Toward a General Theory of Unconscious Processes in Psychoanalysis and Anesthesiology

Psychoanalysis and anesthesiology appear radically different in their clinical practice, yet they share a focus of inquiry: unconscious processes. Despite this common domain, there has been no exploration of the relationship between “the unconscious” as conceived by psychoanalysts and “surgical unconsciousness” as conceived by anesthesiologists. This is likely due to the fact that general anesthesia has been assumed to be a state in which the brain is simply “turned off.” More recent neuroscientific data invalidate this assumption by demonstrating that the anesthetized brain is both cognitively dynamic and capable of implicit learning. Current perspectives on anesthetic mechanisms suggest that general anesthesia is characterized not simply by the absence of cognitive activity, but by the disintegration of cognitive activity. The cognitive unbinding paradigm of general anesthesia is discussed and its application to Wilfred Bion's theory of thinking, as well as his concept of attacks on linking, is elucidated. Based on the common structure and function of unconscious processes in psychoanalysis and anesthesiology, the foundation of a general theory is established.