Is Psychoanalysis the Answer?: California Takes on Homelessness and Mental Health

California Governor Gavin Newsom has an ambitious plan to attack homelessness in the state by building 10,000 new beds in community treatment facilities. To deal with mental illness and substance abuse disorders in this vulnerable population, the governor will place a bond initiative for $4.68 billion on the March 2024 ballot. However, the question is what kind of treatment will be provided?

Medication vs. Cognitive Therapy vs. Psychoanalysis

In examining a meta-analysis presented by John Thor Cornelius in his video “The Case for Psychoanalysis: Exploring the Scientific Evidence,” it should be clear that the most effective way of dealing with most of the mental issues confronting homeless people is some form of long-term talk therapy. While this recommendation seems unlikely and is hard to envision, there is a robust amount of data showing how psychoanalysis is more effective than pharmaceutical medication and cognitive behavioral therapy. 

Although people suffering from extreme psychotic states do benefit from medication, the turn to pharmacology is usually only successful in the long-term if it is combined with talk therapy. Moreover, the recent focus on cognitive behavioral therapy (CBT) has been shown to be short-sighted. For instance, Scotland recently funded an extensive use of CBT for a range of psychological disorders, and after several years of study, they discovered that the positive effects of this form of treatment quickly dissipated. In fact, not only does the Scotland study undermine the belief in the long-term effectiveness of CBT, but a similar study done in Sweden showed that their own emphasis on treating depression and anxiety with cognitive behavioral therapy turned out to be ineffective and was eventually abandoned.  

Another study comparing the use of psychotropic drugs and CBT for the treatment of depression found that both methods only had short-term positive results: While this high-rate of relapse for people suffering from depression should be concerning, research shows that talk therapy often avoids this problem. According to the Cochrane Library meta-analysis of 23 randomized trials composed of 1,431 patients, long-tern psychotherapy provided sustained improvement for patients suffering from anxiety, depression, and somatic issues. This expansive study matches the findings of the Harvard review of the effectiveness of long-term psychoanalytic therapy. Moreover, another related meta-analysis showed that funding long-term therapy is cost-effective.

In Cornelius’ conclusion to his assessment of previous studies, he argues that the use of antidepression medication and CBT have limited long-term success, while psychoanalysis has shown to have lasting positive effect for many different disorders. The problem is that no one has tried to create a state-funded system for wide-spread, long-term psychotherapy for homeless and incarcerated individuals. What needs to be developed, then, in California and elsewhere, is a way of bringing psychoanalysis to large population of people who cannot afford it.

One possible solution is to train more clinical social workers, psychologists, and psychotherapists to provide psychoanalytic treatment. However, one of the things stopping this type of public-supported therapy is that so many people have bought into the biological theory of mental illness.

I plan to push Newsom and the state to consider more effective treatment models, but I would like to ask my readers to suggest ways to make this happen. Please leave your comments below.