A dangerous method? In defence of Freud’s psychoanalysis

He may not fit with modern terminology, but were Freud’s concepts of the mind right on the money? tnarik

Sigmund Freud, the founder of psychology, has recently suffered some serious knocks. His theories have been dismissed as unscientific and his achievements are now considered to be equal parts myth and fact.

But was the Austrian’s theory of the mind really so different to what neuroscience is now telling us? I would argue the differences are smaller than we think.

Charges against psychoanalysis

Psychoanalysis, the best-known form of therapy outside the clinic, is dramatically depicted in David Cronenberg’s new film, A Dangerous Method, released this week in Australia.

While “dangerous” might be too strong a descriptor, it’s true psychoanalysis is no longer recommended for treating mental illness due to a lack of evidence.

A recently published review was unable to find a single randomised controlled trial evaluating classic psychoanalysis and the evidence for long-term, “modern” psychoanalysis was conflicting at best.

To make matters worse, historians now charge that Freud’s signature treatment never really existed, and only attained its perceived uniqueness and cultural prominence through Freud’s “rewriting of history”.

Tragically, Freud abandoned a neurobiological approach to understanding the mind and mental illness because he did not believe we knew enough about the brain, in his era, to link its functioning to psychoanalytic constructs.

And yet, ironically, modern neuroscience may offer Freud a reprieve of sorts, by backing up at least the theory that underpinned his controversial treatment.

Freud’s theory of personality

Psychoanalysis, the treatment, is based on Freud’s theory of personality, which arose from his clinical work with patients and general observation of human behaviour.

According to that theory, the mind consists of three dissociable components:

  • the id
  • the ego
  • the superego.

Freud described the id as the mental expression of our base instincts and bodily impulses, “a cauldron of seething excitations”. Such impulses compel us to pursue rewarding experiences (such as food and sex) and avoid punishing ones (such as pain and rejection).

The id even produces opposing impulses simultaneously, compelling us to both move toward and away from something, or someone. Think of fatty foods, drugs, or an attractive stranger.

How do we control such impulses? Enter the ego. The ego’s role in our personality – through organising and synthesising our mental processes in a coherent way – is to resolve the conflicts that arise from the id.

According to Freud, the ego makes us stop to think about a situation and its consequences. We can remember smoking causes cancer, and that infidelity can lead to divorce - things we, presumably, want to avoid.

The ego pulls us out of the moment, temporarily. Thanks to the ego, we aren’t constantly running amuck, seeking instant gratification. But its job doesn’t end there.

A part of the ego also imposes idealistic standards on our behaviour that compete with the id as well. This is the superego, our conscience.

Freud described the superego as the parent in our head. It is always watching us, and judging the id’s desires: “no respectable person would drink themselves stupid”; “a loyal spouse would never be even slightly tempted by another.”

The superego is therefore often at loggerheads with the id. The ego acts as a referee between the id and the superego, between our impulses and our ideals.

To achieve this task, says Freud, the ego calls on myriad mental tricks, such as repression, to keep unacceptable impulses buried in the unconscious, unexpressed.

According to Freud’s theory, mental illness arises when the ego is incapable of maintaining control of the id and superego, when their impulses are too strong. Freud believed this imbalance was often caused by early childhood trauma.

Neuroscience of personality

How might any of this fit with modern neuroscience? You’ll find no mention of Freud or the id in your typical brain-scanning study. Psychology has largely abandoned Freud’s theory altogether.

For a theory to be scientific, there must be some way you could prove it’s wrong because nothing can ever really be proven to be true.

Science advances knowledge by disproving bad theories, not proving good theories, and Freud’s theory couldn’t offer any “disprovable” hypothesis.

A Dangerous Method opens in Australia this week.

In stark contrast to psychoanalysis, modern neuroscientific theories of personality grew out of research on animals exploring the behavioural effects of drugs and lesions to different areas of the brain.

Among other things, such work revealed damage to certain brain regions (but not others) affected impulse control and, additionally, that natural (genetic) variation in the functioning of these regions underlies individual differences in control.

These days, much of the field has moved on to neuroimaging (“live” scanning of brain activity) and the direct observation of human brain function.

Interestingly, this entirely different approach has also revealed three dissociable (brain) systems:

The same but different?

As with Freud’s id, the approach system responds to perceived rewards in our orbit, compelling us to approach them. It relates to the extraversion trait (sociability, goal-directedness).

Similarly, the avoidance system responds to punishments or threats, compelling us to avoid them. It relates to the neuroticism trait (anxiety-proneness).

The striatum (approach) and the amygdala (avoidance) are key brain structures in these systems. They are evolutionarily “old” structures that reside deep within our brain - areas similar to those of lower mammals, such as monkeys and rats.

As with the ego, the inhibition system resolves conflict arising from within and between the approach and avoidance systems. It relates to trait impulsivity/constraint. It inhibits neural activity in these lower systems when their impulses conflict with each other, or when it detects that acting on an impulse would lead to negative consequences.

This allows us time to stop and think about a situation before acting, as with the ego. The orbitofrontal cortex and anterior cingulate are key brain structures in this system, located in the evolutionarily “newer”, more advanced frontal regions of the brain.

Social rules and abstract notions such as fairness and morality are processed by parts of the inhibition system, thereby resembling the superego.

Neuroscientific theories argue addiction and obesity are caused by a weak inhibitory system that cannot control a hyperactive approach system. Anxiety disorders such as obsessive-compulsive disorder and panic disorder are similarly characterised by a weak inhibitory system that cannot control a hyperactive avoidance system.

One possible cause of these imbalances is the effects of early childhood stress on the brain, but it is certainly not the only cause. Genetic vulnerability and lack of coping skills also play an important role.

Different but the same?

While I’m not advocating a return to psychoanalytic theory, it’s true that, in many ways, we still view mental illness as being caused by an overwhelmed ego struggling to control a “super-charged” id.

The key difference is how we get there. The rigorous experimental approach of neuroscience gives us greater confidence that we are on the right track than anecdotal observation.

Still, in many ways, Freud got the basic structure right 100 years ago, even after he abandoned neurobiology. We should certainly keep this in mind when watching Cronenberg’s film, and whenever we catch ourselves smirking at concepts such as penis envy and the Oedipus complex.

As Freud himself said: “You must not judge too harshly a first attempt at giving a pictorial representation of something so intangible as psychical processes.”