When I was very young, my mother fell ill with painful, haemorrhagic bruises over her joints, and became increasingly disabled. All treatment failed, including having the family pets put down in case the problem was an allergic one. Only arsenic helped, though it was to cause a rare skin cancer years later. Eventually, in despair, my parents wondered if there might be some deep underlying psychological cause, and my mother was admitted to hospital for intensive in-patient psychoanalysis. She emerged six weeks later, cured, her pain and bruises gone.
I was brought up, therefore, to take Sigmund Freud and psychoanalysis seriously, and there were several of his books on my parents’ bookshelves, which I inherited after they died. I doubt if my parents took all of Freud’s theories as gospel truth, but in the middle of the last century, psychoanalysis was immensely influential, although it is now largely debunked.
Seamus O’Mahony is an Irish physician who has written three highly readable books regretting what he sees as the degeneration of medicine and the medical profession, with institutionalisation, the “medico-industrial complex”, the medicalisation of death and the steady loss of the autonomy that doctors had in what he calls the “golden age of medicine”. He laments that he largely missed out on this, as he graduated in 1983. Now retired, in his latest book, The Guru, the Bagman and the Sceptic: A Story of Science, Sex and Psychoanalysis, he has turned his witty and critical eye to Freud (the guru of his title), Freud’s biographer and associate Ernest Jones (the bagman) and the now obscure English surgeon Wilfred Trotter (the sceptic).
O’Mahony describes Freud’s evolution from hard-up, struggling neurologist to dogmatic, international celebrity psychoanalyst, and Jones and Trotter starting out together in London as young doctors at University College Hospital (UCH) in 1902. Trotter was already outstanding – when he was still a very junior doctor the famous neurosurgeon Victor Horsley commented that Trotter was the only member of the UCH staff whose opinion he respected. Trotter was widely read and pathologically shy. “Surgery colonises its practitioners so comprehensively,” O’Mahony tells us, that “surgeon-intellectuals are as rare as unicorns.”
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Despite their wildly different personalities – or perhaps because of them – Jones and Trotter became close friends (and Trotter married Jones’s sister). Trotter went on to write a bestselling book, Instincts of the Herd in Peace and War (1916), in which he stressed the “gregarious” nature of human beings, our irrationality and suggestibility, in marked contrast to Freud’s emphasis on the individual and early “sexual” childhood experiences. We have been using the phrase “herd instinct” ever since. Trotter wrote no more and devoted the rest of his life to becoming one of the most respected surgeons in Britain.
Trotter and Jones had both been interested in psychoanalysis and learned German so that they could read the literature. In 1908 they attended the first international psychoanalytic conference in Salzburg, organised by Carl Jung. Freud spoke for five hours without a break. He received a standing ovation but, Jones wrote, in deference to Freud’s dislike of debate, “papers read at psychoanalytic congresses have never been followed by discussion of them”. Trotter missed Freud’s speech and was to become increasingly sceptical about psychoanalysis.
O’Mahony gives an excellent account of the rise of psychoanalysis, and its cult-like nature. It had much more in common with the received, indisputable “truths” of religion than any science, and clearly filled a gap left by the decline of religious faith. As a counterpoint to Freud and his disciples, Trotter – the true hero of the book – is depicted by O’Mahony as a brilliant and modest surgeon in a prelapsarian age. When O’Mahony contacted UCH to ask if their archives had any material about him, the answer came back that there was none. It is Trotter, O’Mahony writes, who has much more to tell us about science and medicine, and even philosophy, than Freud, but is now completely forgotten. Freud, “flawed and fundamentally in error, a tragic figure whose life’s work was a chimera… is the great man”.
The real joy of this book – and it is immensely entertaining – is O’Mahony’s depiction of the “raggle-taggle army of failed neurologists, curious intellectuals, psychopaths, sexual opportunists… eccentric aristocrats and bored, rich dilettantes” who followed Freud’s banner. He describes them in often hilarious detail. There was, for instance, the manic-depressive, drug-addicted Otto Gross (at one point he and Jung were analysing each other and Jones was sleeping with his wife), who advocated free love and was one of the inspirations for the anti-psychiatry movement associated with RD Laing many years later.
