Freud Was a Fraud: A Triumph of Pseudoscience

Before Freud moved on to Psychoanalasis his critique of the then neuropsychological theoretical model making in his book 'On Aphasia' displayed an intellectual rigour and raised points that twenty first century neurologists and neuropsychologists have still failed to fully address.

Ironically, having demonstrated the problems with modelling observable behaviour in relation to brain function, he seemed to abandon any attempt at objectivity or good scientific practice in developing his theories of Psychoanalasis, which probably tell us more about Freud's own personality and the culture of nineteenth century Vienna than about the human mind.

As other commenters here point out it is interesting to draw parallels between Freud's bad science and bad practice and that of the PACE appologists advocating psychological/behavioural intervention for ME. Similarly you have researchers that have in other contexts demonstrated good understanding of scientific method, then abandon it completely in relation to ME/CFS. Also I suspect their obsession with marketing discrete stand alone intervention packages, purportedly cost effective interventions reflects recent/current British health culture. It is essentially neoliberal free market driven, or Blairite in nature, you ignore any worries about a theoretical underpinning, but claim a pragmatic approach, which ultimately boils down to 'I am right, you are wrong' assertions in a health marketplace more interested in spin than substance.

Though in a World where resources are finite there needs to be some analysis of how cost effective particular interventions are, when an intervention does not actually work it can never be cost effective no matter how much spin you attempt to apply. Indeed this approach gives direct rise to the fake news World of such as Donald Trump, beautifully illustrated by Prof Crawley's own fake news strategy.

 

I agree, @Peter Trewhitt. I thought Freud's early neurology work was good. And I did think this article was a little unfair in parts. It seemed to be applying 21st century standards to a much earlier era. Although the general thrust of the article seemed pretty on-target to me.

 

Seeing as Freud and his followers are still wreaking havoc in the 21st century, those are the standards against which his work should now be measured. If the author had just been talking about a movement in the past in Vienna, which had stayed in the past and stayed in Vienna, and if everyone was getting high on cocaine, ignoring scientific principles and establishing a cult following at that time then of course we shouldn't judge Freud for being a product of his age (although Delboeuf, who was of that time and place, still felt able to critically judge Charcot by the standards of the day).

You could make the same argument about not judging 1950s childrens' homes by 21st century standards.

I've got a psychotherapist student coming to my house this Friday who has some very disturbing views on gender identity and is actually allowed near teenagers, and is permitted to diagnose them and suggest a course of treatment in accordance with Freud's approach, and is actually still taken seriously in this day and age.

I know cultural relativism is supposed to be axiomatic in anthropological research, but I've never been able to quite buy it in other contexts when the damage reaches into the current culture and time. Even by the standards of his day, Freud was a charletan and a fraud, he just managed to fool a lot of people. Would you be happy if, in 100 years, criticism of a certain pillar of the establishment and knight of the realm was tempered as "a little unfair for applying 22nd century standards to a much earlier era"?

I don't really see much difference between a clever chap in the 19th century choosing to use his talents to make a quick buck and establish a movement by proclaiming to be an expert on "hysteria", and a clever chap in the 21st century deciding to use his talents to make a quick buck and establish a movement by proclaiming to be an expert on "chronic fatigue syndrome", especially when the modus operandi is exactly the same. You'd be forgiven for thinking it was a copycat. Filth in any day and age, as judged in its own time or from any other day and age. Filth I tell you. Filth.

 

Science is about rejecting assumptions, and replacing them with rigorous testing. So unless there's solid evidence involving objective outcomes showing people are helped by CBT, we probably can't assume there's any value to it.

Yes, I think we've stumbled on the explanation of the poor quality and bizarre work of the biopsychosocial researchers in ME/CFS and other areas where they dabble: they're all on crack

In the alternative, they may simple have fallen into a habit of maladaptive behavior which has benefited them in the past, but their warped cognitive processes are preventing them from analysis of their own behavior or changing to adapt to a different atmosphere.

