Freudian Psychology

Sigmund Freud (1856-1939) is commonly viewed as "the father of psychoanalysis." Many of his big ideas, like the notion that the unconscious mind plays an important role in how people think and act, are so common place and widely accepted that it is hard to realize that he came up with them in the first place.

Today, to describe a psychologists or psychiatrist a Freudian tends to have negative connotations. It is almost a slur and plays into cartoon stereotypes about what psychologists are like. When used to describe a mental health professional, "Freudian" generally refers to someone who places great emphasis on talk therapy, with a particular focus on the stereotypical inquiries into the patient's early childhood experiences -- drawing on the school of psychological thought that emerged in the wake of Freud's psychosexual theory of development.

Freudians who do their jobs well, of course, have moved far beyond Freud's original theories. They are familiar with the latest empirical studies of childhood development and developmental neurophysiology. They have a much more refined understanding of how the brain works. Most are not terribly doctrinaire in how they treat their patients -- taking lengthy case histories and adhering to the common sense notion that a patient should do what works in his or her individual case, rather than presuming that a psychological problem or mental illness can have a uniform and straightforward simple cure the way a bacterial disease or broken bone might. Many modern Freudians no longer even invoke Freud's name in their work.

But, most modern Freudians share an ideology, informed by their increased understanding, that asserts that most psychological problems, and even many manifestations of biologically based mental illnesses, are rooted in flawed early childhood experiences -- often experiences at or before the limited reaches of the patient's own adult memory.

While few Freudians think of the parents of their patient as being morally blameworthy, in the sense that parents have their own limitations, external and internal, and hence can't be expected to be "perfect" under most circumstances, most do believe that parenting "mistakes" are the cause of a great deal of mental health issues later faced by adults. And, in the minds of most Freudians, a parental "mistake" involves failing to meet parenting standards that no reasonable social worker or judge, for example, would ever call neglectful or abusive. Freudians bemoan parents who are too distant, insufficiently engaged in their children's play, too permissive, too stressed, or have high conflict relationships with each other.

Freudians do not deny the possibility that parenting mistakes can be remedied later in life. Indeed, providing those remedies is their stock in trade. If psychological problems were purely biologically based, there would be no point in talk therapy. If psychological problems were capable of being resolved swiftly with cook book solutions, they wouldn't have much work to do. The inherent link between a Freudian theory of what solves psychological problems, and the large amount of work that resolving those problems leaves that must be performed by a highly credentialed Freudian practitioner, is why health insurance companies hate them so much.

The two big empirical questions underlying critique of the Freudian view are first, whether young children are so easily scarred for life by parenting slights, or whether in fact young children are really more resilient and indifferent to the nuances of their parenting. And, secondly, whether talk therapy works, and if so, if a skilled practitioner really matters.

There is no doubt that many psychological problems and mental illnesses are stubborn, rather than easily changed with a brief conversation. Also, some of the conditions for which studies have shown quick, unskilled talk therapy to be most successful, such as mitigating adult dementia, are progressive, rather than chronic lifetime conditions. But, how do you tell the difference between a condition that is simply hereditary (or perhaps uterine), but doesn't manifest until early childhood because the ability to communicate and think necessary to manifest symptoms of the condition don't exist until them, and a condition truly caused by parental slights?

Almost no adult or adolescent patients can remember those years accurately. Many adult patients lack living parents and siblings who can remember, and many of those people wouldn't have been perceptive enough to have accurate recollections of the psychologically relevant details of those years in any case. Sure, out and out abuse, or truly dire early childhood conditions may be sufficiently documented. But, how do you determine if one's parents were emotionally distant, overly permissive, or stressed, in a manner independent from the symptoms that a patient manifests as an adult? And, even if someone does accurately recall those events in a sufficiently perceptive way, why would they feel impelled to relate them to a mental health professional?

