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Interdisciplinary studies and our practice

David D. Olds, M.D.

[A version of this paper, in a PowerPoint format, was presented on June 11, 2006, at the Annual Meeting of the Rapaport-Klein Study Group]

 

ABSTRACT: This paper attempts an at least partial answer to the often-raised question: why should psychoanalysts learn about other neighboring disciplines? I shall try to respond to the commonly heard argument that, although the information from neuroscience, neuropsychology, evolutionary psychology as well as many others may be of interest to analysts, it has no real effect on their practice, on the way they listen, on the way they respond, on the way they treat their patients. This same way of thinking further urges that there is no reason to include such information in a psychoanalytic curriculum, since it does not help one to be a better analyst. The thesis of this paper is that there are important reasons for interdisciplinary study. The most general reason is that such study may connect our discipline with the broader scientific world, reducing its isolation and inbred parochialism. Relating our central concepts to biological and other scientific foundations can help to justify our discipline intellectually and scientifically, possibly in advance of and independently of other supportive research within our field, such as outcome studies. It is also argued that our own minds, and particularly those of the generation now entering training, have been altered by the changes in the scientific zeitgeist; and we need to have some grasp of these changes. Third, I present some examples of findings from other disciplines that may be even now contributing to our thinking about our psychoanalytic practice. In this paper I concentrate on research from outside our field: research in affect disorder, infant observation, memory research, dynamic systems theories, neuro-science, evolutionary biology. The research from within the psychoanalytic discipline, much of it done by members of the Rapaport-Klein Study Group, I have not included. However, in our discussion we may raise the same question: has psychoanalytic research made changes in our practice?

INTRODUCTION

The sciences devoted to the brain and mind have in recent years made dramatic progress. Many functions of mind have been elucidated and have often been meaningfully related to brain activities. A patchwork of theories has grown up giving us a partial view of how the brain works. Psychoanalysts have faced this deluge of information and responded in various ways. This paper is an attempt to discuss this interchange between psychoanalysis and its neighboring sciences.

We are faced with the question: are there any changes in psychoanalytic practice resulting from the new information? It is generally accepted that scientific information may have led to some changes in psychoanalytic theory building. But it is less certain that it has made much change in the way we treat our patients. Pulver‚s (2003) plenary address, devoted to the „astonishing clinical irrelevanceš of neuroscience, made the argument that our technique is well established, and the neuroscience knowledge tells us „nothing we did not already know.š And, if it does tell us something new about theory, it is still irrelevant to practice.[1] Although in the short term this argument may have some merit, if we take a longer view, we see the issue is much more complex.[2] It may well be that no neuroscience finding is going to suddenly cause a huge shake-up in psychoanalytic practice. One might in fact ask, why should we expect such a revolution? Our practice has been honed and developed over a hundred years; it isn‚t obvious that knowledge of the brain would have a dramatic effect. I think that there are changes and there will be more, but, because our technique is so well established, these changes will be modest, especially in the near future. In fact one might also ask, how much change could there be and our technique would still be psychoanalysis?[3] That question is a reason for anxiety among analysts dealing with this topic.

What is more important for this discussion is that the accumulation of information from other sciences is already having a profound effect on the way we think about the brain and mind. It is changing us and our minds. It is changing the context in which we understand what it is to be a living entity, a mammal, a human being. I think that psychoanalytic practice will evolve slowly and subtly as part of this process.

Reframing the Question

Keeping this in mind we may see the need to reframe the question posed above concerning the impact of interdisciplinary information on clinical practice. Some analysts will say, in answer to the question, that they can not think of an instance where interdisciplinary knowledge has led them to practice any differently, treat patients any differently, even think about their patients any differently. Yet I think most would agree that analytic technique and practice have changed in important ways over the last 30-40 years. Maybe we might rephrase the question this way: There have been important changes in technique in the last half-century; is it possible to say what kind of contribution the cognitive sciences have made to this evolution. Some of the changes in clinical theory and practice that have come about would include: a more active and interactive stance toward the patient by the analyst; the shift from a libido-economic model to a more information, meaning, narrative based and less a drive-based psychology; the development of a „two personš psychology, so that the relational matrix is more important; the importance of brain and body in the analytic situation, most concretely in the use of psychotropic medication commonly as part of the treatment. The short answer to this reframed question may be that the other sciences have contributed to our clinical theory and technique, partly in the ways we‚ll discuss below, and partly indirectly via the impress of the change in the zeitgeist. Because of this cultural change, even the theories that we had already espoused take on some new meanings because of the change in context and the changes brought about by the new information itself. The milieu surrounding us has become so profoundly different, that even when our technique has not obviously changed, our same techniques and our same interpretations may be rendered different in meaning. And we are only at the beginning of this revolution.

