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_-The-Breakthrough-Antipsychotic-That-Could-Change-Everything.jpg?1729528747 "KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg")
Publication Date: 12/11/2023
Duration: 17 minutes, 53 seconds
Transcript:
CHRIS AIKEN: Welcome to the Carlat Psychiatry Podcast, keeping psychiatry honest since 2003. I’m Chris Aiken, the editor in chief of the Carlat Report.
KELLIE NEWSOME: And I’m Kellie Newsome, a psychiatric NP and a dedicated reader of every issue. When we left Sophie Freud in the last episode, the Nazi invasion of Austria had split her family in two. Her father, brother, and grandfather Sigmund escaped to London, and Sophie to Paris with her mother Esti. And as Esti unpacked her belongings a book fell to the floor. On the spine was printed Four Case Studies by Sigmund Freud, but inside the case studies had been removed. In place of the clinical text were black and white photos of beautiful, smiling women in various states of undress. It looked like a secret stash of vintage porn, except her husband Martin Freud was in many of the pictures. Martin had been carrying out affairs through their 19 year marriage. Sophie saw the photos as well, and wrote about them in her diary as a 15 year old. “I cannot honor my father’s taste. Among the 10 little ladies I find two halfway nice, none of them can be compared by father with Mother. And father grins so terribly on all of them… I can imagine how these photos must have broken my Mother’s heart, they scream adultery. They leave me rather cold, although they do give me heart beat and sad feelings…. I do know, he is a free person and I am not here to judge him, and surely it was also Mother’s fault, but still, but still.” Sophie rarely saw her father again. In her 2007 book she writes him off as a cold, aloof man whose development was hindered by being the son of Sigmund Freud. Meanwhile, her mother kept trying to reconcile. She wrote to Sigmund Freud, who was suffering from jaw cancer and had only a few months to live, asking him to intervene as a sort of marriage counselor. Here is Sigmund Freud’s reply:
CHRIS AIKEN: “My Dear Esti, I am so sorry that I cannot fulfill your wish. Lack of understanding between marital partners is nothing that can be changed through the intervention of a stranger, and even the father himself is in such cases a stranger. It is something the two parties have to regulate among themselves.”
KELLIE NEWSOME: Freud tried to stay neutral, but could not help from taking sides as his letter continued …
CHRIS AIKEN: “I only see one thing clearly. The reason for your estrangement which you advance, that Martin no longer finds you pretty, cannot be the true one. I want to say it sounds absurd. Martin is no longer a beauty. You have stayed in better shape than most women of your age and in your life phase there are other things that play a larger role in the mutual relationship than being pretty. I abstain from any partisanship, but I have the impression the reason is that you make your living together onerous.”
He went on to admonish her “hasty prejudgments about people and reprehensible fits of excitement have spoiled many of your chances for more happiness,” and described Esti in even harsher words in a letter to his son Ernst, calling her more than meschugge, a Yiddish word for playful kind of crazy: “She is not only maliciously meschugge but also mad in the medical sense.”
CHRIS AIKEN: When the Nazis invaded France, Sophie fled with her mother to Casablanca and then to America. Upon her arrival, the New Yorker Magazine’s Talk of the Town announced, “Sigmund Freud’s granddaughter, a pretty girl of 18, has just arrived in New York City…. Sophie has never been analyzed. Her grandfather didn’t have the slightest interest in her dreams.” Sophie wasted no time in New York, heading straight to Harvard University in Boston, or at least she would have gone to Harvard if they admitted women back in 1942. So she went to Harvard’s sister school, Radcliffe College, which was gradually absorbed by Harvard in the coming decades. She figured she would become a psychoanalyst and signed up for an introductory course:
KELLIE NEWSOME: “Dynamic Psychology is a very interesting course in which one learns a lot about Freud, but unfortunately our teacher is deadly dull. When I mentioned my name the whole class started to scream and the teacher said “Could you spell that please?” (p139)
CHRIS AIKEN: Her assignment in Dynamic Psychology was to write an autobiographical account of her life, with prompts that were limited to sexual matters like “When did you first masturbate? Did you ever watch sexual relations between your parents?” She found “the whole thing disgusting.”
KELLIE NEWSOME: From Radcliffe Sophie went on to earn a masters and doctorate in social work, and taught at Simmons College in Boston throughout her life. Therapist, author, and podcast host Rick Miller remembers her as a graduate student at Simmons College from 1983 to 1985.
