Content warning: there is going to be a *lot of talk about human sexuality and anatomy. You know I don’t work blue, but we’re looking at the work of Sigmund Freud, so when I say a lot, I mean a lot. This would not be the episode to play in mixed company.
Welcome to the 50th episode of Your Brain On Facts! Considering the vast majority of podcasts are abandoned after 7 episodes, it’s no mean feat. To celebrate, I’ve brought on a bevy of guest hosts to help me tackle a topic I’ve been wanting to do since the beginning – the dubious proclamations and legacy of Sigmund Freud. Psychiatry is arguably the least science-based of all the medical specialties, and Freudian psychoanalysis is arguably the least science-based psychotherapy. The father of psychoanalysis, Freud’s impact on 20th century thought is undeniable, even though he got *almost everything wrong. My name’s Moxie and this is your brain on facts.
Let’s start at the very beginning, which is a very good place to start. For some background on the man himself, please welcome our first guest presenter.
Sigmund Freud was also a serious polyglot, with a strong knowledge of German, Italian, Greek, English, Spanish, Hebrew and Latin, making those of us who got a C in high school French look pretty shabby. Further, it’s said he was already reading Shakespeare at the age of eight. Whatever else is said today, no one will be impugning Freud’s intellectual capacity.
Although he did not keep his Jewish faith, Freud became a particular target of the Nazis when they rose to power. His books were among those burned in 1933, which caused him to snark: “What progress we are making. In the Middle Ages they would have burnt me; nowadays they are content with burning my books.” After Germany annexed Austria, the Nazis raided his apartment, and the Gestapo detained and interrogated his daughter, Anna. With the assistance of his friend and patient, Princess Marie Bonaparte of France, a reluctant Freud fled to Paris and then London with his wife and Anna. Sadly, Bonaparte could not obtain exit visas for four of Freud’s sisters, who would sadly die in concentration camps.
Their deaths were beyond their control, but Freud’s wasn’t. Freud smoked as many as 20 cigars a day. He was been quoted as saying that cigars were essential to his life, and that they improved his work. There is a popular story that one of Freud’s students suggested that perhaps his constant need to have a cigar in his mouth meant that he had an oral fixation, a disorder he [created], which we’ll get into shortly. To this, Freud famously replied “sometimes a cigar is just a cigar.” Except he probably didn’t. This deflective response was first documented in 1950, 30 years after it was supposedly uttered, but there are no other references to it to found in those three decades. After the discovery of a cancerous tumor inside Freud’s mouth in 1923, doctors removed a large part of his jaw. Although he underwent 33 additional surgeries over the next 16 years and had a large prosthesis inserted to separate his sinus and jaw, Freud never quit smoking, so I guess I will question his smarts just a little.
In addition to tobacco, Freud was a big fan and proponent of cocaine, even bigger than Eric Clapton. In the 1880s, Freud grew interested in a drug being used by a German military doctor to rejuvenate exhausted troops—cocaine. He distributed doses to his friends and future wife and touted the drug’s therapeutic benefits in an 1884 paper “On Coca,” which he called ”a song of praise to this magical substance.” However, when Freud gave cocaine to close friend Ernst von Fleischl-Marxow to wean him from his morphine addiction and relieve chronic pain, his friend instead developed a cocaine addiction. With news of other addictions and overdose deaths spreading, Freud stopped advocating cocaine’s medical benefits but continued to use the drug intermittently for migraines, depression, and nasal inflammation. For those don’t know, snorting cocaine through a nose that’s inflamed by cocaine is a bad idea, to the degree that it can cause tissue death or necrosis. He treated this tissue necrosis with more cocaine. His writings on the benefits of cocaine have been called into serious question, as he referenced successful outcomes of patients who don’t seem to have existed. He published a scientific study on the physiological effects of cocaine on reaction time and muscle strength. His only experimental subject was himself! In his write-up, he first tried to explain away his failure to test other subjects, and then claimed he had confirmed his results by testing colleagues, which was a lie. The study was riddled with methodological flaws, and as one biographer commented “may rank among the most careless research studies ever to see print.” Freud was trained as a scientist, but didn’t live up to its principles. In an early article “On Coca,” he demonstrated poor scholarship, omitting crucial references, citing references from another bibliography without reading them, and making careless errors (misstating names, dates, titles, and places of publication). There were numerous instances where it appeared that his own drug use affected his judgment. He even prescribed cocaine to a patient with diphtheria, an often-fatal bacterial infection of the mouth and throat, which most of us have never encountered, thanks to the DTaP vaccine we get as children.
