THE THOUGHT OF SIGMUND FREUD PART THREE

[David Pilavin, an Israeli philosopher who often comments on my posts, observes in an email that Plato's theory of anamnesia can be seen as an anticipation of Freud's theory of the unconscious. An interesting idea.]

Freud was well aware that it was paradoxical, even perhaps contradictory, to speak of “unconscious ideas,” but as I have already indicated, he was driven by his clinical experience rather than by considerations of philosophical consistency. If conceptualizing what was going on in his patients in terms of the notion of unconscious ideas fit his clinical observations better than any other hypothesis, and if the result was the relief of the painful symptoms and debilitating conditions presented by his patients, then he embraced the notion, all the while supposing that it would at least in theory be possible eventually to give an entirely neurological explanation of what he was observing.

Five questions presented themselves with regard to the unconscious mental contents, and Freud explored all five in the very greatest detail for many years. For purposes of clarity rather than narrative and temporal accuracy, I will discuss each in turn. The first question was: Why is it so difficult for patients to access these unconscious ideas and, by accessing them, to relieve the symptoms? The second question was: How can a doctor get access to the contents of the unconscious? The third question was: What is the content of the unconscious? What can we learn about what resides in the unconscious? The fourth question was: What are the laws or rules that govern the way in which the materials of the unconscious function, and is there any way in which those laws or rules are different from the laws or rules governing conscious thinking? The fifth question was: In light of the answers to the first four questions, what is the most effective therapeutic strategy for treating patients afflicted with the sorts of problems Freud was dealing with?

Just to anticipate our answers, so that you will understand where we are going, the answer to the first question, in a word, turned out to be “repression;” The answer to the second question was dreams, jokes, slips of the tongue, and free association. The answer to the third question, in two phrases, was “infantile wishes” and “sex.” The answer to the fourth question, in a three word phrase, was “primary thought processes.” And the answer to the fifth question was psychoanalysis. But that encapsulates a very great deal, so let us get to work.

First: Why is it so difficult for patients to access the unconscious ideas and, by accessing them, to relieve the symptoms?

The ideas consigned to the unconscious are quite unlike the ideas in the pre-conscious. For the most part, I can access the ideas in the pre-conscious when I need to, but even when I cannot do so with ease, I am delighted to be reminded of them. With a snap of the fingers I say, “That’s it! Why couldn’t I remember that?” One of my own most irritating senior moments was my repeated inability at a certain point to call to mind the name of Kathleen Battle, a marvelous operatic soprano, but always, when the name finally came to me, I was delighted to have recovered it. By contrast, Freud’s patients resisted recalling the materials in the unconscious, sometimes protesting vehemently that they could not possibly have such ideas. Freud described these ideas as not forgotten, but repressed. There was no way that he could possibly identify the neurological correlates of this phenomenon, so he described it anthropomorphically by saying that in the mind there is a Censor who stands at the border between the conscious and the unconscious and blocks access of the conscious mind to its unconscious contents. We shall eventually introduce familiar language invented by Freud to describe the various functions of the mind – the Id [or “it”], the Ego [or “I”], the Superego [or “that which is above the I.”] But always he assumed that eventually it would be possible to cash this language in for neurological descriptions and explanations.

What was new and revolutionary in Freud’s description here was the claim that there is a dynamic relationship between the parts of the mind – that effort and energy is expended in maintaining that relationship. “Repression,” unlike “forgetting,” implies an active doing of something, which in turn implies purpose, none of which is conveyed by the passive description “forgetting.” Inevitably, one is led to ask why the mind represses certain contents, why it resists so powerfully recalling them, even though the recalling of them will relieve painful or debilitating symptoms that the patient insists she wants relieved. The obvious hypothesis is that the recalling of the repressed ideas will, for some reason, be even more painful to the patient than the symptoms, so that, faced, in effect, with a choice between acknowledging the unconscious ideas and getting rid of the symptoms, or denying the ideas and continuing to suffer the symptoms, the patient urgently, sometimes even angrily, chooses to deny the ideas and suffer the symptoms.