 

Holy crap, @Tired Sam, you so nailed it

 

I just typed "cognitive behavioral therapy" into PubMed and got over 79,000 papers. A quick perusal of a few of them showed that all the ones I looked at were positive, and based on my past knowledge of the literature, I think it's safe to assume that the vast majority of these papers are positive with respect to CBT. Are you saying that among these 79,000 papers that there's no "solid evidence involving objective outcomes showing people are helped by CBT" at all? If so, on what are you basing your assertion? How many of these 79,000 papers have you studied in detail in order to know that there is no solid evidence anywhere?

I fully sympathize and agree with the view that CBT should not be used to treat a physical illness such as ME/CFS, especially when what is called "CBT" here is a bastardized form of the treatment that bears little relation to the classical CBT that is used to treat real psychological problems. But there is a vast body of evidence that CBT - true CBT - is successful in treating psychological problems, and much of that evidence can be found in those 79,000 papers.

I agree. But it seems to me that you've made an assumption about CBT here without looking at the rigorous testing that already exists.

 

Yes, I agree. From what I read, that is why ACT gained popularity because its based more on taking action, rather than pure CBT that tends to make one more self critical. But the research is weak, IMO, on both psychotherapy techniques and psych meds. I place psychotherapy more in the “buyer beware” category and would rather seek out a person whom I felt comfortable with, who is flexible, and is open to helping me in the way I see best.

 

I think there is a lot to be gained by just talking to someone, especially if one is feeling depressed and anxious. I don’t see a need to run a full blown study on that. I was using the term CBT loosely, but since my posting I have read more about it, and realized another term would have better. Regarding specific techniques, that’s very hard to prove across the board, and don’t expect to see any studies that are conclusive. I assume AI will take over and replace many people in both the medical and psych fields. I am more concerned about that, frankly.

 

If you were to google "psychodynamic", you'd get a huge number of papers too, so the paper count is more about the popularity of the movement than the strength of evidence.

Here's what you'd need to do with your 79,000 papers to see if there's any solid evidence there.

1. Get rid of any studies with less than 20 participants per arm (these are likely to be fluke findings).

2. Now throw out any study that did not include:

a) an active control condition, offered over the same number of sessions, and presented by people as well trained in their technique as the CBT therapists are in theirs; and

b) one or more objective measures that are unlikely to be influenced by participants' expectations. Studies with no objective measures are likely to be hugely biased, as we have seen with PACE.​

Have you got any left? If you have, how many show a reliable benefit for CBT over control on the objective measure(s)? I know what the answer is for most complaints, because researchers have actually done what I've suggested.

If you're lucky enough to find one or two positive studies, now try to estimate how many studies meeting the above criteria might not have been published because they yielded negative findings.

The point wasn't to diss CBT (although I think it does have some problems). The point was to show that we assume CBT is absolutely effective as demonstrated by "solid evidence". But that's not really the case. We think we're so much better than those in the 19th century. But what will the next generation think of the "solid studies" we did to test the therapy fashion of the day - CBT?

 

Powerful, manipulative, warped psychiatrist ... nope, you've got me there Trish .

 

In quite a real way, that is exactly what is being done to PwME.

 

Yes, I think ACT addresses some of the main problems with CBT.

 

Sadly so very true.

 

Just to be a little bit of a devil's advocate, I think it was @Jonathan Edwards who said that there are some trials where objective outcomes are not available, such as when assessing pain, which is itself subjective; but rigorous measures are then needed to deal with potential bias. Cannot recall what those measures are though - careful design of controls may have been one. But I don't think it is fair or feasible to dismiss any trial that does not have objective outcome measures; it's how such trials are designed I think.

 

Please do be a devil's advocate! Its much more fun when we're arguing from different points of view.

You're right. And self-rated pain scores would be fine in a fully blinded study, like a drug study, because then they can't be biased by participants' expectations. The problem is when you have an intervention that can't be blinded. Then you cannot rely solely on self-rated measures. You can still collect them, but you need some objective measures too as a control - to ensure that the effects you're finding are more than just expectation effects.

