In defense of Sigmund Freud

As a medical student, I immortalized myself with my classmates when I informed a lecturing psychiatry professor that I considered Freud’s theories slightly more credible than the nuns’ tales about guardian angels. The lecturer ignored my obnoxious comment and continued his lecture. But Freudians have been on the defensive for the past decade. This trend culminated when the Library of Congress was forced to cancel a tribute to Freud in the name of political correctness.

Freud has always been viewed with suspicion by cultural conservatives. Freud rejected the concept of sin and explained abhorrent behavior regarding unresolved conflicts among competing brain factions — id, ego, and superego — that stemmed from childhood experiences. His treatment was to delve into an individual’s childhood and attempt to resolve these conflicts — psychoanalysis.

But it wasn’t pressure from the religious right that canceled the Library of Congress tribute. It was rather a combination of feminists and neuropsychiatrists. Freud theorized that unflattering female behavior could be attributed to “penis envy,” a verboten concept in the age of political correctness.

But what is truly destroying Freud’s credibility is the exploding field of neuropsychiatry. While medicine has made exponential advances over the past century, the fundamental physiological function for many organs has been understood for centuries. The heart pumps blood through the body by contracting. The stomach sucks nutrients out of food and produces waste. The tongue facilitates speech. But the brain is a whitish gray blob. How does it allow us to reason, lose our temper, or fall in love?

It wasn’t until the advent of a 20th-century invention that scientists were able to conceptualize the brain. The brain is a computer, perhaps one that is almost infinitely complex, but a computer nonetheless. Through our senses, the brain takes input from the environment, processes it through a multibillion unit network of wires called neurons and returns a response.

Once this is understood, it is obvious that an individual’s behavior will vary according to the brain’s wiring. This wiring is determined to some extent by the blueprint given to us by our parents — our DNA. Thus, we are inundated with breakthroughs, practically on a weekly basis, as to how some behavior patterns may have a hereditary basis. Researchers have located genes that may be associated with risky behavior, obesity and sexual orientation.

But our brains are constantly being reprogrammed by our experiences. We learn that making obnoxious comments to our teachers can result in a lower grade and that picking fights with guys who have tattoos can result in large dental bills.

The genius of Sigmund Freud was that he conceptualized how the brain works without ever hearing of a computer or DNA. He also understood that trying to resolve our fears and irrational behavior through therapy was better than resorting to violence or substance abuse. Neuropsychiatrists who prefer Prozac, Xanax and Elavil to psychotherapy miss the point. Yes, these drugs alter the brain chemistry, but on a primitive level that is poorly understood.

Furthermore, what happens to the brain chemistry with psychotherapy? When a patient alters his behavior in response to a psychiatrist’s analysis, a biochemical change in the brain is occurring too. A patient who decides to be more assertive has, one way or another, altered the biochemical structure of his brain. It doesn’t happen by magic! Physicians can debate the relative efficacy of each approach, but they shouldn’t completely discount the value of psychotherapy.

Like Columbus, Freud has been subject to the vicissitudes of public opinion. It is true that Columbus was an intrepid explorer who began the exploration and colonization of the Americas. It is also true that as governor of Hispaniola, he butchered and brutalized the Arawak Indians who would not consent to being enslaved. Freud’s personal life was less than perfect. He manipulated patients to obtain contributions for his research. He fell asleep and wrote letters during therapy sessions. But in spite of his flaws, Freud made the quantum leap required to treat brain disorders in a rational manner and ,in the long run, he will be given the credit that he is due. His guardian angel will see to it.

Joseph Bentivegna is an ophthalmologist and can be reached at his self-titled site, Joseph Bentivegna, MD.  This article originally appeared in Connecticut Medicine.

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