In a number of recent presentations (Nersessian) it has been asserted that psychoanalytic theory is grounded on concepts that are derived from a neurophysiology that is outdated. Freud's basic tenets some of which continue to be the backbone of psychoanalytic theory are over 100 years old. Interestingly, and perhaps surprisingly, a similar point was made recently about neuroscience by Peter Stern in Science in the October 27, 2017, issue. He stated: “Could it be that we are interpreting our data with outdated concepts? Most of the dominant concepts in present-day neuroscience, after all, were developed 50 to more than 100 years ago.”
It is therefore essential, for those of us who have been actively engaged in psychoanalysis to begin the process of revisiting our basic concepts from a more modern vantage point and to try to put forward hypothesis that attempt to explain the efficacy of the psychoanalytic therapeutic approach.
Prior to presenting one such hypothesis, it will perhaps be useful to briefly review the arguments questioning some of the basic concepts.
There may be some differing opinions as to what constitute the fundamental concepts or tenets of psychoanalytic theory, at least as developed by Freud. We have selected the following for the purpose of the present arguments: The dynamic unconscious; repression; drives; pleasure principle and infantile sexuality.
These foundational notions of psychoanalytic theory were developed quite early in Freud's career but continued to be dominant despite the revisions he brought to bear on his hypothesis. The 1923 reworking of the model of the mind presented in the paper “The Ego and the Id,” while introducing important modifications to more classical ideas, nevertheless maintained the primacy of the tenets listed above. What is, however,
essential to keep in mind regarding the 1923 revision is that it cut ties with neurophysiology that is to say with the brain. Psychoanalytic theory became a pure theory of the mind and therefore unconstrained by neurophysiologic principles. It also gave free rein to theorizing and from that point on Freud and his followers proposed various notions that were based on scant verifiable evidence. Psychoanalysis became an independent field with an increasingly complex set of notions that were based on the observations and consequent theorizing of its practitioners without any other scientific validation.
While developing hypotheses which can be properly tested, which is essential in any scientific field, the constraints imposed by the “one on one” confidential relationship of the psychoanalytic situation forecloses the possibility of testing the observations and subsequent theorizing generated in the mind of the psychoanalyst in the clinical situation. Unable to apply regular research protocols, psychoanalysis, over the period of its development gradually and unavoidably became an ever expanding theory made up of opinions of individual practitioners, where the only consensus to arrive at was through other practitioners agreeing with the opinion and its elaborations.
Returning to the fundamental tenets, originally roughly based on the neurophysiology of the day as described in “Project for a Scientific Psychology”, they became relatively quickly independent of any connection to the brain even though and paradoxically, the ideas that were somewhat based on the physiology of the day remained central to psychoanalytic theory and some remain so to this day.
Again, the fundamental hypothesis we have chosen to examine in the present work are the following;
Repression and the dynamic unconscious
Pleasure-unpleasure principle, briefly
Drives, briefly
Infantile sexuality and psychosexual phases of development.
Undoubtedly, the idea of a dynamic unconscious is at the center of psychoanalytic thinking, but Freud did not begin with the notion of an unconscious. Rather, he and Breuer were first led to the concept of defense and repression by their clinical experiences and observations.
The dominant notion of the time, which was shared by Freud, held that memories left a permanent trace; accordingly, if one did not remember, it was because the memory was prevented from being recalled, that is to say, it was defended against or repressed and therefore was unconscious. To make the memory become conscious, a resistance needed to be overcome. This led Freud to use a technique he had learned from Bernheim, who used it to bring forth memories from periods of somnambulism with the pressure on the head, and from this, the notion of resistance became central to his thinking.
In addition, since Breuer and Freud further observed that many of the memories their patients were not revealing had to do with sexual matters, including adolescent crushes and the like, they assumed that repression was keeping these prohibited sexual ideas out of consciousness and that sexuality was also central to psychopathology. Parenthetically, originally Freud did not believe that normal people had an unconscious, only hysterics, but that view rapidly changed.
Over time, as Freud's clinical work advanced and he invented free association, the theory of repression became central in neurosogenesis in general and was not limited to hysteria. Furthermore, through his self-analysis, he discovered the importance of childhood experiences which then led him to the notion of repression of infantile memories and wishful impulses. Eventually, the notion of primal repression needed to be added to justify that not only were wishes and thoughts pushed back but that they were also being pulled, that is to say attracted, into the UCS, an idea closely tied to the of concept of infantile amnesia. By 1914, when he published the metapsychological papers, psychoanalytic theory had become much more nuanced and sophisticated and herein, in the paper on “The Unconscious,” Freud offered a classification of unconscious mental phenomena that delineates the “dynamic unconscious” as the place where repressed impulses and memories reside.
