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The autonomous psychoanalytic institutes that have persisted and proliferated over the last century have developed their own unique approaches to research and training, approaches that have become insulated from other forms of research. With some notable exceptions, the psychoanalytic institutes have not provided their students or faculty with appropriately academic settings for questioning scholarship and empirical research. To survive as an intellectual force in medicine and in cognitive neuroscience, and indeed in society as a whole, psychoanalysis will need to adopt new intellectual resources, new methodologies, and new institutional arrangements for carrying out its research.

Several medical disciplines have grown by incorporating the methodologies and concepts of other disciplines. By and large, psychoanalysis has failed to do so. Because psychoanalysis has not yet recognized itself as a branch of biology, it has not incorporated into the psychoanalytic view of the mind the rich harvest of knowledge about the biology of the brain and its control of behavior that has emerged in the last 50 years. This, of course, raises the question, Why has psychoanalysis not been more welcoming of biology? In Freud argued that biology had not advanced enough to be helpful to psychoanalysis.

It was premature, he thought, to bring the two together. One century later, a number of psychoanalysts have a far more radical view. Biology, they argue, is irrelevant to psychoanalysis. To give an example, Marshall Edelson 14 in his book Hypothesis and Evidence in Psychoanalysis , wrote:. Efforts to tie psychoanalytic theory to a neurobiological foundation, or to mix hypotheses about mind and hypotheses about brain in one theory, should be resisted as expressions of logical confusion.

Simultaneous and parallel psychological and physiological study of a patient in an intense anxiety state produces of necessity two separate and distinct sets of descriptive data, measurements, and formulations. There is no way to unify the two by translation into a common language, or by reference to a shared conceptual framework, nor are there as yet bridging concepts that could serve…as intermediate templates, isomorphic with both realms.

For all practical purposes, then, we deal with mind and body as separate realms; virtually, all of our psychophysiological and psychosomatic data consist in essence of covariance data, demonstrating coincidence of events occurring in the two realms within specified time intervals at a frequency beyond chance. I think it is at least possible that scientists may eventually conclude that what Reiser describes does not simply reflect the current state of the art, methodologically, or the inadequacy of our thought but represents, rather, something that is logically or conceptually necessary, something that no practical or conceptual developments will ever be able to mitigate.

In my own numerous interactions with Reiser I have never sensed him to have difficulty relating brain to mind. Nevertheless, I have quoted Edelson at length because his view is representative of that shared by a surprisingly large number of psychoanalysts, and even by Freud in some of his later writings. This view, often referred to as the hermeneutic as opposed to the scientific view of psychoanalysis, reflects a position that has hindered psychoanalysis from continuing to grow intellectually 16 , Now, psychoanalysis could, if it wanted to do so, easily rest on its hermeneutic laurels.

It could continue to expound on the remarkable contributions of Freud and his students, on the insights into the unconscious mental processes and motivations that make us the complex, psychologically nuanced individuals we are 18 — On the other hand, if the field aspires, as I believe most psychoanalysts do aspire, to be an evolving, active contributor to an emerging science of the mind, then psychoanalysis is falling behind. He died in , after an extraordinary productive and creative life…it is important not to get stuck on him, like some rigid symptom, either to idolize him or to denigrate him.

My focus in this article is on ways that biology might reinvigorate the psychoanalytic exploration of mind. I should say at the outset that although we have the outlines of what could evolve into a meaningful biological foundation for psychoanalysis, we are very much at the beginning.

We do not yet have an intellectually satisfactory biological understanding of any complex mental processes. Nevertheless, biology has made remarkable progress in the last 50 years, and the pace is not slacking. As biologists come to focus more of their efforts on the brain-mind, most of them have become convinced that the mind will be to the biology of the twenty-first century what the gene has been to the biology of the twentieth century.

The next one will concentrate on memory and desire. Will it be able to answer the questions they pose? My key argument is that the biology of the next century is, in fact, in a good position to answer some of the questions about memory and desire, that these answers will be all the richer and more meaningful if they are forged by a synergistic effort of biology and psychoanalysis. In turn, answers to these questions, and the very effort of providing them in conjunction with biology, will provide a more scientific foundation for psychoanalysis.

In the next century, biology is likely to make deep contributions to the understanding of mental processes by delineating the biological basis for the various unconscious mental processes, for psychic determinism, for the role of unconscious mental processes in psychopathology, and for the therapeutic effect of psychoanalysis.

Now, biology will not immediately enlighten these deep mysteries at their core. These issues represent, together with the nature of consciousness, the most difficult problems confronting all of biology—in fact, all of science. Nevertheless, one can begin to outline how biology might at least clarify some central psychoanalytic issues, at least at their margins. Here I outline eight areas in which biology could join with psychoanalysis to make important contributions: 1 the nature of unconscious mental processes, 2 the nature of psychological causality, 3 psychological causality and psychopathology, 4 early experience and the predisposition to mental illness, 5 the preconscious, the unconscious, and the prefrontal cortex, 6 sexual orientation, 7 psychotherapy and structural changes in the brain, and 8 psychopharmacology as an adjunct to psychoanalysis.

Central to psychoanalysis is the idea that we are unaware of much of our mental life. A great deal of what we experience—what we perceive, think, dream, fantasize—cannot be directly accessed by conscious thought. Nor can we explain what often motivates our actions. The idea of unconscious mental processes is not only important in its own right, but it is critical for understanding the nature of psychic determinism.

Given the centrality of unconscious psychic processes, what can biology teach us about them? In Brenda Milner 29 made the remarkable discovery, based on studies of the amnestic patient H. In she made the further discovery that even though H. These memories—what we now call procedural or implicit memory—are completely unconscious and are evident only in performance rather than in conscious recall. Using the two memory systems together is the rule rather than the exception. These two memory systems overlap and are commonly used together so that many learning experiences recruit both of them.

Indeed, constant repetition can transform declarative memory into a procedural type. For example, learning to drive an automobile at first involves conscious recollection, but eventually driving becomes an automatic and nonconscious motor activity. Procedural memory is itself a collection of processes involving several different brain systems: priming, or recognition of recently encountered stimuli, is a function of sensory cortices; the acquisition of various cued feeling states involves the amygdala; formation of new motor and perhaps cognitive habits requires the neostriatum; learning new motor behavior or coordinated activities depends on the cerebellum.

