"Prescriptions for psychiatric drugs keep rising, and yet the mental health of Americans has deteriorated" -- John Horgan

Scientific American

"In her remarkable bestselling 2007 memoir The Center Cannot Hold: My Journey Through Madness, [law professor Elyn] Saks reveals her struggles with schizophrenia.

She has been hospitalized several times for periods totaling hundreds of days. Doctors once called her prognosis “grave,” which meant that she would probably never be fully autonomous, and she would work, at best, in menial jobs.

She has nonetheless overcome her disorder with the help of medications and—you guessed it--psychoanalysis. Saks has undergone psychoanalysis since she had a psychotic breakdown at Oxford University in the late 1970s, and she plans to continue being treated for the rest of her life.

Saks, who has a Ph.D. from the New Center for Psychoanalysis, saw no contradiction between psychoanalysis and physiological approaches to the mind and its disorders. They represent two levels of “discourse,” she explained to me. “One is at the level of molecules and neurotransmitters and brain cells and so on, and the other is at the level of personality, goals, meaning.”

She is well aware of the criticism of psychoanalysis. She nonetheless finds it “richer and deeper” than alternative theories and therapies, such as cognitive-behavioral therapy. Freud, she said, was “an amazing writer. The case studies read like novels.”

Freud’s ideas, Saks noted, have spawned many rival schools of psychoanalysis. Saks’s first analyst practiced a therapy pioneered by Melanie Klein. But Freud is “the granddaddy.”

In her memoir, Saks notes that “Freud and his teachings had always fascinated me.” Psychoanalysis “asks fundamental questions: Why do people do what they do? When can people be held responsible for their actions? Is unconscious motivation relevant to responsibility?”

Saks’s affinity for psychoanalysis is part of larger trend. In her 2015 book In the Mind Fields: Exploring the New Science of Neuropsychoanalysis, journalist Casey Schwartz reports on recent attempts to find common ground between neuroscience and psychoanalysis.

In a 1996 article for Scientific American, “Why Freud Isn’t Dead,” I offered positive and negative reasons for the persistence of psychoanalysis. The positive reasons are those noted by Saks: Freud’s essays and case studies have the compelling complexity and depth of great literature.

The negative and more important reason is that science has not produced a theory/therapy potent enough to render psychoanalysis obsolete once and for all. “Freudians cannot point to unambiguous evidence that psychoanalysis works,” I wrote, “but neither can proponents of more modern treatments.”

I stand by that assessment. Critics liken psychoanalysis to phrenology, the 19^th-century pseudo-science that linked personality to the shape of the skull. But if psychoanalysis is akin to phrenology, so are alternative therapies, which range from psychopharmacology and cognitive-behavioral therapy to “electro-cures” and Buddhism. As I reported recently, prescriptions for psychiatric drugs keep rising, and yet the mental health of Americans has deteriorated, according to measures such as disability payments."