In as much as repression gives rise to the dynamic unconscious, the conceptual problems apparent in both are not only related but synonymous, as we will now enumerate:
Creating a theory of repression based on the patient's resistance to reveal is a flawed thesis grounded in a weak argument. The patient
may simply be consciously withholding in order to avoid a painful emotion.
The original optimism of Freud and Breuer about lifting of repression was not justified. The patients revealing their thoughts under hypnosis or pressure on the forehead did not show consistent improvement.
In a given situation what decides which part of a wish, memory or experience is repressed? The entity Freud called the ego from early on in his work, and which he later made in part unconscious, creates a whole set of theoretical conundrums if it is to be founded on the underlying biology.
The notions of repression, defense and resistance brings up the concept of forces and inevitably raises the issue of the nature and source of these forces, but there is no evidence to support the contention that any such forces exist. While it is possible to talk of inhibition or even suppression in brain activity, it is difficult to justify the notion of force. Moreover, in developing the notion of cathexis and counter-cathexis, Freud went even further out on the limb by stating that these forces are not only involved in keeping ideas associated with instinctual impulses out of consciousness, but they are also involved in pushing them into consciousness. Given that the ideas are assumed to obtain their force by being associated to the instinctual impulse, then what is the source of the anti-cathexis? This issue was never comfortably resolved by Freud, and it does not correspond at all to what is presently known about brain function. In fact, it can be said that the concept is based on a metaphor with no counterpart in reality.
Most importantly, the notion of repression implies discreet entities, be it a discreet memory or a specific wish. In the 1914 paper on the unconscious Freud states, “Unconscious ideas continue to exist after repression as actual structures in the system uncs.” However, (as we know from memory research) wishes and memories are in constant interaction with other wishes and memories, this interaction moves both forwards and backwards, as present and past experiences influence and are influenced by other contents of the
A very brief clinical example to underscore illustrate this point: A 77-year-old man is in conflict with his wife over her wish to travel to foreign countries. He states, “My first foreign travel was to Vietnam when I was 19. I was crawling down VC tunnels with a flame thrower. When I made it back to the US I literally kissed the ground. Those memories are always with me and they prevent me from leaving this country again.” He certainly seems conscious of the trauma, but that does not alleviate the anxiety.
Before further examination of these points, a few very general comments about autobiographic memory and contemporary research on memory may be useful. Memory, which was Freud's primary interest as opposed to semantic memories or procedural memory, is now known from a neuropsychological and neuroscientific point of view to be distorted and inaccurate, and at times even totally fabricated from pieces of memory and experience in part due to processes of consolidation and reconsolidation and contextualization. Accordingly, in this schema, autobiographic memory is malleable; anything that is recalled is a re-construction that may or not be factual. While much of this work on the micro-biology, genetics and epigenetics of memory, as well as on consolidation and re-consolidation is performed on animals and the findings may or may not be applicable or valid for humans, it represents a potential area for fruitful collaborative work between researchers and psychoanalysts.
Laboratory research is necessarily constrained by the limitations of its subjects and by conscribed methods of data collection, and certainly, it is clear that animal brains lack the complexity and layering that allows for the advanced capacities of human memory and that the human environment is infinitely more complex than any pared-down conditioning experiment in the lab. As psychoanalysts whose subjects of study can and do speak volumes, we are uniquely situated to observe and report on the on-going changes in memory functioning that are seen in the psychoanalytic setting.
Returning to the evolution of Freud's ideas and to recapitulate them, his clinical observations of patients led to the view that memories were being kept out of awareness; consequently, he determined that they must be forcefully kept out of consciousness. This then led to the next inference, that of the concept of the dynamic unconscious. It is important not only to note how Freud moved so easily from observation to inference to established theory but even more important for our focus today, we must recognize that these concepts of repression and the dynamic unconscious are based on two outdated ideas: one is the notion of energy, flow of energy and force, and the other is the view that memory is made up of well delineated entities, with all the components, affective, sensory and cognitive being prevented by some force from entering consciousness.
