Analyzing The Proliferation Of Therapy

psychoanalyst's couch
psychoanalyst's couch

It's been more than a hundred years since Sigmund Freud introduced psychoanalysis, and today therapy has gone from the fringe to the fabric of popular American culture. From pills to brain scans to plain old talking, just what is it about therapy? Jeff Greenfield joins us to talk about it.

When Tony Soprano started therapy almost a decade ago, he took a sizeable real-life demographic with him into the doctor's office: Middle-class, blue-collar men who would otherwise never have gone.

"I can't tell you how many e-mails I got from therapists around the country saying, 'I got a man to come to therapy who'd never been to therapy before. And he said, if a tough guy like Tony Soprano can do it, then why can't I do it?'" remarked psychiatrist Glen Gabbard of the Baylor College of Medicine in Houston.

Dr. Gabbard said his profession - once stigmatized - is now more mainstream than ever. And the proof is everywhere:

On television, pills to treat your every mood-swing are advertised like household products, part of a $25 billion industry.

At your local newsstand, even Consumer Reports - known for rating microwaves and cars - has turned its focus to ranking therapies.

And according to the National Institute of Mental Health, Americans now spend about $100 billion a year on psychological care.

What was once seen as a sign of illness or a character flaw is now widely accepted. By one measure, 91 percent of Americans would seek counseling or advise a friend or family member to do the same.

"What people are finding is that there's a tremendous value in baring your soul to somebody who takes the time to listen, and to relate to you like no one else," said Dr. Gabbard.

The idea of baring your soul to a hired listener began over 100 years ago, with a Viennese doctor named Sigmund Freud.

"He invented the 'talking cure,'" Dr. Maxine Gann said. "The quality of listening to people comes from Freud."

Dr. Gann, from the New York Psychoanalytic Society & Institute, said the quest to explain human psychology is nothing new. In Ancient Greece, people's moods were linked to the balance of bodily fluids.

But throughout history, no one talked about their problems - they were either shipped off to Lourdes or held in quarantine.

Then came Freud, who - in a revolutionary turn - treated conversation as a window into the human mind.

"Before Freud, there were no talking cures," Dr. Gann said. "People used to sort of throw their hands up and say, 'I can't understand what they're talking about. They're crazy!' Well, he took a different vantage point. He said, 'Let's listen.' And that's what a really talented psychoanalytic psychotherapist does."

The New York Psychoanalytic Society & Institute is often described as headquarters for traditional Freudian therapy. It requires extraordinary psychological - not to mention financial - commitment: an hour a day for years at roughly a thousand dollars a week, an expense Woody Allen poked fun at in "Annie Hall":

"I was in analysis. I was suicidal as a matter of fact and would have killed myself, but I was in analysis with a strict Freudian, and, if you kill yourself, they make you pay for the sessions you miss."
Allen was hardly the first to joke about psychoanalysis. Freud's theories - while respectable in Europe - were initially laughed at in America.

Dr. Gabbard points to one example, the 1938 screwball comedy "Bringing Up Baby" which depicts "the classic stereotype psychoanalyst. European accent. Spouting jargon, and he's always wrong! And in these films, American leading men like Jimmy Stewart, Gary Cooper, these guys who have the values of mom, apple pie and the American flag, can solve all the problems. And you really didn't need the buffoon from Europe coming over and spouting jargon to you."

Fast-forward two decades, and another view of psychotherapy emerged with movies like "Psycho," with the reassuring comment, "If anyone can explain this, it's the psychiatrist."

"From 1957 to 1963, you see consistently idealized portrayals of psychiatrists" in popular culture, Gabbard said. "Psycho"'s psychiatrist "explains" Norman Bates' mother fixation as "simply doing everything possible to keep alive the illusion of his mother being alive."

(Craig Blankenhorn )
Four decades later, "The Sopranos" depicted what Dr. Gann called "a lot of really good consultation," courtesy of scenes between Tony Soprano and Dr. Jennifer Melfi, played by Lorraine Bracco (left).

"I believe that's because the producer happened to have a brother who was a psychiatrist.

While "The Sopranos" focused on talk therapy, real life mental health care now relies a lot on medication. Over the past five years, more prescriptions have been written for anti-depressants than any other class of drug.

So with all we have learned about the brain - how it really functions - is the whole notion of psychotherapy, the "talking cure," still valid?

More so than ever, says Dr. Gabbard.

"I think it's swinging from a kind of over-medicalization of psychiatry," he said. "I've seen so many patients who've had every drug in the book, and they come to me and say, 'You know, no one ever talked to me for more than ten minutes. Can I tell ya' about what's going on at home with my family?'"

But talking for years about family is contrary to an increasingly popular approach - one that Forbes magazine termed a revolution. It's called Cognitive Behavioral Therapy, or CBT.

"We found that the fastest way to get people better, is by focusing on the real life situations they're encountering today," said Dr. Judith Beck. "If we talk a lot about the past, especially initially, patients don't start to feel better, and sometimes they get very hopeless."

Dr. Judith Beck is one of the best-known proponents of CBT, a technique developed by her father, Dr Aaron Beck. With more than twenty books between them, the Becks preach a limited number of sessions, not a life-long commitment. They aim to dispel phobias by rational reasoning, rather than - as Freud would have it - an excavation of childhood.

Dr. Beck believes that insight is not enough: "People can understand what's going on, yet not be able to make the changes in their life that they need to. And I'm not sure what Freud would even say about taking insight to the next step."

Next step or not, which therapy works best? Who would know better than a man who seems to have tried them all?

Comedian Richard Lewis began airing his neuroses publicly more than two decades ago. Yet he was not the typical analysand, stretched out on a couch under the watchful ear of an analyst.

"The only time I have to literally lie down like I was waiting for a masseuse to come, it was at this Freudian doctor back in the early '70s in the hospital," Lewis told Greenfield. "And I never liked that because I always felt she was not even looking at me, and like, you know, reading a novel , 'cause she wasn't talking."

But there's a serious side to Lewis, who's written about his battles with the demons of depression and alcoholism. He credits therapy for his sobriety over the last 14 years.

"I have a bottomless pit of horrific memories!" he laughed. "If I had any gift, it's to mine all these problems. And when I hear people laughing over the last 38 years, I see them, you know, giving an elbow to their significant other saying, 'You see? You see? You know?'"

In the intervening 38 years, he was more in therapy than out of it.

"Yes," Lewis said. "I have a therapist. I've outlived most of them. I went to almost every possible type of therapy. I was fortunate that since I started I had four or five really good therapists."

For most of us, it may not take five therapists, or any of the products advertised on TV. But a century after Freud introduced an obscure theory in Europe, therapy is now part of the American mainstream.