Different situations and learning experiences recruit different subsets of these and other procedural memory systems, in variable combination with the explicit memory system of the hippocampus and related structures 30 , 31 figure 1. In procedural memory, then, we have a biological example of one component of unconscious mental life. First, he used the term in a strict or structural way to refer to the repressed or dynamic unconscious. This unconscious is what the classical psychoanalytic literature refers to as the unconscious.

It includes not only the id but also that part of the ego which contains unconscious impulses, defenses, and conflicts and therefore is similar to the dynamic unconscious of the id. In this dynamic unconscious, information about conflict and drive is prevented from reaching consciousness by powerful defensive mechanisms such as repression. Second, in addition to the repressed parts of the ego, Freud proposed that still another part of the ego is unconscious. Unlike the unconscious parts of the ego that are repressed and therefore resemble the dynamic unconscious, the unconscious part of the ego that is not repressed is not concerned with unconscious drives or conflicts.

Moreover, unlike the preconscious unconscious, this unconscious part of the ego is never accessible to consciousness even though it is not repressed. Since this unconscious is concerned with habits and perceptual and motor skills, it maps onto procedural memory. I shall therefore refer to it as the procedural unconscious. Finally, Freud used the term descriptively, in a broader sense—the preconscious unconscious— to refer to almost all mental activities, to most thoughts and all memories that enter consciousness.

According to Freud, an individual is not aware of almost all of the mental processing events themselves yet can have ready conscious access to many of them by an effort of attention. From this perspective, most of mental life is unconscious much of the time and becomes conscious only as sensory percepts: as words and images. Of these three unconscious mental processes, only the procedural unconscious, the unconscious part of the ego that is not conflicted or repressed, appears to map onto what neuroscientists call procedural memory for a similar argument see also reference This important correspondence between cognitive neuroscience and psychoanalysis was first recognized in a thoughtful article by Robert Clyman 34 , who considered procedural memory in the context of emotion and its relevance for transference and for treatment.

This idea has been developed further by Louis Sanders, Daniel Stern, and their colleagues in the Boston Process of Change Study Group 35 , who have emphasized that many of the changes that advance the therapeutic process during an analysis are not in the domain of conscious insight but rather in the domain of unconscious procedural nonverbal knowledge and behavior. To encompass this idea, Sanders 36 , Stern 37 , and their colleagues have developed the idea that there are moments of meaning— moments in the interaction between patient and therapist—which represent the achievement of a new set of implicit memories that permits the therapeutic relationship to progress to a new level.

This progression does not depend on conscious insights; it does not require, so to speak, the unconscious becoming conscious. Growth in these categories of knowledge leads to strategies for action that are reflected in the ways in one person interacts with another, including ways that contribute to transference.

Marianne Goldberger 38 has extended this line of thought by emphasizing that moral development also is advanced by procedural means. She points out that people do not generally remember, in any conscious way, the circumstances under which they assimilated the moral rules that govern their behavior; these rules are acquired almost automatically, like the rules of grammar that govern our native language. I illustrate this distinction between procedural and declarative memory that comes from cognitive neuroscience to emphasize the utility for psychoanalytic thought of a fundamentally neurobiological insight.

But in addition, I would suggest that as applied to psychoanalysis, these biological ideas are still only ideas. What biology offers is the opportunity to carry these ideas one important step further. We now know a fair bit about the biology of this procedural knowledge, including some of its molecular underpinnings 8.

The interesting convergence of psychoanalysis and biology on the problem of procedural memory confronts us with the task of testing these ideas in a systematic way. In so doing we will want to examine, in behavioral, observational, and imaging studies, to what degree different components of a given moment of meaning or different moments of this sort recruit one or another anatomical subsystem of procedural memory.

As these arguments make clear, one of the earlier limitations to the study of unconscious psychic processes was that no method existed for directly observing them. All methods for studying unconscious processes were indirect. Thus, a key contribution that biology can now make—with its ability to image mental processes and its ability to study patients with lesions in different components of procedural memory—is to change the basis of the study of unconscious mental processes from indirect inference to direct observation.

By these means we might be able to determine which aspects of psychoanalytically relevant procedural memory are mediated by which of the subcortical systems concerned. In addition, imaging methods may also allow us to discern which brain systems mediate the two other forms of unconscious memory, the dynamic unconscious and the preconscious unconscious. Before I turn to the preconscious unconscious and its possible relation to the prefrontal cortex, I first want to consider three other features related to the procedural unconscious: its relation to psychic determinism, to conscious mental processes, and to early experience.

Every psychic event, whether procedural or declarative, is determined by an event that precedes it. Psychological determinacy is similarly important in psychopathology. Every neurotic symptom, no matter how strange it may seem to the patient, is not strange in the unconscious mind but is related to preceding mental processes.

The connections between symptoms and causative mental processes or between the images of a dream and their preceding psychically related events are obscured by the operation of ubiquitous and dynamic unconscious processes. The development of many ideas within psychoanalytic thought and its core methodology, free association, derives from the concept of psychic determinism The purpose of free association is to have the patient report to the psychoanalyst all thoughts that come to mind and to refrain from exercising over them any degree of censorship or direction 39 , The key idea of psychic determinism is that any mental event is causally related to its preceding mental event.

Each psychic event is determined by the ones which precede it. Although we do not have a rich biological model of psychic declarative explicit knowledge, we have in biology a good beginning of an understanding of how associations develop in procedural memory for a review see reference Insofar as aspects of procedural knowledge are relevant to moments of meaning, these biological insights should prove useful for understanding the procedural unconscious. In the last decade of the nineteenth century, at the time that Freud was working on his theory of psychological determinacy, Ivan Pavlov was developing an empirical approach to a particular instance of psychic determinism at the level of what we now call procedural knowledge: learning by association.

