Meetings of the New York Psychoanalytic Society

November 27, 1979. BUILDING A CLINICAL THEORY: THE SCIENCE OF OUR ART (Abraham A. Brill Memorial Lecture). Walter A. Stewart, M.D.

The quest for an integration of theory and practice was the touchstone of Dr. Stewart's lecture. Beginning with a historical review, he reminded the audience that Freud's earliest writings smoothly integrated a theory, albeit a simple one, of the mind, neurosis, and treatment. Symptoms resulting from strangulated affects were relieved by the recall of repressed unconscious memories. Following the discovery of infantile sexuality, a far more complex view of the mind evolved. A greater appreciation of the roles of insight, reconstruction, and working through extended psychoanalysis beyond symptom removal to the more comprehensive treatment of the individual. Dr. Stewart explored the still elusive aspects of the therapeutic experience. How does the analytic process bring about good results? What is the science of our art? To address this question, Dr. Stewart turned to an evolutionary view and a developmental frame of reference, emphasizing the interrelation of biological maturation, drives, ego development, and the modifying effect of the environment. In this evolutionary process the individual, somewhat freed of reflex action through the use of thought, nonetheless becomes more susceptible to psychoneurosis. Dr. Stewart repeatedly emphasized the importance of the role of the ego and its functions, and how its resolution of tasks determines character. Failure in the resolution of childhood conflicts leads to endless repetition of maladaptive responses. The goal of therapy goes beyond the cure of symptoms through understanding their meaning and beyond interpreting conflicts elicited in dreams and by free association. "The discovery of the actual deleterious experiences in order to understand the damage they have inflicted on development is necessary."

Dr. Stewart outlined the psychosexual stages of development as they unfold i