A second bedrock of psychoanalytic thinking that bears re-examination in the light of 21st century science is the pleasure-unpleasure principle. This idea originated with the constancy principle, which was already introduced in the Project and which gradually assumed a position of central importance in psychoanalytic theory. Even though the idea was modified in “Beyond the Pleasure Principle” with the introduction of the death instinct, the basic principle remained and remains important in psychoanalysis. For Freud, the principle had first to do with the accumulation of excitation that was perceived as unpleasant and the discharge as pleasant. Some of his thinking was based on knowledge of sexual arousal as it leads to orgasm. He considered the state of arousal as un-pleasurable and as leading to a need for discharge in order to restore homeostasis, and he enlarged this observation to encompass the realm of mental functioning. Again, Freud started with an observation and transmuted it into a principle of mental functioning, in the process
conflating observation with explanation. Pleasure in orgasm can be consciously experienced and readily observed, but how does it follow that the mind is regulated by the need to balance pleasure and un-pleasure?
This U-shaped tube concept of pleasure-un-pleasure was very much part of 19th century science and was further advanced in our field by Charles Brenner. But while homeostasis remains an important concept in physiology, to my mind it does not apply to pleasure and un-pleasure. As any clinician has observed, arousal in itself can be pleasurable and there are people who enjoy maintaining arousal for long periods of time because of the pleasure derived from this state: Tantric sexual practices being one example. Additionally, pleasure today is not a simple, unitary concept; there are many varieties of pleasure, complex interactions exist between pleasure and un-pleasure., and some pleasurable experiences may have no connection to un-pleasure. For example, the delight of listening to a piece of music or the joy of seeing a work of art cannot be logically connected to un-pleasure. Instead, like any affective phenomena, pleasure and un-pleasure are conscious, whereas any regulatory mechanism is an integral part of how the brain/mind works.
In this presentation, we will focus on infantile sexuality and the psycho-sexual stages of development and will not delve in detail into the problem of aggression nor the thorny subject of instincts and drives which was so central to Freud's view of the working of the mind. Suffice it to say that some attempts have been made to find correspondence between Freud's Id and drives and the seeking system described by Jaak Panksepp, but to us, these efforts have been unconvincing. A more intriguing line of inquiry that does not rely on the concept of drives comes from the work of Joseph LeDoux who delineates regulatory circuits, the instantiation of which leads to specific goals. He proposes five such circuits: fluid regulation, nutrition, thermoregulation, reproduction and defense that are essential for survival. We hope that this and other such lines of research may eventually yield useful data for our understanding of human behavior rather than the ill defined notion of drives, which if related or identical to instincts is on the level of observation and therefore is too broad. The Id, on the other hand, the dark territory, as Freud himself called it, is an even more difficult hypothetical entity to correlate with anything known about neural activity.
So, turning to infantile sexuality which was already widely discussed and reported in late nineteen century, we see that well-before the “Three Essays on Sexuality.” Freud was already interested in childhood sexuality and erotogenic zones (a term already in use by Binet and others) as revealed in his correspondence with Fleiss. In letter #52, written in 1896, he states, “Hysteria is not repudiated sexuality, it is repudiated perversion. Furthermore, behind this lies the idea of abandoned EROTOGENIC ZONES. That is to say, during childhood sexual release would seem to be obtainable from very many parts of the body, which at a later time are only able to release the 28-day anxiety substance and not the others.” It is not possible to determine how these ideas germinated in his thinking, but perhaps the following quote from letter 75 written in 1897 to Fliess offers a clue:
“I wrote to you once in the summer (letter 64) that I was going to find the source of normal sexual repression (morality, shame etc.) and then for a long time failed to find it. Before the holidays I told you that the most important patient for me was myself; and then suddenly, after I came back from holidays, my self-analysis, of which there was no sign, started ahead. A few weeks ago (letter 72) came my wish that repression might be replaced by the essential thing lying behind it; and that is what I am concerned with now. I have often suspected that something organic played a part in repression; I was able to once before tell you that it was a question of the abandonment of former sexual zones (Freud is referring to erotogenic zones) and I was able to add that I had been pleased at coming at a similar idea in Moll.”
By way of explanation, Albert Moll was a Berlin doctor who was part of a group of physicians considered to be sexologists. These men espoused an idea rather prevalent in the nineteenth century that there was an association between sexual problems and physical disorders. Freud clearly belonged in this group, although he and Moll actively disagreed and even disliked each other. From a historical perspective, it is evident that at that particular point in time in the late 19th century, those—including Freud—who accepted the so-called sexual theory were actively seeking to find proof linking the etiology of certain physical illnesses to underlying sexual disturbances. Further underscoring the legitimacy of this sexual science or Sexualwissenschaft, the journal “Zeitschrift fur Sexualwissenschaft,” was launched in 1908 by Magnus Hirschfield.