Pavlov sought to elucidate an essential feature of learning that had been known since antiquity. Western thinkers since Aristotle had appreciated that memory storage requires the temporal association of contiguous thoughts, a concept later developed systematically by John Locke and the British empiricist philosophers. By changing the timing of two sensory stimuli and observing changes in simple reflex behavior, Pavlov 41 established a procedure from which reasonable inferences could be made about how changes in the association between two stimuli could lead to changes in behavior—to learning for more recent reviews see references 31 and 42 — Pavlov thus developed powerful paradigms for associative learning that led to a permanent shift in the study of behavior, moving it from an emphasis on introspection to an objective analysis of stimuli and responses.

This is exactly the sort of shift we are looking for in psychoanalytic investigations of psychic determinism. I have described this familiar paradigm because I want to emphasize three points relevant to psychoanalytic thought. First, in learning to associate two stimuli, a subject does not simply learn that one stimulus precedes the other. Instead, in learning to associate two stimuli, a subject learns that one stimulus comes to predict the other for a discussion of this point, see references 44 and Second, as we shall see below, classical conditioning is a superb paradigm for analyzing how knowledge can move from being unconscious to entering consciousness Finally, classical conditioning can be used to acquire not only appetitive responses but also aversive ones and thus can give us insight into the emergence of psychopathology.

I now turn to each of these points. For many years psychologists thought that classical conditioning followed rules of psychic determinism similar to those outlined by Freud. They thought that classical conditioning depended only on contiguity, on a critical minimum interval between the conditioned and the unconditioned stimulus, so that the two were experienced as connected. According to this view, each time a conditioned stimulus is followed by a reinforcing or unconditioned stimulus, a neural connection is strengthened between the stimulus and the response or between one stimulus and another, until eventually the bond becomes strong enough to change behavior.

The only relevant variable determining the strength of conditioning was thought to be the number of pairings of the conditioned stimulus and unconditioned stimulus. Kamin found that animals learn more than contiguity; they learn contingencies. They do not simply learn that the conditioned stimulus precedes the unconditioned stimulus but rather that the conditioned stimulus predicts the unconditioned stimulus. Thus, associative learning does not depend on a critical number of pairings of conditioned stimulus and unconditioned stimulus but on the power of the conditioned stimulus to predict a biologically significant unconditioned stimulus These considerations suggest why animals and people acquire classical conditioning so readily.

Classical conditioning, and perhaps all forms of associative learning, likely evolved to enable animals to learn to distinguish events that regularly occur together from those that are only randomly associated. What environmental conditions might have shaped or maintained a common learning mechanism in a wide variety of species? All animals must be able to recognize and avoid danger; they must search out rewards such as food that is nutritious and avoid food that is spoiled or poisoned.

An effective way to achieve this knowledge is to be able to detect regular relationships between stimuli or between behavior and stimuli. It is possible that by examining this relationship in cell biological terms, we may well be looking at the elementary mechanism of psychic determinism.

Conventional classical conditioning is usually carried out in a form called delay conditioning, in which the onset of the conditioned stimulus typically precedes the onset of the unconditioned stimulus by about msec, and both the conditioned stimulus and the unconditioned stimulus terminate together figure 2.

This form of conditioning is prototypically procedural 31 , When a normal human subject learns an eyeblink response to a weak tactile stimulus on his brow, that subject is unaware that he or she is being conditioned. Patients with damage to the hippocampus and the medial temporal neocortex, who therefore lack explicit declarative memory altogether, can be conditioned like normal subjects in a delay conditioning paradigm. A slight variation, trace conditioning , converts implicit conditioning into explicit memory. With trace conditioning the conditioned stimulus terminates before the unconditioned stimulus occurs, so that the conditioned stimulus is brief, and there is a msec gap between the termination of the conditioned stimulus and the onset of the unconditioned stimulus figure 2.

Clark and Squire 48 extended these experiments to humans and found that trace conditioning requires conscious recall. In the course of trace conditioning, normal subjects usually become consciously aware of the temporal gap in the relationship between the conditioned stimulus and unconditioned stimulus. Those subjects who do not become aware of this gap do not acquire trace conditioning. Moreover, this task cannot be mastered by people who suffer from amnesia—from a defect in declarative memory—as a result of lesions to the medial temporal lobe.

Thus, a small shift in temporal sequence changes an instance of psychic determinism from being unconscious to being conscious! This is consistent with the idea that the two memory systems, procedural and declarative, are often jointly recruited by a common task and encode different aspects of the sensory pattern of stimuli or of the external world present to the subject. Where in the medial temporal lobe is this shift from one type of memory storage to the other occurring? Eichenbaum 51 has argued that the hippocampus functions to associate noncontiguous events over space and time.

We in fact now know that trace conditioning recruits the hippocampus and the circuitry of the medial temporal lobe. Which parts of the hippocampal circuitry are key for trace conditioning? Do other regions become involved? Does the prefrontal cortex which we shall consider below —an area concerned with working memory that is thought to represent an aspect of the preconscious unconscious—mediate associations between unconscious and conscious memories that are the subject of analysis?

We have seen that one point of convergence between biology and psychoanalysis is the relevance of procedural memory for early moral development, for aspects of transference, and for moments of meaning in psychoanalytic therapy. We have considered a second point of convergence in examining the relationship between the associative characteristic of classical conditioning and psychological determinacy.

Here, I want to illustrate a third point of convergence: that between Pavlovian fear conditioning, a form of procedural memory mediated by the amygdala, signal anxiety, and posttraumatic stress syndromes in humans. Early in his work on classical conditioning, Pavlov appreciated that conditioning is appetitive when the unconditioned stimulus is rewarding, but the same procedure will produce defensive conditioning when the unconditioned stimulus is aversive. Pavlov next found that defensive conditioning provides a particularly good experimental model of signal anxiety, a form of learned fear that can be advantageous.

It is pretty evident that under natural conditions the normal animal must respond not only to stimuli which themselves bring immediate benefit or harm, but also to other physical or chemical agencies…which in themselves only signal the approach of these stimuli; though it is not the sight or the sound of the beast of prey which is itself harmful to smaller animals, but its teeth and claws. A similar proposal was made independently by Freud. Because painful stimuli are often associated with neutral stimuli, symbolic or real, Freud postulated that repeated pairing of neutral and noxious stimuli can cause the neutral stimulus to be perceived as dangerous and to elicit anxiety.

