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Psychiatry is arguably the least science-based of all the medical specialties, and Freudian psychoanalysis is arguably the least science-based psychotherapy. Freud’s theories have been widely criticized as unscientific, and treatment of mental disorders has increasingly turned to psychotropic medications and effective therapies like cognitive behavioral therapy (CBT). Freud’s impact on 20th century thought is undeniable, but he got almost everything wrong. He was not only not scientific; he was a liar and a fraud. A new book, Freud: The Making of an Illusion, by Frederick Crews, may put the final nail in his coffin.

Crews had access to material not available to previous biographers. The extensive early correspondence between Freud and his fiancée, Martha Bernays, has only recently been released, and it is very revealing of Freud’s character flaws, his sexist attitudes, and his regular use of cocaine.

Freud was trained as a scientist, but he went astray, following wild hunches, willfully descending into pseudoscience, covering up his mistakes, and establishing a cult of personality that long outlived him.

His early work in science was scattershot and lacked follow-through. He “deftly criticized premature conclusions reached by others but never crucially tested any of his own hypotheses.” He was lazy, reluctant to collect enough evidence to make sure a finding was not an anomaly; he generalized from single cases, even using himself as the single case. In an early article “On Coca” he demonstrated poor scholarship, omitting crucial references, citing references from another bibliography without reading them, and making careless errors (misstating names, dates, titles, and places of publication).

His advocacy of cocaine

His advocacy of cocaine was irrational. He wanted to justify his own use of the drug, which he took for migraines, indigestion, depression, fatigue, and many other complaints; and he presented it as a panacea. He claimed it was harmless, refusing to see clear evidence that it was addictive. When nasal applications resulted in tissue necrosis, he treated it by applying more cocaine! He used it to treat a friend’s morphine addiction and only succeeded in leaving the patient addicted to both morphine and cocaine. Then he claimed the treatment had been successful! And in his reports, he referred to other successful cases that never existed. There were many instances where it appeared that his own drug use affected his judgment.

He published a scientific study on the physiological effects of cocaine on reaction time and muscle strength. His only experimental subject was himself! In his write-up, he first tried to explain away his failure to test other subjects, and then claimed he had confirmed his results by testing colleagues, which was a lie. The study was riddled with other methodological flaws, and Crews comments that it “may rank among the most careless research studies ever to see print.”

Charcot and hysteria

Freud spent several months at Charcot’s Salpêtrière hospital in Paris. Another observer, Delboeuf, spent only a week there and quickly realized patients were being sadistically abused and coerced into stereotyped hysterical performances through hypnosis, strong suggestion, peer pressure, and other influences. Freud saw the same evidence Delboeuf saw, but his hero worship of Charcot and his need to ingratiate himself with his mentor made him blind to what was really going on. He believed Charcot had understood and mastered hysteria. Crews comments, “Every stage magician hopes that his audience will consist of precisely such eyewitnesses as Freud.”

Before specializing in the treatment of hysteria and neuroses, he practiced general medicine and neurology. He practiced useless electrotherapy for at least two years and may have continued using it even after he realized it was bogus. But later he claimed to have “soon” realized it was placebo and to have promptly stopped using it. He sent patients to spas for immobility and fattening regimens. He prescribed hydrotherapy. He steered patients to a gynecologist who treated hysterical women with surgical procedures like hysterectomy and excision of the clitoris. He put patients in needless jeopardy, acting on impulsive, sometimes fatal misjudgments. He became so enthusiastic about cocaine that he tried it on everything, even on a case of diphtheria that he misdiagnosed as “throat croup;” he interpreted transient symptomatic improvements as cures and failed to do any follow-up. At one point, he admitted privately that he had yet to help any patients.

In the first years of his practice, he was preoccupied with the rank and status of his patients. He came to specialize in a “disease of the rich,” hysteria, which could never be cured and which generated a continuing stream of income. When some of his “hysteric” patients were subsequently shown to have organic diseases, he still maintained that hysteria was part of the clinical picture. He never admitted being wrong, in one case saying his diagnosis had not been incorrect but had not been correct either. Crews says, “He chose to remain deceived even after having been proven wrong.”

Evidence of dishonesty

He treated pampered, rich socialites. His attitude towards them was cynical; they provided a steady source of income by not being cured, and in one case he rushed back to see a patient in the fear that he might get well in his absence. He had little sympathy for his patients; he actively despised most people, especially those of the lower social orders. He was a misogynist who believed women were biologically inferior. He treated his wife abominably.

Few of his ideas were original. He plagiarized. He borrowed ideas from rivals but then backdated them and treated them as his own. His debts to others were originally acknowledged but “eventually suppressed in favor of the specious appeal to clinical experience. ”He was “actively evasive, malicious, and dishonest” in covering up his mistakes. Crews relates many instances where he re-wrote history, changing the story to put himself in a better light.

He made things up as he went along, constantly changing his theories and methods but not making any actual progress towards a successful treatment.

If a patient disagreed with his interpretation, (“No, I’m not in love with my brother-in-law.”) that only strengthened his conviction that he was right. He violated patient confidentiality. If a former patient improved after leaving his treatment, he took the credit. He was oblivious to the dangers of confirmation bias.

