Psychiatry wars: the lawsuit that put psychoanalysis on trial

Rachel Aviv

The Guardian

Originally posted 11 OCT 22

Here is an excerpt:

In the lawsuit, the 20th century’s two dominant explanations for mental distress collided. No psychiatric malpractice lawsuit has attracted more prominent expert witnesses than Ray’s, according to Alan Stone, the former president of the APA. The case became “the organising nidus” around which leading biological psychiatrists “pushed their agenda”, he told me.

At a hearing before an arbitration panel, which would determine whether the case could proceed to trial, the Lodge presented Ray’s attempt to medicalise his depression as an abdication of responsibility. In a written report, one of the Lodge’s expert witnesses, Thomas Gutheil, a professor of psychiatry at Harvard, observed that the language of the lawsuit, much of which Ray had drafted himself, exemplified Ray’s struggle with “‘externalisation’ – that is, the tendency to blame one’s problems on others”. Gutheil concluded that Ray’s “insistence on the biological nature of his problem is not only disproportionate but seems to me to be yet another attempt to move the problem away from himself: it is not I, it’s my biology.”

The Lodge’s experts attributed Ray’s recovery at Silver Hill at least in part to his romantic entanglement with a female patient, which gave him a jolt of self-esteem.

“It’s a demeaning comment,” Ray responded when he testified. “And it just speaks to the whole total disbelief in the legitimacy of the symptomatology and the disease.”

The Lodge lawyers tried to chip away at Ray’s description of depression, arguing that he had shown moments of pleasure at the Lodge, such as when he had played piano.

“The sheer mechanical banging of ragtime rhythms on that dilapidated old piano on the ward was almost an act of agitation rather than a creative pleasurable act,” Ray responded. “Just because I played ping-pong, or had a piece of pizza, or smiled, or may have made a joke, or made googly eyes at a good-looking girl, it did not mean that I was capable of truly sustaining pleasurable feelings.” He went on, “I would say to myself: ‘I am living, but I am not alive.’”

Manuel Ross, Ray’s analyst from the Lodge, testified for more than eight hours. He had read a draft of Ray’s memoir and he rejected the possibility that Ray had been cured by antidepressants. He was not a recovered man, because he was still holding on to the past. (“That’s what I call melancholia as used in the 1917 article,” he said, referring to Freud’s essay Mourning and Melancholia.)

Ross said that he had hoped Ray would develop insight at the Lodge. “That’s the true support,” he said, “if one understands what is going on in one’s life.” He wanted Ray to let go of his need to be a star doctor, the richest and most powerful in his field, and to accept a life in which he was one of the “ordinary mortals who labour in the medical vineyard”.

Ray’s lawyer, Philip Hirschkop, one of the most prominent civil rights attorneys in the country, asked Ross: “As an analyst, do you have to sometimes look inside yourself to make sure you’re not reacting to your own feelings about someone?”

“Oh yes,” Ross said. “Oh yes.”

“You who’ve locked yourself into one position for 19 years with no advancement in position other than salary, might you be a little resentful of this man who makes so much more money, and now he’s here as your patient?” Hirschkop asked.

The article is here.

Suggestions for a New Integration in the Psychology of Morality

Diane Sunar
Social and Personality Psychology Compass
(2009): 447–474

Abstract

To prepare a basis for a new model of morality, theories in the psychology of morality are reviewed, comparing those put forward before and after the emergence of evolutionary psychology in the last quarter of the 20th century. Concepts of embodied sociality and reciprocal moral emotions are introduced. Three ‘morality clusters’ consisting of relational models (Fiske, 1991), moral domains (Shweder, Much, Mahapatra, & Park, 1997) and reciprocal sets of other-blaming and selfconscious emotions are linked to three evolutionary bases for morality (kin selection, social hierarchy, and reciprocal altruism). Evidence regarding these concepts is marshaled to support the model. The ‘morality clusters’ are compared with classifications based on Haidt’s moral foundations (Haidt & Graham 2007). Further evidence regarding hierarchy based on sexual selection, exchange and
reciprocity, moral development, cultural differences and universals, and neurological discoveries, especially mirror neurons, is also discussed.