Placing this argument in a biological context, Freud wrote:. The individual will have made an important advance in his capacity for self-preservation if he can foresee and expect a traumatic situation of this kind which entails helplessness, instead of simply waiting for it to happen. Let us call a situation which contains the determinant for such expectation a danger situation. It is in this situation that the signal of anxiety is given. Thus, both Pavlov and Freud appreciated that it is biologically adaptive to have the ability to respond defensively to danger signals before the real danger is present.

Signal or anticipatory anxiety prepares the individual for fight or flight if the signal is from the environment. Freud suggested that mental defenses substitute for actual flight or withdrawal in response to internal danger. Signal anxiety therefore provides an opportunity for studying how mental defenses are recruited: how psychic determinism gives rise to psychopathology.

We know that the amygdala is important for emotionally charged memory, as in classical conditioning of fear by pairing a neutral tone with a shock The amygdala coordinates the flow of information between the areas of the thalamus and the cerebral cortex that process the sensory cues and areas that process the expression of fear: the hypothalamus, which regulates the autonomic response to fear, and the limbic neocortical association areas, the cingulate cortex and prefrontal cortex, which are thought to be involved in evaluating the conscious evaluation of emotion.

LeDoux has argued that in anxiety, the patient experiences the autonomic arousal as something threatening happening, an arousal mediated by the amygdala. LeDoux attributes the absence of awareness to a shutting down of the hippocampus by stress, a mechanism considered below. We now have excellent methods for imaging these structures in both experimental animals and humans in order to address the question of how these linkages are established and, once established, how they are maintained 53 — Signal anxiety represents a simple example of an acquired psychopathology.

But, as is the case with all things acquired, some people have a greater constitutional disposition than others to acquire neurotic anxiety. What factors predispose an individual to associate a variety of neutral stimuli with threatening ones? In Mourning and Melancholia and in his other writings, Freud emphasized two components in the etiology of acquired psychopathology: constitutional including genetic predispositions and early experiential factors, especially loss. Indeed, there is evidence in the development of many forms of mental illness for both genetic components and experiential factors both early developmental factors and later acute precipitating factors.

As one example, while there is a clear genetic contribution to susceptibility to depression, many patients with major depression have experienced stressful life events during childhood, including abuse or neglect, and these stressors are important predictors of depression 56 — The case is most clear for posttraumatic stress disorder PTSD , which requires for its diagnosis the presence of stressful experience so severe as to be outside the range of usual human experience. This incomplete penetrance raises the question, What besides genes predisposes people to developing PTSD and other stress-related disorders?

This initial representation of people and of relationships is thought to be critical for the subsequent psychological development of the child.

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The interaction goes both ways. Secure attachment of mother and infant is thought to foster in the infant comfort with itself and basic trust in others, whereas insecure attachment is thought to foster anxiety. By the end of the first year, the motor and intellectual performance of the children in the orphanage had fallen far below that of the children in the nursing home; those children were withdrawn and showed little curiosity or gaiety. Harry Harlow extended this work one important step further by developing an animal model of infant development 63 , He found that when newborn monkeys were isolated for 6 months to 1 year and then returned to the company of other monkeys, they were physically healthy but behaviorally devastated.

These monkeys crouched in a corner of their cages and rocked back and forth like severely disturbed or autistic children. They did not interact with other monkeys, nor did they fight, play, or show any sexual interest. Isolation of an older animal for a comparable period was innocuous.

Thus, in monkeys, as in humans, there is a critical period for social development. Harlow next found that the syndrome could be partially reversed by giving the isolated monkey a surrogate mother, a cloth-covered wooden dummy. This surrogate elicited clinging behavior in the isolated monkey but was insufficient for the development of fully normal social behavior.

Normal social development could only be rescued if, in addition to a surrogate mother, the isolated animal had contact for a few hours each day with a normal infant monkey who spent the rest of the day in the monkey colony. The work of Anna Freud, Spitz, and Harlow was importantly extended by John Bowlby, who began to think about the interaction of the infant and its caregiver in biological terms.

Bowlby 23 , 65 formulated the idea that the defenseless infant maintains a closeness to its caretaker by means of a system of emotive and behavioral response patterns that he called the attachment system. Bowlby conceived of the attachment system as an inborn instinctual or motivational system, much like hunger or thirst, that organizes the memory processes of the infant and directs it to seek proximity to and communication with the mother.

These repeated experiences become encoded in procedural memory as expectations that help the infant feel secure. Both in humans and in experimental animals, declarative memory develops later. Thus, infantile amnesia, which results in the fact that very few memories from early childhood are accessible to later recall, is evident not only in humans but also in other mammals, including rodents. This amnesia presumably occurs not because of the powerful repression of memories during resolution of the oedipal complex, but because of slow development of the declarative memory system Bowlby described the response to separation as occurring in two phases: protest and despair.

Events that disturb the proximity of the infant to the attachment object elicit protest: clinging, following, searching, crying, and acute physiological arousal lasting minutes to hours. These behaviors serve to restore proximity. When contact is regained, these clinging behaviors are shut off, according to Bowlby, by a feedback mechanism, and alternative behavioral systems, most notably exploratory behavior, become activated. If separation is prolonged, despair gradually replaces the early responses as the infant recognizes that separation may be prolonged or permanent and shifts from anxiety and anger to sadness and despair.

Whereas protest is thought to be adaptive by increasing the likelihood that the parent and infant find each other again, despair is thought to prepare the infant for prolonged passive survival achieved by conserving energy and withdrawing from danger. We owe to Levine and colleagues 66 — 68 , Ader and Grota 69 , and Hofer 70 , 71 the discovery that a similar attachment system exists in rodents.

The extension of this research to a rodent model system, which is much simpler, but still mammalian, holds great power. For example, in mice individual genes can be expressed or ablated, which allows a powerful approach for relating individual genes to behavior. Levine found that rat pups show an immediate protest to separation consisting of repeated high-intensity vocalization, agitated searching, and high levels of self-grooming. If the mother fails to return and the separation continues, the protest behaviors wane over a period of hours and are replaced by a number of slower-developing behaviors—akin to despair—as the pups become progressively less alert and responsive, and their body temperature and heart rate drop.

