Patrice Van Den Reysen.
NYTimes May 29, 2004
By D. D GUTTENPLAN
LONDON, May 28 — Who owns psychoanalysis? That question is at the center of the most recent battle here in the Freud Wars, the epic (or as the man himself might say, interminable) struggle over the legacy of Sigmund Freud, pioneer psychotherapist, cartographer of the unconscious and former resident of Hampstead, the leafy corner of Northwest London where the concentration of therapeutic couches per square mile may be even higher than on the Upper West Side of Manhattan.
Late last year a new group calling itself the College of Psychoanalysts sent out a letter inviting British therapists who met certain qualifications to list themselves on the organization's "register of practitioners." The British Psychoanalytical Society, headquarters of classical Freudian analysis, responded with a statement accusing college members of "misleading the public about their training and qualifications." And then the fireworks really started. One founder of the college — which is a professional organization rather than a training institution — countered with a letter describing the society's action as "a phobic response to growth as symbolized in the Oedipal myth." An opponent of the college, on the other hand, described the new group as "an association of wannabes and poseurs."
More recently, the society's Web site included a disclaimer describing the college as a device for allowing therapists "to pass themselves off to the public as though they were trained psychoanalysts." In British law, "passing off" is a form of fraud; this was a declaration of war.
Susie Orbach, a therapist, an active member of the college and the author of the best-selling "Fat Is a Feminist Issue" and other books, says the dispute has already had "a chilling effect" on British intellectual life. To her, the society's argument that the title psychoanalyst "refers not to what the practitioner does, but what they have been trained to do" is nonsensical, a spurious restraint on trade.
"I do the work," she said. "My contributions are contributions to psychoanalysis, its theory and clinical practice, not to some other field."
On the surface, this is a parochial argument about labels and credentials, a tempest in a Viennese teacup — or at most, a professional turf war. But you don't have to probe the protagonists too deeply to discover that this is also a battle over the nature of therapy itself — what it is, what it does, how it works. And it quickly becomes apparent that alongside the intellectual controversy is a bare knuckles fight over money, power and prestige. These people, after all, are professionals of the ego.
The roots of this battle are in some ways peculiar to Britain. Unlike American psychotherapy, which is regulated by states (with some states, including New York starting next year, licensing psychoanalysts as a separate category), British psychotherapy is completely unregulated by the government. Also, until recently, most psychoanalysts in the United States were required to have medical degrees. The British analysts, however, like others in Europe, follow Freud's view in his essay "On Lay Analysis" and have never required medical training or graduate study in psychology. And because almost all psychotherapy in Britain takes place outside the National Health Service, the government has remained neutral. Legally, anyone with sufficient chutzpah can call himself a psychoanalyst here.
Still, the arguments and effects of the dispute are likely to reverberate on both sides of the Atlantic.
"The same conflict exists in the United States," says Jaine Darwin, president of the American Psychological Association's division of psychoanalysis. "There are the same arguments about standards within the profession," she added, having to do with licensing, training requirements and government registration.
Some of these battles have been raging for years. In 1989 the American Psychoanalytic Association — which had required members to have a medical degree — agreed to settle an antitrust lawsuit and allow psychologists, social workers, nurses and other mental health professionals to enter analytic training. That opening to the outside, however grudgingly done, probably saved American psychoanalysis from extinction. (In Britain the members of the British Psychoanalytical Society have an average age of 65.)
The flow of new analysts, though, raised a new set of problems. New candidates had to agree to the traditional training regime: a personal analysis four or five times a week lasting several years, and a number of supervised training analyses where the candidate saw patients, again four or five times a week, under supervision. What is so magical, some wanted to know, about four-times-a-week analysis? Why not three times a week, or two? Is there a real difference between analytic psychotherapy and psychoanalysis?
These questions are now being asked in Britain, along with some others. What began, said Joseph Schwartz, as "a simple jurisdictional dispute — like a fight between rival unions" — has the potential to become something far more interesting. An American transplant to Britain and the author of "Cassandra's Daughter: A History of Psychoanalysis" (Penguin, 2001), Mr. Schwartz is a Berkeley-trained physicist as well as a therapist on the register of the College of Psychoanalysis.
Ever since the day in 1911 when Alfred Adler and his followers left the Vienna Psychoanalytic Society, the history of psychoanalysis has been notoriously divided. Even so, all psychoanalysts share certain beliefs: the importance of the unconscious, for example. And Freud's own legacy is still central. His sense of mistreatment by Viennese academics is one reason psychoanalytic training still goes on mostly in private institutes rather than in university departments.
