Freud advocated that the clinical encounter is not supposed to be ‘face-to-face’. Was this an early attempt at 'Social Distancing'? Sigmund Freud did, after all, live through the Spanish Flu pandemic of 1918 - 1920.
In fact, meeting in a consulting room, but then deploying a furniture arrangement which on purpose ‘hides’ the psychoanalyst from the patient, according to Freud, generates powerful psychological processes.
This seating setup supposedly encouraged patients to recount whatever came to mind without censoring themselves. Otherwise, if they could see the therapist frown as they began to disclose, this might inhibit revelation.
Have you noticed how a much more intimate conversation sometimes evolves when you are sitting next to someone, in a car for example, so not looking directly at them?
During the current pandemic, 'social distancing' rules means that therapists can’t physically meet with patients. What are the implications for the more ‘hardcore’ or ‘old-fashioned’ psychoanalysis, as established by Sigmund Freud, where the patient doesn’t see you directly, but is in the same room with you? How can that be replicated with remote working?
The International Psychoanalytic Association has published on its website some guidance, including: 'Some patients that lie down on a couch might prefer not to see the analyst during the remote session. They can do this by turning off the video option or by placing the device/video screen in a position in which they cannot see it. The risk of doing this is that if the connection suddenly fails, the patient may not be aware of this situation and will continue talking'.
In the UK’s The Guardian Newspaper of April 23rd, psychotherapist Gary Greenberg published an article entitled, ‘Therapy Under Lockdown – I’m just as terrified as my patients are’.
He describes how using a laptop to conduct the sessions ‘face-to-face’ introduces new challenges for the therapist. These include being able to see inside, into the patient’s home for the first time. Will whatever is glimpsed over the patient’s shoulder, now distract the psychoanalyst?
But amongst many difficulties that Gary Greenberg confesses, the central one is that Sigmund Freud, the father of psychoanalysis, and possibly therefore the originator of modern psychotherapy, as we understand it, didn’t appear to offer that much help in this current pandemic predicament.
Gary Greenberg states: 'Freud placed his bet on the human, as the source of both suffering and balm. He didn’t reckon with a nemesis so indifferent as a virus, any more than he worried about a meteor crashing into the Earth or the sun suddenly being snuffed out… we are stuck with the imperative to restrain ourselves to a degree that Freud did not anticipate… At a time when we need each other badly, when we are under attack not by human nature but by nature itself, the best we can do to take care of one another is to stay away from one another. Even Freud at his most misanthropic never imagined that… Perhaps this is not the time to ask “What would Sigmund do?”. He’s not much of a role model in normal times, let alone times like these…'
Is it really true that Freud; ‘didn’t reckon with a nemesis so indifferent as a virus'?
The last great viral pandemic that the western world faced before the current one was the so-called Spanish Flu Pandemic which started in 1918.
Freud’s daughter, Sophie Halberstadt-Freud, died from the Spanish Flu in 1920. She was 27 years old.
Peculiarly, mortality during the 1918 pandemic peaked at the exact age of 28, in other words young people in their late twenties were oddly vulnerable to that virus.
One theory, described in a paper entitled, Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality , with lead author Alain Gagnon, a demographer at the University of Montreal, is that this generation had been exposed to the so-called Russian Flu, which was a pandemic of the early 1890's, just after being born.
Alain Gagnon, in a series of studies, has argued that it might be that exposure to a previous viral infection at a particular early age, may somehow prime the body which then reacts especially badly to another infection later in life. This theory is now being investigated to see if it explains why it is now older adults, not those in their early twenties, who appear particularly vulnerable to Covid-19.
Given what we know now about the vulnerabiltiy of an older age group to this coronavirus, Alain Gagnon wrote somewhat prophetically back in 2013; 'Knowledge of the age-pattern of susceptibility to mortality from influenza could improve crisis management during future influenza pandemics'.
While the jury is still out on that particular theory, we continue to be bombarded with a plethora of scientific answers to the modern plague, so it is tempting to also turn to science for the solution to our suffering.
Freud wrote in a letter to Oskar Pfister, January 27, 1920, just two days after the death of his beloved daughter: ‘This afternoon we received the news that our sweet Sophie in Hamburg had been snatched away by influenzal pneumonia, snatched away in the midst of glowing health, from a full and active life as a competent mother and loving wife, all in four or five days, as though she had never existed. Although we had been worried about her for a couple of days, we had nevertheless been hopeful; it is so difficult to judge from a distance. And this distance must remain distance; we were not able to travel at once, as we had intended, after the first alarming news; there was no train, not even for an emergency. The undisguised brutality of our time is weighing heavily upon us. Tomorrow she is to be cremated, our poor Sunday child! . . . Sophie leaves two sons, one of six, the other thirteen months, and an inconsolable husband who will have to pay dearly for the happiness of these seven years. The happiness existed exclusively within them; outwardly there was war, conscription, wounds, the depletion of their resources, but they had remained courageous and gay’.