For more on cocaine and some surprising theories about sex and the human nose, welcome our next guest.
One of the best known Freudian theories is his identification of the parts of consciousness. Freud thought that all babies are initially dominated by unconscious, instinctual and selfish urges for immediate gratification which he labeled the Id. As babies attempt and fail to get all their whims met, they develop a more realistic appreciation of what is possible, which is called the “Ego”. Over time, babies also learn about and come to internalize and represent their parents’ values and rules. These rules, the “Super-Ego”, are the basis for the the developing child’s conscience that struggles with the concepts of right and wrong and works with the Ego to control the immediate gratification urges of the Id.
Freud didn’t discover the unconscious mind, of course. That distinction goes to French psychiatrist Pierre Janet. Freud was also influenced by his professor Jean Martin Charcot, a famed neurologist who dabbled in hypnosis. But it was Freud who took the concept to the next level by breaking it down even further, and by applying it to psychotherapy and “free associating,” where patients would openly talk about their feelings and experiences regardless of how irrelevant, absurd, or upsetting it sounded.
Human genitalia was kind of a big deal with Freud. In fact, he believed that all people’s personalities and how well the functioned in society were a result of developing through five psychosexual stages: Oral, Anal, Phallic, Latency, and Genital. In Freud’s view, each stage focused on sexual activity and the pleasure received from a particular area of the body. In the oral phase, children are focused on the pleasures that they receive from sucking and biting with their mouth.
In the Anal phase, this focus shifts to the anus as they begin toilet training and attempt to control their bowels. If parents take an approach that is too lenient, Freud suggested that an anal-expulsive personality could develop in which the individual has a messy, wasteful, or destructive personality. If parents are too strict or begin toilet training too early, Freud believed that an anal-retentive personality develops in which the individual is rigid, orderly, and obsessive. As if potty training wasn’t hard enough for parents, adherent’s to Freud’s beliefs also had to deal with worrying that they would make their children *gay by potty-training them incorrectly.
In the Phallic stage, the focus moves to genital stimulation and the sexual identification that comes with having or not having a penis. During this phase, Freud thought that children turn their interest and love toward their parent of the opposite sex and begin to strongly resent the parent of the same sex. This Oedipus complex is named for the Greek tragedy in which the protagonist fulfills a prophecy by unknowingly killing his father and marrying (and having children with) his mother. Supposedly, boys begin to view their fathers as a rival for the mother’s affections; they want to possess their mother and eliminate and replace their father. However, the child also fears that he will be punished by the father for these feelings, a fear Freud termed castration anxiety. Since girls can’t feel this temporary castration anxiety, they instead feel permanent penis envy, which we’ll revisit shortly. They allegedly want to possess their fathers and replace their mothers, which is called an Electra complex. Electra was another Greek character, who plotted with her brother to kill their mother, but theirs was a revenge plot for the death of their father, so the name is kind of a stretch in this reporter’s opinion. Eventually, according to Freud, the child begins to identify with the same-sex parent as a means of *vicariously possessing the other parent. The Phallic/Oedipus stage was thought to be followed by a period of Latency during which sexual urges and interest were temporarily nonexistent. Finally, children were thought to enter and remain in a final Genital stage in which adult sexual interests and activities come to dominate.
