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Psychoanalysis

Szasz completed his psychoanalytic training and worked many years as a psychoanalyst. His appreciation of psychoanalytic theory and therapy runs roughly parallel to his appreciation of Freud. He did criticize all sorts of aspects about psychoanalysis before he criticized Freud himself. The brief sketch below will touch only on some of the major issues.

a. The scientific status of psychoanalysis
Szasz rejects psychoanalysis’s pretension of being a value-free study of human psychic functioning. This would mean that events in psychic lives are connected through the principle of causality, as in physics. The claim that people’s current behavior can be thoroughly understood through their past makes psychoanalysis historistic, and implies that human behavior is completely predetermined. In that case free will, free choices, and thus responsibility would be fictions, even though the historistic theory is paradoxically balanced with an antihistoristic therapy. The concept of “cause” in physics has a different meaning than in the humanities. Besides, as physical laws are relative to mass, so psychological laws are relative to social circumstances. Psychological laws cannot be formulated independently from sociological laws. (The Myth of Mental Illness, pp. 23-24) In an article published in 1959 Szasz posits that the term “explanation” has three meanings in Freud’s writings. Firstly, it is synonymous to etiology, the cause of illness. Secondly, it is synonymous to “translation.” Something means something else and can be translated as such. Thirdly, it means the compilation of an instrumental theory about studied events, and the formulation of that into analytic ascription. In all three cases the concept of explanation has a different meaning. In Psychiatric Slavery (1977) Szasz asserts that the difference between explanation and justification is that explanation refers to events and justification refers to actions. The question why someone does a certain thing can be answered in different ways. Each approach generates a claim, or guess, or view of the event. None can lead to an explanation in the scientific sense of the word. (pp. 2-3)
    Szasz defends the view that psychoanalysis can be best understood as psychological theory. Terms such as erogenous zones, drives, and libido have dubious medical-scientific frameworks of reference. Obviously, for instance, sexual behavior is dependent on the body and its chemistry, just as it is obvious that thinking, feeling, and behavior are dependent on the structure and function of the brain. The sociopsychological frame of reference of such concepts is much clearer. Sexual behavior, for instance, is much more closely connected to social learning and social conventions within a culture than general medical matters are.  Using quotes from Freud, Szasz demonstrates that many pronouncements sound like medical-scientific explanations, but are in fact moral pronouncements, for instance regarding the question of which sexual behavior is healthy (good).
    Szasz concludes that psychoanalysis cannot keep up the appearance of being a medical science. Psychoanalysis shares the status of the humanities, such as theology and ethics. Szasz isn’t completely clear on this point. He speaks about “fake science” when discussing psychiatry and psychoanalysis, and posits that the relationship between psychoanalysis and physics is as the relationship between astrology and astronomy. Szasz told me that he considers only the physical sciences as true sciences. Psychiatry and psychoanalysis, like ethics, anthropology, and law, concern themselves not so much with the question of how people are, but with the question of how life should be lived. Thus they are molded in a moral frame, and derive their significance from that. Szasz mentions another difference: science produces facts. The role of scientific language is to formulate those facts. Psychoanalysis consists of an interplay of views on how life should be lived. Psychoanalytic language seeks to influence, which explains the term rhetoric for this language. Szasz approvingly quotes Voegelin, who considers psychoanalysis a kind of gnosticism. Voegelin contrasts this term to philosophy. Philosophy is the love of knowledge and truth. Its purpose is personal salvation. Gnosticism is the claim to have knowledge or truth. Its purpose is not personal salvation, but domination of others. As a gnostic movement, psychoanalysis is comparable to positivism, Marxism, communism, and fascism. (Karl Kraus and the Soul Doctors, p. 77)

