Psychiatrists, their critics say, live off people's pain at high hourly rates. Psychiatrists refuse to let sleeping dogs lie. Psychiatrists promote not self-reliance, but self-pity, along with a morally indefensible narcissism. Furthermore, the worst of them-- the Freudian psychoanalysts--hew to a doctrine elitist and out-of-date, imposing on hapless patients a seamy sex-and-aggression orthodoxy that reflects not truth, but the flakiness of the founder.
Shrinks are people that people love to hate.
In recent months the press has once again informed us of Sigmund Freud's inadequacies. Two profiles of psychoanalysts--in The Washington Post Magazine and in The New Yorker--reveal such men as all-too- humanly flawed. Another article in The Post discloses that many psychiatrists engage in backbiting, in- fighting and other unpleasantness. And, except for The New Yorker, one can hear in much of these writings a strangely gleeful hah-I-gotcha tone.
One hears this tone again when certain otherwise humane and intelligent people offer their opinions of psychiatry, especially of those therapies that depend more on talk than on drugs, therapies that primarily work with neurotics instead of psychotics and that find a compelling validity in the insights of Sigmund Freud, whether he did or didn't sleep with his sister-in-law. There seems to be a readiness to join in the fun and games of deriding psychiatry. And perhaps it might be useful to talk about why.
The most obvious reason surely has to do with the belief that people should pull up their socks and solve their own problems. You don't go crying on somebody's shoulder every time you get hurt, runs this point of view. Courage and endurance, not a visit to a shrink, are sufficient resources for people of character.
The trouble with this view, although I too admire courage and endurance, is that it serves only the lucky and the tough, and suggests that all of those whose small fragilities are battered by misfortune are lacking not in blessings but in backbone. Furthermore, this trust in human will blithely dismisses the presence and the power of the unconscious--that portion of ourselves that lies outside of our awareness and that nonetheless exerts enormous influence on how we act and feel.
But perhaps another reason that one hears an antipsychiatric bias is psychiatry's focus on the unconscious--on the alarming thesis that our consciously perceived intentions and wishes are not the sole determinants, or even the major determinants, of our behavior. What an affront the unconscious is to our sense of ourselves as capably in control. Indeed, the image of clamorous and often undignified needs impinging upon us without a by-your-leave may evoke distressing anxieties that are best beaten back by beating up the messenger.
And it's tempting to beat up the messengers when they talk, as psychiatrists do, a peculiar jargon; when they talk about things that are better left unsaid; when they talk about the disreputable and embarrassing truths of our bodies and the even worse stuff that goes on inside our heads; when they talk, as the men in the profiles talked, of unworthy emotions no civilized person admits to; and when, although they fight with their spouses and holler at their kids and envy and lust and inflict their share of pain, they present themselves as people who can help us.
Psychiatrists, like glowing beauties in the skin-cream ads, ought to be living proof that their product works. And the fact that they are not may offer further reason to debunk psychiatry.
In an ideal world nobody ever would be tormented by overwhelming terror or despair, by paralyzing anxiety or crippled self-esteem or other neurotic--life-diminishing-- miseries. Failing that, we all would come into this world equipped with the strength to cope with such vicissitudes, with the power of positive thinking and self-command and spunk to pick ourselves up and dust ourselves off and move on. And if we lacked that spunk we then could turn--in an ideal world--to modern magic, to salvation through psychiatry, to noble men and women with impeccable private lives and sterling characters practicing a science guaranteed to make us happy, healed and whole.
But what we have instead are the flawed practitioners of a still imperfect science, using words to help ease psychic pain, examining the undertow that tugs against our sturdiest intentions, trying to identify the damaging patterns of our personal history--patterns that we are doomed to repeat again and again and again until we have learned from them.
What we have instead are human therapists who are doing what they can; who acknowledge their own, and their patients', limitations; and who offer to hundreds of thousands of the psychologically ill their best--perhaps only--real hope of relief and repair.