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“If psychoanalysis is going to endure, even flourish, some of its fundamental tenets are going to have to change.” With this statement Laurence Miller begins his enlightening, massively detailed analyses of how Freud's early experiences in neuropsychology formed the basis for his theory and practice of psychoanalysis, and how today's research still offers crucial additions and emendations to his work that we must attend to. The eventual integration
of psychology and biology seems needed and inevitable, given current clinical practice, in which drug therapy and psychotherapy intersect. It is well known, for instance, that some depressed patients respond well to psychoanalysis whereas others respond only to antidepressants and still others require both approaches (Fieve, 1975). Miller is here taking the first important theoretical steps toward enriching our models of the mind/brain by returning to the neuropsychological roots of psychoanalysis and examining the three pillars on which Freud built psychoanalysis: hysteria, dreams, and parapraxes (or “Freudian slips”).
Like Freud, Miller starts with hysteria. Freud (Breuer & Freud, 1893-1895) regarded Anna O's robust hysterical symptoms—which included mood swings, hallucinations, blindness, deafness, and speech disorders (intermixing different languages, loss of command of grammar and syntax)—as a form of body language, the symbolic expression of repressed material that could be more therapeutically talked out during psychoanalysis. But, Miller points out, virtually every hysterical symptom reported by Breuer and Freud has an analogue in some known form of altered neurocognitive functioning; that is, each symptom can be found in organic brain disease or injury without evidence of hysteria. Miller does not argue that hysterical symptoms are always organic; rather, in accordance with his long-range view of a more integrated mind/brain model, he maintains that a neuropsychodynamic model assumes that the “psychical impetus