There have been a number of observations and criticisms of Freud’s psychosexual theory through the years, on a number of grounds, including scientific and feminist critiques:
The theory is focused almost entirely on male development with little mention of female psychosexual development. His theories are difficult to test scientifically. Concepts such as the libido are impossible to measure, and therefore cannot be tested. He said a thing that he can’t prove to be true, but that’s hard to prove false. Future predictions are vague business at best and should be left to fortune-tellers. The length of time between the cause and the effect is too long to assume that there is a relationship between the two variables. Freud’s theory is based on case studies and *not empirical research, on the recollections of his adult patients, but not on any actual observation and study of children.
Another criticism of the psychosexual stages is that the theory focuses primarily on heterosexual development, and largely ignores homosexual development, except as a side effect of something done wrong. Freud’s theory suggested that heterosexual preferences represent the “normal” outcome of development and suggested that homosexual preferences represented deviation of this process. Freud’s own viewpoints on homosexuality varied, at times expressing biological explanations and at other times social or psychological explanations for sexual preferences. (To his credit, though, Freud didn’t view homosxuality as a pathology in need of correction.)
Those psychosexual stages lent a few phrases to the popular lexicon. For more on that, welcome two of my favorite word nerds.
As we’ve mentioned, Freud believed every adult characteristic could be linked back to a sexual or quasi-sexual incident in childhood. He was convinced that sexual molestation in childhood was the cause of adult psychoneuroses. Freud believed everything patients told him, without the application of critical analysis. He would interpreted their dreams as distorted evidence of actual events in their past. Neurotic patients must have repressed their memories of abuse, he thought, and it was his job to bring them light. At first he thought nannies were the abusers, then he came to believe it was almost universally the patients’ fathers. When a patient’s stories sounded too outlandish to be real, Freud would flip his interpretation. These weren’t memories, they were fantasies. He decided patients were merely fantasizing about sex with fathers because of an Oedipal complex or because they were trying to cover up childhood masturbation and sexual exploration. Helping patients recover “repressed memories” isn’t limited to Freud, sadly. For a great retelling of how doctors helped cause a Satanic panic in the 80’s, check out the first episode of one of my favorite podcasts, You’re Wrong About. And episode 22 on multiple personality disorder. And then the rest of them.
Freud displayed an expanding grandiosity as his career progressed, saying psychoanalysis was the only possible treatment for certain conditions, yet he had very little provable success. When faced with that, Freud stated that therapeutic success was not his primary aim; rather, he aimed only to give patients a conscious awareness of their unconscious wishes. He told a friend, “we do analysis for two reasons: to understand the unconscious and to make a living…we certainly cannot help [the patients].” He believed dreams could reveal arcane knowledge and were more accurate than conscious memories. He also put stock by the paranormal, numerology, and occultism. He claimed that his critics weren’t entitled to pass judgment on psychoanalysis because they didn’t understand it. It’s like every bad behavior from a comment thread, but being perpetuated by someone that people were trusting to help them.
To say that Freud had a bit of a problem with women would be an understatement. He held that women were biologically inferior to men and that women’s problems stemmed essentially from them not having a penis. Women, in his view didn’t have a good sense of justice, were weak socially, have a jealous nature, and are exceedingly vain. Freud was also known to believe women to be the problem in society, especially when it came to sexual tension between the genders. Once a little girl discovers there are different sexes, she experiences “penis envy,” resenting her mother for denying her one, and desiring her father because he has one. As she will never have a penis (or, what he was really saying, that she will never be a man), a woman will always have an underdeveloped superego and thus remain “morally inferior” to men. While Freud promoted penis envy as fact, others have categorized it as a mere reflection of the social mores of the time, which privileged the beliefs of straight men and viewed women as passive creatures.
