It's over, nobody wins" is a verse from a Sinatra ballad about a love affair gone sour that one could apply to America's intellectual love affair with Freudian doctrine. What W.H. Auden once described as a "whole climate of opinion" proved, with experience, to be an ideological blunder typical of this century, producing more victims than victories.

Oxford's Isaiah Berlin, in a powerful essay on political ideas of the 20th century, saw it all coming in 1949 when he identified a crucial shift from 19th century views about human nature.

Whereas in that century people saw themselves as rational creatures grappling with perplexing questions, the "modern" view held that the true reasons for human beliefs and behaviors rest on such irrational, unconscious attitudes that people need leaders to identify and solve these questions for them - leaders who could guide, indeed "cure" them from mistaken points of view.

The communist and fascist conceptions of society were obvious examples. In America - the land of the individual - the accepted ideas proposing an irrational foundation to human nature were the psychoanalytic concepts introduced by Dr. Sigmund Freud in 1900 with his book "The Interpretation of Dreams." That a point of view derived from the infirmary should achieve such remarkable authority in our arts, our literature, and our social mores is an intriguing reflection on our age.

Indeed the history of the psychoanalytic movement replicates the course of other 20th century ideologies. Like them, it begins with shocking propositions and assumptions but modifies them over time, almost out of recognition, as the "party line" responds to criticism.

At last a major assault on fundamental principles is launched and the entire movement is overthrown. I witnessed this course as psychoanalysis first failed in the clinic and has now collapsed as an ideology.

In the 1950s, my medical school classmates and I were taught that psychoanalytic theory provided the best approach to understanding mental illness and, as well, represented the highway to understanding normal human psychology. Since then all watched its claims change with fashion.

For example, until the 1970s, psychoanalysts avouched an infantile sexuality passing through oral, anal, genital phases to culminate in the Oedipal complex expressed in the castration fears of little boys and the penis envy of little girls.

Nobody talks this way now. If you ask psychoanalysts how childhood experiences shape mental development, they say that children are emotionally vulnerable and long for love. Surely this is true but hardly news to anyone in 1900 let alone today. It has, however, been a source of misdirected treatment because of other concepts tied to psychoanalytic reasoning.

To be specific, Freudian teaching - from whence the ideas of castration anxiety came and went - rests upon a fundamental assumption vague enough to resist easy contradiction.

Freud proposed a dynamic unconscious at the center of human mental life, energized by sexual drive and filled with repressed unacceptable thoughts. Through this proposal, Freud and his followers indicated that human nature is systematically irrational and claimed that mental illnesses would be cured through analyzing these unconscious, repressed conflicts.

Even more, such analysis would reveal how human feelings of guilt - especially sexual guilt - is a socially imposed illusion ready for dismissal. What need for any Greek legend when by translating the unconscious wishes and conflicts you can explain behavior and lay claim to a commanding role in directing our world?

The authority of these ideas, including the concepts of repression and a dynamic unconscious, is now being refuted root and branch by insightful thinkers and writers who work from an assumption of human rationality. I can recommend three recent books to those who would follow this collapse of another ruling theory in this deceitful century.

They resolve into (1) a chronicle of the misdirections within psychiatric services to the mentally ill generated by this school of thought, (2) a demonstration of the implausibility of the movement's fundamental beliefs, and (3) a prescription for clinical counseling practices that will benefit and not harm patients in the process of treating their mental disorders.

Edward Dolnick presents the chronicle of errors in his book, "Madness on the Couch: Blaming the Victim in the Heyday of Psychoanalysis" (Simon and Schuster, 346 pages, $25). He is an editor of Health magazine and a former science editor of the Boston Globe. His systematically argued book describes much of the parent-blaming tied to psychiatric opinion throughout this century.

Dolnick shows just how - with no more evidence than their own imaginations - therapists have accused parents of being pathogenic agents. Dolnick reveals the bullying and crude contempt showered on parents by overbearing and overconfident therapists who called these parents "schizophrenogenic" or "refrigerator mothers" when proposing to explain children with infantile autism, schizophrenia, or obsessive-compulsive disorder.

He demonstrates how these mistaken ideas were ultimately defeated by investigators who looked at patients without the biases of dynamic theory and brought effective treatment and genuine understanding to them.

A still more compelling indictment of Freudian reasoning is contained in a collection of essays, "Unauthorized Freud: Doubters Confront a Legend" (Viking, 301 pages, $24.95), drawn together by Frederick Crews, former chairman of the department of English at University of California at Berkeley. This book presents critical essays on Freudian thought published previously in the scientific and philosophic literature.

The essays are strengthened by Crews' smoothly written commentaries placing them in context and underlining the conclusions. The collection includes essays by such well-known students of psychoanalysis as Peter Swales and Adolf Grunbaum. Stanley Fish, former professor at Johns Hopkins and renowned for identifying hidden rhetorical purposes in many literary products, has an essay directing attention to the shabby reasoning in Freud's paper on the Wolf Man case.

Finally for a prescription, I recommend "Smoke and Mirrors: The Devastating Effect of False Sexual Abuse Claims" by Terrence W. Campbell (Insight Books, 334 pages, $28.95) where one can find coherent rules for a rational psychotherapy. Dr. Campbell is a clinical psychologist in Michigan who recounts pertinent cases of false allegations of childhood sexual abuse and "repressed memories" that have captured attention over the last decade.

I admire this book for its careful review of therapists' claims masquerading as science that generated ferocious false charges against family members in our courts of law. Campbell presents thoughtful reviews of such notorious cases as McMartin in California and Kelly Michaels in New Jersey.

The book has a superb summary chapter where Campbell reviews what a patient should expect from sound counseling and psychotherapy. He encapsulates his principles in six rules that should be written on every psychotherapist's wall.

I shall not repeat them all, but the first indicates how counter to the century's madness this book is. Campbell states: "Psychotherapy will [be] effective ... when therapists assume a more peripheral role while mobilizing the family and friends of clients into positions of central significance."

This proposition directly challenges those psychotherapists who have entangled patients in years of therapy attempting to draw out imagined repressions. The most effective psychotherapists deal with the real and documented difficulties patients face and move quickly out of their lives, indeed usually teaching patients how to appreciate what their family can do for them.

As this century turns to dust, we should remember that although all patients are human, all humans are not patients. Healthy humans are rational and free. They are capable of building a better world than we can imagine today - especially if we let them try.

Paul R. McHugh, M.D., is Henry Phipps Professor and the director of the department of Psychiatry at Johns Hopkins Medical Institution. He, along with Phillip R. Slavney, authored "The Perspectives of Psychiatry," a standard text used in American medical schools. He has also written articles for the American Journal of Psychiatry, Medicine and Nature Medicine.

Pub Date: 8/23/98