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Freud's dazzling and complex theory of the mind—one of the great intellectual triumphs of all time—came along when American psychiatry was doing little more than warehousing the insane and performing the occasional crude Cuckoo's Nest lobotomy. Though most of Europe's intelligentsia remained unimpressed with Freud, a generation of largely Jewish disciples of the master, fleeing Hitler and the Nazis, spread the faith widely in the U.S. It quickly attracted the well-to-do, who could alford the treatment, and enticed the literati, who were smitten by the subtlety and symbolism of these fashionable excursions into the subconscious.
Throughout the 1940s and 1950s, psychoanalytic chic ran high, generating optimism about its potential that far outran Freud's. The master, of course, thought he had made a decisive breakthrough, but one destined to be modified by other discoveries, some of them biological and chemical. Psychoanalysis, he said, could do little for the seriously ill, such as schizophrenics and other psychotics, and even many neurotics should expect little more than transforming "hysterical misery into common unhappiness." Even that might not be achieved if the patient was too old and set in his ways.
Freudian psychoanalysts in particular, who account for only 10% of the nation's psychiatrists, have felt the common unhappiness of post-Freudian deflation. Freudian talk therapy is designed for the less seriously ill, precisely the constituency that has shifted toward quick Pop treatments. A 1976 survey by the American Psychoanalytic Association showed that the average psychoanalyst had 4.7 patients under treatment, down from 6.2 a decade earlier. Applications to the Freudian training institutes are also declining. When Psychoanalyst Herbert Hendin director of the Center for Psychosocial Studies in Montrose, N Y., applied to the prestigious Columbia Psychoanalytic Clinic for Training and Research a generation ago, more than 120 students competed for nine openings. "Now," he says, they're lucky to get twelve applicants for roughly the same number of spots."
In classical Freudian psychoanalysis, the patient, lying on the inevitable couch, meets with the analyst for an hour, three to five times a week. Whether the patient talks about problems, fears and dreams, or simply free associates—voicing any thoughts that come to mind—the theory is that his unconscious difficulties will gradually break through into conscious thought. The analyst is generally passive and silent, offering no advice and speaking only to prod the patient into uncovering more nuggets from the inner recesses of the mind. The key to the Freudian "cure" is transference—the analyst replaces some crucial figure in the patient's background, usually a parent—and the patient eventually re-experiences blocked emotions and frees himself of the past.