The Letter, Issue 46, Spring 2011, Pages 3 - 11
Psychoanalysis, Psychiatry and Bipolar Disorder in the Twenty First Century
Daniel Burston
During the last quarter of the twentieth century neo-Kraepelinian psychiatry joined forces with non-psychiatric critics to repudiate and ridicule Freud and his followers. This paper addresses some of the causes and consequences of the decline of psychoanalysis within mainstream psychiatry, and argues that many of the reproaches once leveled at Freud by his late twentieth century critics could now be directed with equal or even greater justice to neo-Kraepelinian psychiatry. This is especially true with reference to bipolar disorder, where contemporary psychiatry would be wise to heed its own motto: ‘Back to Kraepelin’.
Keywords: Bipolar disorder; DSM; Freud wars; Kraepelin; polypharmacy
In March of 1987, I was an Oscar Diethelm Fellow at the History of Psychiatry Section at The Payne Whitney Psychiatric Clinic in New York City. My supervisor was Eric (“Ted”) Carlson, a specialist in the history of phrenology, hypnotism, American psychoanalysis and multiple personality disorder. After one of our seminars, I asked Ted what he thought the twenty-first century held in store for psychoanalysis. To my astonishment, he said it would probably go the way of phrenology. In addition to being surprised, I was a little offended by his remark. Weren't phrenologists charlatans, by and large? Now it was Ted's turn to be offended. He shot back that until the mid nineteenth century or so, most phrenologists were perfectly respectable physicians. No, he said, he was merely suggesting that with the passage of time, clinicians would differentiate what was valid in psychoanalysis and then discard the remainder, and that those elements of enduring value would be absorbed into a new and genuinely scientific discipline, much as phrenology gave way to neurology.