This behavior is, of course, completely unlike that of most patients who come to a doctor seeking relief. For the most part, medical treatment is carried out by the doctor without anything more than the passive consent of the patient. Indeed, in some cases, the patient may even be under anesthesia when the treatment is applied. To be sure, a cure may involve some cooperation by the patient – take these pills, stop smoking, eat healthier foods, exercise – and the patient may be derelict in carrying out the doctor’s instructions. But very rarely can the patient be described as resisting being cured. Freud spent a good deal of time figuring out what was going on, why, and how to deal with it.

Second: How can a doctor get access to the contents of the unconscious?

As we have seen, Freud, following Charcot, began by using hypnosis to access unconscious thought contents, but for a variety of reasons this technique was of limited usefulness. First of all, some patients were hard to hypnotize. Secondly, merely bringing the repressed content to consciousness frequently did not, of itself, result in a relief of symptoms. Nor were the “cures” in many cases permanent. Recognizing the dynamic nature of the repression, Freud sought other ways to get at the unconscious. Very early on, it occurred to him that dreams might give him the access he needed.

By the time Freud came along, there was a very long and rich tradition of dream interpretation in Western culture, as well as in many other cultures as well. For millennia, people had been viewing dreams as omens of the future, as messages from the gods, or as contacts with the spirit world. In opposition to these traditions, a number of scientifically trained or influenced authors had offered purely physiological explanations of dreams – as responses to sounds hear during sleep, as reactions to bodily sensations induced by bedclothes, as a response to intestinal distress, and all manner of other physical influences.

Everyone had observed certain familiar and puzzling facts about the remembered content of dreams. Some dreams are recalled by the dreamer, upon waking, as quite realistic, filled with familiar people and places doing familiar things. Other dreams seem to consist of several incidents or story fragments that have nothing to do with one another. In some dreams, people appear who are long dead. In others, impossible and seemingly magical things happen – people fly like birds, animals talk, people die and come back to life. Some dreams are reported as filled with images in full color. Other dreams are reported as spare, monochromatic.

It occurred to Freud that perhaps the content of dreams was, in some way, a slipping of repressed ideas past the Censor, who could be thought of as letting down his guard, or napping, during sleep. Since the ideas, when they appear in dreams, do not lead to action – we do not really do anything when we are asleep, no matter what we may be dreaming – the Censor might be less concerned about the eruption into consciousness of dangerous or unacceptable, and hence repressed, ideas. [I will not keep repeating that Freud understood this to be anthropomorphic language that must, ultimately, be replaced by proper neurological explanations. I rely on you to keep that fact ever in the back of your minds.]

THE THOUGHT OF SIGMUND FREUD PART TWO

Freud [and Charcot also, I assume] noticed something very odd about the symptoms and complaints that psychiatric patients presented to them. The complaints echoed or reflected ordinary non-medical conceptions of the body, rather than the anatomical understanding of neurologists. If a patient had lost the ability to use her right hand, for example, the precise extent and nature of her paralysis did not seem to correspond to the underlying neurological structures that would be familiar to an anatomist. Rather, the patient would not only say, let us suppose, that she could not touch her finger tips with her thumb, so that she could not pick something up. Her loss of motor ability would be exactly what she described, even though that precise impairment might have no natural anatomical or neurological counterpart. Since this is so important that I am going to take some time to make it more precise, with the aid of materials extracted from Wikipedia.

Here is the description, in a Wikipedia article, of the nerves servicing the hand. Take a moment to skim through it so that you will be able to follow what I am saying:

“All of the nerves that travel to the hand and fingers begin together at the shoulder: the radial nerve, the median nerve, and the ulnar nerve. These nerves carry signals from the brain to the muscles that move the arm, hand, fingers, and thumb. The nerves also carry signals back to the brain about sensations such as touch, pain, and temperature.

The radial nerve runs along the thumb-side edge of the forearm. It wraps around the end of the radius bone toward the back of the hand. It gives sensation to the back of the hand from the thumb to the third finger. It also supplies the back of the thumb and just beyond the main knuckle of the back surface of the ring and middle fingers.

