The drama of psychoanalysis | The BMJ

Henry Miller, the witty and now dead neurologist from Newcastle, said that one of the great challenges for 21st century medical historians would be to explain the obsession with psychoanalysis in the 20th century. How did thinking what was more cult than science take over American psychiatry and bewitch intellectuals? Seamus O’Mahony doesn’t specifically set out to answer that question in his wonderfully readable and funny book The Guru, the Bagman, and the Sceptic: a story of science, sex and psychoanalysis, but he provides some answers.1 The book is also filled with delicious and entertaining stories: the early pioneers of psychoanalysis and their patients may have been self-deceiving, but they were rarely boring.

His book is built around the intertwined stories of three men. One of them, Sigmund Freud, the guru, is one of the best-known figures of the 20th century or any century. Ernest Jones, the bagman and disciple, translator, and biographer of Freud, a “psychoanalytic capo,” is far from a household name but is well known in psychoanalytic and literary circles. In contrast, the surgeon, Wilfred Trotter, the person whom O’Mahony admires, is largely forgotten despite saving the life of George V and treating Freud.

Jones, a lower-middle class, clever, and energetic boy from Swansea, qualified in medicine and met Trotter at University College Hospital. Jones called Trotter “my best friend—and apart from Freud—the man who mattered most in my life.” Trotter, a gifted and deeply humane surgeon and “a philosopher in a profession where there are none,” was pathologically shy, and Jones was his only close male friend. Trotter was the first to refer to the “herd instinct” in his best-selling book Instincts of the Herd in Peace and War published in 1916.

Jones, whom O’Mahony describes as a “fixer, seducer, and opportunist,” was in 1906 charged with gross indecency in relation to three teenage girls. Although probably guilty, he got off but needed a career other than a traditional medical one as he was forced to resign his hospital post. It was Trotter, a wide and great reader, who introduced him to Freud, and psychoanalysis proved a natural home for Jones. Trotter, in contrast, had a distinguished surgical career and was revered by those who worked with him. They were unlikely friends, and O’Mahony pins down the big difference between them: Jones “admitted that he was ‘not overliberally endowed by nature’ with scepticism,” while in Trotter it was “all-embracing.” Jones swallowed psychoanalysis whole, while Trotter kept his distance.

One thing that Freud, Jones, and Trotter had in common were that they were all fine writers. Freud was more writer than scientist or doctor. He was, writes O’Mahony, “indifferent to the outcome of therapy; his patients and their problems were simply the raw material for his ideas and his writing—he didn’t really care whether they got better or not, and this indifference has persisted within psychoanalysis to this day.” Many people, including friends, who have been helped by psychoanalysts would not agree with that judgement. Freud’s fame flourishes because of his writing and thinking not because of his science or contribution to medicine, but many of his ideas were not original—for example, the philosopher Arthur Schopenhauer conceived of the unconscious decades before Freud.

One reason that psychoanalysis became so popular is that after the First World War it was adopted wholesale by many intellectuals and the highly influential Bloomsbury Group. “Psychoanalysis was as influential in Cambridge in the 1920s as communism in the 1930s; if religion was the opium of the masses, psychoanalysis was the opium of the intellectuals.” Even people like Archie Cochrane, who later promoted the importance of evidence and inspired the Cochrane Collaboration, were swept up by the enthusiasm: like many others he went to Vienna to be analysed.

Virgina Woolf was the only prominent Bloomsberry unconvinced by Freud, whom she described as “a screwed up shrunk very old man, with a monkey’s light eyes.” Despite her scepticism, she and her husband published Freud’s work, which didn’t stop her satirising the great man’s work: “I glance at the proof and read how Mr A.B. threw a bottle of red ink in the sheets of his marriage bed to excuse his impotence to the housemaid, but threw it in the wrong place, which unhinged his wife’s mind—and to this day she throws claret on the dinner table. We could all go on like that for hours; and yet these Germans think it proves something—besides their own gull-like imbecility.”

Another reason for the success of psychoanalysis was that it was a great business. With minimal training, you treated the rich for up to three guineas an hour three times a week for years. Freud could charge more. Eight patients could provide a rich living. Jones had houses in London, the English and Welsh countryside, and the French Riviera.

Jacques Lacan, the French neo-Freudian, reached the business peak. He saw patients for 10 minutes without reducing his fee, meaning he could see 80 patients a day. He would see his tailor, pedicurist, and barber while analysing patients. “He died a multimillionaire, leaving a legacy of discarded lovers, several patients who died by their own hand, and a dozen or more psychoanalytic societies and associations, each claiming to be the true heir to his progressive and revolutionary ideas.”

Dozens of characters alive and dead feature in the book, including in addition to the main characters George V, Malinowski, Princess Alice of Greece, the mother of the Duke of Edinburgh, Boris Johnson, Napoleon, Jomo Kenyatta, R D Laing, Njinski, Clement and Lucien Freud, James and Lucia Joyce, and many others, but my favourite was Princess Marie Bonaparte, who illustrates the eccentric characters who took up psychoanalysis in the early 20th century and the theory’s obsession with sex..

She was the great-grandniece of Napoleon and had inherited a fortune. Freud treated her in 1925 for “frigidity,” which she defined as the inability to achieve orgasm in the missionary position. She was ‘in search of the penis and orgiastic normality’. Her supposed frigidity did not stop her having multiple lovers. It was to her that Freud asked the famous question: “What does a woman want?”

The Princess was the one who got Freud, his family, papers, and antique figurines out of Vienna and away from the Nazis. “Her imperious manner and high connections opened many doors; Nazi officials were impressed and slightly intimidated.” Catherine Deneuve played the princess in a television film in which she “bares her soul (and her breasts) to Freud,” who “tells her – somewhat regretfully – that he is an old man, and moreover, a petit-bourgeois.”

The Guru, the Bagman, and the Sceptic is filled with similar characters, making for an excellent book that reads like a novel. O’Mahoney savages the early psychoanalysis movement and sums it up: “Psychoanalysis was the banner behind which marched a raggle-taggle army of failed neurologists, curious intellectuals, psychopaths, sexual opportunists, cultural entrepreneurs, eccentric aristocrats, and bored rich dilettantes. It was the making of many of them… Psychoanalysis was the solution to the pressing problem of what to do with their lives.” Not everybody will agree with his demolition, but whatever your views on psychoanalysis you can enjoy the book.