Against Therapy

Masson published Against Therapy in 1988, four years after The Assault on Truth. In the later book, which is decidedly more radical than its predecessor, the target of Masson’s criticism broadens from Freud and psychoanalysis to the entire psychiatric profession. The book consists of a series of case studies, all of which, Masson argues, reveal the fundamental abusiveness of psychotherapy. His examples range from Ludwig Binswanger’s Sanitarium Bellevue at the end of the nineteenth century to the American therapist John Rosen, who was forced to surrender his medical license in 1983 after patients accused him of kidnapping and torturing them. Many of Masson’s cases offer extreme instances of violence committed by doctors against their patients, and he confidently states that such abuse is not unusual. But his more important point is that grossly abusive therapies are structurally identical to seemingly humane ones and thus ought not to be considered anomalous. They simply make more palpably horrifying what goes on in every therapeutic situation.

Once Masson had come to grief in the psychoanalytic community by publishing his heretical views on the seduction theory, he seems to have felt liberated to embrace a position fully consistent with the implications of his critique of Freud. In Against Therapy he argues that any kind of psychotherapy, no matter how apparently enlightened or sophisticated, is indefensible. Psychotherapy, Masson charges, claims to help people when its real purpose is to make them conform; it is a vehicle of social control. At the same time Masson criticizes psychotherapy on what might be called epistemological grounds: it rests on an illegitimate pretension to psychological expertise—on a false belief that the so-called professionals have a better understanding of the “patient” than does the individual seeking treatment. Masson’s own experience as an analyst, he says, persuaded him that the therapist has no such superior insight, any more than he enjoys superior psychic health:

Many times I sat behind a patient in analysis and became acutely and painfully aware of my inability to help. Many times, indeed, I did feel compassion. But at times I also felt bored, uninterested, irritated, helpless, confused, ignorant, and lost. At times I could offer no genuine assistance, yet rarely did I acknowledge this to the patient. My life was in no better shape than that of my patients. Any advice I might have had to offer would be no better than that of a well-informed friend (and considerably more expensive).^[26]

Over and over again Masson returns to the impossibility of knowing a person better than the person knows himself. The individual is always the best judge of his own reality. Psychotherapists falsely pretend to a degree of intellectual intimacy that cannot be achieved even by friends or lovers.

With complete consistency, Masson asserts that the supposed object of psychotherapy—the ailment that justifies its existence—doesn’t properly exist. “There is no such medical entity as mental illness,” he writes.^[27] He does not deny that people experience great suffering and emotional pain, but he argues repeatedly that mental illness is simply a label those in power attach to unpopular opinions or unconventional ways of living. It represents an illegitimate translation into psychological terms of what is at bottom a political matter. Society finds various ideas and actions threatening, and it seeks to repress them by calling them insane. “Mental illness” is thus an ideologically loaded label for a difference in worldview. In the end, psychotherapy amounts to nothing more than the attempt to break a person’s will.

With these opinions Masson joins the ranks of a well-established antipsychiatric tradition, whose foremost representatives are Thomas Szasz, R. D. Laing, and Michel Foucault. Masson acknowledges his affinities with Szasz and Laing, and Foucault’s Histoire de la folie à l’âge classique (which analyzes the asylum as a mechanism of social control) appears in his bibliography, although not in his text. But while recognizing that his ideas are not unprecedented, Masson insists that he alone has pursued the antitherapeutic point of view to its logical conclusion: his predecessors hoped only to replace existing forms of therapy with better ones, while he regards the very idea of psychotherapy as misguided.

Seen from the perspective of The Assault on Truth, the most striking thing about Against Therapy is that it completes the earlier book’s implicit move from psychology to politics. In The Assault on Truth Masson constructed a fantasy of Freud’s evolution into a political activist and the transformation of psychoanalysis into a revolutionary movement. Now he openly attacks the political quietism of all forms of psychotherapy and their corrupt implication in the existing order. The immediate goal of Masson’s own politics is to abolish the profession of psychotherapy, which, he writes, “can and should be replaced by open and searching criticisms of the very foundations of our society.”^[28] And he readily identifies his campaign against psychotherapy with such other recent political causes as Andrea Dworkin’s and Catherine MacKinnon’s efforts to outlaw pornography and the ban on electroshock passed by Berkeley voters in 1982—despite the failure, Masson notes scornfully, of the local therapeutic community to support it publicly. Masson’s turn from psychology to politics brings to mind the analogous development among the neo-Freudians, who, in the 1930s and 1940s, criticized the perceived neglect of social factors in orthodox psychoanalysis. As was the case with the neo-Freudians, Masson’s progressive political views have been purchased at the cost of Freud’s grim psychological insights. Herbert Marcuse showed in his famous critique of neo-Freudianism in Eros and Civilization that Freud’s unsentimental insistence on the burdens of sexuality and aggression is, in the end, both more radical and more humane than the facile call for social reform.