The median nerve travels through a tunnel within the wrist called the carpal tunnel. This nerve gives sensation to the thumb, index finger, long finger, and half of the ring finger. It also sends a nerve branch to control the thenar muscles of the thumb. The thenar muscles help move the thumb and let you touch the pad of the thumb to the tips each of each finger on the same hand, a motion called opposition.

The ulnar nerve travels through a separate tunnel, called Guyon's canal. This tunnel is formed by two carpal bones, the pisiform and hamate, and the ligament that connects them. After passing through the canal, the ulnar nerve branches out to supply feeling to the little finger and half the ring finger. Branches of this nerve also supply the small muscles in the palm and the muscle that pulls the thumb toward the palm.”

Let us suppose [I am making this example up] that a woman comes into Freud’s consulting room complaining of an inability to pick things up because she cannot make the pad of her thumb touch the tips of her fingers. She cannot grip anything with either hand. As a neurologist, Freud knows that it is the median nerve, descending from the shoulder, that controls this motion, and he also knows that the same nerve gives sensation to the index finger, long finger, and half of the ring finger. So he runs a metal object lightly along those surfaces and asks whether the patient feels anything. “Oh yes,” she says, “that is not the problem. I can feel that well enough, but I cannot make my thumb close around an object and touch the tips of my other fingers.” This puzzles Freud, because if there is an impairment to the median nerve that results in the loss of “opposibility” for the thumb, then that impairment ought also to result in a loss of sensation on the surface of the other fingers served by the same nerve. What is more, the patient has precisely the same problem in both hands, which is simply anatomically incomprehensible.

Under hypnosis [let us suppose], the patient recalls picking up a newspaper in which it was reported that her father, whom she loves devotedly, has been arrested for embezzlement, and that the arrest has taken place in a bordello where he was visiting a prostitute. The woman is horrified by all of this, and blames herself for having picked up the newspaper, thinking [not very clearly] that had she not picked it up, the terrible events would never have occurred. Confronted with this memory after coming out of the hypnotic state, she breaks down, cries inconsolably, and regains the use of her thumbs. [Okay, okay, it is a very hokey example. I am a philosopher, not a novelist or a psychoanalyst. This is the kind of example philosophers come up with all the time. It is why you never want to rely on philosophers for practical advice.]

Now, it is of course perfectly possible that a severe emotional experience can produce dramatic changes in the body, Descartes and the mind-body problem to the contrary notwithstanding. If I receive news that a loved one has died, the blood may drain out of my face and I may feel faint. A sphygmomanometer will reveal a sudden drop in blood pressure, sure enough. If I see a tiger about to attack me, I may experience a flow of adrenaline into my blood stream. What is more, I may well have these physical reactions even though the news is a mistake and the supposed tiger is really a stuffed animal. In other words, the physical change is caused by my idea, not by the reality that the idea purports to represent. Some physical changes caused by ideas, like the drop in blood pressure, may be momentary. Others may be long lasting, or even permanent and irreversible. Nothing puzzling there. We are all quite familiar with such phenomena. They are called psychogenic.

But Freud’s patient, when she came into his consulting room with paralyzed thumbs, had no memory whatsoever of picking up the newspaper, or the news she read there. And if indeed that news produced some sort of psychogenic change in her nervous system, it cannot be found upon examination. Indeed, her actual impairment does not correspond to any neurological deficit that might have been so caused. It is as though the idea of the news about her father continues to be present in her mind, leading her, out of her guilt and horror, to somehow interfere with the operation of her thumbs, even though she cannot call the idea up and report it to Freud when asked. Where can the idea be? Freud formed the extraordinary hypothesis that there is some portion of the mind, some mental region, in which ideas can reside and be efficacious even though we are not conscious of them. He gave to this region the title “the unconscious.”

But for as long as thoughtful people had been speculating about such matters, which is to say for more than two thousand years, it had been an article of faith that the defining characteristic of ideas is consciousness, just as the defining characteristic of bodily things is extension, or perhaps solidity. Unconscious ideas? One might as well talk of bodies that are not extended in space!