As Betty Friedan wrote in the Feminine Mystique, “Because Freud’s followers could only see woman in the image defined by Freud – inferior, childish, helpless, with no possibility of happiness unless she adjusted to being man’s passive object – they wanted to help women get rid of their suppressed envy, their neurotic desire to be equal. They wanted to help women find sexual fulfillment as women, by affirming their natural inferiority.”
Freud’s views on the inferiority of women derived at least in part from anatomy, even though he never studied it in a serious way. He viewed sexual pleasure from the clitoris as huvenile and immature. The vagina was the woman’s “mature” sexual center and he thought that if women did not orgasm when they had sex with men, it was due to penis envy. As Freudian contemporary Frank S. Caprio writes, “whenever a woman is incapable of achieving an orgasm via coitus, provided the husband is an adequate partner, and prefers clitoral stimulation to any other form of sexual activity, she can be regarded as suffering from frigidity and requires psychiatric assistance.” Anatomically speaking, the vagina serves a reproductive purpose and lacks the degree of sensitivity of the clitoris, which has no other function than that of sexual pleasure. A 2017 study published in the Journal of Sex and Marital therapy reports that only 18% of women, less than one in five, can achieve orgams through vaginal stimulation alone. So, yeah, not so good when it comes to a fundamental understanding of the anatomy. In a 1970 essay, Anne Koedt goes on to argue that the myth of the vaginal orgasm popularized by Freud perseveres primarily because “the best physical stimulant for the penis is the woman’s vagina,” and because holding the “power” to make a woman orgasm boosts a man’s own ego, perpetuating the Freudian stereotype that women are a mere appendage of men.
In response to his belief that many of women’s ills belonged to the fact that they did not have a penis and were jealous of men for having one, a female contemporary came up with the alternate theory of womb envy. Also known as vagina envy, this is an alternate theory that states men are actually jealous of women, because they do not have a womb and thus cannot create life. To make up for this jealousy, men try to construct businesses instead so it feels like they are creating something. One feminist even makes the argument that Mary Shelley’s Frankenstein is essentially a story about a man with womb envy.
Perhaps his wildest theory, at least in the category of penis envy, which is saying something, is the plaiting/weaving theory. According to Freud, women were born with a “genital deficiency,” an inherent inferiority that, combined with their lack of aggression, led to them contributing little to the advance of civilization, save for one skill — plaiting and weaving. Why? Women were motivated to invent plaiting and weaving out of shame. Not shame for not having invented the cool things men had, but their unconscious desire to hide their shameful “castration.” According to Freud, early women attempted to plait their pubic hair together in order to better conceal their lack of external genitalia. Having mastered the plait, women easily went on to invent the art of weaving. There is of course no anthropological evidence to back up his theory on the origins of weaving, as there was rarely evidence from other scientific disciplines to back up most of Freud’s proclamations.
Intersecting the topics of homosexuality and misogyny, Freud believed that homosexuality in men, while neurotic, was not particularly problematic. Lesbianism, on the other hand, was a gateway to mental illness. This is because only men have moral sense needed to control their homosexual desires. Boys aren’t born with this moral sense, but acquire it through the castration complex — the fear that their fathers will emasculate them for their misbehavior. Having no external genitals to fear for, girls and women will lie and conive to get what they want. They must be guided through civilized life by their father and then their husband. Because lesbians don’t marry men, they remain loose cannons, fundamentally untrustworthy. Freud’s daughter Anna was his closest intellectual and emotional companion. And a lesbian. Sort of flies in the face of Freud’s teachings that lesbianism is always the fault of the father and is curable by psychoanalysis. Freud cautioned followers that analysis is an erotic relationship. Analyst and patient must scrutinize the amorous feelings that flow between them. This being the case, by rules he asked his followers to honor, Freud could not attempt to cure his own daughter’s lesbianism. When Anna was 23 and in an apparent relationship with a woman, he took her into analysis anyway. For six nights a week for the next few *years, he and Anna dissected her masturbation fantasies, which featured an angry father figure beating a child who had made a mistake over which she had no control. Can you think of anything more cringe-worthy than having to discuss your fantasies with your father and having him make them about himself? How about if he then lectured on them? He spoke publicly about her fantasies at a conference while Anna sat on stage in “the wife’s’ chair” near the podium. In a small saving grace, Freud He didn’t identify the patient, but we know it was Anna because, when she wanted to become an analyst, she described the same fantasies in a paper called “Beating Fantasies and Daydreams.” Try as he might, Freud was never able to “correct” Anna’s lesbianism. She enjoyed 54 years of happy monogamy with Dorothy Burlingham, heir to the Tiffany fortune.
