Alex Linklater explores the "deep, cultural fault-line" that is dividing our understanding of the way the mind works, and its impact on mental health services.
Last year, the 150th anniversary of Sigmund Freud's birth passed here in Britain with low-key, often confused acknowledgement. It didn't seem to be clear either what there was to be celebrated or what issues were at stake. Which was a pity. It might have been a perfect moment to explore the deep, cultural fault-line that now divides our understanding of the way the mind works.
Over the last 20 years, Britain has taken a lead in the development of new "cognitive" models of the mind, and their related therapy-CBT, or cognitive behaviour therapy.
Richard Layard, the economist and Labour peer, has for some time been arguing that we should train as many as 10,000 new cognitive therapists, and the department of health recently set up two pilot schemes which, if successful, could see Layard's plan implemented-making the NHS the biggest incubator of cognitivism in the world.
The evidence suggests that cognitive therapies are more effective treatments for most mental disorders than any of the so-called "psychodynamic" methods that spring from the Freudian tradition.
The NICE guidelines which promote best-practice in public health recommend cognitive therapy as a treatment for almost all mental disorders. For better or worse, cognitivism has become academic and medical orthodoxy.
So what is the difference between the old psychoanalytic (or psychodynamic) view of the human mind, and the new cognitive one? Very few non-professionals have even a vague answer to that question, yet this divide represents nothing less than a war for the meaning of the human mind.
There are those who believe in the old Freudian symbolism, and there are those who hold by the new cognitive functionalism. (Most of us, by now, have probably absorbed a muddled mixture of both.)
If this were purely a scientific question, then there would be very little left of the traditions of psychoanalysis-whether Freudian, Jungian, Kleinian or Lacanian.
Yet so profound was Freud's cultural impact on the 20th century, that some of his more resilient classifications are ingrained in the language: the unconscious; the idea of repression; the relationship of id, ego, and superego; the Oedipus complex.
Cognitive science does not believe in any of these. But, as ideas, they have the staying power of myth. Why? Because Freudianism wasn't just nascent scientific theory, it was evangelical belief. Secular western society was converted to the unconscious, whether it existed or not.
Cognitivism says that the unconscious does not exist-or, at least, only as metaphor. As neuroscience has mapped memory, language and voluntary action onto specific regions of the brain, so there is no need to hypothesise a generalised realm of unconscious motivation and repression.
We know that most of the brain is non-conscious, but that's got nothing to do with a murky Freudian unconscious. Evolutionary psychology posits prehistoric survival strategies in the place of Freud's psycho-sexual dramas; personality (including its disorders) is viewed as the result of gene-environment interactions.
The great quest for brain scientists is how to explain consciousness, not what lies beneath.
So why aren't we all thinking like cognitivists now? The answer is that, while cognitive science has better empirical methods, and greater evidence for its efficacy in practice (through the litmus test of CBT and associated therapies), it has made nothing like the cultural impact that psychoanalysis had in the 20th century.
It is, by contrast, culturally thin. It thinks in terms of mental function and dysfunction; its conceptualisations of thought spring from computational models of information processing; it shows little curiosity about its own philosophical underpinnings.
Cognitive therapy relieves symptoms, it doesn't attempt to explain the person. The human self, because it has no specific neural location, must be viewed by cognitive neuroscience as a kind of illusion.
The idea that subjective experience-the feeling of being in the world-has an ontological reality, generated through a history of life-events dating back through stages of psychic development is, cognitively speaking, meaningless.
On one level, this is a purely conceptual problem; but it has very real outcomes. Take for example, the mother of a child with behavioural problems. Her GP might refer her down one of two fundamentally different paths, without the mother ever understanding what kind of choice has been made.
If, for example, she ends up taking her child to the Tavistock clinic, which is based on psychodynamic principles, she will be given therapeutic support, and her child will be viewed as having a series of complex relationships and conflicts with family and the outside world.
But the mother will not be told that her child has a specific condition such as obsessive compulsive disorder (OCD) or Attention Deficit Hyperactivity Disorder (ADHD). This would be viewed as crude reductionism.
If the mother ends up talking to cognitive therapists at the Maudsley hospital, on the other hand, something like OCD will be diagnosed, and viewed as a medical entity that needs to be attacked and resolved through target-specific treatment, such as exposure therapy.
The causes, meaning and experience of the condition will be less important than reducing symptoms. In short, this represents an entirely different view of who the child is, and how he or she functions psychologically.
So, on the one hand we have a psychoanalytic tradition, which takes the depth of the human mind seriously, but which shies away from scientific scrutiny and has, as a result, become increasingly redundant.
And, on the other, we have a new cognitive realm which possesses excellent empirical methods but lacks a meaningful language of human experience and relationships.
What needs to happen is for this war of attrition to emerge into a state of open conflict, so that people can begin to understand what kind of ideas are at stake.
The concepts can be difficult and neither side in the war is good at explaining them. But what is at stake is both a profound public health issue, and the continuing, unresolved quest for a science of subjective experience.
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