CHRIS AIKEN: I imagine she was quite comfortable on a motorcycle after the many miles she peddled that bicycle through France to escape the Nazis. Sophie eventually gave up the motorcycle her 70’s – reluctantly but smartly so. As a psychiatrist I don’t see a lot of patient deaths – but the ones I do see track right along with the high risk activities on mortality stats – scuba diving, opioid use, and motorcycle accidents. Motorcycles account for 3% of all vehicles on the road but 15% of all traffic fatalities, and most of those deaths cluster in those under age 30 and over age 65.
KELLIE NEWSOME: When it came to health, Sophie lived an intentional life - she regularly exercised, swimming and jogging around Walden Pond near Boston, but she was also a believer in fate. “I think that one has only 5 percent liberty in how to control one’s life,” she wrote. In her classes, Sophie taught both psychoanalytic and family systems theories:
CHRIS AIKEN: Sophie joined with many feminist scholars in criticizing her grandfather’s view of women. At the heart of this debate is whether mental disorders stem from internal causes in the patient’s psyche – their conflicts and fantasy life, or from external causes. Were women seeking traditionally male pursuits because of penis envy, or was it because they lived in a society that limited their options and treated them like second-class citizens? In an age when psychoanalysis was dominant, this debate often one Sigmund Freud’s most famous theories: The seduction theory. Some see it as the birth of psychoanalysis, others the suppression of real trauma.
CHRIS AIKEN: As Freud was developing his psychotherapeutic technique in the 1890’s, shifting from hypnosis to free association talk therapy, he heard patient after patient describe stories of sexual abuse in their childhood. At first, he thought these were factual accounts of abuse, but as the stories piled up he found it hard to believe that sexual abuse was so ubiquitous. Hen pivoted, concluding that they were fantasies concocted by an unsettled imagination. Some patients, he conceded, may have been abused, but that was not the cause of their problems. Neurosis, he believed, was caused by a conflict between the child’s sexual desires and their need to repress those desires. Freud’s ideas quickly got him in trouble with the medical establishment, but not because he was denying childhood trauma. Just the idea that children have sexual feelings was abhorrent to Victorian society, even though Freud got the idea from empirical sources. Other turn-of-the century physicians like Sámuel Lindner and Wilhelm Stekel had described sexual behaviors in young children. Today, the controversy has turned the other way. It’s the denial of childhood sexual abuse that is controversial, and this is where Sophie Freud stepped in.
KELLIE NEWSOME: Sigmund Freud’s ideas evolved over the half a century that he wrote about psychoanalysis. Before he died he admitted to some self-doubt, leaving the door open for his daughter, the child psychoanalyst Anna Freud, and his granddaughter Sophie.
CHRIS AIKEN: "That is all I have to say to you about femininity" he wrote in 1933. "It is certainly incomplete and fragmentary and does not always sound friendly... If you want to know more about femininity, enquire about your own experiences of life, or turn to poets, or wait until science can give you deeper and more coherent information."
KELLIE NEWSOME: Most of Freud’s descendants settled in England, including a famous painter – Lucian Freud and several politicians, novelists, and BBC talking heads. Sophie’s was the branch that made it to the US, and her legacy continues here. Her daughter, Dania Jekel, recently stepped down as executive of the Asperger-Autism Network in Watertown, Massachusetts; her other daughter Andrea Freud Loewenstein is a novelist. Her son George Loewenstein studies the psychology of economic behavior at at Carnegie Mellon University; and she has five grandchildren and two great-grandchildren.
The audio you heard of Sophie Freud was generously provided by the Milton Erickson Foundation whose online library hosts thousands of therapy lectures at catalog.erickson-foundation.org
KELLIE NEWSOME: Now for the moment you’ve been waiting for. A preview of the CME quiz for this episode, which you can earn through the link in the show notes.
1. TRUE OR FALSE: In the early 1900’s, Sigmund Freud created controversy by suggesting that neurotic disorders were rooted in childhood sexual trauma.
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The Carlat CME Institute is accredited by the ACCME to provide continuing medical education for physicians. Carlat CME Institute maintains responsibility for this program and its content. Carlat CME Institute designates this enduring material educational activity for a maximum of one quarter (.25) AMA PRA Category 1 CreditsTM. Physicians or psychologists should claim credit commensurate only with the extent of their participation in the activity.
