In medical school we glossed over Freud because psychoanalysis had largely become outdated.  Popular culture has turned his method into a mockery; we chuckle to think of the bearded psychiatrist listening intently to some dude reclining on a sofa talking at length about the hidden sexual meaning underlying his bedwetting dreams.  In the new era of cognitive behavioral therapy and evidence based medicine, the realm of the subconscious seems better studied by functional MRI scans, neurobiological theories, and data-driven analysis & interventions.  To see medical professionals chasing fanciful interpretations of dreams or inkblots would now seem quaint at best and like quackery at worst.  Do we really esteem Freud’s preoccupation with the psychosexual stages of children with anything but puzzlement?  Unsurprisingly, I was taught to have a low opinion of Freud and consequently rarely thought about him or his theories through the rest of my clinical training.

And yet I’ve recently come to a new appreciation for Freud from an unexpected source.  My wife and I recently enrolled in an online seminary class on trauma counseling.  It has been a humbling, revelatory, and transformative experience thanks to the diversity of classmates, expertise of our professors, and global contextualization.  Our reading began with the history of studies on trauma, and I was surprised to find Freud featured prominently.  In Judith Hermann’s seminal work Trauma and Recovery, she writes:

For two decades in the late nineteenth century, the disorder called hysteria became a major focus of serious inquiry. The term hysteria was so commonly understood at the time that no one had actually taken the trouble to define it systematically. In the words of one historian, “for twenty-five centuries, hysteria had been considered a strange disease with incoherent and incomprehensible symptoms. Most physicians believed it to be a disease proper to women and originating in the uterus.”  Hence the name, hysteria. As another historian explained, hysteria was “a dramatic medical metaphor for everything that men found mysterious or unmanageable in the opposite sex.”…

In spite of an ancient clinical tradition that recognized the association of hysterical symptoms with female sexuality, Freud’s mentors, Charcot and Breuer, had been highly skeptical about the role of sexuality in the origins of hysteria. Freud himself was initially resistant to the idea: “When I began to analyse the second patient . . . the expectation of a sexual neurosis being the basis of hysteria was fairly remote from my mind. I had come fresh from the school of Charcot, and I regarded the linking of hysteria with the topic of sexuality as a sort of insult— just as the women patients themselves do.”

This empathic identification with his patients’ reactions is characteristic of Freud’s early writings on hysteria. His case histories reveal a man possessed of such passionate curiosity that he was willing to overcome his own defensiveness, and willing to listen. What he heard was appalling. Repeatedly his patients told him of sexual assault, abuse, and incest. Following back the thread of memory, Freud and his patients uncovered major traumatic events of childhood concealed beneath the more recent, often relatively trivial experiences that had actually triggered the onset of hysterical symptoms. By 1896 Freud believed he had found the source. In a report on eighteen case studies, entitled The Aetiology of Hysteria, he made a dramatic claim: “I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood, but which can be reproduced through the work of psycho-analysis in spite of the intervening decades. I believe that this is an important finding, the discovery of a caput Nili in neuropathology.”

A century later, this paper still rivals contemporary clinical descriptions of the effects of childhood sexual abuse. It is a brilliant, compassionate, eloquently argued, closely reasoned document. Its triumphant title and exultant tone suggest that Freud viewed his contribution as the crowning achievement in the field.*

To summarize, Freud was one of the first modern physicians to recognize that “hysteria” was really a response to rape (specifically, childhood rape); it represented the manifestation we now understand as PTSD/complex trauma.

Why don’t we recognize and credit Freud for his meticulously researched insight?  Hermann continues:

Instead, the publication of The Aetiology of Hysteria marked the end of this line of inquiry. Within a year, Freud had privately repudiated the traumatic theory of the origins of hysteria. His correspondence makes clear that he was increasingly troubled by the radical social implications of his hypothesis. Hysteria was so common among women that if his patients’ stories were true, and if his theory were correct, he would be forced to conclude that what he called “perverted acts against children” were endemic, not only among the proletariat of Paris, where he had first studied hysteria, but also among the respectable bourgeois families of Vienna, where he had established his practice. This idea was simply unacceptable. It was beyond credibility. Faced with this dilemma, Freud stopped listening to his female patients…

Out of the ruins of the traumatic theory of hysteria, Freud created psychoanalysis. The dominant psychological theory of the next century was founded in the denial of women’s reality. Sexuality remained the central focus of inquiry. But the exploitative social context in which sexual relations actually occur became utterly invisible. Psychoanalysis became a study of the internal vicissitudes of fantasy and desire, dissociated from the reality of experience. By the first decade of the twentieth century, without ever offering any clinical documentation of false complaints, Freud had concluded that his hysterical patients’ accounts of childhood sexual abuse were untrue: “I was at last obliged to recognize that these scenes of seduction had never taken place, and that they were only fantasies which my patients had made up.” Freud’s recantation signified the end of the heroic age of hysteria. After the turn of the century the entire line of inquiry initiated by Charcot and continued by his followers fell into neglect. Hypnosis and altered states of consciousness were once more relegated to the realm of the occult. The study of psychological trauma came to a halt. After a time, the disease of hysteria itself was said to have virtually disappeared.**

Hermann goes on to describe the sociopolitical circumstances at the time that may have influenced this outcome, turning the bulk of academia against his position.  In essence, the reason Freud’s psychoanalysis appears like folly today is precisely because it was contrived.  Neither he nor society could bring themselves to believe that the perversion that is rape (particularly of children) is as grotesque or as common as it really is, and so they manufactured other reasons to explain it away.

Are we really any different today?  Do we have the courage to call evil for what it really is?  Or will we too come up with clever ways to assure ourselves that we are not as perverse as the prophets say?

*Herman, Judith L. (2015-07-07). Trauma and Recovery: The Aftermath of Violence–From Domestic Abuse to Political Terror (p. 10-13). Basic Books. Kindle Edition.

** Ibid p.13-15.