The editors of Freud’s letters and other papers were members of his cult and were dishonest. Comparison to the original documents shows that they changed words and omitted passages that they thought would have made him look bad. They “put the most damning evidence under the rug.” For example, “Out of 284 letters Freud wrote to Fliess, only 168 were represented, and all but 29 of them underwent diplomatic and often silent alteration.”

One of the foundational cases of psychoanalysis, the prototype of a cathartic cure, was the “Anna O” case reported in a book by Breuer and Freud. They said she had recovered after Breuer’s treatment, but that wasn’t true. In fact, she got worse and was hospitalized. After leaving psychoanalytic treatment, she improved on her own and eventually led a successful life as an activist opposing the sex trade. (This was interpreted in psychoanalytic terms as a means of unconsciously wishing to prevent her mother from having sex with her father!) She probably didn’t even have a psychiatric illness, but rather a physical, neurologic one, and many of her most troubling symptoms were caused by the morphine addiction Breuer had inflicted on her. Freud’s interpretation of the case contradicted the facts: he was either lying or venting a delusion of his own.

He found his true métier as a storyteller, using anecdotes from his own case history to illustrate how his mind was “cured” of bafflement over the origin of mysterious symptoms. He described adventures of the intellect. His orientation was more literary than scientific.

Crews says, “Freud was something of a specialist in gleaning precious admissions from people who couldn’t be reached for checking.” His “standard practice was to smear his former associates as soon as they posed an obstacle to his goals.”

Freud’s obsession with sex

He was preoccupied by sex, presumably because of his own problems in that area. His own wife called psychoanalysis “a form of pornography.” He saw everything an infant did as a source of sexual pleasure, from sucking milk to excreting. He was obsessed with masturbation and believed it was the cause of most mental illness. He developed a succession of questionable concepts like virginal anxiety, penis envy, and the Oedipus complex. He decided each hysterical symptom was a depiction of a sexual fantasy; he told one virginal patient that her cough was caused by her unconscious desire to suck her father’s penis.

At one point, he was convinced that sexual molestation in childhood was the cause of adult psychoneuroses. He believed everything patients told him, and even made things up for them and interpreted their dreams as distorted evidence of actual events. He failed to distinguish their fantasies from his own, even believing they had telepathically transmitted their thoughts to him. He thought his neurotic patients had repressed their memories of abuse, which he tried to bring to light. At first he thought nursemaids and governesses were the abusers, then he came to believe fathers were the abusers. Eventually he realized some of the stories about fathers were too outlandish to be real, so he switched gears. He decided patients were merely fantasizing about sex with fathers because of an Oedipal repressed yearning for paternal incest, or because they were trying to cover up the auto-erotic activities of early childhood sexuality. Some of the fantasies were bizarre, like an account of female circumcision where the little girl was forced to eat her own labia after it was excised. This prefigured the repressed memory witch-hunt of the 20th century, with its many false accusations of child molestations and Satanic ritual abuses. At one point he entertained the possibility that he had forced daydreams of molestation upon his patients, but then quickly rejected the idea.

When he thought he could get away with it, he would align details of a case history to support his current theory. He “awarded himself a license to invent, suppress, alter, and rearrange facts in the interest of enhanced self-portraiture and theoretical vindication.”

Off the deep end

One whole section of Crews’ book is titled “Off the Deep End.” Freud developed into a “manic speculator,” who fantasized, interpreted, and guessed. And his speculations were often fueled by cocaine. In a damning admission that his editors suppressed, he once confessed:

I am actually not at all a man of science, not an observer, not an experimenter, not a thinker. I am by temperament nothing but a conquistador – an adventurer, if you want it translated – with all the curiosity, daring, and tenacity characteristic of a man of this sort.

He displayed an expanding grandiosity, saying psychoanalysis was the only possible treatment for certain conditions and claiming impressive successes. In reality, he had not achieved a single cure. He knew his claims of healing lacked any basis in fact, and sometimes he said therapeutic success was not his primary aim; rather, he aimed only to give patients a conscious awareness of their unconscious wishes. He told a friend, “we do analysis for two reasons: to understand the unconscious and to make a living…we certainly cannot help [the patients].”

He claimed that his critics weren’t entitled to pass judgment on psychoanalysis because they didn’t understand it. His criterion for the truth of his ideas was internal consistency, not external reality.

He believed dreams could reveal arcane knowledge and were more accurate than conscious memories. He believed in the paranormal, in numerology, and in occultism.

Conclusion: A bad man, but a good book

Freud was a despicable person with multiple character flaws. He betrayed his scientific training in a tour-de-force of self-deception, succumbing to all sorts of irrational beliefs. His vaunted psychoanalyses never objectively helped a single patient. It is astounding that his ideas and his cult were so influential for so long. Freud was a fraud, a liar, a bad scientist, and a bad doctor; but Crews’ book about him is excellent. Crews’ detailed, well-referenced investigation of Freud’s descent into pseudoscience is a fascinating read. Readers familiar with the development of alternative medicine treatments will find many parallels.

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.