To be sure, everyone was familiar with the fact that we have many ideas that are not, at this very moment, present to the mind. My telephone number, for example or the capitol of California, or the names of the actors who starred in Butch Cassidy and the Sun Dance Kid. But though I do not hold before my mind at all times all the ideas that can, in some sense, be said to be “in my mind,” I can access them if I need to [leaving aside senior moments.] We can describe these, with Freud, as residing in the “pre-conscious.” The problem with Freud’s patients was that they seemed possessed of ideas that were having a direct and continuing effect on their bodies, but which ideas they could not access no matter how hard they tried.

In short, Freud had discovered the unconscious. The remainder of Freud’s life and career can be described, as I once heard Bruno Bettleheim put it, as a ceaseless quest for the unconscious..

THE THOUGHT OF SIGMUND FREUD - FIRST POST

Well, you asked for it [six or seven of you did, anyway, which is more than enough for me.] So here we go. This will take a little while, and besides, I am in Paris, which has other attractions besides my laptop, so be patient.

The Thought of Sigmund Freud

Preamble

With this post, I begin a tutorial on the thought of Sigmund Freud. Several caveats are in order as I launch on what may well be a series of five or six posts. First of all, I am no sort of expert on Freud or psychoanalysis. I have, if I may put it this way, the intimate knowledge of psychoanalysis that clay has of the craft of pottery. Having spent twenty years of my life in one form of psychotherapy or another, I have a pretty good worm’s eye view of the matter, but nothing more. Faithful readers of this blog will be well acquainted with my habit of referring my readers to my published writings on whatever subject I am pontificating about [irrelevant aside, triggered by my use of the word “pontification” – as Susie and I walked through the parvis in front of Notre Dame this morning, we encountered a full-scale avertissement of the current efforts to fast-track the beatification of Pope Paul II, on the way to his inevitable sanctification. My word of advice to those in need of intercession with the Heavenly Father – pin your hopes on someone else. I have enough respect for deities in which I do not place faith to believe that this is one sanctification the See has got wrong.] At any rate, there are no publications by me on Freud, for the very good reason that such would be, for me, a bridge too far.

Second, and rather more important, you will find, as I proceed that I have the as idiosyncratic a view of Freud and psychoanalysis as those I have already exhibited with regard to anarchism or Marxism. You will expect me to spend a good deal of time on infant sexuality or the Oedipus Complex or Freud’s retrograde opinions about homosexuality. All of those will come up, inevitably, but they will get very short shrift [another religious metaphor, it turns out.] My goal is to show you, as clearly as I am able, what I understand to be the fundamental and revolutionary ideas that Freud bequeathed to us. I do genuinely believe them to be both revolutionary and true, hence of the greatest importance for our understanding of the human condition. If I am successful, perhaps you will find what I have to say both interesting and useful.

So, with those warnings, let me begin.

Part One: The Discovery of the Unconscious

Anyone interested in the bare facts of Freud’s life is directed to the Wikipedia article on him. My understanding of Freud is deeply indebted to the brilliant book by the philosopher Richard Wollheim, Freud [later, Sigmund Freud] first published in 1971. Peter Gay, the great intellectual historian of modern Europe, is the author of an important biography of Freud. For those who wish to read Freud’s own writings, which were voluminous, I recommend starting with the work he himself considered his masterpiece, The Interpretation of Dreams, published in 1899.

For our purposes, it is important to place Freud in his historical time and place. Freud was born in 1856 to a Jewish family in a small town in Moravia, and moved with his family in 1865 to Vienna, the city with which he is most closely associated. He studied medicine at the University of Vienna, and chose neurology as his specialty. An early turning point in his development came in 1885, when he won a fellowship to spend time in Paris working under a famous neurologist named Charcot.