Hans Selye 72 had pointed out as early as that humans and experimental animals respond to stressful experiences by activating their hypothalamic-pituitary-adrenal HPA axis. The end product of the HPA system is the release of glucocorticoid hormones by the adrenal gland. These hormones serve as major regulators of homeostasis—of intermediary metabolism, muscle tone, and cardiovascular function. Together with catecholamines released by the autonomic nervous system and by the adrenal medulla, the secretion of glucocorticoids is essential for survival in the face of stress.

Levine therefore asked the question, Can the long-term response of the HPA system to stress be modulated by experience? If so, is it particularly sensitive to early experience? Levine discovered that when, during the first 2 weeks of life, pups were removed from their mothers for only a few minutes, the pups showed increased vocalization, which elicited increased maternal care.

The mothers responded by licking, grooming, and carrying these pups around more often than if they had not been removed. By contrast, when, during the same 2-week period of life, pups were separated from their mothers for prolonged periods of time 3—6 hours per day for 2 weeks , the opposite reaction ensued. Now the mothers ignored the pups, and the pups showed an increase in plasma ACTH and glucocorticoid responses to stress as adults.

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Here we have a remarkable example of how early experience alters the set point for a biological response to stress. Studies by Charles Nemeroff and Paul Plotsky have found that these early adverse life experiences result in increased gene expression for corticotropin-releasing factor CRF , the hormone released from the hypothalamus to initiate the HPA response. Daily maternal separation during the first 2 weeks is associated in the rat with profound and persistent increases in the expression of the messenger RNA for CRF, not only in the hypothalamus but also in limbic areas including the amygdala and the bed nucleus of the stria terminalis 74 — However, the biological insights into attachment theory do not stop here.

What is the connection between the patients utterance and what he said five minutes ago, or yesterday? Is the patients facial expression in harmony with or in contradiction to what he is saying? Is that which he just mentioned to be found in Freuds table of symbols? Is his affect commensurate with his utterance? By the time the analyst considers all these points the patient will have gone on to something else. No, discovering what the patient really means does not.

In performing this part of his task the tool of the analyst is his own unconscious. Does this admission deny the scientific character of the psychoanalytic method? How can the analyst, working with his intuition, actually know if that which he has surmised is really correct? The answer to this question may be postponed for the time being.

An interpretation, it has been stated, can only be effective if it is given at the moment when the distance between what is said and what is meant is at a minimum. How can the analyst know when to interpret? He must constantly have an awareness of the strength of the resistances operative at any given moment. Everything that prevents the patient from producing material derived from the unconscious is resistance.

It is impossible to tabulate the various ways in which resistance can be expressed. The patient may stop talking, or he may talk so much that a common factor cannot be deduced from his utterances. What he says appears to deviate further and further from what he actually means; it seems to be extensive rather than deep.

If we call the patients attention to this, he may reply: You asked me to say everything that comes to my mind. If my associations tend to spread out in all directions, should I therefore abandon the basic rule of analysis? The answer is simple: The patient must follow the basic rule as closely as he can. If, however, no common factor develops, the analysis is confronted with an antecedent problem, which must be recognized before what is actually meant can be surmised: Why do the patients associations extend in all directions? Both the analyst and the patient must co-operate to find out why the patient expresses his resistance in this specific form.

The patient may forget certain things, important events of the day before, or something that has already been discussed in the analysis. He may criticize every comment of the analyst; he may feel antagonistic or ill at ease. It is the aim of analysis to demonstrate to the patient the disturbing residues of the past in his present feelings and reactionsto connect the present with the past. Thus a certain form of resistance consists in the patients talking only about the present and refusing to see the past; in the converse form of resistance the patient talks only about childhood memories and refuses to see their representations in present reality.

It is the aim of analysis to confront the patients reasonable ego with the irrational emotions effective within him. Thus a certain form of resistance consists in the patients always being reasonable and refusing to have any understanding for the logic of emotions; in the opposite type of resistance the patient floats continuously in unclear emotional experiences without getting the necessary distance and freedom which would permit him to look at them reasonably. All these are forms of resistance that are easily recognizable as such. Some resistances, however, operate far more secretively.

A patient may, for example, appear to be doing good analytic work; he may make progress in understanding the forces working within him, sense connections, and dig up new childhood recollectionsand yet there is no change in his neurosis. This may be due to the operation of various hidden resistances. A certain attitude of the patient, which itself has not been analyzed, may nullify the effect of the analysis. For instance, he may have a feeling of doubt: That would all be very fine if it were true, but I dont know if it is true.

Or the patient may have understood what his associations and the analysts interpretations showed him and yet the knowledge remains entirely separated from his real life. It is as if he said to himself: This is all valid only as long as I lie on the couch. Or a patient may accept everything the analyst tells him merely as a matter of courtesy; but it is just this courteous attitude which protects him from reliving to the full his instinctual conflicts, and which therefore must first be analyzed.

There are intellectual resistances in which patients try to refute the theoretical validity of psychoanalysis instead of seeking to clarify their own mental life. But there are also intellectual resistances of the reverse type: some patients become enthusiastic supporters of psychoanalysis in order to avoid applying it to themselves. An acute resistance, one that is directed against the discussion of some particular topic, is far easier to handle than character resistances. These are attitudes which the patient had previously developed in order to maintain his repressions, and which he now exhibits toward the analyst.

These attitudes must first be broken down before the repressions can be resolved. Understanding the contents of the patients unconscious from his utterances is, relatively, the simplest part of the analysts task. Handling the transference is the most difficult. It seems very natural that in the course of an analytic treatment the patient should produce powerful affects.

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They may appear as anxiety or joy, as an increase in inner tension beyond the point of endurance, or as a happy feeling of complete relaxation. They may also take the form of specific feelings toward the analyst: an intense love, because the analyst is helping him, or bitter hatred, because the analyst forces him to undergo unpleasant experiences.

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But the problem becomes more complicated when a patients affect is in contradiction to what is happening in the analysis, as, for example, when a patient hates the analyst for helping him, or loves him for imposing an unpleasant restriction. The problem is even more complicated when the patient obviously misconstrues the real situation and loves or hates the analyst for something which, in the judgment of the analyst, is nonexistent.