Shaped partly by their divergent histories and partly by differing national cultures, British and American psychoanalysis became quite different enterprises. In Britain, the encouragement of lay analysis and the influence of Bloomsbury figures like Virginia Woolf, who published Freud's writings in English, and whose brother Adrian Stephen actually trained as an analyst, gave psychoanalysis a distinctly literary flavor. The Hungarian refugee Melanie Klein, with her emphasis on internal experiences, envy and aggression, became the dominant figure in postwar British psychoanalysis.
During the same period in the United States the vast majority of psychoanalysts were also medical doctors. One consequence of this was that much more psychoanalysis in the United States took place in institutional settings like hospitals or asylums. Another was a gradual loss of prestige as psychiatry, with its growing armory of antidepressant and antipsychotic drugs, turned toward the pharmacy and away from the talking cure.
Both sides of the current dispute in Britain put clinical practice at the heart of psychoanalysis. Here the differences are as much political as theoretical. Analysts today are already free to discount Freud's focus on instinct. And though the requirement of analysis four or five times a week for candidates does guarantee steady work for the training analysts, their trainees are going to have to compete for patients in a world enthralled by quick fixes, whether out of a bottle or in a behavioral therapist's office, and where the superiority of psychoanalysis — once commonly described as the "gold standard" of therapy — is no longer taken for granted.
Julia Fabricius, incoming president of the British Psychoanalytical Society, says, "Psychoanalysis as an academic discipline is open to anybody," but she defends the society's qualifications for membership. She adds that she does not regard psychotherapists who aren't analysts as "second-class citizens."
Robert Maxwell Young, a Yale-educated British-trained psychoanalytic psychotherapist and former Cambridge historian of science, is outside both camps. Though he points out that he held the first chair of psychoanalytic studies in Europe, at the University of Sheffield in England, he is not a member of the society. And he has no desire to join the college. "I don't go to parties where I'm not invited," he said of the college's claim on the label psychoanalyst. "Even so, I have nightmares," he confesses, about not being allowed into psychoanalytic meetings.
What gives the dispute over the College of Psychoanalysts even more urgency is the sense that, in the next few years, psychoanalysis in Britain will soon be regulated. Lists and standards are going to be drawn up. Battle lines are forming over who who sets the standards and who keeps the lists.
Scientific American May 24, 2004
Death by Theory
Attachment therapy is based on a pseudoscientific theory that, when put into practice, can be deadly
In April 2000, 10-year-old Candace Newmaker began treatment for attachment disorder. Her adoptive mother of four years, Jeane Newmaker, was having trouble handling what she considered to be Candace's disciplinary problems. She sought help from a therapist affiliated with the Association for Treatment and Training in the Attachment of Children (www.ATTACh.org) and was told that Candace needed attachment therapy (AT), based on the theory that if a normal attachment is not formed during the first two years, attachment can be done later.
According to the theory, the child must be subjected to physical "confrontation" and "restraint" to release repressed abandonment anger. The process is repeated until the child is exhausted and emotionally reduced to an "infantile" state. Then the parents cradle, rock and bottle-feed him, implementing an "attachment."
Candace was treated by Connell Watkins, a nationally prominent attachment therapist and past clinical director for the Attachment Center at Evergreen (ACE) in Colorado, and her associate Julie Ponder. The treatment was carried out in Watkins's home and videotaped. According to trial transcripts, Watkins and Ponder conducted more than four days of "holding therapies." On one day they grabbed or covered Candace's face 138 times, shook or bounced her head 392 times and shouted into her face 133 times. When these actions failed to break her, they put the 68-pound Candace inside a flannel sheet and covered her with sofa pillows, while several adults (with a combined weight of nearly 700 pounds) lay on top of her so that she could be "reborn." Ponder is reported to have told the girl to imagine that she was "a teeny little baby" in the womb, commanding her to "come out head first." In response, Candace screamed, "I can't breathe, I can't do it! ... Somebody's on top of me.... I want to die now! Please! Air!"
According to AT, Candace's reaction was a sign of her emotional resistance, calling for more confrontation to achieve emotional healing. ACE (now operating as the Institute for Attachment and Child Development) claims that "confrontation is sometimes necessary to break through a child's defenses and reach the hurting child within." Putting theory into practice, Ponder admonished, "You're gonna die." The girl begged: "Please, please, I can't breathe." She then vomited and cried, "I gotta poop." Ponder instructed the others to "press more on top," on the premise that such children exaggerate their distress. Her mother entreated, "I know it's hard, but I'm waiting for you."