I would first like to make a general comment and then get down to specific possible contributions from other sciences.

OUR ISOLATION AND ITS VIRTUES

We are aware of the history of psychoanalysis in the 20th century, a history in which our discipline traveled an increasingly isolated path, divorced from what was happening in the outer scientific world. Although this probably degraded our status as a scientific discipline, it also may have had the effect of preserving some of our central tenets, and allowing us to continue to develop our own concepts and theories, particularly those that consider the interiority and agency of the self - a mind in control, a mind in conflict. If we had mingled freely with the rest of academia we might have been buried under the tide of behaviorism, and would only now be starting to dig ourselves out. As it happened, we preserved our basic principles, and now it turns out that many of them were valid, and that, as Kandel (1999) has pointed out, we had a theory of mind that was the most comprehensive theory available. So in this most general view, psychoanalysis has preserved some basic principles, and these may ultimately have an effect on the other sciences. In the two-way exchange that now seems to be occurring, we may find some of those principles validated and some losing intellectual credibility. We are also finding that some of the phenomena that analysts have been alone in growing to profoundly understand will provide information for other sciences at the same time that they raise questions for these scientists to answer.

WHO ARE OUR NEIGHBORS?

When we think of our isolation, we must think of what are our boundaries, and who are the neighbors? This paper focuses on the nearby biological sciences such as neuro-science, cognitive psychology, primatology and evolutionary biology. It is part of our lore that Freud aspired to forge connections with such sciences, but the level of knowledge made it impossible until recently. Other boundaries were considerably more porous, and the traffic brisk. The earliest insights into crucial Oedipal and other family dynamics emerged from Freud‚s reading of Sophocles and Shakespeare. Freud‚s thinking was shaped by his deep immersion in philosophy from the pre-Socratic to the modern. In the other direction there have been important influences from psychoanalysis on literature, history, anthropology, and other social sciences. There has been a fruitful back and forth interplay between our discipline and a major branch of biologically oriented philosophy, including the works of Cavell, Churchland, Dennett, and Searle to name a few. In fact such interdisciplinary intercourse is the model for the scientific interchange that is now occurring. It is often at the boundaries of disciplines that innovation and creativity emerge, both at the theoretical and practical levels. That is why a professional education usually explores the neighboring terrain. It may be impossible to understand a boundary of one‚s own discipline until one has seen what is on the other side of it. And, it is at the borders that differing ideas first come into contact and produce new thinking.

Another close neighbor that space considerations prohibit discussing in this paper is the realm of infant and child observation. This vast enterprise has blossomed in recent decades to provide much information of value in our formulations about patients and in our techniques. Even here some have argued that the information is of no importance clinically, the reasoning being similar to that about the other scientific disciplines. (Wolff, 1996) Yet we often hear notions coming from attachment theory and child development research creeping into our discussions of patients and our techniques of therapy. [4] Another important neighbor that combines developmental and evolutionary perspectives is the research in the components of attachment behavior in infants of other species. (Hofer 1996, 2003; Soumi, 1995).[5]

The end result of the new ecumenism, despite the inevitable epistemological difficulties involved in trying to integrate disciplines with such different basic concepts and databases, should be that we have a firmer place in the scientific world, resulting in a positive effect on the way the world views us, and upon our own morale and self esteem. These changes will influence how and how much we practice psychoanalysis, possibly preserving the discipline from its recently threatened demise. So one effect may be the influence on whether anyone practices psychoanalysis at all. 

INFORMATION THAT MIGHT BE RELEVANT

What sort of data are we talking about? What kind of interdisciplinary information would have any effect on our work? I will present six examples of new knowledge and open for consideration the question: do they really make a difference? These are mirror neurons, procedural memory, cognitive function, affect, trauma, and dynamic systems theories.