It is also in a previous letter to Pfister, a priest and a psychotherapist, dated 10 September 1918, that Freud makes a revelation about his view of human nature, which is one of his most infamous quotes (in bold here): "I do not break my head very much about good and evil, but I have found little that is 'good' about human beings on the whole. In my experience most of them are trash..."
Did his own suffering, and that he experienced in his patients, in the end, embitter Freud?
The psychiatrist Anthony Storr in his book, ‘Freud: A Very Short Introduction’, explains ‘…in his clinical work Freud was kind and tolerant… however his kindness was not based on any great expectations of the human race, whom he regarded with distaste or with detachment rather than with love…’
Anthony Storr concludes; ‘…Where human frailty was concerned, Freud exhibited a quite unusual tolerance. This, because it has led to a more civilized attitude towards neurosis, sexual deviation, and other forms of emotional maladaptation, is one of Freud’s most valuable legacies…’
Freud never believed that advances in science, or in particular, neuroscience, would ultimately provide an answer to the problem of human suffering. Instead the solution would arise out of the way we treated each other, and our understanding of ourselves and our emotions. There was a sense in which he believed this was forever beyond the reach of laboratory experiments.
Maybe one reason that some are finding psychotherapy, on both sides of the couch, not so helpful at this time, is that modern treatment has for too long over-emphasised technique, theory and academic teaching, at the expense of the human.
The real legacy of Freud that might be most valuable right now, comes through his humanity when directly confronting the reality of human suffering.
On April 11, 1929, Sigmund Freud wrote to his friend the psychiatrist Ludwig Binswanger, who was grieving for the death of his eldest son, Robert, just 20 years old: ‘My daughter who died would have been thirty-six today… We know that the acute sorrow we feel after such a loss will run its course, but also that we will remain inconsolable, and will never find a substitute. No matter what may come to take its place, even should it fill that place completely, it remains something else. And that is how it should be. It is the only way of perpetuating a love that we do not want to abandon.’
Dr. Peter Bruggen passed away in 2018. While this article was written by Dr. Raj Persaud, Dr. Bruggen's name is retained biographically as a tribute to his contributions overall.
Recommendations for Psychoanalysts Regarding the Use of Videoconferencing in their Practice. International Psychoanalytical Association. https://www.ipa.world/IPA/en/News/corona_remote_sessions.aspx
Therapy Under Lockdown – I’m just as terrified as my patients are. Gary Greenberg. The Guardian Newspaper April 23rd https://www.theguardian.com/society/2020/apr/23/therapy-during-coronavirus-pandemic-lockdown-psychoanalysis-freud
Letter from Sigmund Freud to Oskar Pfister, January 27, 1920. Psychoanalytic Electronic Publishing https://www.pep-web.org/document.php?id=zbk.051.0327a
Psychoanalysis and Faith: The Letters of Sigmund Freud and Oskar Pfister, eds. Heinrich Meng and Ernst L. Freud, trans. by Eric Mosbacher. New York: Basic Books, 1963 (or elsewhere I saw 1964).
Letter from Freud to Ludwig Binswanger, April 11, 1929. Psychoanalytic Electronic Publishing. http://www.pep-web.org/document.php?id=zbk.050.0196a
Psychoanalysis and Faith: Sigmund Freud and Oskar Pfister (Book Review) Storr, Anthony. New Society; London Vol. 2, Iss. 62, (Dec 5, 1963): 25. https://search-proquest-com.libproxy.ucl.ac.uk/docview/1307076492/50C69B4CA8834D59PQ/2?accountid=14511
Freud: A Very Short Introduction (Very Short Introductions) Paperback – 22 Feb. 2001. Anthony Storr. Oxford University Press
Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality. Alain Gagnon, Matthew S. Miller, Stacey A. Hallman, Robert Bourbeau, D. Ann Herring, David JD. Earn, Joaquín Madrenas. PLOS One https://doi.org/10.1371/journal.pone.0069586
Pandemic Paradox: Early Life H2N2 Pandemic Influenza Infection Enhanced Susceptibility to Death during the 2009 H1N1 Pandemic. Alain Gagnon, Enrique Acosta, Stacey Hallman, Robert Bourbeau, Lisa Y. Dillon, Nadine Ouellette, David J. D. Earn, D. Ann Herring, Kris Inwood, Joaquin Madrenas, Matthew S. Miller. American Society for Microbiology https://doi.org/ 10.1128/mBio.02091-17