Once again, Freud was part of the scientific zeitgeist, but he took a decisive turn when he began to look more specifically for the sexual genesis of psychopathology. As we know, this shift in focus was also influenced by his studies with Charcot and by Charcot's eventual categorization of hysteria as psychological, as well as by his collaborations and publications with Joseph Breuer.
Freud's focus on sexuality did not develop in a vacuum, and given the predominance of ideas about the importance of sexuality in both physical and mental functioning, it undoubtedly influenced the discoveries he made in his self-analysis. According to the editors of the Standard Edition, “Three Essays on the Theory of Sexuality” stands alongside the “Interpretation of Dreams” as Freud's most momentous work.
There is no doubt that it impacted psychoanalytic thinking in a continuous way for the next hundred years and continues to do so, for some, even today. These essays helped to explain not only pathology but also character formation and entered into the realm of public discourse in myriad ways, sometimes in a salutary manner. Think, for example, of the changes in the ways we understand childhood and in how we approach child rearing that have been the result of the wide-spread dissemination of Freud's thinking.
The importance that Freud attributed to infantile sexuality cannot be underestimated. In the “Three Essays,” he describes three important phases of sexual development in the child with relation to the progression of masturbation from infancy to early childhood to adolescence. Regarding the second phase, which he ascribed to beginning around age 4, he stated the following:
“The second phase of infantile sexuality may assume a variety of forms which can only be determined by a precise analysis of individual cases. But all its details leave behind the deepest unconscious impressions in the subjects memory, determine the development of his character, if he is to remain healthy, and the symptomatology of his neurosis, if he is to fall ill after puberty. In the latter case we find that this sexual period has been forgotten and that the conscious memories that bear witness to it have been displaced.”
This is a sweeping claim—that masturbation in early childhood is
strenuously repressed and that this repression, which he calls infantile amnesia, determines future character development and psychopathology.
Unfortunately, however, as a reading of the “Three Essays” reveals today, there was no solid data on which all this was based. Freud's data on erogenous zones, which was part of the sexual science of the day, and on the notion of component instincts were derived from knowledge about adult's perverse sexual practices as well as from such mundane observations of his day such the pleasure of kissing and anal intercourse and the sensitivity of the buccal and anal mucosa. Information obtained from adults in analysis was interpolated and applied to children. Babies were hypothesized to derive pleasure in an autoerotic way from sucking the breast or their thumb, just as they were presumed to derive sexual pleasure from their bowel movements. For example, apropos of the anal zone under the heading “Masturbatory Sexual Manifestations” Freud wrote, “like the labial zone, the anal zone is well suited by its position to act as a medium through which sexuality may attach itself to somatic functions” (St. Ed. vii, pp. 185). The very bedrock of Freud's theory rested on parallels which were drawn between adult sexual thoughts and behaviors and the behaviors of the child. Not only does such a theory presume that the mind of the child functions in its most significant aspects like that of an adult, but the theory also attributes an exaggerated sense of agency to the child. For example, asserting that the baby holds back feces in order to then have more pleasure presumes that the baby is capable of thinking and that it is capable of controlling his/hers bodily functions.
Given the state of neurobiological knowledge in the first half of the 20th century and the central role of repression and defense in psychoanalytic theory, the notion of infantile amnesia and its role in neurosogenesis seemed plausible. It is only later that studies of brain development in infants determined the timetable for the maturation of specific parts of the brain, and this knowledge allows for an entirely different understanding of infantile amnesia as an artifact of the ontogenesis of brain development.
There is no doubt that we can see behaviors in children that appear sexual, and there is also no doubt that there is a degree of curiosity about sexuality in children beginning around the age of 4 or 5 and sometimes even earlier. But for us, the critical issue is how do we understand this
and how do we determine what role, if any, it has in character development and psychopathology. To our mind, the question as to whether we can speak of sexual pleasure in children in a Freudian sense is an open one that requires unbiased investigation. For example, it has not been determined whether the brain circuits activated in children during thumb-sucking or bowel movements are the same as those activated in the adult during sexual arousal and pleasure, and any such investigations would have to take into account the vast differences between adult levels of sexual hormones and the very low sexual hormone levels of children.