Homosexual desires were also the root cause of paranoia, in Freud’s thinking. Unreasonable paranoia is a commonly observed symptom associated with mental illness. For whatever reason, he saw paranoia as a projection of unconscious homosexual desire. Freud also thought that paranoia might be a defense mechanism for protecting self-esteem, and this is the only aspect of his theory of paranoia that is still taken seriously today. Later psychoanalysts generally discarded Freud’s original theory of paranoia and came to agree that the deeply hidden psychological cause was not a projection of repressed homosexuality, but rather a projection of repressed childhood aggression. This theory seems to make a bit more sense, since most paranoid people are paranoid about someone or something intending to harm them in some way. From a purely scientific perspective, however, the cause of paranoia is still unclear.
But Freud also believed people had an “innate bisexuality,” though that refers more to gender than sexual preference. Everyone has both active and passive aspects to their personality and behavior. Freud thought of “active” aspects as being inherently masculine and of “passive” aspects as being inherently feminine. Therefore, everyone must be a mix of masculine and feminine components and so everyone must be inherently bisexual. This idea was strengthened, if not arrived at, by his colleague Wilhelm Fliess, the ear, nose, and throat doctor from earlier. He became Freud’s closest friend throughout Freud’s most productive period, and Freud would bounce ideas off Fliess and vice versa. Like Freud, Fliess was highly ambitious and able to dream up some pretty wild theories. Both men also believed that sexual problems, and masturbation in particular, played a key role in the causation of neurotic illnesses. Even though Fliess was an ear, nose, and throat specialist, he began to treat hysterical, depressed, and anxious patients by applying his own weird fusion of psychoanalysis and nose doctoring. Fliess believed that changes inside the nose were directly related to the genitals and that this was especially observable in menstruating women, in whom he would sometimes cauterize the nasal passages to stop excessive menstruation. Since nasal passage changes were observable in both sexes, then, according to Fliess, that was only “consistent with our bisexual constitution.” Freud and Fliess eventually had a falling-out when Fliess began to insist that Freud had stolen his ideas about innate bisexuality, which he had confided to Freud but had not yet published. Some time after their relationship had ended, Freud explained in letters to a friend that Fliess’s influence over him had been a manifestation of Freud’s own latent homosexual longing, which he had finally managed to overcome, unlike paranoid people. Interestingly, Freud later encountered a similar problem in his relationship with Carl Jung.
It seems like Freud never met a treatment he didn’t like. He practiced electrotherapy for at least two years though he claimed to have “soon” realized it was placebo and to have promptly stopped using it. He sent patients to spas for immobility and fattening regimens. He prescribed hydrotherapy. He steered patients to a gynecologist who treated hysterical women with surgical procedures like hysterectomy and removal of the clitoris. He put patients in needless jeopardy, acting on impulsive, sometimes fatal misjudgments. Freud’s pattern of patient treatment shows that he interpreted transient symptomatic improvements as cures and failed to do any follow-up. If you looked a little better, you were on your own.
