The crimes of psychiatry are legion, but they can mostly be attributed to a single cause: the idea that the therapist knows more than the patient.
— A. Collins Braithwaite, Untherapy
I have been fascinated by psychiatric case studies since I came across a copy of Robert Lindner’s The Fifty-Minute Hour thirty-odd years ago. ‘I am a psychoanalyst. I meet and work with murderers, sadists—people at the edge of violence—and some who have passed that edge,’ proclaims the lurid cover. What teenager could resist? Later on, though, when I started reading the case histories of Freud, Breuer and others, I came to see each case as a novel-in-waiting, not because of the extraordinary characters who are often the subjects of such studies, but because of the relationship played out between therapist and patient.
By their very nature, case studies present only one point of view. It is the therapist who selects what material to include and exclude, and the interpretation of this material is inevitably viewed through the lens of whatever theory he or she happens to espouse. I came to see these ‘studies’ less as factual accounts of an interaction between medical practitioner and patient, than as skewed encounters between a pseudo-objective ‘expert’ and a voiceless other. How different, I wondered, would these encounters appear if related from the other side of the consulting room?[*]
My interest in this stuff was rekindled by a couple of obscure volumes I recently unearthed in Glasgow’s chaotic Voltaire & Rousseau bookshop: Ways to Psychic Health (1944) by Alphonse Maeder and Untherapy (1965) by A. Collins Braithwaite.
Alphonse Maeder (1882-1971) was a Swiss psychoanalyst, who trained under Jung. Maeder recognises that the personality and belief system of the therapist plays a role in the interaction with the patient; that it is not a wholly objective, scientific process. In addition to his medical and psychiatric training, however, he is a practising Christian. ‘Only a humble self-surrender to God,’ he writes, ‘can really bring about a liberation and transformation…Man’s spiritual and mental being must be firmly anchored in religion…The Bible can, in fact, once again become the decisive experience for modern man.’
I was curious to discover the extent to which this bizarre doctrine would shape Maeder’s interactions with his clients.
Ways to Psychic Health consists of fifteen case histories, mostly drawn from the Viennese upper- and middle-classes: ‘The patients themselves must be suitable’, ie. neither lacking in education nor too mad and institutionalised. Maeder is attentive to his patients’ mannerisms and quirks; the gaps between what they say and how they say it. He stresses the importance of not passing judgement, although his language at times betrays him.
A couple of his studies are of particular interest.
Max is a seventeen year old high school student, whose chief sin appears to be an enthusiasm for jazz. The problem with this inclination is that his father disapproves: his son will never make a living as a jazz musician. For Maeder, Max’s attitude to jazz is never considered a legitimate interest, but is instead both a ‘defiant self-assertion and rejection of his father’ and a pursuit ‘which offers sensual and aesthetic gratification’. After some questioning about Max’s religious beliefs (he declares himself an atheist) and masturbation (which he at first denies practising). Maeder declares Max to be suffering from what he calls ‘defiance neurosis’.
It is reported that Max has started taking an interest in some religious quotations. Max then contacts Maeder: he has given up jazz and now admits to feeling guilty about masturbation and having ‘dirty thoughts about girls’. Maeder seizes his chance, telling him that a ‘road exists which leads from a positive relationship to his father and acceptance of authority to the affirmation of a personal God.’ For Maeder, the positive trajectory is for Max to suppress his egocentric urges and submit to authority. In this he triumphs: ‘Jazz no longer appeals to him, although classical music does.’ The young man’s struggle assert himself as an individual has been quashed. Order – and conformity – is restored. This is presented as a wholly positive conclusion to Max’s case.
Martha, a sixteen-year-old schoolgirl, is suffering from anxiety, insomnia and fainting. Maeder labels her as a ‘hyperthyroid’ or ‘pseudo-hyperthyroid’. Between the ages of twelve and fourteen she had been abused (fondled beneath her dress) by a schoolteacher, and had previously, from the age of five, been fondled by an older farm boy. On her second visit, she ‘realize[s]… that she had felt a secret attraction’ to her abusive teacher, this accompanied by the ‘insight’ that she was ‘a participant and shared in the complicity.’ The suppression of this realization results in feelings of guilt and ‘pathogenic effects’. The abusive incidents with the teacher have also led to Martha losing her faith. It is only through ‘confession’ of her feelings of arousal and complicity that she can be liberated. Maeder makes explicit the parallel between confession to a psychoanalyst and confession to a priest, an analogy in which the patient is cast in the role of ‘sinner’. Similarly, Maeder’s instinct to pathologize Max and Martha makes it clear that there is ‘something wrong’ with them: they are offenders, somehow to blame for their own difficulties.