Mirror Neurons

My first example is the discovery of „mirror neurons,š a recently described set of neurons that may be important for imitative learning and some other types of motor learning, including language. The work of Rizzolatti, Gallese, and others has demonstrated this entity in monkeys. (Rizzolatti, et al, 1996; Gallese & Goldman, 1998) A monkey, in their experiment, wears an array of micro-electrodes that record the activation of individual neurons in the cortex. When the monkey picks up a morsel of food and puts it in its mouth, a characteristic read-out appears from the pre-motor cortex. The pre-motor cortex has been known for years to be where co-coordinated actions are generated, in contrast to the motor cortex, which controls individual muscle contractions. Therefore this finding was no surprise. However, it was discovered almost accidentally in one experiment, that when the resting, motionless monkey sees an experimenter do the same thing, namely pick up a food morsel and put it in its mouth, the same cortical read-out occurs in the monkey. In other words, in the experience of viewing a motor event of another, there seems to be a virtual pre-motor-cortical event in the viewer. The same cells fire that would fire had the observer performed the same action.

This finding has caused quite a stir in neuroscience circles. V. S. Ramachandran, an eminent neurobiologist, has declared that „mirror neurons will do for psychology what DNA did for biology: they will provide a unifying framework and help explain a host of mental abilities that have hitherto remained mysterious and inaccessible to experiments.š (Ramachandran, 2000, p.5) Why such a fuss? And, why should we be interested? For their part the neuroscientists feel that this sort of data reveals something about the biology of higher mental function. From our point of view, it may give some insight into interpersonal communication. It reveals an aspect of perception that we had not thought of before. To make a bold claim, we might say that this research finding reveals the intense interpenetration of subjective beings who are in personal contact. It means that when you see another person performing an action, you do a virtual performance, or simulation, of that action in your head; that is what it means to perceive an action. (Olds, 2005) This lead has been followed further by Rizolatti and his colleagues in Parma, and now some at U. C. San Diego. (Gallese, et al, in press; Jacoboni, in press) They have also shown that when one perceives another‚s affect there is a similar kind of virtual manifestation in one‚s own brain. It is speculated that one has a mild form of the other person‚s affect; that could help us understand something about empathy.

This gives us another point of view on the phenomena of imitation and identification, and the role of mirroring in development and maturation and in the psychoanalytic situation. In psychotherapy it is observed that the patient and therapist sometimes find themselves in mirroring postures. It is also noted that patients, in a process of identification, take on some of the mannerisms, verbal expressions and even the theories of the therapist. To some this information produces an uncanny feeling that in a dyad, each is reading the other‚s mind, unconsciously. But, although the reading is unconscious, it influences what happens next, what feelings, associations and enactments will emerge.

It may be that we already knew all of this. But these findings tell it to us with more dramatic impact: that every facial and bodily expression will have an effect on the other, and most of it will be unconscious, and it will guide the entire session.

With respect to the clinical situation in psychoanalysis, these forms of interpenetration of selves by non-verbal, largely unconscious, means provide arguments against the use of the couch, and also arguments for the use of the couch. With the couch we give up the intense mutual interpersonal control arising from the mirroring response. Some have pointed out that the „communication between right brainsš is important to therapy, and that to give it up is to lose a major asset. (Schore, 1994) But in psychoanalysis that may be what we want: to allow freedom from that control. (Olds, 2005) This should be a fruitful area of research; it may be difficult or impossible to free-associate while engaged in the kind of interactive mutual control that influences face to face interactions. 

Procedural Memory

The phenomenon of procedural memory has been known about for years, and has recently been seen as important to analysts. The by now well known report of the case of HM, who in 1956 underwent surgery resulting in the loss of both hippocampi, in an attempt to treat an intractable seizure disorder, was an early step in the process of separating several different kinds of memory. (Scovile and Milner, 1957) After the surgery the patient was found to have lost his recent episodic memory (conscious memory for events), but he retained his procedural memory (for habits and procedures). This mode of memory, usually categorized under the heading of implicit or unconscious memory, can be seen as a way that repetitive psychological and behavioral schemas are maintained. [6]

