The fading of Freud

Adam Phillips's favourite pronoun is "we." He assumes an audience of like-minded people who have read the same books and who warm to generalisations such as "we don't think of babies as sane," and "we have become the only animals who cannot bear themselves."

In his latest book, Going Sane, this prolific psychoanalytic populariser develops the idea that "we" need a new definition of sanity. "We can't quite work out how our lives would be better, or even different, if we were sane."

Whom is he talking to? Not me. Certainly not in his claim that madness is artistically fascinating, that "sanity doesn't quite come to life for us in the same way: it has no drama." Tell that to any admirer of Leopold Bloom, the Dublin Jew who holds Ulysses together with his humane ordinariness. And what about Jane Eyre, sitting in the windowseat at Thornfield Hall while the upper classes frolic at charades? And Huck Finn and Tom Sawyer? The honest life reasonably led is as much the essence of literature as the disquiet of Hamlet or the murderousness of Raskolnikov.

Phillips's short book is full of other ex cathedra pronouncements such as: "The search for understanding is no more and no less than a fear of freedom for the sane adult." He is striving for a new definition of sanity that will combine a conception of the good life with an acceptance that "everyone is anxious all the time." Greed, destructiveness and confusion must be acknowledged. His new golden rule would be: "Humiliating another person is the worst thing we ever do." But Phillips's call for a new concept of sanity will not rally many troops.

What "we" do need is an understanding of how the brain works. The nature of consciousness is the most exciting unsolved scientific problem of the day. How is memory stored? How does vision work? What makes dreams?

In the last 20 years of his life, the Nobel laureate Francis Crick, co-discoverer of the double helix of DNA, shifted his curiosity from molecular biology to brain science. Crick formulated the theory that consciousness lies in the interaction of neurons—nerve cells. "To understand the brain," he says in The Astonishing Hypothesis: The Scientific Search for the Soul, "you must understand neurons and especially how vast numbers of them act together in parallel."

Another academic neurologist, Antonio Damasio, also locates consciousness in the mechanics of the body. The way that the body reports, in thousands of ways, the state of its cells and tissues and strives to keep them stable adds up to consciousness, he says in The Feeling of What Happens. The net effect on the body's owner is a sense of self, "a revelation of existence." Going further, Damasio sees consciousness, with the help of memory, reasoning and language, as "a means to modify existence."

Modifying existence is where neuroscience meets psychoanalysis. Freudian theory is having to make peace with the new theories of the causation of behaviour. Surprisingly, Crick, the arch rationalist, had some good words for Freud: "A physician who had many novel ideas and who wrote unusually well." Damasio goes further. Freud, in his eyes, woke up the world to the reality of the unconscious, the importance of sexuality and of childhood.

But, Freud himself, who trained as a neurologist, foresaw that psychoanalysis would be superseded by neuroscience. In 1909, at a meeting of the Vienna Psychoanalytic Society, he admired the attempt of a surgeon to find the neural basis of mental states. He himself could not reduce his psychological theories to neuroscientific ones but he believed that these problems "may be on the agenda a century after us."

And so they are. The argument that psychoanalysis is a science is not often heard today. Freud was the first, and only, psychoanalyst to be made a member of the Royal Society (in 1936 he was elected as a corresponding member, aged 80). The society awarded him its honour not as an endorsement of the therapeutic use of psychoanalysis, as was clarified in the society's obituary notice in 1941, but as a recognition of his discovery and exploration of the unconscious mind.

For many scientists, Freudianism is bunk. In a forthcoming book, Lewis Wolpert, professor of biology at University College London, ascribes the popularity of Freudian theory to its encouragement of easy causal explanations. In the analysis of dreams, for example, "there is almost always a resemblance between the images in the dream and the supposed cause." Dreams of snakes relate to the penis, or a policeman to an authoritarian father. Anybody can do it.

Not all scientists are so harsh. Steven Rose, professor of biology at the Open University and author of The Twenty-First Century Brain, considers that psychoanalytic therapy does have a place in helping people through "existential" troubles.

To someone going through a bad divorce or in love with an unsuitable person or unhappy at work, the chance to talk to a disinterested person trained in the art of listening can bring great relief. As one therapist said to me when I began work on a biography of Ernest Jones, a pioneer of psychoanalysis in Britain: "The talking cure may not work in theory but it works in practice."

In spite of the medical products now available to treat mental affliction, psychoanalysis is still in demand. Britain's Institute of Psychoanalysis has more members now than it did 40 years ago. But the numbers are not large: there were 403 recognised analysts in 2003-04 compared with 273 in 1963-64. The traditional five day a week analysis being expensive and inconvenient, it is not surprising that many clients now prefer other treatments, with clearly defined time limits. There seems to be a steady stream of people willing to pay £50-100 an hour to pour out their troubles to a professional listener.

Is the talking treatment suitable for those diagnosed with mental illnesses such as schizophrenia? To my surprise, the answer is a qualified "yes." Joseph Schwartz, a London psychoanalytic psychotherapist and author of Cassandra's Daughter, a history of psychoanalysis, believes that, even for psychotics, psychoanalysis (in conjunction with medication) can help to avoid permanent incarceration in a mental institution.

The mental health charity Sane receives thousands of calls every week. What the callers want above all, according to Marjorie Wallace, Sane's director, is "somebody to talk to." About 90 per cent of the callers are on medication, but only 4 per cent have had any counselling.

I, too, believe that the talking cure works. I have undergone psychoanalysis in the "classical" form: couch, five days a week, August off, no pre-agreed date for ending treatment. The theory, on the rare occasions it showed through, seemed ludicrous. "London is a breast," interpreted my Kleinian analyst one day when I was trying to describe why I loved my adopted city. Yuk. Yet for me the net effect of analysis was salutary. It was especially helpful in resolving my difficulties with my young stepchildren whose mother had died. Trying to be the new mother was a mistake when I was, in fact, a stepmother.

In retrospect, what might seem the worst drawback—apart from the cost—turned out to be the best part. As a writer, I found the daily ritual very satisfying. Little time was wasted recapitulating events; you just picked up where you had left off. The much-vaunted "free association" turned out, more often than not, to be a recital of what had gone wrong at the office rather than buried memories popping up from the past.

Constructing a narrative of one's own life has also turned out to be a very good preparation for writing someone else's. Since I became a biographer, I have found I accept many psychoanalytic givens—that the child is father to the man; that small, apparently irrelevant, details matter, and that nothing reveals a life more than the manner of choosing a mate, or facing the loss of parents.

The similarities end there. I work in a room by myself and am not trying to modify anyone's life. Perhaps, however, the biographer, the neuroscientist, the psychoanalyst and the counsellor do have something in common as they ply their various trades. Defining "sanity" does not come into it.