Masson’s unqualified attack on psychotherapy takes him well beyond the bounds of my present concern with recent critics of psychoanalysis. For my purposes, the main interest of Against Therapy lies in its implication for Masson’s view of Freud and his thesis about the abandonment of the seduction theory. Most immediately, Masson’s denial of the reality of mental illness might seem to undermine his contention, in The Assault on Truth, that Freud’s seduction theory was correct. The whole point of the seduction theory, after all, was that childhood sexual abuse gave rise to neuroses. Indeed, Masson praised Freud as the first thinker in history to have recognized the profound psychological consequences of child abuse. But if hysteria, like all psychiatric diagnoses, is a fiction—a clinical label for ideas or behavior that society disapproves of rather than a genuine illness—then the seduction hypothesis no longer makes any sense. By the logic of Against Therapy, Masson himself would seem to have abandoned it.

Masson nowhere admits that he has become ensnarled in contradiction. I suspect his silence is less a matter of bad faith than evidence that, from the start, he understood the seduction theory very differently from Freud. When he wrote The Assault on Truth, he still spoke of Freud’s patients as hysterics, and he accepted Freud’s judgment that they were genuinely sick. But Masson was never especially interested in the specific etiolological proposition Freud advanced, namely, that childhood seductions resulted in one particular neurotic disorder, hysteria. Rather, he sought always to conflate this formulation with the more general idea that childhood sexual abuse had severe and deleterious psychological consequences. Four years later, in Against Therapy, Masson refuses to speak of sickness, and he blames Freud for so labeling his patients. But he still believes that childhood seductions cause great suffering, especially if therapists deny their reality. Apparently, when we say that something causes suffering or mental pain, we are not, in Masson’s view, pronouncing the sort of intrusive and presumptuous judgment on another person’s experience that he so objects to in psychotherapy. But the difference between these two exercises—the one authentic, legitimate, and humane; the other bogus, illicit, and repressive—needs to be more fully explained. Otherwise, the impression persists that Masson’s extreme antipsychiatric views in Against Therapy contradict his earlier defense of the seduction theory.

Only one chapter of Against Therapy deals with Freud. It presents a critical examination of the Dora analysis, which Masson considers the single most influential case in the history of psychiatry—and one that dramatically illustrates the wrongs of psychotherapy. For Freud Dora was a hysteric; he originally titled her case “Dream and Hysteria” (“Traum und Hysterie”). Masson, however, denies that Dora was actually ill. He ignores the various “presenting symptoms”—including a persistent cough, hoarseness, and loss of voice without organic cause—that Freud considered the evidence of her hysteria. Instead, Masson insists, Dora offers a clear-cut example of perfectly reasonable behavior that, because of his intellectual (and ultimately political) prejudices, Freud arbitrarily chose to call pathological.

In 1898, when she was fifteen, Dora was brought to Freud by her father. Alongside her physical symptoms and general sullenness, she had developed, according to her father, an irrational belief that his close friend Herr K. had made sexual advances toward her. Freud’s initial response to Dora was not at all what her father expected: Freud concluded that her account of Herr K.’s behavior was accurate, and he agreed with her that her father had in effect handed her over to Herr K. as the price for his own affair with Herr K.’s wife. Freud’s response to Dora also seems to surprise Masson, who, in The Assault on Truth, alleged that, having abandoned the seduction theory, Freud routinely attributed his patients’ stories to fantasy, thereby excusing the abusive actions of adults. In this instance, however, Freud initially took the side of reality against fantasy, and of the child against the parent.

But, Masson complains, Freud’s loyalty to Dora was short-lived, his original alliance with her soon giving way to opposition. Instead of accepting that she simply found Herr K.’s attentions unwelcome and was understandably angered by her father’s self-interested betrayal, Freud insisted that Dora’s hostility to Herr K. was unreasonable and her anger against her father excessive. Indeed, Freud regarded both her intense aversion and her anger as manifestations of her hysteria. After all, Freud reasoned, Herr K. was a prepossessing man still in his thirties: Dora should have been aroused, not disgusted, when he embraced and kissed her (at age fourteen), just as she should have been flattered by his serious romantic interest in her. Freud even suggested that the whole matter could have been satisfactorily resolved had Dora married Herr K., which would of course have freed Frau K. to marry Dora’s father.

Masson is far from being the only reader to find Freud’s response to Dora lacking in sensitivity—to put it mildly. Peter Gay, for example, is no less appalled by Freud’s interpretive aggression and self-righteousness: Gay considers it astonishing that Freud ever published the case. Masson thus easily gets a good deal of legitimate mileage out of Freud’s manifestly retrograde views on women and on the proper relations between the sexes. What Freud calls hysteria—namely, Dora’s failure to respond to Herr K. and, especially, her anger at her father—is, Masson insists, simply a pejorative label for attitudes and behavior that Freud disapproved of. It is a classic example of the way psychotherapy invidiously uses psychological categories to mask political prejudices.