b. Psychoanalysis as a therapy
Rejecting psychoanalysis as a (physical) science on the one hand, and locating it beyond the realm of treatment for illness on the other, Szasz is led to develop a variation of psychoanalytic psychotherapy. He details it in The Ethics of Psychoanalysis (1965). Therein he credits Freud and psychoanalysis for the absence of coercion and deception in the therapeutic relationship. The contractual nature of this relationship became for Szasz the prototype of contractual psychiatry.
    This therapeutic relationship forms the framework for The Ethics of Psychoanalysis. The aim of therapy, which Szasz calls autonomic psychotherapy, is that clients are assisted in becoming more free and in expanding their autonomy. This is achieved by reducing complaints and insoluble problems to what he considers their essence, namely the impediment of free choices. Thus psychotherapy is a kind of social action, aiming to broaden clients’ freedom of choice by equipping them with more knowledge about themselves and others. This is done by analyzing communications, rules, roles, and games. He combines insights from psychoanalysis with insights detailed in The Myth of Mental Illness, and with his thoughts on contractual relationships and liberty as a core value in life. (See Chapter III, 2.2.)
    Autonomic psychotherapy was awarded little attention in psychoanalytic circles as Szasz himself writes in 1974. He postulates that it jeopardized psychoanalytic dogmas too much, such as by rejecting psychoanalytical mythology and criticizing training-analysis.

c. Training-analysis
In three articles aside from in The Ethics of Psychoanalysis Szasz criticizes psychoanalytic training, and specifically the required analysis of the trainee.  In the epilogue to The Ethics of Psychoanalysis he asserts that a personal analysis is generally sensible, but that a required training-analysis is for the purpose of becoming a psychoanalyst rather than to be liberated from internal confines. Psychoanalysis independent of training is more useful. Also, “Having a ‘good’ analysis does not make one a good analyst, nor does knowing one’s ‘blind spots’ ensure him against analytic ineptitude.” And further, “The notion that the psychotherapist’s personal analysis is bound to make him a better analyst than he would be without it is illogical and probably untrue.” (p. 216)
    Psychoanalysis is characterized by a voluntary relationship between therapists and clients, where the clients’ goals are to learn more about themselves and others, and that way become more free. This situation is perverted in obligatory training-analyses. Both therapists and clients are tied to all sorts of outside interests. The clients wish to complete their training. They have social and professional interests in a good, and preferably expeditious, analysis. The therapists have a double loyalty. They are a therapist to the client, but have a secondary loyalty as trainer to the training center and to the future clients of the trainee. In 1962 Szasz publishes a study using questionnaires that were distributed among psychoanalysts who analyze trainees.  He concludes that most psychoanalysts do not mind discussing the contents of the training-analysis with others, and in particular with the people in charge of the training, although some do mind. In the entire United States there was only one training center that did not involve training therapists in its assessment of candidates’ suitability. This means that the basic rule of privacy, that generally applies to psychoanalysis, was frequently violated. Szasz considers this an inadmissible form of spying on the private lives and functioning of trainees. In a 1958 article Szasz sheds light on psychoanalytic training from the power angle. The more desirable the status of psychoanalyst became during the course of time, the more requirements were put to the trainee. Trainee analysis was introduced at a meeting in Budapest in 1917. Szasz considers it no coincidence that at that same meeting a growing demand for psychoanalysis was observed. An international training program was never developed. Each national association does that in its own way. Szasz quotes Balint, who opines that this is because of conflict between the generation of older analysts and younger ones. 
    According to Szasz, the need to select candidates for analytical training raises a peculiar ambiguity about being neurotic or being disturbed. On the one hand, there is a tendency to refuse obviously disturbed or neurotic candidates. On the other hand it is emphasized that everybody has neurotic tendencies, and that they who deny that about themselves must have strong psychic defenses, meaning that they are too neurotic. Therefore, in order to make themselves acceptable to the training center, candidates must navigate between the Scylla of a neurotic presentation of themselves and the Charybdis of a non-neurotic presentation of themselves.
    It is amazing that practically no attention is directed to the possibility that training-analysis could harm trainees. This is all the more surprising, Szasz notes, as the notion that parents or doctors can harm their children or patients respectively, as well as benefit them, is as old as psychoanalysis itself.
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