Back to the Couch

Imagine you’re a new mother and your baby cries more than she sleeps. You’re worn out, which doctors misdiagnose as postnatal depression. Along comes a psychiatrist who promises to make you feel better. Ignoring the impact of a difficult baby, he sheets home your troubles to repressed feelings of resentment toward your mother. His methods seem odd. He tucks your hair behind your ears, dries your tears and hugs you. He suggests walks on which he holds your hand and spills about his own life. One time, out of nowhere, he asks you what your clitoris looks like, and another time to describe an orgasm. When you ask why, he reacts as though you’re a bit dense, explaining that “to be a confident, complete mother, you need to be a confident, complete woman. That means being comfortable with all aspects of your femininity, which includes your sexuality.”

This was an early instalment in Rebekah Beddoe’s calamitous encounter with psychiatry, which she recounts in Dying for a Cure (Random House; 346 pages). While the memoir focuses on how psychotropic drugs sent her mad during the early 2000s, Beddoe’s account of her dealings with the eminent Melbourne psychiatrist she calls “Max Braydle” also shines an unflattering light on the talking component of the profession. “Terrible,” says Jon Jureidini, head of psychological medicine at the Adelaide Women’s and Children’s Hospital, of the methods Beddoe ascribes to Braydle. “Sadly, people who read this book will think that is the alternative to being on drugs.” And is it? No—at least it needn’t be. Specialists in psychotherapy, or talking therapy, say Braydle’s style was not only uncommon and wrongheaded but amounts to malpractice. The code of the Royal Australian and New Zealand College of Psychiatrists forbids not only sex with patients but “any behavior which might be reasonably interpreted by a patient as demeaning or as a sexual advance.” Psychiatry will never rid itself entirely of practitioners who use talking therapy to satisfy voyeuristic urges, but it doesn’t want to lose the wheat with the chaff. Indeed, the metaphorical couch is gaining favor over pills as the main tool of treatment for many conditions, with training institutions recently increasing their emphasis on psychotherapy. “We really want to get the balance right,” says Charles Le Feuvre, chair of the r.a.n.z.c.p.’s Psychotherapy Section, “and it may indeed be the case that things have gone too far away from psychotherapy. It’s important that the psychiatrist continues to try to be a humanist as well as a scientist.”

Beddoe—the subject of a Time cover story in 2005—writes that Braydle’s goatee and narrow spectacles lent him a Freudian air. And in the therapist’s preoccupation with sex there are echoes of the work of Sigmund Freud. Psychoanalysis, the family of psychological theories and methods he devised in the 1890s, underpins the many forms of psychotherapy available today. Freud postulated the existence of the unconscious, which he said is shaped by early experience and can profoundly affect moods and behavior, its secrets detectable in dreams and slips of the tongue. “[Braydle] would justify his treatment of [Beddoe] as building a relationship with her,” says Jureidini, who wrote the foreword to Beddoe’s book, “but it’s a bastardization of psychotherapy, just as the way she was treated with medication was a bastardization of the biological approach.”

The arrival of new drugs for depression and psychosis in the early 1990s was a setback for psychotherapy, which some doctors began to portray as a chicken-soup remedy compared to the magic bullets they believed they now had. But in recent years, research has revealed the drugs’ limitations and led to calls for a rethinking of the drug-based approach to treating depression. Aside from lifestyle changes, the only alternative for sufferers is some form of psychotherapy, whose quality could be lifted, experts say, if governments required people calling themselves psychotherapists to meet certain standards. Some of Freud’s ideas have been rightly discarded, says Gil Anaf, president of Australia’s National Association of Practising Psychiatrists, but Freud was right in arguing that early trauma can mess up people forlife: “And with drugs you can’t even touch personality difficulties and maladjustment.”

The drugs hype and advances in neuroscience caused psychotherapy to be neglected in medical education, says Louise Newman, director of the New South Wales Institute of Psychiatry. Lately, she says, “we’ve reintroduced psychotherapy principles in the first year of training”; the aim is “returning to a more holistic approach” to treating mental distress. For the afflicted who want neither to take drugs nor be grilled about intimacies by a doctor, that can only be good news.