Such misconstruing of the actual psychoanalytic situation is a regular occurrence in almost every analysis. Freud was at first surprised when he met with this phenomenon ; today Freuds discoveries make it easy to understand it theoretically. The analytic situation induces the development of derivatives of the repressed, and at the same time a resistance is operative against it.

The derivatives. Resistance distorts the true connections. The patient misunderstands the present in terms of the past; and then instead of remembering the past, he strives, without recognizing the nature of his action, to relive the past and to live it more satisfactority than he did in childhood.

He transfers past attitudes to the present. In analysis, transference has a twofold aspect. Fundamentally it must be considered as a form of resistance. The patient defends himself against remembering and discussing his infantile conflicts by reliving them. Transference actions since the object is not the right one and the situation is not fitting serve the purpose of distorting the original connections, and the discharge thus attained is necessarily insufficient.

The analysand, seeking immediate satisfaction of derivatives instead of facing his original impulses, attempts to use a short-circuit substitute for his repressed drives. On the other hand, the transference offers the analyst a unique opportunity to observe directly the past of his patient and thereby to understand the development of his conflicts. In everyday life, too, there are transference situations.


It is a general human trait to interpret ones experiences in the light of the past. The more that repressed impulses seek expression in derivatives, the more hampered is the correct evaluation of the differences between the present and the past, and the greater is the transference component of a persons behavior. However, the psychoanalytic situation in particular promotes the production of transference in two ways: 1 The environment which is reacted to has a relatively uniform and constant character and therefore the transference component in the reactions becomes much more pronounced.

Thus the transference character of the patients feelings becomes clearer. The analysts reaction to transference is the same as to any other attitude of the patient: he interprets. He sees in the patients attitude a derivative of unconscious impulses and tries to show this to the patient. Practically, this task is far more difficult than any other type of interpretation.

Were the analyst to behave as the patients parents had previously done, he could not help him, for then what had occurred in the patients childhood would merely be repeated. And were the analyst to behave in a contrary way, he would not be able to cure the patient either, for then he would only be fulfilling the patients resistance wishes.

The analyst, therefore, must do neither the one nor the other. If he were to feel flattered by the love of the patient and responded in kind, or if he were hurt by the patients feeling of hate, in short, if he were to react to the affects of his patient with counteraffects, he could not successfully interpret; for the patient could respond to interpretations in some such way as: No, I love you or hate you not because of unresolved love or hate tendencies of my past but because you have actually behaved in a lovable or hateful way.

There are several reasons why analytic institutes require that all analysts themselves first be analyzed. One of the reasons is that in psychoanalytic courses it is not possible to give clinical demonstrations, and consequently the future analyst can learn analytic technique only by personal experience. A second reason is that the analysts own repressions would make him overlook certain things in his patient, or see others in an exaggerated way and therefore falsify their significance. Much more fundamental is a. It is not easy to face the innumerable and various affects with which patients bombard the analyst without reacting with counteraffects, whether conscious or unconscious.

The unconscious tendencies of the analyst to express his own unresolved love and hate tendencies by reacting to transference with countertransference must therefore be eliminated through a training analysis. Systematic and consistent interpretative work, both within and without the framework of the transference, can be described as educating the patient to prooduce continually less distorted derivatives until his fundamental instinctual conflicts are recognizable.

Of course, this is not a single operation resulting in a single act of abreaction; it is, rather, a chronic process of working through, which shows the patient again and again the same conflicts and his usual way of reacting to them, but from new angles and in new connections. A familiar objection made to psychoanalysis is that interpretations are arbitrary, that the analyst more or less projects his own fantasies onto the patient. He is said to make things easy for himself: if the patient says yes to an interpretation, that is taken as a proof of its validity; if he says no, he thereby shows a resistance to the interpretation, proof positive of its validity.

As for scientific certainty, there simply is no evidence of it. What is the real situation? As a matter of fact, it is correct that a patients yes usually is accepted as a confirmation and that, under certain circumstances, a no is not regarded as a refutation. Freud very rightly called attention to an analogous situation, that of the judge The confession of an accused person is generally valid as proof of guilt, although in exceptional cases the confession may be false; but a denial on the part of the accused is by no means proof of innocence.

The difference between the accused and a psychoanalytic patient is merely that the former consciously conceals the truth, the latter unconsciously. Hence neither a yes nor a no in reply to an interpretation is a final criterion as to its validity. It is rather the manner in which the yes or no is expressed. Certainly there is a kind of no that merely represents a final attempt to maintain an attitude that has become insupportable. There are various signs by which such a patient betrays, immediately after uttering his no, that he has been inwardly affected by the interpretation and feels that what the analyst has called to his attention really exists within himself.

But in general one can say that an interpretation to which the patient objects is wrong. That does not necessarily mean that it is wrong in content, that, for instance, the impulse which the analyst sur-mised and imparted to the patient had never been operative. The interpretation may be correct in content but incorrect dynamically or economically, that is, given at a moment when the patient could not grasp its validity or get any farther with it.

Sometimes a yes may be simulated by the patient out of politeness or negligence or fear of the consequences of a contradiction or for some other reason, whereas his behavior may show that inwardly he is saying no. To put it differently, it is not a matter of the words used by the patient in responding to an interpretation. In giving an interpretation, the analyst seeks to intervene in the dynamic interplay of forces, to change the balance in favor of the repressed in its striving for discharge.

3. Foundations: Freud

The degree to which this change actually occurs is the criterion for the validity of an interpretation. It is the patients reactions in their entirety that give the answer, not his first yes or no. A valid interpretation brings about a dynamic change, manifested in the subsequent associations of the patient and in his entire behavior. Freud once compared psychoanalysis to a jigsaw puzzle, in which the aim is to construct a complete picture out of its fragments There is but one correct solution.

So long as this is not discovered, one can perhaps recognize isolated bits, but there is no coherent whole. If the correct solution is found, there can be no doubt as to its validity, for each fragment fits into the general whole. A final solution reveals a unified coherence in which every hitherto incomprehensible detail has found its place. And, also before this happy point is reached, dynamic-economic changes in. Since earlier levels of development are retained or returned to in neuroses, they cannot be understood without a thorough knowledge of these early stages.

