One of those

Response to the head to head debate: Does psychoanalysis have a valuable place in modern mental health services? Published in the BMJ, 20th February 2012 BMJ2012;344:e1211

BMJ rapid-response by Dr Peter J. Gordon, 28 February 2012:


One of those

Dr Jeremy Holmes quite correctly points out that none of the ‘contestants’ in this head-to-head debate is a psychiatrist.[1] I write then as a psychiatrist who is not a psychoanalyst but who welcomes the middle ground reasoning that Jeremy Holmes brings to this debate.

It was during a similar head-to-head debate celebrating George Bush’s ‘Decade of the brain’ that Steven P.R. Rose said “Bridging the gap between biological and social psychiatry must be an aim for us all; but it cannot be done by retreating into entrenched positions, or by insisting that the social is subservient to the biological.”[2]

As a mainstream psychiatrist I find that I wish to defend neither Freud nor traditional psychoanalysis. Rather I am with Raymond Tallis, who in his 1998 paper ‘Burying Freud’ suggested that Sigmund Freud was terribly wrong to state that his analysis could “open all secrets with a single key.”[3] As Robert Wilcocks has suggested this was the rhetoric of a fairy tale.[4]

Shortly before he died, Leon Eisenberg, author of ‘Mindlessness and brainlessness in psychiatry’[5]wrote me a note of thanks. I had written to him that this, his 1986 paper, still held up today. In review of this current head-to-head on the place of psychoanalysis, were he alive today, Leon Eisenberg might have said that those against the argument (Wolpert and Salkovskis) were rather ‘mindless’. Let me rephrase this, in my own, less eloquent way: polar thinking (or black and white if you wish) has surely only served to damage the further understanding of biological AND cognitive science.

In a recent documentary on Radio 4 about the increasing ‘chasmic’ divide between science and humanities, Lewis Wolpert was quoted to say about the latter: “Of all the things that I wouldn’t waste my time that’s one of those.” Here we are propelled backwards in time to 1959 and the ‘two culture’ debate raised by C.P. Snow. To make the point, let me offer a pathological example for 2012 from my current field of study. If today we relied upon Lewis Wolpert’s strict biology, somewhere in the order of 50- 60% of older adults would be diagnosed with ‘Alzheimer’s disease’: this going by the presence of the ‘gold standard’ macro-presence of amyloid plaques and neurofibrillary tangles[6]. If we include study of the cognitive dimension then the true incidence comes back to what makes epidemiological and human sense. To progress understanding here we need both biological AND cognitive sciences.

I am dispirited that today we seem to have capitulated to such strict biologism.

I am not a psychoanalyst but I write as ‘one of those’.

Three-good-books-for-scient

 


[1] Holmes, Jeremy. Rapid response reply to the head-to-head debate on the place of psychoanalysis in clinical medicine today BMJ February 2012

[2] Rose, S.P.R. Moving on from old dichotomies: beyond nature—nurture towards a lifeline perspective British Journal of Psychiatry, 2001. 10.1192/bjp.178.40.s3

[3] Tallis, Raymond. Burying Freud. The Lancet. Vol 347, March 9th 1996

[4] Wilcocks R. Maelzel’s chess player: Sigmund Freud and the rhetoric of deceit. Maryland: Rowman and Littlefield, 1994.

[5] Eisenberg, Leon. Mindlessness and brainlessness in psychiatry. BJP May 1986 148:497-508; doi:10.1192

[6] Reisa A. Sperling et al Toward defining the preclinical stages of Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease Alzheimer’s & Dementia 7 (2011) 280–292.

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