Unlike Maeder, Collins Braithwaite seems to spend most of his time telling his patients (or ‘visitors’ as he prefers to call them) that there is nothing wrong with them. ‘Everyone want to be mad these days,’ he writes, ‘but hardly anyone is. Not properly mad at any rate.’ Also in contrast to Maeder, Braithwaite makes no pretence of being either objective or non-judgemental. Clients are gleefully dismissed as perverts, dimwits, cry-babies and ‘raving nymphos’ among other things. Of one, he writes, ‘Here we have a man so spineless that, just as a worm does not recognise it does not have a backbone, nor does he: John’s problems are never due to his own failings, but to the universe conspiring against him. Boo-hoo!’
Subjecting oneself to therapy from Braithwaite must have been terrifying. Reading about it is tremendously entertaining.
Braithwaite was born in Darlington in 1925 and, from the scant information available, appears to have had a brief period of celebrity in the mid-1960s. This was a moment when many of the certainties of psychiatry were being challenged by the likes of RD Laing, Erving Goffman and Thomas Szasz. Braithwaite eschews anything that might be described as a doctrine. ‘All psychiatric theories are lies,’ he declares, ‘nothing more than the projections of the egotists who concoct them.’ Nevertheless, he is clearly influenced by Laing whose The Divided Self had been published four years before, both in his suspicion of the psychiatric establishment’s rush to diagnosis, and in finding a certain ‘truth’ in what what previously been dismissed as psychotic or schizophrenic experiences.
Braithwaite’s clients, or at least the ones he chooses to write about, are mostly drawn from the ‘swinging’ London scene of the time. There is ‘Jane’ the ‘nymphomaniac starlet’ who still lives with her middle-class parents in ‘a suburban house full of brown furniture’; there is Milly the fifteen-year-old daughter of a well-to-do (white) solicitor, who believes she is a ‘negress’; there is ‘John’ a successful theatre director who sleeps at home in a cot surrounded by his childhood toys; ‘Alec’ a fifty-something thespian who lives in fear of being exposed as a homosexual, and so on.
Braithwaite treats them all with uncompromising candour:
“My whole life is act,” Alec tells him.
“Well, it’s not much of an act,” Braithwaite retorts. “I could tell you were queer the moment you walked through that door.”
Most of Braithwaite’s therapy appears to consist of telling his clients that there is nothing wrong with them. You want to sleep with your childhood teddy? Go ahead. You feel the need to masturbate ten or twelve times a day – what’s the problem? You think you’re a negress? Maybe you are. And, at least in Braithwaite’s (admittedly endlessly self-aggrandising) account, it seems to work. His clients do not want to be diagnosed. They mostly want to be reassured that other people are just as weird as they are.
If there is a recurring theme through the cases he presents though, it is that his clients are traumatised not by their eccentricities themselves, but by the stress of concealing them; of being forced to present different personae to different audiences. Braithwaite’s remedy is to embrace the idea of ‘being several’ (a phrase he uses repeatedly): to give up the idea that one persona is any ‘truer’ than any of the others. Once one has thrown off the idea of a ‘hierarchy of selves’ one can happily be whoever one wants, whenever ones wants.
With such a credo, it’s easy to see why the Bohemian set of the era appears to have beaten a path to his door. It’s intoxicating stuff.
Braithwaite also goes out of his way to debunk the idea of the therapist as kind of guru with access to truths unavailable to his clients. ‘The only reason my visitors listen to anything I tell them,’ he writes, ‘is because they’ve paid me fives guineas an hour to hear it. Likewise, dear Reader, the only reason you might believe anything in this tawdry little book is because you’ve paid 12/6 for the privilege of reading it.’
And thus he signs off. This reader, for one, will be seeking out more of his tawdry little books.
© GMB, April 2019
[*] Freud’s famous account of the so-called Wolf-Man provides a case in point. Freud bases his entire analysis of his patient on his (somewhat preposterous) interpretation of a childhood dream of his patient. Yet when the Wolf-Man—actually a Russian aristocrat called Sergei Pankejeff—came to write a 300-page account of his life, this dream upon which his psychoanalyst had placed such crucial importance merits not a single mention.
https://archive.org/details/fiftyminutehourclind
Graeme Macrae Burnet 
Intriguing but i’d be just as interested to know if you are using this material in your next book. What is your next book? Michael Macmillan
Thanks, Michael. Your instincts are correct – my new book very much inhabits this terrain. It’s actually called Case Study and will be published in October. I plan to post some info here soon . . .