 

What you describe is actually not practicing CBT to the letter. You are describing something known as "rumination-focused cognitive behavioral therapy" (RFCBT), which is a therapy that is separate and distinct from classical CBT, although it certainly contains elements from CBT. Yes, this therapy does posit that you can ruminate yourself into depression, and I know enough about depression to know that that doesn't make sense, especially when applied to major depressive disorder. I don't know if a therapist would actually tell someone that they need to stop the negative thoughts in order to recover. I would certainly hope they would be more skillful than that; otherwise, as you noted, such a statement could be harmful.

But in any case, that's not standard CBT; it's a variation that I agree has real problems.

I know a fair amount about CBT, and I know of nothing in it that should make someone more self critical. It's certainly not the goal of the therapist to do that; if someone ends up more self critical after CBT, then it would seem to be a problem with the way the therapist is conducting the treatment. Skills of therapists vary drastically, and unfortunately, this is something that no amount of large-scale testing can take into account.

I would like to quote a short section from a patient's story from In-Depth: Cognitive Behavioral Therapy on PsychCentral that I think addresses at least some of the concerns of @Woolie and @MErmaid:

This sounds to me like a very upbeat approach to therapy, and is consistent with what I know of CBT.

I agree; a bad psychotherapist practicing CBT can be quite harmful, as can a bad psychotherapist practicing essentially anything. And good psychotherapists can be hard to find. In many ways, psychotherapy is more an art than a science, and finding the right person who knows how to work with people in a constructive way would seem to be more important than what particular school they're following.

@Woolie, I think you've raised some very cogent points in your recent posts. But rather than take this thread really off topic, I'll address them in a new thread, although that may take me a little while.

 

I don't know much about RFCBT. But the models of depression on which mainstream CBT for depression is based - like the Beck model in all its incarnations - continue to attribute a central role to negative thoughts and rumination in particular.

People sometimes assume that CBT is assumption-free, but its not. It makes various assumptions about the relationships between thoughts and feelings. Some of the ideas that were influential at its inception are no longer widely accepted. These include the idea that depressed people have distorted beliefs (a bunch of studies in the 80s found that depressed peoples' assessments of themselves and their prospects are actually more realistic than those of non-depressed people, who tend to be overly positive). So the term "distorted beliefs" has been replaced with "maladaptive beliefs" or "unhelpful beliefs". But the basic idea of gently nudging thoughts and beliefs is still core to CBT for depression. Its right there in the "C" part of the name.

I agree that a good CBT therapist would not explicitly tell the patient to stop thinking negative thoughts. They would be much more subtle. But people are not stupid, and most can discern the underlying thrust of a therapist's narrative, however subtly phrased.

You also have to distinguish between the core approach that is CBT, and what people who call themselves CBT practitioners actually do in practice. Most CBT practitioners use discretion about how strictly they stick to the main tenets, and how much they let their own clinical instincts guide them. But if we're going to have a discussion about the value of CBT as a distinct approach to therapy, then we have to focus on the core features that define CBT and distinguish it from other therapies. The idea of changing thought patterns to alter emotional responses is one of those core features.

Yes, I think we agree here. If I got depressed I would also be happy to sit down and talk with a good therapist. But I'd rather leave actual CBT at the door.

Good discussion, let's continue on a new thread!

 

I once read a text (sorry I can't remember where, no source...) by someone who had had recurring depressive episode all his life. He said psychoanalysis had been of no use, quite the contrary in fact, because the therapy kept bringing him back to sad memories that made him more depressed.

He was very more positive about CBT, because, like the person @zzz talked about, it gave him tools to deal here and now with his depression. The most helpful tool was that he had learned to distance himself from his depression, when he was in a difficult episode, with terrible thoughts, he now attributed these thoughts not to himself, but to his depression. He said it didn't cure nor made the depression go away, but it made it more easy to go through.
So is it classic CBT? No, in the sense that "distorted thoughts" were not seen as causing the symptoms. But it is CBT in the sense that changing his ideas about how he saw his depression had a positive effect.

Evaluating psychotherapy is a wild goose search in a sense, because it relies on a stereotyped setting up which has to be followed to the letter by the therapist, while a good therapist in real life is someone who is able to constantly interact with their patients, adapt and forget about theory.