Procedural memory has captured the attention of analysts, and many see it as a satisfying rubric that may help understand what we call the repetition compulsion. It has led to an emphasis on the repetition itself as opposed to the repressed episodic, autobiographical memory, which previous theories viewed as the motivation for the repetition. In current practice many analysts privilege the exploration of the transference over the recovery of the repressed memory. We encourage the transference to unfold and develop, and allow it to reveal a repetitive structure, which seems to be a basic schema, or set of schemata, governing the patient‚s life. It is often the case that we can trace this pattern back to childhood and to early structural fantasies. The pattern is the way the child responded to the family dynamics, and the fantasies related to those dynamics, and oftentimes managed a situation that was more or less traumatic. That pattern persists in the patient‚s later life. In therapy we may observe the pattern in the patient‚s interactions with others and the accompanying fantasies. In analysis we allow the pattern to flourish in the relationship with the analyst. This of course is what we have always done. But I think there has been a change in emphasis. At one time the pursuit of the repressed episodic memory was more of a central goal. Now it seems that we emphasize the pattern or schema of behavior and fantasy more, and use the childhood memories, especially those that are relevant to the pattern, as ways to understand the pattern itself. We have been influenced by what has come to be seen as the unreliability of long term memory and the idea that historical truth is unreachable, and that what counts is a narrative truth, namely the underlying set of narratives and fantasies that has been used to organize the patient‚s life.

Fonagy (1999) has emphasized the importance of the effect of psychotherapy on a patient‚s procedural schemas. In his view, this is the crucial factor bringing about change via analytic therapy, more important than the interpretation and reconstruction of repressed (episodic) memories. You may or may not agree with him, but it would seem that your opinion on that matter would have an effect on your clinical practice. The debate between Fonagy and Blum (2003), and the Internet discussion that followed, shows that this change in emphasis, partly stimulated by the discovery of multiple types of memory - particularly procedural memory - could definitely make a difference in analytic technique.

We have here mainly a question of emphasis, privileging the patterns of interaction evolved in procedural memory over the recovery of repressed memory. And this interest in patterns seems to accommodate a parallel emphasis on the importance of the dyad in the development of the individual, and the emergence in the analytic dyad of transferential and countertransferential schemas. The focus on the interacting analytic couple has provided fertile ground for relational and intersubjective models of the analytic encounter. As the analytic relationship evolves there may be more attention to the „here and now,š which reveals the schemas encoded in procedural memory Ų another important change in clinical practice.

Cognitive Processes and Capacities

Another significant alteration in technique has emerged as a result of our increasing understanding of cognitive processes and ego functions. The idea of „conflict freeš psychological functions or ego capacities received attention via the adaptational point of view. This directed our attention to the fact that we can‚t assume that every patient has the same cognitive equipment. Within the normal range of patients there are variations in such capacities as reality testing, ego boundaries, long and short-term memory, and language abilities that lead to unique understanding of experience and unique interaction with any given analyst. Increasingly, however, we also see patients not in the normal range, people whose lives have been bedeviled by impairments in these cognitive capacities. With many of these a classical conflict model where the understanding would be of a fear of success, or of Oedipal victory, may have to give way to the idea that failure is due to such an impairment. Analysis may be appropriate for some such patients, but there will be much more need for attention and sometimes direct help in countering reality distortions and organizational difficulties.

As is often the case, psychoanalysts encountered these problems before the cognitive scientists. Hartmann and others wrote extensively about the conflict-free sphere and developed a detailed understanding of cognitive deficits. Only later have the neural scientists described some of the underpinnings of such deficits. The most dramatic example is the case, described in detail by the Damasios, of Phineas Gage, the railroad worker who lost a large portion of his pre-frontal cortex in an accident, and whose life deteriorated from then on because of a sociopathic syndrome based on flaws in social judgment.

Kafka (1984), Bellak (1997), and more recently Marcus (2004), have enumerated ego capacities such as boundary definition, reality testing, attention, integration, and many more. The brain studies done by neuroscientists reveal more and more specifically the brain functions impaired in these discrete deficits. Such patients are increasingly treated in analysis. Consequently, the analyst‚s awareness of the nature of these functions as they derive from brain pathology, and as they fit into the personal psychodynamics of the individual, is becoming more important. In fact the new recognition of cognitive deficits has produced new techniques and even new resistances. Some patients, whose academic failure or feeling of incompetence is recognized as a variant of Attention Deficit Disorder, may be quite relieved, deriving comfort from the idea that their difficulties have a brain cause rather than a „bad personalityš cause. But the treatment may then have to take account of ways in which the patient uses the diagnosis as a defense, or as a cover for other conflicts and inhibitions.[7]

Affect Systems and Disorders

A crucial change in both theory and technique has been forced by the appreciation and research into affect systems and the treatment of affect disorders. The cognitive scientists were late in the game, having spent much of the last century studying various forms of cognition and memory. The psychiatrists, however, were working on the clinical front, finding that medications could have direct and dramatic effects on disorders such as depression and mania. More recently the „affective neuroscientistsš such as Panksepp (1994, 1998) and LeDoux (1996) have done important work integrating the cognitive and affective systems.

