The first surprise was the weather. Most of us arrived in Santiago to bright sunshine and early summer temperatures that lasted most of the week. Next was the registration that topped off at more than 1,600, swelled by participants from the local academic community, who contributed to an unusually accepting atmosphere for the IPA congress.
The start of the scientific program was delayed by the arrival of Eduardo Frei, President of the Republic of Chile, who used the occasion to make a major policy statement, calling for justice for the “disappeared” and asking the country “never to forget,” in sharp contrast to his earlier advocacy of forgiveness for past injustices. As a result, the congress made front page news with a photograph under the headline “Sigmund Frei.”
For the scientific program, the hope of reconciling many of the disparate theoretical points of view initially seemed overwhelming. This experience was best captured by Sander Abend in his paper for the Overview Panel on the final day. Noting his own dysphoria and sense of inadequacy toward the task at hand, he compared the position of the listener at the congress to that of a patient, who, hoping to come away with certain answers, finds instead that he or she comes only to see certain questions more clearly.
The focus of the congress was on affect. While the clinical presentations each morning, and the effort to include clinical data throughout, helped to clarify some of the different theoretical and conceptual positions represented, I have nonetheless been puzzling over the confusion and disorientation that occurs as one analytic culture encounters another. Armed with Abend's interpretation and thus freed of the obligation to reach synthesis, I think I can see some of the questions more clearly.
As North Americans we hold a unique and ambivalently regarded position in the eyes of the rest of the psychoanalytic world. At the IPA congress in Amsterdam, it was said that the United States had “interpersonalized psychoanalysis” and in so doing lost touch with the unconscious. In Barcelona our focus on empirical methodology, both in research and in clinical listening, was felt to overshadow our appreciation of unconscious data. Because I believe we inevitably try to avoid focusing on unconscious conflict, these criticisms concern me.
In Santiago it became clear once again, that whether it be from the point of view of structural theory, self psychology, or some variant of relational psychoanalysis, North Americans work with a leaner theoretical edifice. We are not alone in this, but we seem not to share the enthusiasm that some Europeans and Latin Americans have for higher levels of theoretical abstraction. We are less comfortable than they with competing theoretical frameworks. Their writings at times seem muddy and overly complex to us, and ours appear simplistic and under-theorized to them.
It is an old tension, expressed by Freud in his references to the “witch metapsychology” and to that most abstract level of theory which he thought could be “discarded and replaced” without harm, a point of view that was later elaborated extensively by George Klein and, briefly, by Robert Waelder.
Over the course of the week I found myself looking to Waelder's 1962 writings for help. Waelder once charted the different levels of psychoanalytic thinking in terms of levels of abstraction or degrees of distance from the clinical material. Thus he outlined sequentially (1) observation, (2) clinical interpretation, (3) clinical generalization, where analysts gather groups of data into generalizations about symptoms or character types, (4) clinical theory, which includes concepts such as defense and regression, (5) metapsychology, with its more abstract notions like psychic energy and (6) philosophy, specifically the nature of Freud's philosophical positions. Waelder regarded the level of metapsychology as the top of the psychoanalytic structure and “far less necessary” to the clinical enterprise than those levels below it. He considered the level of philosophy to be of no clinical consequence whatsoever.
Charles Brenner, before his own recent theoretical prunings, disputed in 1980 Waelder's view of metapsychology, arguing, correctly I think, that Freud simply meant the term as a synonym for psychoanalytic theory in general and that “in every branch of science even the simplest observations involve ideas of the highest order of abstraction,” the only important consideration being how well the theory fits the clinical data. From this we might argue that all levels of theory are ultimately clinical theory.
We should also note that along with the relative spareness of psychoanalytic theory in North America, there are, paradoxically, increasing appeals to philosophy, in which it is held that philosophical considerations are superordinate and, in fact, determinative of clinical approaches and might even dictate specific clinical interventions. Here the sequence from observation to theory that Waelder had in mind is turned on its head.