But there is another critical point to consider when looking at children: how much of any behavior is biologically determined and only secondarily assumes mental content? Children's play, for example, is at least in part genetically determined and is not that different from playful behavior observed in other species. I am in no way claiming here that there is no learned behavior or play but only that it would be highly questionable to ascribe to such cross-species biologically driven behaviors a central and exclusive role in on-going character development and in the evolution of psychopathology. Freud was not bound by such strictures; as I mentioned earlier, in the first decades of the twentieth century, generalizations, speculations, and even contradictions were readily accepted in theorizing. And, since taking biologically determined phenomena and giving them psychological motivations did not strike scientists as problematic the way it would today, Freud could, with equanimity, assert in the paper “The Dissolution of the Oedipus Complex (St. Ed. Vol. xix, , p. 179) the following: “Renunciation of the penis is not tolerated by the girl without some attempt at compensation. She slips—along the line of a symbolic equation, one might say—from the penis to a baby. Her Oedipus complex culminates in a desire, which is long retained, to receive a baby from her father as a gift—to bear him a child. One has the impression that the Oedipus complex is then gradually given up because this wish is never fulfilled. The two wishes—to possess a penis and a child—remains strongly cathected in the unconscious and help to prepare the female creature for her later sexual role.” (The use of the word creature here is interesting. Is he extending his idea to animals?) None of the above assertions is based on data; rather, it is pure theorizing at a level which appears rather fanciful through today's lens. In fact, the same can be said about Freud's Oedipus complex. The data
for this supposedly invariant phase of psychosexual development came from Freud's self-analysis during the writing of the “Interpretation of Dreams,” although, there is some suggestion that it also may already have been part of the discourse of the sexologists of that time. Unfortunately, however, as a reading of the “Three Essays on Sexuality” reveals today, there was no solid data on which all this was based.
These scientific considerations are important, but more critical for psychoanalysis today are the negative consequences of this intense focus on erogenous zones and psychosexual development and phases, most especially on the Oedipal phase. It has led us to narrow our view of early development and to so constrict our line of inquiry as to prevent us from being at the forefront of research on how the brain/mind of humans comes to be. Now that there is no evidence to support any of the connections between psychopathology and the psychosexual phases of development, be it obsessive compulsive disorders, phobic disorders, depressive disorders, paranoia etc. which Freud, Karl Abraham and others proposed, as well as data showing that orientations such as homosexuality or various gender preferences appear to have other possible determinants, it would free up psychoanalytic thinking if we took a broader view and studied the various contributions to the growing mind in a nondualist way.
The above is not to in any way apply that today's neuroscience is capable of explaining all the complex phenomena which go into what we call mind, in fact we can not even fully explain consciousness and self consciousness at this point, but only to say that whatever we have learned in the past 40 to 50 years requires that we revise psychoanalytic theory completely. However, the reality is that while such a revision can be initiated, it can not be fully accomplished with data from today's neuroscience, in other words, we do not yet possess sufficient validated knowledge to be able to explain the mind and the working of the various parts as well as their integration.
With the above in mind, we would very tentatively and speculatively suggest a different way of looking at early development, one that does not rely upon psychosexual development. I propose three significant elements: The genetic, the epigenetic, which is gaining increasing importance, and the environmental. All three of these elements contribute in a proximate, moment-to-moment fashion to the gradual growth of the
brain/mind. As the neuronal connections increase, the interaction with the parents and surrogates and the environment (in reciprocal action with the genetic and epigenetic factors) form the infants mind. Every step effects the next step and may even alter aspects of the previous step, thus making us the individuals that we are, like our parents and other important people of our early life, and yet distinctly different. In a previous work (Nersessian) it was suggested in a tentative way that one way to describe what happens is to consider that these many factors create dynamic templates, maps, networks or using a modern popular concept, algorithms that determine the way the individual thinks and feels and reacts. In other words, the individuals mind is comprised of these maps, which include both explicit and implicit resultants of experiences including emotions. It is, we think, evident that the earlier experiences in life when the mind/brain is developing have a singularly important role in later experiences and therefore are a determining factor in these algorithms. Understanding and dissecting these dynamic maps or algorithms would be, to our mind, one way of defining psychoanalytic work.
Long before this paper was conceptualized, one of the authors, when faced with a patient who required an explanation for how therapy works, would answer with this somewhat funny joke:
“A man enters a big, modern synagogue. He notices that all the regulars bow upon entering. He turns to the very old man next to him for an explanation for this unusual practice. The old man tells him that this congregation started out in 1927 in the basement of a tenement. The doorway was only 5 feet high and if you didn't duck, you would smack your head. And they kept doing it even in the new building. These people think they are bowing, but they are really ducking. All people make rational decisions, commensurate with their understanding, to deal with the people and issues of their early life. It works to some degree or other. But 25 years later you may be engaged in the same ducking and think it is bowing and not realize that it is completely unnecessary. Maybe through our looking at your life in detail you will be able to give up some of the ducking.”