The implications for psychoanalysis have been profound. In recent decades psychoanalysts have been faced with the fact that psychotropic drugs can have major effects on patients, in many cases enhancing the effects of the psychotherapies. Analysts have made the adjustment, and many now accept that a change in a brain function Ų in this case affect and affect regulation mechanisms - alter the dynamic formulations we can make, and the kinds of interpretations we might venture. Here again, the same phenomenon mentioned above, a success phobia previously interpreted as Oedipal in origin, may turn out to have an affective aspect. In this situation the patient‚s capacity improves dramatically when a medication produces a shift in mood, with a consequent alteration in self-esteem, self-confidence, assertiveness, and adventurousness. In hindsight, with a patient thus improved, we might decide that the Oedipal-competition conflict with a parent is less important than we thought, or, alternatively, that it was very important, and that the improvement in mood made the patient less inhibited in the competitive situation, or that the improved mental functioning allowed the patient to use the treatment more productively in analyzing the conflict.

Trauma

Another major contribution to clinical practice is that resulting from research into the effects of trauma. The course that Freud took from the source of pathology in early real trauma, to the theory that much of pathology resulted from imagined trauma, is now to some extent being reversed with the spotlight again turning to the actuality of traumatic losses and sexual or violent assaults that have lasting effects on the psyche derived from biological change. In current theory about the defects in memory arising from trauma, it is understood that some of the memory distortions may not simply be willed actions of repression to avoid painful recollection. Research suggests that the hippocampus, mentioned above as the organ important in remembering autobiographical events, may be chemically disrupted by the flood of stress hormones during a traumatic event. This makes a difference clinically when one is trying to evaluate possible false memories, and also in the degree to which one tries to undo „repressionš in treating the patient suffering from the after-effects of trauma. We are appreciating the difference between a defensive alteration or distortion of memory in a neurotically conflicted person, with a brain functioning within essentially normal limits, and the omissions and misconstructions of a brain with trauma-induced interference in memory storage and memory retrieval.

As with the other sources of new information this one also adds to the clinical complexity. It is not clear when an issue crosses from conflict to trauma Ų conflict as we have conceived it between psychic structures, or between motivations, to trauma as described above Ų the kind that may produce functional brain distortion. In all cases there will be interactions between the trauma and the psychic reconstruction of the trauma and the desire to repress or disassociate memories. Busch (2005) discusses the conflicts arising from the patient‚s need to avoid trauma-induced feelings. There are also significant differences in degree with respect to kinds of trauma. Terrorizing experiences such as being held hostage, tortured, or witnessing the murder of loved ones seem qualitatively different from the traumas within emotionally abusive families, yet we may not be able to predict the degree of brain damage, of memory distortion, or intrapsychic conflict. Even more complicating is the issue of identification with aggressors that is often part of the traumatic and post-traumatic experience. Such identifications may be repressed, elaborated in fantasy, and become players in intra-psychic conflicts. In the more severe traumas we do not tend to recommend psychoanalysis as a treatment, but again there must be a blurred boundary between the severe and not-too-severe. It may be that imaging tools may help to map the degree of damage to the brain, and this might in turn help decide on the choice of therapy.

In any given patient there may be a complex combination of the ego deficits discussed in the previous section and their mutual interaction with the results of trauma. And, these factors interact with the affective systems. In the severe personality disorders there can be synergies among traumatic brain effects, ego deficits, and affective instabilities. (Kernberg, 2004, 2005; Depue, 1996; Steinberg et al, 1994).

