Jewish World Review June 8, 2001 / 18 Sivan, 5761
The first -- the longest continuous study of mental health ever done -- was conducted at Harvard Medical School and was front page news last week. Published in the American Journal of Psychiatry, it tracked 724 men for 60 years and showed that key mental factors such as a stable marriage, completing university, and using certain kinds of defence mechanisms are vital protective factors for health.
The second study, though it applies to only one occupation, should still be of interest to all. It turns out that psychoanalysts have extremely low mortality rates, lower than almost any other occupation save one ("private household workers").
We all die, so the ultimate mortality rate is a perfect 100%. Yet epidemiologists can compare the mortality rates of various groups for a given age. Thus we might ask, what are the rates of death for artists versus politicians when they are 60 years old, or 75?
The study, from the latest issue of the Journal of the American Psychoanalytic Association, compared the mortality rates of male psychoanalysts to all American males, and to all other occupations, for the 30-year period of 1953 to 1982. It found psychoanalysts have a 48% lower mortality rate than the male population at large, which means that, in a given year, they have half the chance of dying as the average American male.
That difference is measured with a statistic called "the standardized mortality ratio," in which an actual death rate of a group forms the numerator, and the death rate of a comparison group forms the denominator. The standardized mortality ratio of male psychoanalysts is lower than all but one of the 124 white male occupational groups listed in Mortality by Occupation and Industry, a U.S. government document. (The lowest ratio was for "private household workers.")
The finding is not attributable simply to the fact that psychoanalysts have higher education or income than average, two factors that correlate with lower mortality. The psychoanalysts in the study were also physicians, yet had significantly lower mortality rates than physicians with comparable years of education, and similar or higher incomes.
The psychoanalysts had each also trained as psychiatrists. Psychiatrists who were psychoanalysts had significantly lower mortality rates than psychiatrists who were not. (Indeed, psychiatrists who were not analysts had the second-highest mortality rate of all physicians.)
What causes these reduced rates? Is it related to the process that selects who will train as analysts? Applicants undergo interviews, based on psychoanalytic estimations of psychological-mindedness, neuroses, defences and development. This process is far from perfect. But perhaps these psychological criteria predict physical health.
Or are the reduced rates an effect of the personal psychoanalysis which is a mandatory part of psychoanalytic training, though not of psychiatric or psychological training?
That is certainly possible. A recent German study (Dossman, Kutter, Heinzel, & Wurmser, 1997) found a one-third decrease in medical visits of all kinds for patients in psychoanalytic psychotherapy or psychoanalysis. Patients also had a 2/5 decline in lost work days, a 2/3 decline in hospitalization and a 1/3 decrease in the use of all medications, sustained in the 2 1/2 years since the completion of therapy.
Though some continue to make the ridiculous claim that all physical illness is psychosomatic, physiologists have documented that the mind can affect the body through a variety of pathways, including the autonomic nervous and immune systems. Of course, the commonest illnesses, such as heart disease, stroke and some cancers can be promoted by behaviours which are under mental control.
I suspect that psychoanalysis has its healthful effects because it works on two fronts. One involves a direct focus on repetitive, self-injurious activities. This involves the relentless examination of how we deceive ourselves as to the effects of certain of our actions. This aspect of analysis has roots going back to the ancient classical tradition -- starting with Socrates, and extending through Plato and Aristotle -- that directed us to use reason to examine all our actions, and ask, do they lead us toward or away from happiness?
But unlike some inheritors of the classical tradition, Freud never succumbed to a simplistic stoicism that demanded we simply control ourselves when we discover our unreasonable tendencies. He realized we could both be under-controlled but also over-controlled. He discovered some of our most self-injurious behaviours come from over-control of natural drives. He showed that repetitive self-injurious behaviours are not always simply bad habits to be eliminated. They often express distortions of our natural, instinctual desires.
Such desires, if not satisfied, lead to longings for substitute satisfactions, which often are felt as irresistible, insatiable cravings. They are insatiable because they are substitutes, not the real thing -- the satisfaction of which is deferred.
The person who is isolated, lonely and eats too much may do so because he or she never addresses the primary longing for passionate human attachments.
Though Freud is often depicted as a stoic, he was actually quite influenced by the Romantic movement -- as his early writings and love letters make clear. From the Romantic line of thought and writers like Schiller he learned that the irrational, and the world of our feelings, are a powerful force that must be heard, if not always acted on, and that they attach us to life and are, for the great majority of people, what makes life worth living.
But Freud's classicism moderated his Romanticism. Thus while he insisted, in a classical way, that civilization is in significant part based on the repression of sexual and aggressive instinctual drives, his Romanticism insisted that if repression is too uncompromising, these instincts will re-emerge in monstrous, symptomatic ways.
Hence, Freud made a new grand synthesis, not only of medical knowledge and neuroscience, but also of classical and Romantic lines of thought, to form a new treatment. One doesn't have to be psychoanalyzed to begin to apply these principles to one's own life.
Most people who were born in 1856, as Freud was, lived to be about 50; Freud
lived until he was 83. This new study makes us wonder whether psychoanalysis
indeed has the power to prolong life, and whether it is true to argue, along
with Solomon, in Proverbs, 13:12 that "Hope deferred maketh a sick
heart,/But desire fulfilled is as the Tree of