Transference can be understood as the living out of these algorithms in the context of a new situation which provides few clues of what is expected. The analyst is accepting, non-judgmental, curious and gives little
guidance. The patient has maximal latitude to express and experience previously created algorithms while the analyst observes and comments upon them. For example, “I have noticed that sometimes when I begin to speak, your body tenses and your head cringes. You have described how your father playfully smacks the back of your head and it startles you.”
The issue for the patient in analysis is that certain patterns or algorithms have created patterns of behavior and emotion that interfere with a successful and happy life. The analytic work on these networks, which are how the patient experiences herself and the world, brings about a particular degree of inner freedom with important consequences in the persons way of being in and experiencing the world.
A case example: A 45-year-old lawyer entered treatment because, “I want to get married and I can't.” He was an only child, born to an American couple who worked for the State Department in various foreign countries. He described his family life as “wonderful, my parents were the best.” He is good looking, athletic and successful. He has had numerous serious relationships with women but always finds a reason for not marrying them. The reasons are always different, seem to be reasonable, but he can see that they are rationalizations. Early development seemed to have been happy and within expected norms. But over time the therapy revealed a number of trouble spots. His father had never been able to stand up to his mother to express what he wanted and over time the relationship deteriorated badly. In all of his relationships with women, the patient repeated this pattern of his father's. The relationship would unravel as he felt more unfulfilled, he would emotionally withdraw and the woman would finally leave. His mother was experienced as very self involved and sure of herself.
The patient had no male friends. He was quite gregarious, athletic and had numerous friends until puberty when all his peers shot past him. He did not begin to grow or sexually develop until he was 18. From 13 to 18 he was the butt of continuous sadistic and humiliating pranks due to his childish appearance. The world became a dangerous place and his only safety was experienced with his family. This pattern continued until he sought treatment.
One could say that the following algorithm dominated his thinking and behavior:
The world will humiliate me. Friends will hurt me. I am only comfortable around my family. Even if I find a woman who seems to love me, it is impossible to negotiate or work out with her a viable relationship. And she will ultimately be interested in her own selfish needs.
All of these themes were painfully experienced in the transference and gradually analyzed.
Many experienced clinicians instinctively work in this manner, without resorting to concepts such as infantile sexuality or the Oedipus complex. Some clinicians seem to feel that they must “throw a bone” to such concepts, otherwise it is not real analysis. Certainly, many feel that such concepts must work their way into cases that are written up for various reasons. And as for memory, the bulk of the work in the above case was done in the here and now of the transference. Certainly, the patient frequently associated to past or long past experiences. But those memories were not the basis of interpretations.
According to the patient, the most helpful thing in the treatment was the ability to put his feelings BASED ON HIS EARLY EXPERIENCE into words and have his pain understood and accepted. The things that he spoke about were not newly uncovered memories. They were thoughts and feelings that he had never dared to speak about before. That the analyst heard him and still accepted him felt surprising and powerful.
To talk of experience raises the issue of memory and it may be useful here to briefly review our current understanding of memory, its types, its consolidation and its loss.
Since Freud and other psychoanalytic thinkers such as Ernst Kris, memory research has made important advances forward. The studies done on the patient HM by the neurosurgeon William Beecher Scoville and the neuropsychologist Brenda Miller were important in ushering in the progress made in memory research. Research that has benefitted from the contributions of Daniel Schacter, Larry Squire, Joseph LeDoux and many other prominent researchers in the field.
These studies have led, if not to a fuller understanding of memory, certainly to a classification of memory that has allowed for deeper
appreciation of the types of memories that humans and other mammals rely on. This classification distinguishes broad categories of sensory memories, short term memories and long term memories. Psychoanalytic interest lies mostly, though not only, in long term memories and in particular in autobiographical memories. Briefly, long term memories are divided into Explicit and Implicit Memories. Explicit memories being conscious and implicit being unconscious. Included in implicit memories are procedural memories which have to do with procedures such as tying shoe laces. Declarative memories are explicit and they include episodic memories, which are memories of events and experiences, and semantic memories, which have to do with facts and concepts. Autobiographical memories, which are explicit memories, are what have traditionally interested psychoanalysts.
Recollection during psychoanalysis of repressed memories, whether through associations, dreams, or in response to interpretation has played an important role in psychoanalytic work from its beginning though the early period conviction in the curative value of the lifting of repression has taken backstage. Instead, an exploration in detail of certain memories and how they have been altered has become the therapeutic modality. In other words, psychoanalysis has asserted that the inaccuracies and even outright fabrications in autobiographic memory are significant because such alterations have been made for a reason, that memory distortions are tendentious, and their analysis helpful in understanding the important issues in the persons life. In the classical psychoanalytic way of thinking the distortions are the result of defensive activity motivated by unconscious forbidden wishes (Nersessian).