The emerging alternative to the Freudian view is that hereditary and pre-natal circumstances play a bigger role in who we are than we are comfortable admitting, but that while early childhood events can have a great lifetime influence particularly in extreme circumstances (e.g. lead poisoning, neglect, and abuse), most children in non-pathological circumstances are not profoundly shaped by the day to day nuances of how they are raised. A child's future may not be fate at his birth, but notion that the Cinderella's of the world are likely to prevail no matter what their circumstances because of who they are, while other children will be dragged down by their hereditary legacies, even if removed to perfect adoptive homes, is a notion that is gaining increased respect. But for the fact that this idea is contrary to deep seated national ideals of equality, and embraces aristocratic vestiges that are repugnant to our national DNA, this view would probably be even stronger still.

The strong hereditary influence school of thought, ironically, is strongly influenced by several empirically well established aspects of psychosexual development. It is increasingly clear that homosexuality, at least male homosexuality, is cemented before birth. Similarly, studies of children born genetically male but with birth defects requiring male organs to be suppressed and raised as girls, have shown that no amount of concerted conscious efforts by parents to raise a child as a girl can overcome the genetic predispositions of the child.

Another trait heavily studied in the developmental context is IQ. There is strong evidence of a hereditary basis for a significant share of individual variation in IQ.

The Flynn effect, which shows rising IQs for whole populations over time, would seem to be the strongest evidence to dispel the strong hereditary hypothesis. But, increasingly it is becoming clear that Flynn effect in populations comes largely from a decline in poor performance at the bottom of the scale, rather than from major improvements in absolute terms on IQ tests by median or top performers. Thus, the argument goes, the Flynn effect may be explained by great reductions in malnutrition, lead poisoning, and similar environmental harms that mostly afflicted the poor in the past, as societies grow more affluent.

Parenting and environment appear to have have an impact, but, if anything, hereditary effects appear stronger, rather than weaker, over time, as children grow up and have sufficient experiences to grow into their underdeveloped natural abilities or lack the boost provided by constant moment by moment parental stimulation which helps them outperform their natural abilities. And, the biggest impacts appear to be most pronounced when they involve extreme neglect or abuse, rather than mild differences within the range of normal parenting.

If even concerted efforts to impose gender identity, or influence IQ, through parenting are to no avail, why should we believe that parenting has any greater impact on other psychological traits?

Furthermore, to the extent that early childhood parenting impacts are important because they get hard wired into a child's persona, so to speak, as the developing brain grows, what good does it do to try to distinguish between early childhood impacts, pre-natal impacts and hereditary impacts, from a treatment perspective? Either way, a child pretty much is who he or she is going to be by the time he or she reports to the local elementary school for kindergarten or 1st grade, often the first real chance for the public to intervene on behalf of a child having problems.

There are also studies on the effectiveness of talk therapy. Most show that talk therapy does work. But, with a handful of specific exceptions (such as the progressive dementia case), the evidence that one kind of talk therapy is much better than another, or that the professional training of the therapist has much impact on the quality of the result, is weak.

The best Freudians can talk a good talk. They can weave very persuasive, plausible arguments for the profound impact of seemingly slight parental actions in childhood on adult mental health. They can link this to increased scientific understanding of brain development, and can offer engaging anecdotes that encourage a leap of faith to this theory. If they are right, our society is doing a profoundly bad job of raising our children and a radical reform of how we do that, with a big focus on parent education could transform our society into a far more mentally healthy one in a generation or two. But, looking at the fundamental premises of the theory and the empirical assumptions that underlie that theory, it is hard to avoid reaching the conventional wisdom that makes a description of someone as a Freudian professional something of a slur, and sees children as more resilient and resistant to parenting impacts than Freudian theory would suggest.

If the strong hereditary school of thought is closer to the mark, biochemically based psychiatry, rather than psychoanalysis, and preventing of child neglect and abuse, rather than improvements in average parenting quality, should be where our policy be focused if we want to improve our society's overall mental health, and the impacts will not be nearly so dramatic, even if these policies are implemented.