I am not, of course, eager to defend Freud’s treatment of Dora, least of all his blithe recommendation of Herr K.’s attractions. The important feature of Freud’s analysis, however—and the point at which Masson’s disagreement with Freud is most intriguing—does not lie in Freud’s ideologically loaded disregard for Dora’s legitimate interests. Much more significant is Freud’s belief that her behavior cannot satisfactorily be explained solely by an appeal to her conscious perceptions and intentions. Characteristically, he insists on deeper, unconscious sources for her actions. Freud suggests, in particular, that Dora was unconsciously in love with Herr K. and very much desired a romantic relationship with him. Her unconscious attraction explains why she reacted so violently both to Herr K.’s sexual advances and to her father’s contention that she had merely fantasized them. There was in fact an element of fantasy involved in her situation: the advances were real enough, but they were not entirely unwelcome. Dora’s extreme disgust disguised feelings of self-reproach. She had, in effect, gotten what she could not admit she wanted.

Here we have the essential point of opposition between Freud and Masson. Once again, as with the seduction theory, it comes down to a disagreement about the self and what can be known about it. Freud articulates a modern conception of the self: it is divided, at odds with itself, ambivalent. It houses desires that are not always compatible with its conscious convictions, and Freud regards its self-representations with suspicion. For Masson, on the other hand, the self is fundamentally unified and reliable. There are no secret corners, no hidden recesses unavailable to consciousness, that might stand at odds with explicit ideas or beliefs. Thus, when Dora says she was disgusted by Herr K., that settles the matter. Likewise, when Dora insists she was angry with her father because he questioned her trustworthiness, no more needs to be said. Only outrageous presumption allows Freud to pretend to know something about Dora’s inner life that she herself denies. Masson’s Dora is a little philosophe, driven by a passion for the truth—just as Masson himself, so he tells us, was driven by his passion to discover the truth about the seduction theory. Dora is thus allowed none of the psychological ambiguity that Freud, as a modernist, imputes to her. Jacques Lacan has identified Dora’s unmodern sense of innocence with Hegel’s notion of the “beautiful soul.” Dora articulates the beautiful soul’s naive protest against what the world has done to it. But Freud responds: “Look at your own involvement in the disorder which you bemoan.”^[29] The modern self, in other words, is complicit in its own disarray, whereas Masson’s Dora, like the hysterical patients of the seduction theory, is an innocent.

Already in The Assault on Truth Masson showed little sympathy for the idea of the unconscious. He did not explicitly dismiss it, but he objected to Freud’s invoking unconscious fantasies to explain what were, in Masson’s view, perfectly straightforward recollections of past mistreatment. At the very least, the unconscious, like infantile sexuality, had grown superfluous to Masson’s understanding of human behavior. In Against Therapy, especially in his analysis of the Dora case, his rejection of the unconscious becomes fully transparent. Even if one were to grant that a person might be unaware of certain impulses, those impulses, Masson argues, would be even less accessible to the therapist than they are to the patient. For all practical purposes, therefore, the unconscious simply doesn’t exist. Dora’s experience in analysis shows that the appeal to the unconscious is gratuitous as well as repressive: when she identified the conspiracy between Herr K. and her father, a conspiracy that Freud, as one of the boys, sought to abet, she had successfully got to the bottom of the problem. Everything else—all of Freud’s supposedly expert opinions—was mere presumption. Far from easing his patient’s misery, Freud added to it.

What Freud should have done, according to Masson, is not analyzed Dora—which was unnecessary and abusive—but taken her side in the controversy. Because the issue was essentially political, it called for a political response: a denunciation of male sexual exploitation and hypocrisy. But the burden of the correct political response had, in the end, to be borne by Dora alone. When Freud continued to insist that she was unconsciously in love with Herr K., she walked out on Freud. She later confronted Herr K. and his wife and obtained confessions from them, an action that Masson applauds as “a political statement of remarkable maturity.”^[30] Dora, in his view, was not a hysteric but an emerging feminist.

Masson makes no effort to bring the Dora case into line with the seduction hypothesis. In The Assault on Truth Masson assumed, in keeping with the seduction theory, that whenever Freud identified a patient as a hysteric, the patient had been sexually abused as a child. But Masson advances no such claim about Dora. On the contrary, he suggests that, by finally publishing her case (in 1905), Freud intended to send a muted signal to his professional colleagues that he had given up his heretical views about seduction. Nor does Masson try to establish a structural parallel between the Dora case and the seduction model, as he did with Emma Eckstein’s operation and Freud’s diagnosis of hysterical longing—presumably because Freud’s acknowledgment that Dora was the object of a genuine seduction by Herr K. effectively rules out any such structural argument. But, more fundamentally, Masson’s newly acquired antitherapeutic bias and his denial of the reality of mental illness seem to have dimmed his enthusiasm for what was, after all, essentially a diagnostic theory linking childhood abuse with adult neurosis. Like it or not, the seduction theory belongs to the old psychiatric order, which Masson is out to discredit in Against Therapy. Thus, without explicitly rejecting the theory, he consigns it to a conceptual limbo.