Wendy Dennis makes much of the way the TV show The Sopranos has popularized psychoanalysis (“Why Psychoanalysis Matters,” September), calling it “a brilliant advertisement.” It is no coincidence that for generations both television and psychoanalysis have exploited the human mind’s capacity for self-deception. Psychoanalysis is largely about dredging up memories, and, when dealing with memories, your mind makes things up because it’s no longer a living part of your experience. The situation is similar when you watch TV, which feels like reality because your mind automatically fills in the blanks. Reliving your memories and watching TV are both simulations: they do not challenge you in the way real situations do.
It’s true that many people who live unfulfilled lives can benefit from brief therapy, but only if the therapist’s focus is on bringing about change and expanding the person’s world. But what does it say about a person when he goes to a psychoanalyst for one or more days a week for years? It tells him that he is incapable of changing himself. It fosters dependence, rather than independence.
Real change doesn’t come from insight into our childhood traumas, but from meeting challenges on a day-to-day basis. This cannot be done by reliving memories, no matter how emotionally convincing they may be. For most of us, change and maturity require years of just getting on with our lives. This is slow hard work, not always rewarding in the short term, and usually not very glamorous. But there are no substitutes. The opportunity for “deep expansive reflection” that psychoanalysis affords is ultimately nothing more than a very expensive form of entertainment. Like watching television, it can be fascinating, but its effects on personal growth and maturity are superficial at best.
Prince Rupert, BC
It sounds as if Wendy Dennis had a marvellous time in her personal psychoanalysis, and I am delighted for her. While I agree that The Sopranos is one hell of a good TV drama and that Dr. Melfi is an excellent role model for a shrink, I do wish to raise caveats that may sprinkle a few showers on her parade.
Contrary to Dennis’s laudatory paean, the “art” of psychoanalysis is still as far away from a scientific (neurochemical or neuro-imaging) underpinning today as it was in Sigmund’s time. I would enjoy reading the hard data she cites for the practice’s “80 percent” effectiveness rate and other imagined claims for its worth, as most psychiatrists and psychologists would beg to differ strongly. Dennis ignores, downplays, demeans, or is seemingly ignorant of the success, and scientific validity, of many other so-called talking therapies.
Psychoanalysis has traditionally been limited to the educated, affluent, and introspective. It may have some benefit for those interested in self-exploration, but so do other approaches. For those with “real” psychiatric disorders, such as schizophrenia or bipolar depression, or suffering from the ravages of living (Iraq, New Orleans, and the like), it can be an exercise in futility, or worse.
Saul Levine
Professor of Psychiatry,
University of California at San Diego
Chairman of Psychiatry,
Children’s Hospital
San Diego, California
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