Complex Models of Mind

A more subtle but pervasive influence on our practice may come from what might be called „complexity theories.š These theories themselves have emerged from the needs of the biological sciences to find less mechanistic models to explain very complicated dynamic processes. Biologists, like psychoanalysts, were finding mechanistic linear models limiting and unsatisfactory in their attempts to describe complicated phenomena that have so many interdependent variables that prediction is virtually impossible. Several theories have been developed by mathematicians responding to the challenge to understand discontinuous, seemingly chaotic phenomena. We have had General Systems Theory of von Bertalanffy, we have had chaos theory, connectionist or neural network theory, and recent versions of dynamic systems theory. Examples of this are Palombo‚s (1999) integration of dynamic systems models and psychoanalysis, and Westin and Gabbard‚s (2002) use of connectionist theory in updating the concepts of psychological conflict and transference. (See also Olds, 1994; Piers, 2000, 2005)

Here, I can only sketchily refer to these models without explicating them in any detail. Underlying all the models is the fact that in biological systems there are so many variables that the mechanistic predictability implied in the linear model of physical systems, such as that of billiard balls, must be given up. Although we assume that physical causality still holds in such a system we cannot claim the possibility of complete predictability. With billiard balls you can recreate the experience of hitting one ball with another to send it into a pocket. You can put the balls back in the same place and hit the first ball at the same angle and be sure of the result. But in a biological system - or even a complex non-biological system such as the weather - with thousands of variables, you can never perfectly recreate the set-up and therefore cannot absolutely predict the outcome. This phenomenon, called „sensitivity to initial conditions,š means that you can never completely recreate the scene. You can predict that the rat will push the lever to get a food reward, but only if it is hungry, and not anxious, and not otherwise trained, and not in a different cage, etc. etc. Behavioral experiments are designed to reduce the number of variables, but with many biological systems, including human thought and action, we have found that we always run into limits.

The systems of complexity may lead to important effects on our theorizing and ultimately our practice.[8] The new thinking has allowed us to understand some of the discontinuities in child development, such that children go through not completely predictable sudden shifts in maturation, in object relations, in skills. The kind of predictions we used to make, assured that a person from a certain kind of childhood would become sociopathic, or depressed, or unanalyzable, are made less often. Also, the epigenetic model, which implies a set blueprint in which developmental stages are timed to go off in a prescribed sequence, has had to be loosened. (Galatzer-Levy, 2004) This does not mean that all bets are off; we do indeed make fairly reliable predictions about people; but we are more modest. It means, among other things, that we may be less willing to foreclose our patients‚ potentials. The theories have again opened up the way to relational theories, emphasizing that one‚s behavior is often influenced by the other, that in a dyad, there may be mutual influence, making the behavior of each person less predictable and more interactive. This dyadic interactivity may be partly explained by the mirror-neuron phenomenon described above.

INTERDISCIPLINARY KNOWLEDGE AND PSYCHOANALYTIC TRAINING

Let me turn briefly to some of the implications of this discussion on how we think about analytic training. Courses in scientific interdisciplinary studies are appearing in analytic institutes, sometimes against resistance. One frequent argument is the same one that initiated this paper, namely that these studies have no effect on clinical practice, so why teach them? Behind this argument may lie the conviction that analytic education is really training for a craft on the apprenticeship model. The argument taken to its extreme would suggest that all we need to study is what the patient and analyst say and do in the consulting room; we learn how to do this with no need for theory. This argument can be extended to say that no theory, even that which is traditionally taught in our institutes, has much effect on practice; we learn practice from practice, and from supervision. The model is more like the training of a technician than the training of a professional student.

The analytic theorists who focus on meaning and those who are antagonistic to the scientific search for underlying mechanisms might agree here, the anchor of their agreement being that the only thing that counts is the patient‚s behavioral output, that including what the patient says and means. This puts both of them ironically in the bed of the behaviorist, where I‚m not sure they would be comfortable. The behaviorist argument has always been: we are interested in the behavior, not the interior; we are interested in probabilities and patterns, but only in behavioral and verbal output. It is that output that can to some extent be scientifically studied. Mentalism, or the sense that there is an inner source of agency, an ego, or a central self, is ruled out. Paradoxically, I think that the integration with science could allow mentalism to be ruled back in.

This raises the question of how does the integration with the sciences affect analytic education. I have been involved in developing a course for analytic candidates that attempts to integrate information from other disciplines with psychoanalysis. One point that we have recently begun to appreciate in teaching the course is that the introduction of information from neighboring sciences enhances learning, rather than confusing students, as we had initially feared. Where there are biological correlates relevant to psychoanalytic theories, they make the theories more comprehensible and believable than before. When we „learnedš psychoanalytic theory by the voice of authority, we often found ourselves parroting the ideas without really understanding them. An example might be the success phobia mentioned above. It may be appropriate in one patient to apply an Oedipal model in understanding the dynamics, but in others it might be confusing and distorting to force it into that model alone; issues of trauma, affect and cognitive capacity may help produce a better explanatory picture that may be more helpful to both analyst and patient.

