For people with mental illness and their families, Freudian psychology has been a catastrophic deterrent to society's understanding of serious brain disorders, and it has postponed our human rights for a century. This should never have happened.
Back in 1900, a new scientific era of biological discovery about brain disorders seemed imminent. German neurologist Alois Alzheimer (1864-1915) had located the "senile plaques" and "neuro-fibrillary tangles" related to the disease that was eventually to bear his name. The founder of modern scientific psychiatry, Emil Kraepelin (1856-1926), had assembled a world-class group of neurologists in Munich to study the brain. There was widespread medical consensus that the diseases we now call schizophrenia, manic depression and major depression were organically based, and that the new field of neuropsychiatry would offer greater understanding and more effective treatments.
But that bright promise was hijacked -- shanghaied by the American psychiatric profession itself, which repudiated the biological basis of mental illness and replaced it with Freudian personality theory.
When Sigmund Freud famously arrived on this continent in 1909 to lecture at Clark University in Ottawa, he introduced his theory of personality neuroses -- defined as developmental immaturities caused by sexual and emotional conflicts with parents (mostly intrusive, domineering, withholding or seductive mothers). In his view, neurotic behavior provided a refuge from the responsibilities and obligations of adulthood. He believed that those neuroses could be fixed through psychoanalysis -- the "talking cure."
Freud himself believed that the most severe disorders -- the psychoses -- were biologically based. But in the hands of American psychiatry, Freud's neurosis premise was greatly expanded -- actually embroidered upon -- with devastating results. If neurosis occurred bec ause of misguided mothering, the theory went, then psychosis must indicate the most profoundly perverse, deplorable forms of parenting. For the next three generations, America's top talent went not into brain research but into teaching and promulgating theories of personal andfamilial blame.
The remedies were woven from the same cloth: Separate the patient with mental illness from the wounding family and psychosis would recede, leaving a simple case of neurosis, which would respond to the talking cure. When this regimen predictably failed, psychiatrists blamed the patients themselves for not trying hard enough to get better.
It is fashionable in some circles to regard all this as ancient history -- to say that we have passed beyond this simplistic Freudian framework and understand the realities of struggling with a biological brain disorder. Unfortunately, this is not true. Here's Bill Gates, talking to a New York Times magazine reporter about his friend Warren Buffett: "Warren thinks it's very tricky to be in a meeting one minute where you're talking about giving away lots of money, and then in the next minute you're thinking about making money. He thinks that's a little schizophrenic. . . . [A]t least so far, it hasn't created any schizophrenia for me."
How is it that this technologically innovative, otherwise hip person can be so uneducated, so cavalier about schizophrenia? You may say his misuse of the term is just a common figure of speech. But would Gates have been caught dead referring to Parkinson's -- or any other brain disease not tainted by the Freudian stigma -- in this manner? Would he characterize some action as being "a little epileptic"?
Of course not. The fact is, Gates's comments reflect a deep national unconsciousness about brain disorders. And ignorance is also still apparent among professionals. Consider this clinical evaluation, sent to me last year by a mother who was trying to get her son with manic depression out of jail and into a hospital:
His "passive-aggressive personality is . . . based upon very infantile and egocentric ideas in which he is maximizing the secondary gain related to his disability . . .," the doctor wrote. "He is heavily enmeshed in patterns of family pathology, particularly in relationship to his mother. He is unlikely to benefit from therapy unless he is willing to disengage himself from his family and maintain an independent lifestyle."
I ask you: If you showed this psychiatric evaluation to members of your state legislature, could you persuade them that it was their duty to do something about mental illness? Not on your life! When has public policy ever been responsible for what is perceived as self-induced hardship?
This is the bitter harvest of a century of blame. The stereotyping of mental illness as character- and family-based has discouraged public sympathy for those afflicted with brain disorders, and excused public policymakers from taking action.
We have just witnessed the end of the "Decade of the Brain" -- a congressionally mandated commitment to brain research as a national priority. Another age of neuroscience is dawning. It is within our grasp to forge a social contract to care for and ameliorate mental illness, the way we have for cancer, developmental disabilities, even AIDS. We have the opportunity to build the first mental illness recovery system in human history. We may have missed the boat in 1900; but anyone who has experienced, or witnessed, the firestorm of mental illness deserves their chance now.
Joyce Burland is deputy director of education and training of the National Association for the Mentally Ill (NAMI) in Arlington. This article was adapted from a speech she gave in June to its Maryland chapter.