Psychoanalysis—a Cognitive Process

Cognition is defined in Webster as an intellectual process by which knowledge is gained about perception and ideas and as the act of knowing in the broadest sense. This is a straightforward definition and useful in its application to psychoanalytic therapy.

The act or process of knowing may be organized as verbalizations that can be linguistically communicated or it may be organized as perceptions, ideas and beliefs that do not become crystalized in linguistic representations. In investigating reactions to the diagnosis of malingnancy at Memorial Hospital, Ohrbach and I (1957) found that some patients, without ever verbalizing it, believed that if they lived a good, moral life, serious illness and accident would not befall them. When we concretized these beliefs to them, the patients readily acknowledged that they held such ideas and reaffirmed them without question. Of quite a different order is knowledge shut out of consciousness because there is a fear of facing it. Some patients denied knowledge or even suspicion of serious illness despite the fact that they dreamed of loved ones dying and they also had dreams indicating apprehension. Such knowledge is no less cognitive because it is unconscious.

Psychoanalysis has developed from its very beginnings as a cognitive method of psychiatric treatment. Any therapeutic method that relies mainly upon interpretation and insight is obviously cognitive. Yet Freud and Breuer, in their original studies of hysteria, committed themselves to the theory of the primacy of affect and that cognition was in the service of affect disorders. In the Introduction to Volume II of the Standard Edition of Freud's work, the editors, James Strachey et al., described the basic theory as follows:

The main theoretical position adopted by the authors (Freud and Breuer) … seems on the surface a simple one. They hold that in the normal course of things, if experience is accompanied by a large amount of affect, that affect is either discharged in a v