After 40 minutes of struggling, Candace went silent. Ponder rebuked her: "Quitter, quitter!" Someone joked about performing a C-section, while Ponder patted a dog that meandered by. After 30 minutes of silence, Watkins remarked, "Let's look at this twerp and see what's going on. Is there a kid in there somewhere? There you are lying in your own vomit. Aren't you tired?"
Candace wasn't tired; she was dead. The death certificate listed the proximate cause as asphyxiation, and her therapists received the minimum sentence of 16 years for "reckless child abuse resulting in death." The ultimate cause was pseudoscientific quackery masquerading as psychological science. "However bizarre or idiosyncratic these treatments appear--and however ineffective or harmful they may be to children--they emerge from a complex internal logic based, unfortunately, on faulty premises," write Jean Mercer, a psychologist at Richard Stockton College of New Jersey, and Larry Sarner and Linda Rosa of the National Council against Health Fraud in their 2003 analysis, Attachment Therapy on Trial: The Torture and Death of Candace Newmaker.
Other children have died after AT as well. The American Psychiatric Association states: "While some therapists have advocated the use of so-called coercive holding therapies and/or 're-birthing techniques,' there is no scientific evidence to support the effectiveness of such interventions." Nevertheless, AT continues to flourish. ATTACh claims to have about 600 members. The numbers may be even higher, Mercer, Sarner and Rosa say, because the practice goes by different labels, including holding-nurturing process, rage reduction, cuddle time and compression therapy (see www.ChildrenInTherapy.org).
By whatever name, AT remains a pseudoscience. We should ban its practice before it tortures and kills children again.
Michael Shermer is publisher of Skeptic
(www.skeptic.com) and author of The Science of Good and Evil.
New Scientist 14 June 04
Memory fails you after severe stress
People are woefully bad at recalling details of their own traumatic experiences. When military personnel were subjected to threatening behaviour during mock interrogations, most failed to identify the questioner a day or so later, and many even got the gender wrong.
The finding casts serious doubt on the reliability of victim testimonies in cases involving psychological trauma.
Numerous studies have questioned the accuracy of recall of traumatic events, but the research is often dismissed as artificial and not intense enough to simulate real-life trauma. Other studies have suggested that intense, personal experiences might produce near photographic recollection, something that prosecutors and juries in legal cases often assume.
But some researchers think this is an illusion. "People come away from these experiences feeling they will never forget what happened," says Gary Wells, an expert on eyewitness testimony at Iowa State University in Ames, "but they confuse that with thinking they remember the details."
Now Andy Morgan at Yale University and his colleagues have evidence from truly stressful situations. They studied over 500 soldiers, sailors and pilots at "survival schools" - three mock POW camps run by the US military, who partly funded the study. The subjects, whose mean age was 25, were being trained to withstand the mental and physical stresses of capture.
After 48 hours without food or sleep, they were subjected to intense interrogation. Half of the subjects were physically threatened, and this caused them to show all the signs of intense physiological stress - very high heart rate and levels of adrenalin and cortisol, combined with plummeting sex hormones.
Twenty-four hours after release from the camp, the subjects were asked to identify their interrogators. Some of them were shown a live line-up of 15 people, others were shown a photo-spread, and a third group was shown single photos sequentially.
Using a scale of 1 to 10, participants were asked to say how confident they were that they had chosen the right person. Most of the mock interrogators appeared or were pictured dressed in standard military garb, but some were shown dressed exactly as they had been during the questioning.
The performance of all groups was abysmal. Only 30 per cent could find the right person in a line-up, 34 per cent from a photo-spread and 49 per cent from sequential photos - though the clothing cue boosted correct identification to 66 per cent. Thirty people got the gender wrong, and those subjected to physical threats were the worst at recognising their interrogator.
Elizabeth Loftus, a psychologist at the University of California at Irvine, says the study is unique because the stresses were intense and real. "I think people will pay attention to this," she adds. Wells agrees: "What it illustrates is that stress does not help memory."
Journal reference: International Journal of Law and Psychiatry (vol 27, p 265)
Stress can encourage false memories
Law and psychiatry, Yale
Post-traumatic stress disorder, MedlinePlus
International Journal of Law and Psychiatry