Madness on the Couch: Blaming the Victim in the Heyday of Psychoanalysis

You have to wonder if there's anyone left out there who dares call themselves a Freudian. Little is being written in defense of Freud and his legacy while the critiques, ever more confident and ever more damning, continue to fall from the presses like heavy Vienna snow. Madness on the Couch is one of the best.

Dolnick begins with a useful retread of the case against Freud himself, but his main argument is against a cherished principle of the master's followers. Freud always stuck to the idea that he was treating the psychological problems of the sane, but in the 1950s and 1960s, a much more grandiose idea emerged in psychiatric circles, the notion that "the talking cure" could sponge away madness itself.

One of the problems with this ambitious proposal was its vagueness. "Madness" could mean anything, including such different conditions as schizophrenia, autism, and obsessive-compulsive disorder. As Dolnick shows, analysts of various kinds had just two things in common: a systematic inability to do any good for patients with any of these conditions and a vast blindness, if not outright dishonesty, about that failure.

Like other critics of Freud's legacy, Dolnick is convinced that Freud-inspired analysis is guilty of doing its patients, and their families, great harm--by "explaining," for example, autism in terms of parental neglect. The section in Madness on the Couch on autism is especially good, concluding its discussion of all the things autism isn't (pace the wild and largely evidence-free surmises of therapists) with a balanced discussion of just how big a puzzle it still is.

Dolnick sometimes has an irritatingly sarcastic and melodramatic tone; a shame--the material he has assembled speaks strongly for itself. --Richard Farr