What we would propose at this time, however, is that memories, specifically autobiographic memories, and their distortions, whatever the reason for the distortions may be, while important, play a much smaller role in analytic treatment and that for the reasons we will describe.
In the late 19th century and through a good part of the twentieth, memory was seen as presence of islands in the mind (island of memory). This implied that they were circumscribed and resided in the mind/brain after being consolidated. Important research by Alberini and others on consolidation and reconsolidation has shown the degree to which memories are modified through this process. The approach I am proposing
tentatively here is that we include in our conception of memory the total effect of the event on the person, of which the memory is but a part.
When we look at our lives, we see continuity, a narrative which is more or less cohesive and which gives our self a sense of existence over a period of time usually from our childhood to the present. Even though these memories are most often not continuous, and the ones from our childhood are really like islands, we nevertheless develop a feeling of continuity and cohesion. In other words, we can build a story of our life. A story however, which not only is not always totally accurate (the inaccuracies of autobiographical memory have been well documented. However, more studies in the nature of the alterations and distortions are needed in order to better understand the reasons, perhaps multiple, for such alterations and their salience namely, whether there are essential elements of memories that are different from what occurred or less important details), but which, much more importantly, is not but a small part of the life we have lived. This is because who we are is based on our experiences, physical, sensory, mental, and explicit memory is only the foam on top of the ocean water. Experiences and experiencing is in fact who we are. In other words, our individual selves, who we are, is to a very large extent the result of what we have lived through and experienced, and this extended experience over time is mostly out of our awareness. It could be said it is unconscious, but we find the term unconscious inadequate to describe what we are alluding to. The term implicit memory is a possible way to describe what we are proposing but we find it also a bit misleading because implicit memory is too close to knowledge that we are not consciously accessing. Memory is often defined in one variation or other as basically the faculty by which the mind stores and remembers information. Some have defined it as the faculty or process of retaining information over time, others have defined memory as remembering the past allowing us to find our future path.
What we have in mind, however, with experience, is a lot more than a faculty or a process, it is who we are as a result of what we have experienced from day one, if not from when we were a fetus inside our mothers. This experience is global and events are only a part of it. The baby develops in specific ways based on its interaction with its mother or caretaker, with its father, the environment, its physical health, its hormonal balance, the food it eats, the bed it sleeps in, the way it is held and so on. These
experiences from early in life cause us, along with the genetic, epigenetic, endocrine and other contributors, to be who we are. This experience is broader than memory in all its forms. At any single point in our lives we are the resultant of our experiences, and these experiences change and develop over time, with earlier experiences effecting later ones and later ones allowing a re-evaluation of earlier ones but only up to a point. Parenthetically unlike memory, experience is not in the usual course of our life altered or distorted, even though the memory of an experience can be altered or distorted. The above does not imply that memories, especially past memories, as reported in the therapeutic setting are not valuable, but that they are only a small part of the process and as a narrative of the persons life they present guideposts to be deeply explored.
Returning to the question of the therapeutic action of psychoanalysis, the persons who enter psychoanalysis are in addition to the biological, their experiences. What this means is that what they say, how they feel, how they act and react, how they love or hate, how they understand, in sum their thinking, feeling behaving self is based on the experiences of their life. And, this self is affected by new experiences, just as it could be affected by hormonal and other changes. It is this self, in part the sum of experiences, that is the focus of psychoanalytic work. It bears repeating that this view of the mind, namely as the sum of our experiences along with the biological contributions, and the proposal that these experiences create or contribute significantly to creating maps and algorithms that determine our being is at best a simplification given the fact that so much of the workings of the brain and body remain undiscovered.
Another clinical example:
The patient is a young woman who enters analysis at the age of 28. She is dressed in a style that makes her resemble an adolescent boy. Shorts, sneakers and a baseball hat. She is single and has not had any relationship beyond short lasting dates. Men see her more as a friend and one of them rather than an attractive female. She is well educated but has a job just above the lowest level at this firm. She is aware something is wrong. History reveals a cowboy father whom she was very close to and a highly intellectual, cold, distant mother. She has no siblings and maintains a good relationship with her parents who leave far from New York and therefore sees them only on holidays and special family occasions.
