Consciousness

For decades Allan Hobson has proclaimed Freud's dream theory as thoroughly mistaken. He has also suggested that Freud's use of the mistaken tenets of 19th-century neurology undermined not just that theory, but also the fundamental psychoanalytic propositions of Freud's (1900/1950b) mental apparatus as conceptualized in Chapter 7 of The Interpretation of Dreams. He is wrong on both accounts! Freud's theory of dreams remains an accurate general framework in which to understand and explore the origins, nature, and meaning of dreams. In addition, embodied within Freud's model of the mental apparatus are inferences about brain processes not just relevant to dreams but also to conscious perception, memory, reality testing, and creativity that are remarkably consonant with modern neuroscientific understanding.     

Kingsley Hall: The Politics of Madness

This article replies directly to the two cornerstones of Hobson's legendary transposition of Freud's dream theory, that is, the theory's presumed empirical untestability and its scientific obsolescence or replaceability in the scientific arena. After an outline of Freudian dream theory, empirical data coming from two research paradigms (“children's dreams” and “drug dreams”) are reported. From a theoretical-epistemological point of view, the studies show that Freud's dream theory includes clear “potential falsifiers,” that is, in Popper's terms, certain events, which if found to be true, would unequivocally show Freud to be wrong. This challenges Hobson's accusation concerning the empirical untestability of Freud dream theory. From an empirical viewpoint, these studies show that Freudian dream theory is not even remotely scientifically outdated and obsolete. The results of these studies are consistent with the cornerstones of Freudian dream theory (e.g., the hypothesis of dreams as wish-fulfillment, the disguise-censorship model) and suggest the viability and worth of further investigation in this arena. Indeed, Freud's dream theory is alive and useful in explaining the phenomenon of dreams in various fields of application. These authors believe that J. A. Hobson's dismissal of Freudian dream theory is thus misguided and premature because, to date, the findings indicate that Freud was essentially correct.     

History of Aphasia Freud as an aphasiologist

Between 1891 and 1901, Sigmund Freud published both psychoanalytic and neurological works. This review analyses the interactions between Freud's On the interpretation of the aphasias (1891) and the development of psychoanalytic concepts, as well as Freud's theoretical views on brain–mind interrelations and his neurolinguistic theory. It is pointed out that in his aphasia book, Freud developed elements of a neurobiological theory of cognition and behaviour that became important for the theoretical foundation of psychoanalysis. Although Jackson, whom Freud regarded highly, had understood that people communicate by propositions, Freud followed Wernicke in that the word and the word concept were the basis of language. This assumption guided the interpretation of associations in psychoanalysis. For aphasiology, Freud is one proponent among others who criticised mechanistic localisationist theories. His major obstacle was the lack of linguistic theories. Freud's influence on aphasiology was rather limited, mainly because his book was hardly read, to his dismay.     

On a Case of Bulimia

Freud proposed two sharply contrasting conceptions of the body's place in mental structure. Both were radical departures from established views of the mind. In the first, body-based thought is rooted in the drives and instincts. It is primitive in contrast to the body-free, logical, and rational thought of maturity. Freud remained committed to this view in his formal conceptions of the mind throughout his working life. It remains the one most fully accepted in psychoanalytic thought today.

Less formally, particularly in conceptions of the “accidental” factors that structure the primary processes, “stereotype plates” that pattern our experience, thinking as “action in the mind,” and “internalizations” that form our inner worlds, he suggested an even more radical notion. In this view, “bodily” refers to the behavioral patterns (of personal motivation, action, attitude, wish, and feeling) as opposed to mental ones. Body-based patterns occur primitively, but they may also become mental and structure the mind at the highest levels of sophistication. Neither in Freud's time nor subsequently, however, has it been possible to integrate this second view of the bodily in mental functioning into the accepted psychoanalytic theory of mind.

Now, however, developing perspectives in psychoanalysis provide a framework in which this second view can be accommodated. In this model the mind is initially composed of social-emotional-behavioral patterns (in Stern's useful term, “patterns of lived experience”) established in familial life (Freud's “accidental” factors that form “stereotype plates”). These patterns, articulated and modified in the course of development, can increasingly be activated mentally with or without accompanying bodily action (Freud's “action in the mind” and “internalization”). These, rather than the rational-logical processes of traditional thought, constitute the mature mind.     

On “Remembering,Repeating and Working Through,” Again

This article examines Freud's key paper "Remembering, Repeating, and Working Through” for its significance in the history of psychoanalysis. Each of the words in Freud's title are taken to be integral to Freud's writing.     

