Correspondence

Is Psychoanalysis Science?

N Engl J Med 1997; 337:1635November 27, 1997

Article

To the Editor:

Mark Twain is said to have cabled home from abroad, “Reports of my death are greatly exaggerated.” The same could be said of psychoanalysis. In his review of Edward Shorter's book, A History of Psychiatry (July 3 issue),1 Dr. Pope amplifies some of Shorter's inaccuracies.

Psychoanalysis is not simply a phenomenon of one time and place. Throughout the world, more patients are now being treated with psychoanalysis than at any time in the century of its existence. Most modern psychotherapies, especially insight-oriented psychotherapies, are based on psychoanalytic ideas about unconscious emotional conflict.2 In science, reasoned challenges are always welcome, but simplistic attempts to dismiss ideas and data because they seem irksome are a disservice. Vast (and increasing) amounts of evidence that supports purportedly “bankrupt notions” such as transference cannot just be blithely ignored.3,4

Journal readers need to know the facts: that psychoanalysis is alive and available, and that it often succeeds where other treatments fail.2,5

Lawrence D. Blum, M.D.
2400 Chestnut St., Philadelphia, PA 19103

5 References

1. 1

   Pope HG Jr. Review of: A history of psychiatry: from the era of the asylum to the age of Prozac. N Engl J Med 1997;337:57-58
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2. 2

   Doidge N. Empirical evidence for the efficacy of psychoanalytic psychotherapies and psychoanalysis: an overview. Psychoanal Inq1997;102-150
   CrossRef

3. 3

   Luborsky L, Crits-Christoph P. Understanding transference: the core conflictual relationship theme method. New York: Basic Books, 1990.
   

4. 4

   Shevrin H. Is psychoanalysis one science, two sciences, or no science at all? A discourse among friendly antagonists. J Am Psychoanal Assoc 1995;43:963-1049
   CrossRef | Web of Science | Medline

5. 5

   Fonagy P, Target M. Predictors of outcome in child psychoanalysis: a retrospective study of 763 cases at the Anna Freud Centre. J Am Psychoanal Assoc 1996;44:27-77
   Web of Science | Medline

Author/Editor Response

The author replies:

To the Editor: Dr. Blum cites several references for the “vast” evidence supporting psychoanalysis. Space precludes a methodologic critique of all the studies he cites. But taking his fifth citation as an example, one finds that it is a retrospective, nonrandomized, uncontrolled, nonblinded study in which outcome measures of untested validity are used and the serious problems of selection bias, expectational bias, and confounding variables are barely acknowledged. Such studies offer psychoanalysis little support.

Developments in the years since Shorter's narrative leaves off have eroded this support even further. For example, the concept of repression of traumatic memories, which Freud once termed the “cornerstone” of psychoanalysis,1 has come under widespread attack, both in the literature2,3 and in the courts.4,5 Practitioners of therapies aimed at repressed and recovered memory are facing mounting malpractice verdicts.4,5 In this climate, psychoanalysis will survive only by offering methodologically rigorous, independently replicated studies of its efficacy — just as other medical disciplines must do. Until this happens, Shorter's account stands.

Harrison G. Pope, Jr., M.D.
Harvard Medical School, Boston, MA 02115

5 References

1. 1

   Freud S. The standard edition of the complete psychological works of Sigmund Freud. Strachey J, trans. Vol. 14. London: Hogarth Press, 1957:16.
   

2. 2

   Frankel FH. Discovering new memories in psychotherapy -- childhood revisited, fantasy, or both? N Engl J Med 1995;333:591-594
   Full Text | Web of Science | Medline

3. 3

   Pope HG Jr. Psychology astray: fallacies in studies of “repressed memory” and childhood trauma. Boca Raton, Fla.: Upton Books, 1997.
   

4. 4

   Johnston M. Spectral evidence: the Ramona case: incest, memory, and truth on trial in Napa Valley. Boston: Houghton Mifflin, 1997.
   

5. 5

   Loftus EF. Creating false memories. Sci Am 1997;277:70-75
   CrossRef | Web of Science | Medline

Citing Articles (1)

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1. 1

   Bartoloni, Alessandro, , Sabatinelli, Guido, , Benucci, Maurizio, . (1998) Performance of Two Rapid Tests for Plasmodium falciparum Malaria in Patients with Rheumatoid Factors. New England Journal of Medicine 338:15, 1075-1076
   Full Text