In the first years of his practice, he was preoccupied with the rank and status of his patients. He came to specialize in a “disease of the rich,” hysteria, which could never be cured and which generated a continuing stream of income. When some of his “hysteric” patients were subsequently shown to have organic diseases, he still maintained that hysteria was part of the clinical picture. He never admitted being wrong, in one case saying that while his diagnosis had not been correct, it hadn’t been incorrect either. A prime example of this behavior is the case of “Anna O,” one of the foundational cases of psychoanalysis, the prototype of a cathartic cure. Freud and colleague Joseph Breuer claimed that Anna had recovered after treatment, when in facts she had gotten worse, to the point of needing to be hospitalized. After leaving psychoanalytic treatment, Anna improved on her own and eventually led a successful life as an activist opposing the sex trade. Freud claimed that her activism was a manifestation of her unconsciously wanting to prevent her mother from having sex with her father. It’s entirely possible that Anna O didn’t even have a psychiatric illness, but rather a physical, neurologic one, and many of her most troubling symptoms were caused by the morphine addiction that came along with the treatment.
Looking back to ancient Greece to a name again, Catharsis is when people feel better after venting their feelings, a response Aristotle observed in the audiences of tragedies. The cathartic method involved using hypnosis to recall the traumatic events at the root of the patient’s neuroses. Freud used and developed the cathartic method along with hypnosis before arriving at his more effective theory of the psychoanalytic technique. Freud recognized a number of problems with the cathartic method, which eventually led to him abandoning it. For starts, it had no lasting results, but at the same time he never disputed its immediate effectiveness. Some analysts still use a cathartic method today, with things like encourage angry patients to punch pillows, though many therapists argue against it, claiming that it only makes people more angry.
Only around one in every 20,000 Americans still use psychotherapy, but many who do value it highly. Likewise, those who still practice psychotherapy don’t really take Freud literally. “Psychotherapists who rely on theories derived from Freud do not typically spend their time lying in wait for phallic symbols,” psychologist Drew Westen said. “They pay attention to sexuality, because it is an important part of human life and intimate relationships and one that is often filled with conflict.” For the Freud-faithful, it probably helps that the famed psychoanalyst actually coined the terms used to describe those who stand in denial. “Freud discovered and taught about the unconscious mind and psychological defenses, including denial and repression,” says psychiatrist Carole Lieberman. “So, in fact, in trying to deny Freud’s insights, people are actually affirming them.”
The primary trouble with Freud is that, while his ideas appear intriguing and even common-sensical, there’s little empirical evidence to back them up. Modern psychology has produced very little to substantiate many of his claims. There’s no scientific evidence to support the idea that boys lust after their mothers and hate their fathers. His notion of “penis envy” is now both laughable and tragic. There’s no proof of the id, ego, or superego, and no evidence to support the notion that human development proceeds through oral, anal, phallic, and genital psychosexual stages. Nor that the interference with these stages leads directly to specific developmental outcomes. And we can’t forget his stance that only “mature” women could orgasm from vaginal sex, and that women who could only climax via clitoral stimulation were somehow developmentally stunted. There’s also no evidence that Freudian psychotherapy is any better than others, including Skinnerian behavior modification therapy, systematic desensitization, or even assertiveness training.
And now, on balance, our final guest presenter for the day, Kate from the Ignorance Was Bliss podcast. Kate definitely has the bona fides for this project. She has several degrees in mental health counseling, Clinical Psychology, and criminal justice; has worked in forensic psychology and crisis evaluations; and she has taught at several universities in New England. Her show, Ignorance Was Bliss, is a podcast about crime and psychology; who gets locked up and who gets a key? The answers may be uncomfortable.
And that’s where we run out of ideas, at least for today. Thanks for being with me this past year. While it’s not small amount of work, it’s been my pleasure to produce this podcast every week. Each time I see someone retweet an episode or comment on a social media factoid, it makes my day. I hope you’ll be with me for the next 50 episodes and beyond as well as my next big project, a podcast *and YouTube channel with my niece, called Science With Savannah, Age 7. Look for that this spring. Thank you for listening and thanks for spending part of your day with me.