Therapeutic Action and the Story of the Middle

Abstract. The work of Sándor Ferenczi anticipates various challenges of contemporary psychoanalysis—clinical, technical, and theoretical. Among the most novel is his elaboration of the concept of trauma. Ferenczi's 1930s writings were mostly read by the psychoanalysts of his time, including Freud, as a return to Freud's seduction theory. Nevertheless, in Ferenczi, there is an innovation that distinguishes him from Freud. Although today's psychoanalytic community expresses a growing interest in Ferenczi's trauma theory, the field pays less attention to his focus on the traumatic dimension of language itself and the effects language has on the subject. In fact, Ferenczi's later work uniquely explores the relationship between trauma and language. In part, what makes Ferenczi's trauma theory unique is that it anticipates Jacques Lacan's work on the traumatic dimension of language, which the French psychoanalyst referred to in his final theoretical production through the concept of lalangue.     

The Cross-Cultural Therapeutic Dyad

The impact of Nikos Kazantzakis's memoir Report to Greco on the author is explored. Writing a “letter” to Kazantzakis in a style that mimics Freud's 1936 public letter, A Disturbance of Memory on the Acropolis: An Open Letter to Romain Rolland on the Occasion of his Seventieth Birthday, the author muses on an epiphany while facing the Parthenon. The author's personal sense of aliveness and deadness is presented as a measure of the interpenetration of psychoanalysis and the humanities.     

Psychosis as a Disorder of Reduced Cathectic Capacity: Freud's Analysis of the Schreber Case Revisited

Approximately 100 years ago, a prominent German public figure name Daniel Schreber wrote memoirs of his experiences in asylums. His case was diagnosed Dementia Praecox at times and Paranoia at others by his treaters. Freud analyzed Schreber''s memoirs from the perspective of his “libido” theory of developmentally organized mental “cathexes” or ideational/emotional investments in self and others. Revisiting Freud''s analysis of the Schreber case suggests that it may represent the first theoretical articulation that the pathophysiologic core of psychosis is one of deficit, i.e., of diminished (organic) cathectic capacity for normal mental and affective investments in life.     

“In Praise of My Doctor”— Frieda Fromm-Reichmann

This article reviews the chapter on Edith Jacobson and Otto Kernberg in Greenberg and Mitchell's (1983) classic volume. It summarizes both their mostly accurate overview of the proposals of these two psychoanalytic contributors, and points to some misunderstanding of them in Greenberg and Mitchell's critique. The article then clarifies Otto Kernberg's present views, and proposes a concept of human motivation that includes both its neurobiological basis and the secondary symbolic level of organization of experience and motivation. This proposal includes a reformulation of the origin of Freud's dual drive system, and stresses the concept of unconscious intrapsychic conflict as a core aspect of psychoanalytic theory.     

Si je vous dis « rouge », à quoi pensez-vous ?! Discussion autour d’une dynamique associative inconsciente

PurposesThis article aims to deepen a theoretical model of the psychic apparatus introduced in a previous work, in particular one of its main characteristics: the presence, at the center of its functioning, of an unconscious dynamic of perceptive association partly inherited from the primary process of the Freudian theory.MethodThe article first surveys Freud's writings about three psychic phenomena: dreams, slips of the tongue, and jokes. Analyzing these works suggests a theoretical difficulty concerning two processes (primary and secondary) considered to be opposites by Freud, and leads to an alternative applied by our model. The article then moves on to the famous experiments conducted by Alfred Binet with his hysterical patients at the end of the 19th century, in which the so-called phenomenon of “double consciousness” was put on display.ResultsIt appears that the unconscious dynamic of perceptive association is always a driver of psychic life, in both unconscious phenomena as well as in regular thinking. It typically operates when we facetiously ask the reader: “If I say ‘red’, what comes to mind?” This dynamic seems to bring to the natural mechanism of thinking some proprieties of condensation and displacement already identified by Freud, in a more intense form, in the making of dreams and attributed to his primary process. More precisely, thinking appears to be the product of this dynamic, given that it is supervised by the activity of the field of consciousness, simultaneously able to activate and channel it.DiscussionThe irruption of dreams possibly results from a kind of switching in the collaboration between consciousness and the unconscious system during sleep: the lowering of conscious activity then opens the way for the associative dynamic of the unconscious whereas, on the contrary, the former tightens its grips in the alert thinking. More generally, we can consider that thinking, in all its forms, always depends on the control exercised by the field of consciousness over the associative dynamic of the unconscious. A great freedom given to the latter would necessarily be a condition for artistic creation, for example.ConclusionOur reflections and model clearly borrow from Freudian theory, while also clearly departing from it in several respects. Starting from the dynamic of the unconscious system, this article highlights the importance of conscious activity when Freud instead tended to minimize it. From this perspective, our model would appear to occupy a middle ground between Freud's and Janet's.     