These arguments and developments notwithstanding, the clarity of Waelder's description of different levels of abstraction in psychoanalytic thinking may be useful in sorting out the international confusion of tongues. In Waelder's schema, it would seem that North Americans in general are more comfortable with those conceptual levels up to and including the level of clinical theory. The major concepts in Brenner's current version of structural theory — the compromise formations made up of wishes, painful affect, defenses, and self-punishing trends — coalesce on this conceptual level. Less compatible are those conceptualizations at the level of what Waelder called metapsychology. These indeed include concepts like psychic energy, cathexis, and the death instinct, concepts that are still considered clinically essential in other parts of the world.
At the Santiago congress the enthusiasm for these more abstract notions was voiced by those with a more fundamental conviction about the importance of earlier Freudian conceptualizations than we tend to find in this country. Some Europeans and Latin Americans comfortably integrate formulations about topography and psychic energy with later post-Freudian conceptualizations regarding object relations and language. Like Anna Freud and Joseph Sandler, many abroad regard both the topographic and the structural models to be useful at different times for different sorts of data.
Henry F. Smith, M.D., is a training and supervising analyst for PINE and Associate Editor of JAPA. He served as North American co-chair of the Program Committee for the forty-first IPA Congress in Santiago.
These earlier and mixed models are felt to be particularly applicable to our more disturbed patients. At the congress we heard about patients who, having little capacity to achieve a verbal or symbolic representation of their own affect states, are overwhelmed by affect; in the countertransference, their analysts are similarly afflicted. Inferences about early infantile experience were said to explain the etiology of such disorders. In his plenary address André Green argued cogently that borderline patients suffer from an inseparable mix of affect and representation, in which the one cannot be distinguished from the other, leading to unmanageable affect states in the patient and despair in the analyst.
As I thought back on the different kinds of theory, the different uses of theory, and the different degrees of abstraction inherent in the theories we heard, I wondered, were we all looking at the same phenomena and putting them into different words, or were these different words irreconcilable and mutually exclusive? I thought of Sandler's nearly life-long attempts to integrate structural theory with object relations theory through the intrapsychic focus of his “representational world.” And as I kept settling into my sparer and more familiar versions of contemporary conflict theory, I wondered whether an update of Waelder's classifications might help us build a more integrated theory. If we share common ground, might that ground be more compatible on some levels of abstraction than on others? Might more familiar North American conceptualizations coexist with other more abstract notions on different levels of abstraction?
Could it be that we in North America are focusing on different kinds of affects than are our European and South American colleagues? Might our theories fit their view of affects no better than their theories fit ours? As Abend suggested in his overview of the congress, perhaps we ought to consider the possibility that the wide range of affects that accompany libidinal and aggressive drive derivatives may have a “quite different psychic economy, and perhaps a different physiological basis as well,” from the variations of signal anxiety and depressive affect that are the focus of structural theory.
Some phenomena have always seemed to fit less comfortably than others with structural explanations, especially given our current aversion to the concept of psychic energy. One such area, which received considerable attention at the congress, is the quantitative factor in the experience and expression of affect, particularly among our more disturbed patients. In the effort to describe and explain the intensity of some affect states and the difficulty patients have in controlling and reflecting upon them, energic considerations in their original topographic frame begin to seem less remote. If we venture into these more inferential waters, can we learn from those struggling to explain such data with integrations of topography, energy, and object relations? While maintaining a clear separation between the data of psychoanalysis and those of neurophysiology, will generalizations emerging from the neurosciences in time allow us to update our metaphors of psychic energy?
The Santiago congress leaves us with a final question: Are we struggling with fundamentally irreconcilable frames of reference, or is a more cohesive theoretical integration possible? If the effort to integrate stems in part from the wish to relieve one's own psychic pain and confusion, then this article must also serve such a purpose. I am grateful to all who presented their own points of view in Santiago, and my apologies for not mentioning them all by name.