The following chapters, therefore, present a brief and schematic outline of mental development. Conclusions concerning early mental life have been very slowly worked out from the material gained in the analysis of adult neurotics. Later these findings were confirmed through direct observation of children. The earliest years have necessarily remained most obscure. First, it is not always imperative to go back to the earliest period in order to analyze and cure a neurosis; second, it becomes increasingly difficult to grasp mental reactions the further one delves into periods in which there is as yet no language and in which many later separate functions are still undifferentiated from each other.

Attempts to overcome these obstacles by the direct observation of infants are difficult before the development of speech; data gained in this way allow a variety of psychological interpretations. The temptation is great to apply concepts and ideas valid for higher stages of maturation to the behavior of young children.

In fact it seems that this criticism applies to various psychoanalytic studies about the early phases of the ego. Few systematic observations of infants have as yet been undertaken from the standpoint of psychoanalysis , , , , , , Observations made by experimental psychologists have contributed much , ; however, such research approaches the material chiefly in a way very different from that of psychoanalysis. The analysis of psychotics with their regression to primitive ego phases greatly increases the knowledge of these earliest stages.

Analysis of psychotics does for the understanding of early mental development what analysis of neurotics with their return to infantile sexuality did for the understanding of the infantile stages of sexuality. The psychoses are, of course, not the only states where regressions of the ego are observable. In the healthy person, too, archaic ego functions return under conditions of intoxication, exhaustion, and especially in the states of falling alseep and awakening , , Thus the earliest phases must be comprehended by means of the expressions excitation and relaxation, and only the later phases can be characterized in more definite and differentiated terms.

The ego becomes differentiated under the influence of the external world. Correspondingly, it can be said that the newborn infant has no ego. The human infant is born more helpless than other mammals. He cannot live if he is not cared for. Innumerable stimuli pour out upon him which he cannot master. He is not in a position to move voluntarily and is not able to differentiate the encroaching stimuli.

He knows no object world and has no ability yet to bind tension. One can guess that he has no clear consciousness but has at most an undifferentiated sensitivity to pain and pleasure, to increase and decrease of tension. Precisely the functions that later constitute the ego and consciousness are not yet developed: the taking in of the external world perception , the mastery of the motor apparatus motility , and the ability to bind tension by countercathexis. Of course, even prior to the development of the ego there are reactions to stimuli; the subsequent functions of the ego are carried out in an undifferentiated manner by the organism as a whole.

The origin of the ego is not a homogeneous process. It begins with or perhaps even before birth and is in a strict sense never completed. At birth, the organism emerges out of a relatively quiet environment and enters an overwhelming state of stimulation with a minimum of protection from stimuli. This flooding with excitation without an adequate defense apparatus is, according to Freud, the model for all later anxiety Probably this being flooded by excitation is highly unpleasant and evokes the first mental tendency, namely, the tendency to get rid of the state of tension.

When the outside world succeeds in helping the infant cope with these stimuli satisfactorily, he falls asleep. New stimuli, such as hunger, thirst, cold, awaken him. The first traces of consciousness do not differentiate between ego and nonego but rather between greater and lesser tension; at this time relaxation is concomitant with loss of consciousness.

If every need could be immediately taken care of, a conception of reality would probably never develop. Hunger and disturbing stimuli leads to a state of tension and thus to a tendency to get rid of the tension. It disappears with satiation, and sleep, a relative freedom from stimuli, sets in. The first signs of object representation must originate in the state of hunger. When more distinct beginnings of the later ego functions appear, the infants grasping of the fact that something has to be done by the outside world in order to.

An object relationship of this primitive kind exists only as long as the object is absent. With its appearance, the longing disappears and sleep follows Before the establishment of this first object the infant is physically dependent on persons whose ministrations keep him alive. These persons, however, are not the infants objects in a psychological sense, since he is not aware of the outside world but only of his own tension or relaxation.

The first awareness of an object must come from a longing for something already familiar to the infantsomething that has the ability to gratify needs but that is not present at the moment The first acceptance of reality is only an intermediary step on the road to getting rid of it. This is the point at which a contradiction of basic importance in human life arises, the contradiction between longing for complete relaxation and longing for objects stimulus hunger. The striving for discharge and relaxation, the direct expression of the constancy principle, is necessarily the older mechanism.

The fact that external objects brought about the desired state of relaxed satisfaction introduced the complication that objects became longed for; in the beginning, it is true, they were sought only as instruments which made themselves disappear again. The longing for objects thus began as a detour on the way to the goal of being rid of objects of stimuli.

This is probably meant when it is sometimes stated that hate is older than love.

Philosophy of Psychiatry Bibliography Page 3: Psychoanalysis

The truth is, however, that the first object relations are neither hate nor love but the still undifferentiated forerunner of both The origin of the ego and the origin of the sense of reality are but two aspects of one developmental step. This is inherent in the definition of the ego as that part of the mind which handles reality , The concept of reality also creates the concept of ego.

We are individuals inasmuch as we feel ourselves separate and distinct from others. In the development of reality the conception of ones own body plays a very special role At first there is only the perception of tension, that is, of an inside something. Later, with the awareness that an object exists to quiet this tension, we have an outside something.

Ones own body is both at the same time. Due to the simultaneous occurrence of both outer tactile and inner sensory data, ones own body becomes something apart from the rest of the world and thus the discerning of self from nonself is made possible. The sum of the mental representations of the body and its organs, the so-called body image, constitutes the idea of I and is of basic importance for the further formation of the ego The body image does not coincide with the objective body; for example, clothing or phantom extremities may be included within it , A compulsion neurotic patient was obsessively worried about his clothes which had to fit perfectly because otherwise he felt extremely distressed.

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He had a kind of hypochondriasis about clothes. It turned out that actually it was his physical well-being about which he was concerned. Something wrong with his clothes meant something wrong in his body. The clothes were included in his body image. The first reactions to objects recognized as such contain much, integrated as a unit, which will later be further differentiated.