Murder and Memory

Lois Oppenheim has offered us a very complete analysis of Samuel Beckett's creative work. We shared with her his huge suffering, his craziness connected to his family history, and his incredible energy in writing. Beckett was a brilliant artist whose creations are frightening for most of us and at the same time make us very curious about witnessing the pain of human beings. I discuss two points in particular: Oppenheim's hypothesis that trauma was the cause of Samuel Beckett's troubles and the influence on his writing of his experience with psychoanalysis.     

Marr and Reductionism

David Marr's three-level method for completely understanding a cognitive system and the importance he attaches to the computational level are so familiar as to scarcely need repeating. Fewer seem to recognize that Marr defends his famous method by criticizing the “reductionistic approach.” This sets up a more interesting relationship between Marr and reductionism than is usually acknowledged. I argue that Marr was correct in his criticism of the reductionists of his time—they were only describing (cellular activity), not explaining (cognitive functions). But a careful metascientific account of reductionistic neuroscience over the past two decades reveals that Marr's criticisms no longer have force. Contemporary neuroscience now explains cognition directly, although in a fashion—causal-mechanistically—quite different than Marr recommended. So while Marr was correct to reject the reductionism of his day and offer an alternative method for genuinely explaining cognition, contemporary cognitive scientists now owe us a new defense of Marr's famous method and the advantages of its explanations over the type now pursued successfully in current reductionist neuroscience. There are familiar reasons for thinking that this debt will not be paid easily.     

The Form of Play in the Shape and Unity of Self

In The Three Essays, Sigmund Freud advances a radical account of gender, sexuality, and knowledge. The power and implications of his account remain underappreciated, even within contemporary psychoanalysis. Freud portrays masculinity and femininity as equally problematic and painfully acquired social constructs. Concepts such as the unconscious and desire further undermine conventional ideas about masculinity and femininity, sexuality and rationality. Despite objectionable statements about women, Freud's ideas subvert traditional justifications for male dominance. Freud makes the equally radical claim that there is no intrinsic relationship between anatomical difference and sexual desire. Heterosexuality is neither the “natural” expression of the drive for pleasure nor a consequence of anatomical difference. Conventional gender arrangements and sexual identities reflect socially conditioned channeling of desire. Despite the supposed pervasiveness of psychoanalytic thinking, such ideas contravene conventional Western thinking. Taken seriously they undermine dominant notions of gender relations, ideologies of the family, and theories of knowledge and the mind. Such still scandalous ideas partially account for the persistent disrepute of Freud's ideas.     

The “Voice” of Breakdown: On Facing the Unbearable Traumatic Experience in Psychoanalytic Work

This article weaves together three major contributions to the theory of trauma and repetition compulsion: Freud's (1920/1955b) reformulation in “Beyond the Pleasure Principle” of his metapsychological theory regarding the notion of trauma and the compulsion to repeat traumatic experiences and traumatic dreams; Cathy Caruth's (1996) elaboration, based on a dramatic story in Freud's article, of “the voice that cries out, a voice that is released through the double wound”; and Winnicott's (1963/1986, 1965/1989a) unique ideas about the early unthinkable breakdown that has not yet been experienced and has to be relived and experienced in analysis.

The author explores the clinical implications of the intricate relation between knowing and not-knowing in facing trauma, which is simultaneously demanding and inaccessible, massively dissociated, and thus never and forever there. In particular, she relates to the profound difficulty of hearing the “voice” of breakdown that cries out from the belated “double wounding,” the critical importance of experiencing the unexperienced with the analyst; and the immensity of the terror and hope that is at the heart of reaching to the original unbearable traumatization in psychoanalytic work. Three detailed clinical illustrations from psychoanalytic writings and an autobiographical essay by Virginia Woolf are presented.     

