I just read an interesting essay, prompted by a new film called “Freud’s Last Session” (the film doesn’t sound great, by the way). The article discusses a “rebirth” of Sigmund Freud both in the public consciousness and in psychological theory. Here’s the author’s speculation as to why Freud is of current interest:
After a decade in which “mental health” – and perhaps trauma especially – has grown as an amorphous public health issue and cultural conversation, many are seeking a response which goes beyond chemical cures and cognitive behavioral therapy, towards the more expansive theory of the mind offered by Freud, and those who followed him. Politically, too, many have sought to reckon with the losses of the left not just materially, but psychosocially.
Recently The New York Times and Chronicle of Higher Education (warning: paywalls) both have reported on a resurgence of interest in Freud.
I have no particular beef with resurrecting Freud for film or other fiction (indeed, many of Freud’s ideas about the mind and mental health are more humanities-style musing than formal theory). And I’ll acknowledge that Freud sometimes gets an unearned bad rap from secondary sources. He’s an interesting read in the original — for instance, some sections of The Interpretation of Dreams are not at all bat-shit crazy (the apocryphal quote, “Sometimes a cigar is just a cigar,” captures the essence of Freud’s argument that a lot in dreams are mundane and not actually laden with symbolic content).
I also have no problem with examining Freud for historical purposes. After all, he was a major force in promoting the idea that mental illness is treatable, something that previous generations did not take as obvious.
But as psychological theory, Freud’s ideas are often untestable, and therapies based on them have often proven ineffective. For example, compare the discredited Freudian approach to simple phobia to the robust effectiveness of systematic desensitization. Additionally, it will surprise no behavior analyst that Freudian-inspired ideas about autism have made zero contribution to the development of effective interventions. That would be expected given theorizing like this:
Autistic thinking was characterized by infantile wishes to avoid unsatisfying realities and replace them with fantasies and hallucinations. ‘Autism’ defined the subject’s symbolic ‘inner life’ and was not readily accessible to observers.
This view, it should be noted, helped to inspire the infamous “refrigerator mother” explanation for autism, first advanced in a 1949 paper by Leo Kanner:
Most of the patients were exposed from the beginning to parental coldness, obsessiveness, and a mechanical type of attention to material needs only. They were the objects of observation and experiment conducted with an eye on fractional performance rather than with genuine warmth and enjoyment. They were kept neatly in refrigerators which did not defrost.
Yikes.
A resurgence of interest in Freud as a bona fide offering in the marketplace of scientific ideas is, therefore, something to be concerned about. In the world of evidence-based practices, a key maxim is that anything that doesn’t work necessarily does harm — either active harm, by exacerbating the condition being treated, or passive harm, by wasting resources an allowing suffering to continue. If Freud is back, then so too are treatments that don’t work, and with them the adverse effects of active and passive harm.
But there is a bigger lesson here. We like to think we live in an enlightened era in which effectiveness evidence has, after a long and torturous history of lousy-to-horrible human services, finally taken center stage. But renewed interest in Freud demonstrates how tenuous the evidence-based practice movement is. The truth is that people don’t tend to think logically and aren’t good at following threads of evidence. Entire books have been written on the ways that human thinking strays into fallacious reasoning.
One consequence of this is that discredited ideas have a tendency to be recycled. Like zombies, just when you think they’ve been destroyed they rise from the grave to torment the living. In the experience of behavior analysts, a classic example is facilitated communication (FC), shown in the early 1990s to be entirely bogus — yet, with minor repackaging, it remains all around us (Postscript 1). As behavior analyst Jim Todd and colleagues have written, it remains in use with a ton of people with autism, and is supported by grant funds and government-sponsored projects (ironically, just as I was reading the Freud article a thread erupted on one of my listservs bemoaning yet another outbreak of FC use).
What we can take from this is that tons of FC-debunking research evidence, tracing back to the 1990s, counts for little in the court of public opinion.
Which defines a continuing challenge for behavior analysts and everyone else who cares about demonstrably effective treatment. Applied behavior analysis has been enjoying a moment in the sun, but we cannot pretend that this means ABA’s place as a preferred mode of treatment is secure. Just as Freud’s popularity has ebbed and flowed over time, zombie ideas that directly compete with ABA will resurge to threaten the well-being of those for whom applied behavior analysts care.
