By the time I started my psychiatric training, Sigmund Freud and psychoanalysis had already begun to fall out of favor with both the public and the psychiatric profession. Nonetheless, therapy guided by psychoanalytic technique and theory was, and still is, an effective treatment for many kinds of problems. Unlike most psychiatrists of my generation, I devoted a large part of my practice to psychotherapy, including, but not limited to psychoanalytic therapy. I also provided adjunctive drugs when they were required.
The “talking cure” lost its popularity for a variety of reasons, among them the advent of Prozac, the first relatively non-toxic psychotropic drug. It became increasingly fashionable, and profitable, to view most psychopathology as being biologically, not psychologically, based. Why waste time sitting for years hashing over the past and confronting demons if, by swallowing a magical substance, you would be spared that unpleasant struggle and freed to get on with life, not much changed, perhaps, but feeling better?
To a certain degree, that made sense. But this attitude goes beyond therapy. It pervades our culture. People more readily embrace their negative traits and behaviors. They no longer value insight and introspection. Disinclined to look beyond what is superficial in themselves and in the world, they are increasingly self-centered and dismissive or hostile toward others who have different priorities and points of view. Often, aided by the mixed blessings of instant communications, they act impulsively and without a lot of consideration for the effects their actions have on themselves and others.
The adverse consequences are painfully evident.
Unlike ours, the lives of Freud’s patients were severely restricted by social norms that forbade frank self-expression and overtly self-serving behavior. Socially forbidden feelings and desires were automatically pushed into the unconscious rendering them inaccessible to conscious recognition and rational thought. Thus the the person was spared awareness of unbearable guilt and shame.
This came at a price. Unconscious guilt and shame were converted into anxiety, depression, panic attacks, OCD, paralysis, blindness, inability to speak or to hear and all sorts of other neurotic symptoms and behaviors. Psychoanalysts helped people to gain awareness of those repressed forbidden thoughts and feelings and to bring to consciousness the unconscious guilt attached to them. Once the circumstances that brought them about were understood, the feelings and wishes, though still unacceptable, were completely understandable. This permitted patients to repent within themselves and to put their guilty feelings into perspective. The guilt became a positive motivation to actively choose to behave in a mature, considerate and responsible manner consistent with socially condoned behavior.
In Freudian jargon, the id, the inner animalistic aspect of our psyches, along with its attendant energy, would first be acknowledged consciously. Then the ego (the voice of reason in our heads that forms the mature aspects of our identity) could redirect that energy away from symptoms and into constructive actions. Freud summed it up by saying, “Where id is, let ego be.”
Fast forward to the second half of the 20th century, the age of “if it feels good do it” and “let it all hang out.” Some blame psychoanalysis for our “me generation,” because, having had their id impulses accepted non-judgmentally by therapists, instead of controlling them, many felt justified not only to accept them but to act on them as well.
One of the senior residents in my psychiatric training program had inscribed the cover of his notebook with his “crest of arms” whose motto cleverly riffed off of Siggy. It read, “Where Ego is, let Id be.” Though it seemed funny at the time, the widespread adoption of that attitude in today’s world is no joke.
Space does not permit a detailed treatise on the many reasons this has occurred. Sigmund may have contributed to it, but it’s not all his fault. Ironically, his nephew, Edward Bernays, did more to facilitate it. He was the father of modern advertising, pubic opinion shaping and media propaganda. He created the science of manipulating perceived reality with contrived imaging to shape public attitudes and opinions. For example, Bernays planted lovely young women in the New York City Easter parade and induced the newspapers to publish photos showing them smoking in public. Smoking among women then took off. Such ploys encouraged people to indulge their ids in the service of id-driven business and political interests. I need not go into detail about how his techniques evolved into media gone crazy during the age of TV and the internet.
The resultant narcissistic culture culminated in the rise to the presidency of a man who is pure id. That such a person was able to gain the support of so many is partly due to the fact that he embodies, models and encourages ugly traits and attitudes that many have been conditioned to view as acceptable, even admirable. He normalized these traits for a whole generation of politicians and their base.
Trump is almost pure id. He is deficient in ego ( ego in the psychoanalytic sense, even though, in lay language, we describe him as “egotistical”) and in superego as well. Superego is the primordial conscience that develops into a mature conscience beginning around age five or so. The reason Donald Trump has the mentality of a three year old is largely due to the fact that he never developed a conscience. His personality fixated at the “pre-oedipal” (younger than 5 years old) level. This formed the basis of both his narcissistic personality disorder and anti-social personality disorder, i.e. criminality.
Trump’s cult of followers, in the electorate and in government, are now dismantling our democratic system with a pattern of bald faced lying, cheating and obstruction of any legislation aimed at critical needs of the people and the world. At the root of this are greed, prejudice, ignorance and the desire for dominance, the fuel on which the id feeds. Like their hero, their actions are unmitigated by conscience. They are allowing their ids to rule their priorities and, in turn, to wreak havoc. The tragedy is that this, thanks to relentless media brainwashing that we all are “special” and deserve to “have it your way,” has come to be regarded as normal and acceptable by a huge portion of the citizenry.
Our Victorian predecessors indeed suffered from their excessive guilt and shame, but maybe that wasn’t really so terrible. Today, it seems to me, we are sorely in need of a bit more of both.