Analysis at 5 times a week lasts six years. She moves up to the position of head of department at her firm, marries, has two sons. When she comes to see me years after the end of the analysis she describes herself as satisfied with family and work life. Children older and ready to go off to college, marriage satisfactory, work going very well. She is poised, elegant, self-reflective and very self-possessed. She talks about her analysis, how when in analysis she felt she would just come to her sessions and all problems would be solved, whereas now she has to deal with all the vicissitudes of life. Analysis, she believes. gave her the possibility to navigate life as well as it can be done.
Psychoanalysis itself can be seen as a new, formative experience in a person's life. A successful young man came into treatment because of a persistent but vague feeling of dissatisfaction with himself and with all that he did. He was quite bright, but with a significant, childhood undiagnosed learning disability. His intelligence allowed him to “slip by” in almost all situations, even when he knew he was not doing the work. He would not read the assignment but was able to figure out the right answers. He was charming and manipulative. All of these issues were extensively worked with in a productive, 8 year analysis. He now felt more genuine and deserving of his success.
The patient asked for a follow-up visit about six years post termination. He said that the reason for the visit was to inform the analyst of a significant event that had occurred during the analysis but had never been mentioned. One day the patient paid his bill and instead of writing “Twenty two Hundred and Fifty,” he wrote “Twenty Two Fifty.” The analyst returned the check and asked that it be rewritten properly. The patient thought to himself, “What an obsessive asshole,” but said nothing and brought a new check the next day.
“I soon began mulling over that episode and picking out so many different aspects. My anxiety about saying anything angry to you. Your forthrightness in expressing what you wanted. Your valuing the importance of detail, of getting it right, of reality. My submissiveness. My trying to slide by. My not caring about reality. I know we talked about many of these issues, but this living out of my ways of being next to your ways of being has left a permanent impression on who I am.”
The powerful experience of meeting with a new kind of person four or five times a week is what we are focusing on. This new person is interested, curious, non-judgmental, and with no agenda. This experience allows for any and all thoughts to be felt, examined and expressed. An experience like no other experience. And like all previous formative events, relationships and experiences, it is incorporated into the fabric of the analysand's identity. (As well as into the fabric of the analyst.) This may be the most important agent for change. This may be why, when people are asked years later about their analysis, they most often remember events in the analysis rather than insights. “The time my analyst handed back the check I had written because it was not accurate.”
In ending, we would say that embarking on a therapeutic journey is like visiting a city (preferring this to the metaphoric description to Freud's train ride) one has visited before but has not delved deep into. Familiarity with the main arteries and sights and a few of the connecting streets has allowed one to navigate and partake in the city life but now the visit is to be for a longer period of time and for the purpose of living in it. More streets will need to be discovered, more sights, more nooks and crannies. Every discovery will facilitate the next discovery and after some time, the visitor now a resident will look back and see how much more he or she knows and how the same destinations can be reached more efficiently, with less worry or anxiety and with an enjoyment heretofore not available or attainable. This is the patient who after a period of time looks back at his or her life and sees how it has been less difficult; not so because life does not have its hardships but easier because the person has not added to those hardships unnecessary complications. The patient who now sees a continuity in her or his life and therefore looks at the future with a certain feeling of empowerment and control.
This increase in knowledge about the city that is our mind is never complete and can never ever be complete during ones life time. Much will remain outside awareness, including sources of anxiety and fear. While an occasional dream may suddenly reveal a hitherto unknown fear, a great deal will always remain out of our reach as therapist and as patient. At the same time, however, with the new and limited knowledge, we would be navigating our world with more ease and hopefully happiness and gratitude.
In ending, we would like to quote from a letter to Stefan Zweig from Freud in October 1937 wherein referring to his work he says: “ No one can predict how posterity will assess it. I myself am not completely certain—Doubt can never be divorced from scientific research, and I have surely not discovered more than a small fragment of truth”.
The small fragment of truth had and to some degree continues to have a large impact in the way we see the world and ourselves within this world, however, as science has inexorably moved forward, it is time for psychoanalysis to participate in this progress by revisiting its outdated theories.
mind/brain creating networks. Therefore, there are no structures or discrete entities such as Freud delineated, rather, there are increasingly complex networks.
This notion of discrete entities is also problematic in relation to Freud's idea of the return of the repressed, which implies that one of these objects or discreet entities in the mind can enter consciousness in a circumscribed way and can be recognized as such. Instead, we know that all experiences, including traumatic or emotionally relevant ones, are always present in the mind. They exist today because of the effect they have had on subsequent experiences; they are embedded in them. To the degree that any experience is in interaction with other past and future experiences, it is difficult to justify that recalling a specific event can alter all the subsequent effects of the original experience.