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Jones had to abandon hopes of a conventional medical career as a result of accusations of sexual impropriety with patients. He was even tried in court after three girls at the Edward Street School for Defective Children – for which he was medically responsible – made accusations against him. When he was acquitted on all charges, Horsley threw a party. The Royal College of Surgeons paid for his legal expenses. As O’Mahony dryly observes: “In 1906 the testimony of intellectually disabled children was not taken seriously by the courts.” But there were further similar problems, including in Toronto where he had gone in the hope of salvaging his medical career after more scandals.
Psychoanalysis, with Freud as its godhead, provided Jones with a career and purpose (and also many sexual liaisons) and he went on to write a three-volume biography of his hero. He also came to act, in effect, as Freud’s agent, referring many English patients to Freud in Vienna in the 1920s – patients he vetted for both social class and financial means.
It became quite fashionable for Cambridge intellectuals to go to Vienna, though Freud was often too busy to see them. Among them were the brilliant philosopher Frank Ramsey and Archibald Cochrane, the founding father of evidence-based medicine. Both had gone because of sexual problems. Neither was especially impressed by psychoanalysis or by Theodor Reik, the analyst who treated them. Ramsey was probably cured by a Viennese prostitute, and Cochrane was never cured, although he later attributed his problems to familial porphyria.
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It is difficult to take psychoanalysis seriously – if you ever did – after reading this very well-researched book. Inspired by it, I found my parents’ copy of Freud’s masterwork The Interpretation of Dreams. Freud wrote extremely well, and reading it you are initially seduced by his dream stories and their interpretation. His fundamental – and completely mistaken – insight was that all dreams express wish fulfilment. In the chapter “Distortion in Dreams” he confidently explains away, with convoluted inventions, the fact that so many dreams are nightmares, filled with anxiety. How can they possibly express wishes?
Much of this chapter reads like a passage from Sherlock Holmes, with whom Freud liked to compare himself. The learned professor brilliantly reveals the clues. He tells us that when his patients had unpleasant dreams it was because their unconscious was trying to resist their analysis. Their dreams were fulfilling the wish that their dreams were not about wish-fulfilment. Heads I win, tails you lose.
As the book progresses, you start to descend into the “secular hell”, as O’Mahony calls it, of psychoanalytic writing. Freud had to invent repression and infant polymorphic sexuality, castration anxiety, penis envy, the Oedipus complex and so forth, to justify his dogma that all dreams express disguised desires and can be decoded by the initiated.
This is not to say that psychoanalysis did not help some patients, and since we know that confident doctors have greater therapeutic success than unconfident ones, belief in the Freudian mythology might well have been beneficial.
My mother did comment that her successful treatment may have been because her psychoanalyst, like her, was a refugee from Nazi Germany and this, combined with the enforced rest in hospital from a very demanding life as a mother of four children, might have been responsible for her cure, more than any Freudian insights. The haemorrhagic lesions recurred 30 years later, but on this occasion she was treated with the anti-leprotic drug Dapsone, and she recovered immediately without any psychoanalysis. The diagnosis was probably of some kind of vasculitis, which may or may not have been stress-related.
Freud did not discover the unconscious – Goethe, Schopenhauer and the ancient Greeks had all written about it. He was certainly right to stress the importance of early childhood in our later psychological development and the role of sexual repression in turn-of-the-century Vienna, but his theories of psychosexual development and neurosis now seem absurd. Nevertheless, despite a century of progress in neuroscience since Freud, the relationship between what is conscious and unconscious in our brains remains deeply mysterious.
The Guru, the Bagman and the Sceptic: A Story of Science, Sex and Psychoanalysis
Seamus O’Mahony
Apollo, 336pp, £27.99
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[See also: What could Sigmund Freud possibly teach Sherlock Holmes?]
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This article appears in the 19 Apr 2023 issue of the New Statesman, Axis of Autocrats