It seems clear that good, testable theories are easier to understand than outmoded or unsubstantiated theories that we have to twist and turn in order to bring them to relate to our clinical experience. We get a bonus from our interdisciplinary studies: theory is more understandable and satisfying.[9]

WHAT ABOUT THEORY?

As hinted above, one could question whether any theory has an effect on practice. Certainly, metapsychological theories have been denigrated in recent years. Michels (1999) makes an important point about the function of theories. He reviews Sandler‚s (1983) argument that analysts use both a conscious „official, standard or publicš theory, and a less conscious patchwork of theories derived from the personal, clinical situation. The latter set of theories covers more of the analyst‚s clinical experience, and guides much of the daily work. And these theories may not be well organized, they may contradict each other, and they guide practice, often in our most „intuitiveš interventions.

Among the formal theories, Michels suggests that there are „Bridging theories,š which can be traced back (1.) to the biological theories of Freud‚s Project, (2). to the evolutionary concerns of Totem and Taboo and the ethologists, such as Bowlby, and (3) to the ontogenetic interests of the Three Essays, and the work of subsequent developmental researchers. These are all interdisciplinary theories like those I‚ve been discussing. A second type of theories includes the „Psychological theoriesš which attempt to describe and categorize mental functioning, with less regard to origins and more to phenomenology. And, third, Michels contends, there are clinical theories, which may be traced back to „Studies in Hysteriaš and „Analysis terminable and interminable.š These deal with the clinical experience with transference, resistance and working through. It seems clear that the current biological interests are in the tradition of the bridging theories. Among the functions of these theories is to provide a scientific grounding for practice, as sources for the understanding by which we generate interpretations, and as theoretical bases for the analyst‚s role, the way we practice in practice. It is likely that the interdisciplinary information is already contributing to change our unconscious, workaday theories, and that it will be only later that they will become a recognized part of our formal theories. In other words, it seems clear that the culture, including the scientific culture, influences our unofficial, implicit, clinical model. That is what I mean in the beginning that the interdisciplinary interests are „changing us and our minds.š But the change has not yet had time to make obvious modifications in the formal theories; this may be one reason many analysts see these interests as irrelevant.

CONCLUDING REMARKS

One result of all this interdisciplinary input is that we deal with a much more complex situation than we had in the past, or at least than we thought we had. The number of points of view from different fields of inquiry is mind-numbing. Instead of a central dynamic that we can be confident will fit all patients, we have information from several levels and several different disciplines, as well as patients who have all kinds of unique characteristics. There is some danger that such complexity will lead analysts to throw up their hands and give up trying to adapt to this changing scene. Hopefully, however, it is also possible that we will integrate much of this information in our own unconscious procedural memories, leading to subtle and not necessarily conscious changes in technique. Once we get the idea about different kinds of memory, or the idea of ego deficit in the sense of organically derived cerebral dysfunction, they permanently change the way we think. We will still follow our hunches, our frissons, our countertransference signals, but they will be richer in their backgrounds of information.

Friedman (2005), in his elegant paper on love in the analytic situation, refers to the loving aspect of gaining the deepest possible knowledge of a person, a kind of love that has aspects of normal human love, as well as of love of knowledge and discovery, a love rather unique to the analytic dyad. I would suggest that the deeper and richer knowledge of a patient deriving from a multi-level understanding of the person as an individual and as a human biological being would contribute to this kind of love.

When psychoanalysis was the only game in town, everybody got analyzed. The success rate in that situation was doubtful. This may be one factor that led to a general disillusionment with psychoanalysis, as high expectations led to disappointment. In recent years, the numerous competing forms of treatment have taken away much of the work of analysts. But the work of analysts, with a more selected group of patients, has probably been blessed with much better results. This is likely partly because of selection processes, so that analysis really is the most appropriate treatment for the patients, and also because of the changes in technique, some of which are influenced by new understanding of the brain.

Although I have tried to show some specific instances where the findings of other disciplines have contributed to clinical work, these instances are only small steps in the process we are all now going through. As I hope is evident from some of the above examples, one effect of the information from other sciences is to provide fodder for already active controversies within our field, i.e. the thinking about the value of the couch, or the Fonagy-Blum debate. The new information will not suddenly revolutionize the way we work. We will use it in our own deliberations about our clinical theory and technique, and that will contribute to the evolution of our practice.