These reactions are like reflexes; that is, every stimulus demands an immediate reaction, in accordance with the constancy principle. Stimulus intake and stimulus discharge, perception and motor reaction stand extraordinarily close together; they are inseparably interwoven. Primitive perception is precisely characterized by its closeness to motor reaction. One perceives by first changing ones body through the influence of the perceived objectand then taking cognizance of this bodily change. Many perceptions usually considered optic are really kinesthetic , Similarly, eidetic research has shown that primitive optic perceptions are bound up with motor reactions ready for discharge 83 ; the same is shown by the findings of the motor attitudes in hypnagogic and hypnopompic hallucinations The original connection between perception and motor action is also demonstrated by Freud in his paper, A Note upon the Mystic Writing Pad He makes clear the activity in the function of perception.

As long as intensive stimuli from the outside world flood the organism, the organism experiences this passively. The construction of a perception apparatus, coinciding with an apparatus protecting against too intense stimuli, brings about a change from passivity to activity. The perceptions take place rhythmically, obviously under the influence of centrifugal motor throbs of cathexes, which may be regarded as a first attempt at mastering the outside world. This is the basis for the differentiation of systems of perception and systems of memory , and the origin of a more differentiated consciousness.

After the completion of this differentiation, the organism is in a position to protect itself against too much influx of stimuli by shutting off the function of perception The newly formed ego can again sink back into the id. This ability can be observed in fainting and in the symptoms of traumatic neuroses. It is clearly the model for all later defense mechanisms and can be applied against internal pains as well as against displeasure of an external origin. Repression, too, may be looked upon as a specific blocking of the perception of particular instinctual demands. Another kind of return of the ego into the id takes place in sleep.

An important function of the ego is the phenomenon of fascination which Bernfeld described A primitive attempt at the mastery of intense stimuli consists in the primitive egos imitating that which is perceived. Apparently, perceiving and changing ones own body according to what is perceived were originally one and the same thing.

Goldsteins patients with brain injury could compensate for their alexia by outlining the letters they saw with head movements, and then they could read by becoming aware of their kinesthetic sensations , This primitive imitation of that which is perceived is a kind of identification, the awareness of which brings perception. Another primitive reaction to the first objects appears simpler and more comprehensible: the infant wants to put them into its mouth.

It was hunger, repeatedly disturbing the peacefulness of sleep, which compelled the recognition of the outside world. The experience of satiation, which first banished this tension, then became the model for the mastery of external stimuli in general. The first reality is what one can. Recognizing reality originally means to judge whether something helps to gain satisfaction or whether it raises tensions, whether one should swallow it or spit it out Taking-into-the-mouth or spitting-out is the basis for all perception, and in conditions of regression one can observe that in the unconscious all sense organs are conceived as mouthlike , The primitive reactions of imitating what is perceived and the oral introjection of what is perceived belong close together.

Identification in normal psychology and in psychopathology gives the impression, as Freud always emphasized , , of being a regression, a secondary identification, repeating an archaic primary one. The concept of a primary identification denotes that actually putting into the mouth and imitation for perceptions sake are one and the same and represent the very first relation to objects. In this primary identification, instinctual behavior and ego behavior are not differentiated from each other. It is all one: the first oral object love, the first motor reaction to external stimuli, and the first perception Identifications play a great part in the process of building up the subsequent ego, whose nature therefore depends on the personalities of the persons around the infant cf.

The imitation of the external world by oral incorporation is also the basis for the primitive mode of thinking, called magic, to be discussed later. This incorporation, which is the first reaction to objects in general and the precursor of the later sexual and destructive attitudes, in a psychological sense destroys the existence of the object. The attitude that the object exists only for the egos satisfaction and may disappear once satisfaction is achieved can still be observed in some childish types of love.

But the aim of the incorporation of objects does not necessarily reflect a subjective destructive tendency toward the object. This primary incorporation is the matrix of what later becomes love as well as destructive hate, but it is not yet either of these. An exaggerated desire to destroy, which actually appears in some children and is not merely later projected back into childhood by manic-depressive patients , is not active in every infant sucking at the mothers breast.

Certainly the existence of early infantile oraldestructive drives can be proved in pathological cases. The oral strivings of the normal infant do not contain such highly destructive aims and such correspondingly great fears of retaliation. Too, it must not be forgotten that incorporation is only secondarily destructive, its objectively destructive nature being used for subjective purposes; the first hostile strivings toward objects, which bring pain or hinder pleasure, is not to swallow them but to spit them out. It is also questionable whether the same object which once brought satisfaction and later refuses satisfaction is recognized as one and the same by the primitive ego; it is more likely that first there are different conceptions of a good object, which one wants to possess by swallowing, and a bad object, which one wants to spit out and only later wants to destroy by swallowing.

It is a matter of definition whether primitive incorporation is designated ambivalent and the ambivalence of emotions thus described as congenital. It is ambivalent in so far as elements of subsequent love and hate are contained in it; it is not ambivalent in so far as love and hate as opposites do not exist as yet An urge to get satisfaction without consideration of the object whereby the object may be destroyed and an urge to destroy an object out of hate are not the same. To return to the study of perception: The differences between the perceptions of infants and of adults have the consequence that they experience the world differently.

Observations made on psychotics, who have regressed to primitive modes of perception, confirm the fact that they experience the world in a more vague and less differentiated way. Objects are not necessarily sharply distinguished from one another or from the ego or from parts of it. The first images are large in extent, all enveloping and inexact. They do not consist of elements that are later put together, but rather of units, wholes, which only later are recognized as containing different elements.

Not only are perception and motility inseparable, but also the perceptions of many sense organs overlap, The more primitive senses, especially the kinesthetic sensations and the data of depth sensibility proprioception prevail. Besides the form of infantile perception, the contents that are perceived are also different. Hermann called perceptions which the small child possesses, but which later disappear for inner or external reasons, primal perceptions The different nature of these primal perceptions is partly due to the biological characteristics of the child. The world appears to the child in quite another perspective due to his small size and to his different experience of space , To a greater part the characteristics of archaic perception result from its unobjective character, its emotional nature.

The world is perceived according to the instincts as a possible source of satisfaction or as a possible threat; instinctual wishes and fears falsify reality. Psychoanalysis in El Barrio. Learn More. Psychoanalysis in the. CAGS alumna Vanessa Cid uses psychoanalysis to help pre-school students distinguish feelings from behavior, to stop action and initiate talking. Read More.

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