going to turn to another area of subject matter; we’re going to turn back to the question of television censorship. In a few weeks we will again cooperate with the Manhattan Society for Mental Health and bring you two more programs in the general area of mental health in this country today. Next week then, television censorship. See you then.
Announcer: WRCA has just presented The Open Mind. Your host on The Open Mind is Richard D. Heffner. Mr. Heffner’s guests today were Mr. Mike Gorman, and Dr. Sandor Rado. If you have any comments or questions on today 1 s program or if you have any suggestions for future programs please send them to The Open Mind, WRCA, New York 20, New York.