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-- The continuing success of drugs in the treatment or alleviation of mental disorders ranging from depression to schizophrenia. Roughly 10 million Americans are taking such medications. To his credit, Freud foresaw this development. In 1938, a year before his death, he wrote, "The future may teach us to exercise a direct influence, by means of particular chemical substances." Still, the recognition that some neuroses and psychoses respond favorably to drugs chips away at the domain originally claimed for psychoanalytic treatment.
-- The Clinton health-care reform proposals, oddly enough, which are prompting cost-benefit analyses across the whole spectrum of U.S. medicine, including treatments for mental illness. Whatever package finally winds its way through Congress, many experts concede that insurance will not be provided for Freud's talking cure. (A 50-min. hour of psychoanalysis costs an average of $125.) Says Dr. Frederick K. Goodwin, director of the National Institute of Mental Health: "It's clear that classical psychoanalysis, which is four to five times a week for a four- to five-year duration, will not be covered. It won't be covered because there is no real evidence that it works." Goodwin, for the record, professes himself an admirer of Freud the theoretician.
-- A spate of new books attacking Freud and his brainchild psychoanalysis for a generous array of errors, duplicities, fudged evidence and scientific howlers.
This last phenomenon is an intensification of an ongoing story. While Freud was winning cadres of acolytes and legions of notional recruits, he and his ideas regularly attracted sharp attacks, often from influential quarters. As early as 1909, philosopher William James observed in a letter that Freud "made on me personally the impression of a man obsessed with fixed ideas." Vladimir Nabokov, whose novels trace the untrammeled and unpredictable play of individual imaginations, regularly tossed barbs at "the witch doctor Freud" and "the Viennese quack." For similar reasons, Ludwig Wittgenstein objected to the pigeonholing effects of psychoanalytic categories, even though he paid Freud a backhanded compliment in the process: "Freud's fanciful pseudo explanations (precisely because they are so brilliant) perform a disservice. Now any ass has these pictures to use in 'explaining' symptoms of illness."
The steady rain of anti-Freud arguments did little to discourage the parade of his theories or to dampen the zeal of his followers. In fact, Freud erected an apparently invulnerable umbrella against criticisms of psychoanalytical principles. He characterized such disagreements, from patients or anyone else, as "resistance" and then asserted that instances of such resistance amounted to "actual evidence in favor of the correctness" of his assertions. For a long time, this psychoanalytic Catch-22 worked wonders: those who opposed the methods put forth to heal them and others could be banished, perhaps with a friendly handshake and a knowing smile, as nuts.
That illogical defense has largely crumbled. The recent discovery of documents relating to Freud and his circle, plus the measured release of others by the Freud estate, has provided a steadily expanding body of evidence about the man and his works. Some of the initial reassessments are unsettling.