What can be done about this? I can think of two strategies. The first is to be sure to educate each consumer to whom we offer services about how to evaluate effectiveness. This includes checking for peer reviewed evidence of effectiveness as well as defining objective benchmarks of progress for each individual case. It might sound strange to say, but people need to be taught to discriminate between harm and help, and once they learn they can spread the word to others. This is, in effect, what Catherine Maurice did for us in Let Me Hear Your Voice.
I worry that in the current rush to meet an impossible demand for services this important educative function often is being overlooked. I’m pretty sure, for instance, that big venture-capital-funded companies aren’t programming in clinician time to teach consumers about the logical nuts and bolts of evidence-based practice.
The second thing we can do should play to our strengths: Conduct a functional analysis of why zombie ideas keep bouncing back into prominence. My guess is that they scratch an itch that we are failing to address. What that might be could vary across instances, but the author of that essay about Freud, mentioned above, speculated that Freud’s resurrection might have something to do with a contemporary concern for dealing with psychological trauma. This is not something that has received massive attention in behavior analysis. It’s telling, for instance, that the first reference to psychological trauma in ABA’s flagship journal, Journal of Applied Behavior Analysis, was in 2021.
There now exist a smattering of publications focusing on how ABA might address trauma (Postscript 2), but it’s safe, I think, to call these preliminary discussions. We are far from developing a unique, evidence-based alternative to other trauma-informed practices. In this vacuum, if people are concerned about trauma, it’s no surprise that they go looking for insights wherever else those may be found. And since people don’t tend to think clearly about evidence, it’s also no surprise to find they aren’t great at separating the wheat from the chaff
I’ll add one more thought that should come as no shock to anyone who’s read my published work or previous blog posts: When we tackle a problem of great public interest, like trauma, we need to do more than develop effective solutions. We also have to talk about the problems and solutions in ways non-behavior analysts will understand and find satisfying. The beauty and the shame of Freud is that his writing is often so abstract that you can see in it what you want. It’s a verbal Rorschach test. Even if it says nothing objectively testable, at first blush it feels profound and seems to scratch all kinds of itches. Words are a powerful vehicle of first impressions, and as Catherine Maurice so colorfully illustrated, our discipline has not, historically, been great at first impressions. If we want to crowd bogus stuff out of the marketplace of ideas, we will need to do better.
Postcripts
1. More on FC as a Zombie Idea
- Hagen, L. K. (2012). Speechless: facilitated communication, a long-debunked pseudoscience, makes a surprising return. Skeptic (Altadena, CA), 17(3), 14-20.
- Wombles, K. (2014). Some fads never die—they only hide behind other names: Facilitated communication is not and never will be augmentative and alternative communication. Evidence-Based Communication Assessment and Intervention, 8(4), 181-186.
2. Some Resources on ABA and Psychological Trauma
- Rajaraman, A., Austin, J L., Gover, H.C., Cammilleri, A.P., Donnelly, D.R., & Hanley, G.P. (2022). Toward trauma‐informed applications of behavior analysis. Journal of Applied Behavior Analysis, 55(1), 40-61.
- Anderson, B.M., & Kalil, D.A (2023). Trauma-Informed Approach to Applied Behavior Analysis. In Hall et al. People Skills for Behavior Analysts (pp. 308-315). Routledge.
- Wheeler, K., Hixson, J., Hamrick, J., Lee, J., & Ratliff, C. (2023). Behavior analysts’ training and practice regarding trauma-informed care. Behavior Analysis in Practice. Advance online publication.
- Prather, W., & Golden, J. A. (2009). A behavioral perspective of childhood trauma and attachment issues: Toward alternative treatment approaches for children with a history of abuse. International Journal of Behavioral Consultation and Therapy, 5(1), 56-74.
- McLean, C., & Follette, V. M. (2016). Acceptance and commitment therapy as a nonpathologizing intervention approach for survivors of trauma. Journal of Trauma & Dissociation, 17(2), 138-150.