A possible result of the development of a more scientific base for psychoanalysis may be an increased cultural foundation for the discipline, leading to a greater sense that we are part of a network of effective psychological modalities. The mechanisms of behavioral, cognitive, hypnotic, and pharmacological treatments have become known, and at least partially elucidated by what is known in basic psychological and neuro-scientific theories. There is no reason that psychoanalytic concepts cannot be studied similarly. Over the years measures of the efficacies of therapies have been partially successful, now becoming a more urgent problem in this time of „evidence basedš treatments. Such studies have proven very difficult to do, although in future they may become more possible. In the meantime an important support for psychoanalysis will be its credibility derived from parallel sciences. To make our concepts supportable and understandable as part of the larger biological and psychological universe will be helpful in the process of making it a rational endeavor. It will become evident, that the psychoanalytic approach is different from the other forms of therapy, and that in certain types of patients it has a clear rationale, that it has an understandable scientific basis, and that for them it is the best possible treatment.



[1] Other leading psychoanalysts have voiced agreement with Pulver‚s view. Goldberg (2005) in his panel discussion of this paper argued that there is in principle no reason to expect relevant information from other sciences to influence our clinical discipline. Sciences have boundaries, and once you cross a border into neuroscience or evolutionary biology, you are in that discipline, not the one you left.

[2] Despite the bombastic title, Pulver‚s paper gives a thoughtful consideration of a „congruence modelš embracing both psychoanalysis and the cognitive sciences at the level of theory. My area of disagreement is in the larger picture, which includes the clinical realm.

[3] We can say that there have been major changes in the realm of the psychotherapies, some of which are justified by specific information from other sciences. Therapies such as cognitive-behavioral and the interpersonal modes are examples, but they have left the territory of psychoanalysis.

[4] This paper emerged from a panel at the Winter Meeting (2004) of the American Psychoanalytic Association. The panel, chaired by Bonnie Litowitz, PhD, was called, „Have Non-Psychoanalytic Sciences Affected Your Practice?š Panelists were Alexandra Harrison, PhD., and the author. Dr. Harrison gave a presentation discussing the effects of developmental, child-observation research on practice. Discussants were Morris Eagle, PhD, and Arnold Goldberg, M.D.

[5] For a thoughtful paper making connections between psychoanalysis and both attachment theory and the neurosciences, see Demos (2001).

[6] Clyman‚s paper in (1991) introduced the concept of procedural memory as having implications for child development, the phenomenon of transference, and all kinds of repetitive schemas of behavior. Reviews of the different kinds of memory can be found in Pally (2000), Schacter (1996), and Westin & Gabbard (2002a&b). Rosenblatt (2004) discusses the relationship of procedural memory to working through in analysis.

[7] The neuro-biology of executive function is a growing and massive undertaking. Damasio is a major contributor, who has demonstrated the need for integration of cognitive and emotional elements in adaptive decision-making. His books, The Feeling of What Happens (2002), and Looking for Spinoza (2003) are important works. The topic is addressed in Beer (2004), Depue (2005), Kernberg (2005) & Solms and Turnbull (2002). 

[8] There is a large and growing literature on the importance of systems theories to clinical practice and technique. Introductions to the theoretical models include Gallatzer-Levy (2002, 2004), Harris (2004), Piers (2000, 2005), Thelen (2005), Thelen and Smith (1994),. Important works relating systems theories to practice include Fishman (1999), Schlessinger (2003) and Seligman (2005). Two recent journal issues have been thematically focused on this topic: Psychoanalytic Inquiry, vol. 22, nr. 5, (2002); and Psychoanalytic Dialogues, Vol. 15, Nr. 2, (2005)

9 Interestingly, Lewin (1965) suggests that theories may originate in attempts to teach. Good theory makes a good pedagogical tool, often providing rich and useful metaphors and analogies to aid in understanding. He says that „teaching and theorizing coincide and that the business of teaching leads to the production of theories.š (p. 138)


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Note: This paper was presented at the Winter Meeting of the American Psychoanalytic Association, 1/25/2004. In press, Journal of the American Psychoanalytic Association.
 
David D. Olds, MD (Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research; Clinical Professor of Psychiatry, Columbia University College of Physicians and Surgeons)
108 East 96th Street, Apt. 6F
New York, NY 10128
Robert R. Holt, Ph.D.
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