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Dear Editors,
I applaud the efforts of Bohleber et al. (2013) to bring clarity to psychoanalytic concepts, enactment in particular. To further the discussion, I would like to suggest that analysts be cautious about relying heavily on the dichotomies that we humans seem to adopt so readily. Uncritically accepted dichotomies foster oversimplification and can foreclose useful discussion. This point can be illustrated with three concepts raised in the article by Bohleber et al.: symbolization, action, and enactment.
The authors consider whether a patient's material is “symbolized (repressed)” or “not-symbolized (trauma-related)” (p. 517), a simple, but likely false, dichotomy. Apart from perhaps neurological reflexes or deeply learned muscle memory (such as walking or playing a scale on a piano), is there any human behavior that is not “symbolized”? Even a very crude, basic behavior, such as punching a wall, has numerous symbolic meanings, and no meaning could ever be transmitted or received without some kind of symbolic representation. Rather than the either/or symbolized/unsymbolized, a more complex and useful question is: ‘On what levels, with what symbolic systems, is the patient communicating?’
Similar considerations apply for the question of “action versus thought” (p. 519). Yes, the task in psychoanalysis is to put thoughts and feelings into words, rather than action. But speech also is a type of action, and insofar as speech is motivated or wishful, it pulls for further action. One consequence of this quality of speech is the remarkable tendency in analysis for patients' talking to the analyst to gradually transform into the playing out of their intrapsychic conflicts in their relationships with the analyst. Thus, while the conclusion that: “Thinking and acting are two sides of the same coin,” (p. 519) is true in a limited fashion, we might be conceptually clearer and more clinically agile without the dichotomy. Why not think of a spectrum, and ask what aspects of