Back to work with a chronic dysexecutive syndrome? (A case report)

Abstract

We present the case of G.L., a 33-year-old medical doctor, who, nine years after traumatic brain injury, was admitted to our department after he had drifted through several jobs. According to his superiors he spent too much time on routine activities and seemed unable to adapt himself to open problems and the requirements of novel or changing situations. From a psychometric perspective we found G.L. rather unremarkable, with largely good attentional, memory, and problem-solving performance. Behavioural analysis, however, revealed that G.L.'s discrete but definite frontal-lobe damage had produced defects in “executive functions”. After 12 months of intensive training G.L.'s mental structure had been modified to incorporate new source schemata, which enabled him to carry out demanding routine thought operations. In creating and practising these higher-level schemata his handicap could be diminished to the point that he now has got a supported employment. His basic cognitive incompetence, however, remained unchanged. This remarkable case fits in with Norman and Shallice's model of cognitive control of action and thought operations.     

From research to clinical practice: Considerations in moving research into people's hands. Personal reflections that may be useful to others

It may take many years for published clinical research findings to be found, understood, adopted and applied in practice. In recognition of this delay, many jurisdictions and agencies are now promoting a stronger link between research and its dissemination in useable forms that will enable practitioners to access, understand and use new ideas. The purpose of this paper, first presented as a keynote address at the 15th Annual Meeting of the European Academy of Childhood Disability in Oslo in October 2003, is to share experiences of the author and his colleagues at a childhood disability system-linked research centre in Ontario, Canada. The lessons learned include the value of striving to describe one's findings in plain language; writing study reports for parents and children who are involved in research studies; using multiple methods to disseminate one's work; and making explicit the potential importance and applicability of the findings to readers of the work. Engaging end users at many stages of the development and field testing of one's work will enhance buy-in and lend added credibility to the work, as well as influencing content and process as the research unfolds. The result is likely to be greater recognition of ‘familiar’ aspects of the research and the adoption of relevant findings.     

Three Conflict Levels

The use of the self-state metaphor requires careful attention to changes in a patient's subjectivity that may go unnoticed by the patient. Affect, fund of knowledge, beliefs, worldview, idiosyncratic behaviors, physiologic state, and other aspects of subjective experience may vary from self-state to self-state. These shifts are especially visible when “not-me” self-states are present. Changes in self-state in the analyst in resonance with similar shifts in the patient provide avenues of inquiry and insight that are far reaching and make the most of the use of the analyst's self in an analysis of enactment. Not-me self-state experience is especially challenging to uncover and is often the focal point of the patient's or analyst's resistance to knowing his own mind. Intense overwhelming affects are often at the core of this resistance. Attention to these focal points may open the not-me self-state to view as a subject for analysis. Distinguishing these complex dissociative processes from psychotic process is of critical importance and requires alert consciousness for the mechanisms of dissociative experience.     

Cognitive Behavior Therapy for Psychosis: From Understanding to Treatment

Abstract

Recent randomized controlled trials carried out in the UK suggest that there is now strong evidence for the efficacy of cognitive behavioral therapy in the management of people with chronic treatment resistant psychosis. At the core of this approach is a focus on the subjective needs of people with psychosis (in particular the experience of voices, paranoia, delusions, and depression) and an attempt to understand or make sense of these problems from the individual's perspective. The cognitive behavioral offers both a new set of therapeutic skills, which may be utilized by psychiatric rehabilitation practitioners (see Kuipers and Turkington), and a new way of thinking about the needs of people with psychosis. The implications of the cognitive behavioral model of people with chronic psychosis can therefore inform an approach to psychiatric rehabilitation in which goals of rehabilitation genuinely reflect the concerns of the individual with mental illness. In this paper we outline the clinical implication of recent research findings and illustrate the application of cognitive behavioral formulation and therapy to the management of complex cases of psychosis.     

“A Psychotherapy for the People”

The development of psychoanalytic technique can be traced in part to the dialogues between Sigmund Freud and Sándor Ferenczi, dialogues that took place in the context of psychoanalysis's encounter with poverty and destitution in the wake of World War I. These dialogues, which served as precursors to contemporary, especially Relational, psychoanalysis, also inspired Freud's call for greater psychoanalytic engagement with the poorest and most vulnerable. This inspired the early psychoanalysts to “sharpen in all directions the sense of social justice” by engaging in political activism, experimenting with clinical technique, and by promoting short-term, more affordable treatments. The relevance of this history for clinical work with diverse populations will be discussed, and aspects of contemporary psychoanalysis (countertransference, enactment, new relational experience) will be understood in light of Freud and Ferenczi's responsiveness to the underprivileged.