Psychoanalysis is arguably the single most important intellectual development of the 20th century." So begins Joseph Schwartz's history of psychoanalysis, Cassandra's Daughter. A little presumptuous maybe? Not when you have a doctorate in the only other branch of science - particle physics - which could lay claim to such a boast.
To an outsider, the switch from the certainties of science to the uncertainties of the human psyche is about as radical a change of direction as can be imagined. Schwartz's conversion shortly after he completed his PhD in the early 1960s reflected an unwillingness to accept the standard story about science, he explains, which at that time was that everything could be reduced to physics.
One of Schwartz's teachers was physicist-turned-biologist, Max Delbrook, one of the founders of molecular biology and a teacher of James Watson of DNA fame.
"If you look at biology and look at the success of molecular biology you see that they don't have anything to do with physics. Delbrook was a physicist and he went into biology, not because he thought biology could be reduced to physics, but he thought biology could maybe make new laws of physics. It presented entirely new phenomena that could not be understood in terms of physics.
"And essentially that's what proved to be the case; it was how the atoms were arranged that generated living phenomena. It has its own dynamic that encourages one to look at the world as a historical evolution rather than in terms of decreasingly small structures. You can make a time-line of the entire universe beginning with the Big Bang, an area of inanimate which then evolves and develops into living matter, which then evolves into conscious matter. The levels developed out of each other but they can't be reduced.
"And that's why, for me, psychology and psychoanalysis is so original. We do have a real theory of human psychology that is not reducible. What evolves from the human organism is personality. It's unique. So we wouldn't be looking for brain chemicals. One is looking for distortions of personality that come from lived experience. One might have drug therapies, but if we're trying to understand the distress, the disturbance, we're not looking a chemicals, we're looking at what happened in the lived life, what the biological response of the whole human organism is to its lived environment."
Joseph Schwartz has now been a clinical psychotherapist for 20 years, but in Cassandra's Daughter, his fascinating account of the first 100 years of psychoanalysis (Freud's The Interpretation of Dreams was published in 1899), the objectivity of the scientist remains, though he says that "practitioners will recognise that I take a relational point of view". Relational in this sense means the belief that our primary need is for human relationships, while Freud, for example, believed the human goal was pleasure. It was the overemphasis on Freud in the available literature that persuaded Schwartz that a balanced overview was needed.
"I felt very oppressed by the overwhelming quantity of Freud stuff. And I felt that the field was really in need of something that was oriented towards the major issues and not so much the dominant personalities, a history of the problems and the prospects in the field as its developed over the century. There is such a highly developed popular historical consciousness here compared to the States, a sense of being able to learn from history, I thought that by showing how ideas developed people would understand just what psychoanalysis was all about."
The vocabulary of psychoanalysis is part of our lives - ego, unconscious, complex - yet most of us know little enough about it, how it developed and what therapy actually entails and tries to achieve. The history of psychoanalysis and the "talking cure" (the name coined by a patient of Breuer, an early mentor of Freud's) is one of factionalism and falling out. Sadly the in-fighting and resulting divisions documented by Schwartz continue to fragment the field to this day.
However, he believes recent developments in the understanding of the biochemistry of the brain, and the success of the new generation of anti-depressant drugs, have not diminished the role of the talking cure one jot, although Schwartz does not dismiss them entirely. He likens mental health to a spring.
"Sometimes you can stretch it so much that it bends the metal and doesn't return, and that can happen emotionally: the mental pain can be so great that the organism can't really return. If someone is in that much pain you can't talk sensibly, and maybe there is a need for some kind of biochemical intervention to help with the pain, to help with the distress, to help someone feel more in control and it can make a person available to therapy."
What neither medical psychiatrists or analytic psychotherapists can agree on is which comes first, chemical imbalance or emotional trauma. "From my point of view, I think what were fighting against is hostility against emotional life; people do not like to think that pains can be caused by feelings."
Yet we have all experienced the effect of emotion on the body - the adrenaline rush caused by fear, for example. While a doctor, Schwartz contends, will say, "Here, take these pills, he probably won't be as interested in what makes the heart race, whereas the psychotherapist will say, `let's talk about it. What are you frightened of? Why do you think, say, a bus is going to run you over. When did this fear of buses first begin? What do you think is going on?' So they are very different approaches. Our understanding of our mind and body links is relatively poor. Many of the early psychoanalysts were very aware of this.
"There was a sense of limitation, that there are things happening in the body that are not accessible to the talking cure. But whether or not they had been caused by life experiences or caused by some inborn constitutional factor may not actually be relevant."
Psychoanalysis is still regarded with suspicion on this side of the Atlantic. The American model, where the weekly trip to the analyst is as essential to celebrity life as a personal trainer, is right to be viewed askance, Schwartz believes. Woody Allen's well-documented love affair with psychoanalysis has done it no favours either.
"There is still a huge prejudice against every aspect of psychotherapy," says Schwartz. "People who deal with loonies are loony. People who have extreme mental states are loonies. People who have difficulty with feelings are somehow not strong enough."
One of the problems in changing this perception is that success stories are rarely shouted from the hill tops. One exception was Princess Diana, whose descent into mental illness was charted as it happened through the unremitting eye of the camera lens. Then came her equally public psychotherapy and extraordinary recovery. As the long-time partner of Diana's therapist Susie Orbach, Schwartz is well aware of the impact of this very public success story on public opinion, a case where pictures spoke much louder than words.
"They pack a lot more punch than the verbal presentation, and the Diana situation was really right in your face, and it was very powerful and very moving, and people respond to that."
And he believes things are improving. "It's a very difficult struggle. Psychoanalysis has to gain a genuine appreciation, where people who have trauma or extreme social states will consult a well-trained and competent analytic psychotherapist and know they will receive sympathy and effective treatment for aspects of their lives that currently go untreated except by drugs or even more traumatically by electric shock therapy."
Yet the distrust between psychiatry and psychotherapy is no help to patients. He believes that GPs have become more amenable to the idea of the talking cure, and that, compared with hospitalisation, even three years of psychotherapy (the period Schwartz suggests as the optimum) is still cost-effective. As for the different strands of psychoanalysis, that remains a problem.
"Psychoanalysis has grown up outside established university tradition, so there is no forum where differences can be discussed in a collegial way. We need a better way to discuss cases, a better way to engage different points of view. Where is the common ground, where are the differences, what evidence might exist that could be brought to bear on things and of engaging with the experience of people for whom psychotherapy has failed."
Cassandra's Daughter, A History of Psychoanalysis in Europe and America by Joseph Schwartz (Allen Lane The Penguin Press £20 in the UK)