An Alternative Model

Alternative combinations of these elements have been suggested, most notably by Haidt and his colleagues (Graham, Haidt, & Nosek, forthcoming; Haidt & Joseph, 2008), mapping Shweder’s three ethics or moral domains, and Fiske’s relational models, onto Haidt’s moral foundations. As described above, these authors match community with ingroup/loyalty and authority; autonomy with harm/care and fairness/reciprocity; and divinity with purity/sanctity. In addition, they suggest that three of the foundations can be matched with three of Fiske’s relational models (leaving out MP). In this scheme, fairness/reciprocity is linked with EM, care and ingroup morality with CS, and authority/respect with AR. Harm and purity as moral foundations are not linked with relational models, as they argue that these two foundations ‘are not primarily modes of interpersonal relationship (Haidt & Joseph, 2008; p. 386). Similar to my proposed clusters, they also link the morality of harm and care to kin selection and that of fairness to evolved mechanisms of reciprocal altruism, but in contrast see purity as a derivative of disgust mechanisms without a specific social basis.

The paper is here.

ICP Ethics Code

Institute of Contemporary Psychoanalysis

Psychoanalysts strive to reduce suffering and promote self-understanding, while respecting human dignity. Above all, we take care to do no harm. Working in the uncertain realm of unconscious emotions and feelings, our exclusive focus must be on safeguarding and benefitting our patients as we try to help them understand their unconscious mental life. Our mandate requires us to err on the side of ethical caution. As clinicians who help people understand the meaning of their dreams and unconscious longings, we are aware of our power and sway. We acknowledge a special obligation to protect people from unintended harm resulting from our own human foibles.

In recognition of our professional mandate and our authority—and the private, subjective and influential nature of our work—we commit to upholding the highest ethical standards. These standards take the guesswork out of how best to create a safe container for psychoanalysis. These ethical principles inspire tolerant and respectful behaviors, which in turn facilitate the health and safety of our candidates, members and, most especially, our patients. Ultimately, ethical behavior protects us from ourselves, while preserving the integrity of our institute and profession.

Professional misconduct is not permitted, including, but not limited to dishonesty, discrimination and boundary violations. Members are asked to keep firmly in mind our core values of personal integrity, tolerance and respect for others. These values are critical to fulfilling our mission as practitioners and educators of psychoanalytic therapy. Prejudice is never tolerated whether on the basis of age, disability, ethnicity, gender, gender identity, race, religion, sexual orientation or social class. Institute decisions (candidate advancement, professional opportunities, etc.) are to be made exclusively on the basis of merit or seniority. Boundary violations, including, but not limited to sexual misconduct, undue influence, exploitation, harassment and the illegal breaking of confidentiality, are not permitted. Members are encouraged to seek consultation readily when grappling with any ethical or clinical concerns. Participatory democracy is a primary value of ICP. All members and candidates have the responsibility for knowing these guidelines, adhering to them and helping other members comply with them.

The ethics code is here.

Freud in the scanner

M. M. Owen
aeon.co
Originally published December 7, 2017

Here is an excerpt:

This is why Freud is less important to the field than what Freud represents. Researching this piece, I kept wondering: why hang on to Freud? He is an intensely polarising figure, so polarising that through the 1980s and ’90s there raged the so-called Freud Wars, fighting on one side of which were a whole team of authors driven (as the historian of science John Forrester put it in 1997) by the ‘heartfelt wish that Freud might never have been born or, failing to achieve that end, that all his works and influence be made as nothing’. Indeed, a basic inability to track down anyone with a dispassionate take on psychoanalysis was a frustration of researching this essay. The certitude that whatever I write here will enrage some readers hovers at the back of my mind as I think ahead to skimming the comments section. Preserve subjectivity, I thought, fine, I’m onboard. But why not eschew the heavily contested Freudianism for the psychotherapy of Irvin D Yalom, which takes an existentialist view of the basic challenges of life? Why not embrace Viktor Frankl’s logotherapy, which prioritises our fundamental desire to give life meaning, or the philosophical tradition of phenomenology, whose first principle is that subjectivity precedes all else?

Within neuropsychoanalysis, though, Freud symbolises the fact that, to quote the neuroscientist Ramachandran’s Phantoms in the Brain (1998), you can ‘look for laws of mental life in much the same way that a cardiologist might study the heart or an astronomer study planetary motion’. And on the clinical side, it is simply a fact that before Freud there was really no such thing as therapy, as we understand that word today. In Yalom’s novel When Nietzsche Wept (1992), Josef Breuer, Freud’s mentor, is at a loss for how to counsel the titular German philosopher out of his despair: ‘There is no medicine for despair, no doctor for the soul,’ he says. All Breuer can recommend are therapeutic spas, ‘or perhaps a talk with a priest’.

The article is here.