On Concreteness*

“Concrete” is an adjective used to describe a variety of clinical situations that at first blush may appear unrelated. We are accustomed to labeling as concrete the thought-disordered patient's idiosyncratic ram-blings, which leave him unable to define a proverb beyond his or her private associations to the saying. The clinician may also call concrete the poignant search for a specific clue that will unlock a forgotten recent memory in the organically impaired individual. Concrete may also describe the seemingly impenetrable misery of the depressed patient who, despite the analyst's best efforts to impart understanding, continues to wallow inaccessibly in unhappiness. The common thread running through these instances is the concrete patient's imprisonment in a current situation (the pressure of an intrusive thought, the desperate grasping to recover a lost thought, the seemingly endless fog of depression) that casts a shadow of narrow meaning across all experiences. The concrete patient cannot lift himself out of the immediacy of the moment and is trapped in a state of mind that cannot see beyond itself. I will use the term “concreteness” generically for this overall mode of functioning that spans a number of clinical manifestations.

Paradoxically, despite the widespread use of concreteness to describe clinical phenomena, little attention has been paid in the literature to understanding the psychological processes that underpin it. Some notable exceptions have come from the work of developmental psychologists such as Piaget (1945, 1954) and Werner (1957); however, these studies focused exclusively on cognitive development, and their findings are not linked with any theory of the growth of interpersonal relationships.