There are two fundamental facts about Freud that it is absolutely essential to be clear about as we proceed. They shaped and defined everything Freud did and said, and although everyone knows them, they tend to be ignored when Freud’s thought is discussed. The first fact is that Freud was a medically trained neurologist – not a philosopher, not a sociologist, not a cultural critic, not a literary critic, not an ideologue, not even a psychologist, but a neurologist. His first research was an unsuccessful effort to decipher the mysterious sexuality of the eel [who knew there was a problem?]. He thought as a neurologist, he saw the problems of his patients as a neurologist, he sought neurological explanations of the symptoms he encountered. And he remained, to the end of his days, as a neurologist would, convinced that what he was studying ultimately had to have a basis in, an explanation in, the nervous system of the human body.

The second fact is that during most of his professional career, Freud spent six or eight hours a day, five or six days a week, in his consulting room seeing patients. He did not spend an hour a day, just to keep his license, as it were, and then knock off to speculate about the human condition. He was, during his entire career, a practicing physician. That means that the focus of his concern, each working day, was curing the patients who came to him seeking treatment for their ailments. To him, the most compelling evidence of the correctness of a hypothesis he might formulate about the sources of a patient’s symptoms was his success in relieving those symptoms.

Furthermore, as a practicing physician trained as a scientist, he was always ready to revise an explanation or scuttle an hypothesis if the evidence pointed in another direction. At a certain point in his career, he developed something of a following of other physicians who gathered around him and in effect undertook to proselytize for his theories. And because his theories met with a good deal of skepticism and opposition, this circle took on the mental set of a cult or cause. But that was not the way Freud thought, and though he was convinced that his theories were correct, I do not think he wanted to become a quasi-religious guru of a cult.

Freud was, at least at first, simply one more young doctor following the great Charcot as he made his rounds in a mental hospital. Eventually, Freud established a closer working relationship with Charcot. Many of the patients Charcot treated suffered from what were called “hysterical” symptoms [you can amuse yourself by exploring, on the internet, the connection made by ancient Greek physicians, and their successors over the millennia, between mental problems and the womb – “hysteria” and “hysterectomy” have the same root.] Patients would present, for example, suffering from blindness or deafness or partial paralysis for which there was no discernible neurological cause. This was the late nineteenth century, not the early twenty-first, and doctors did not have the armamentarium of sophisticated diagnostic techniques now routinely employed – no CT scans, no MRIs, not even x-rays, which, although they were being developed, were not yet used for medical purposes. But neurologists did have a quite sophisticated knowledge of the anatomy of the nervous system, and they were capable of finding damage to the optic nerve or the auditory nerve or the verves serving the hand or arm or leg, if damage there was.

Charcot had been having some success in the treatment of hysterical symptoms with the radically new technique of hypnosis. Under hypnosis, patients could recall what they were thinking and doing when the hysterical symptom began. After being brought out of the hypnotic state, if confronted with this information, in some cases they were thereupon relieved of the symptom. They were, or at least appeared to be, cured. Freud learned all this from Charcot, and himself began to use hypnosis in the treatment of hysteria. It might be, for example, that a patient afflicted with periods of hysterical blindness would recall seeing something terrible or “unacceptable” that she could not reconcile herself to [the patients were mostly women, at this point, by the way.] The blindness, it seemed to Freud, was the patient’s way of shutting out terrible sights, or perhaps even of punishing herself for having seen something that she should not have seen.

But these explanations for the symptom, although apparently confirmed by the relief produced by hypnosis, posed a deep, fundamental, conceptual problem, the eventual solution of which laid the foundations for everything that Freud subsequently did. This is the most important single idea in this entire “tutorial,” far more important than infant sexuality or the Oedeipus Complex or what ever Discontents Civilization maybe feeling. I am going to take a good long time to explain it, and you my find my explanation tedious, but stay with me, because if you do not completely understand this simple idea, nothing I say hereafter will really make much sense to you.

PARIS UPDATE

The strike is over, the garbage has been picked up, and Paris is looking lovely again. We dined on caneton a la brochette [for two] last night at our favorite little restaurant and then slept for ten hours, so we are almost recovered from the trip. Since we have not been here for eleven months, there were lots of housekeeping chores today [a new bulb for the chandelier in the kitchen area, etc.]

A sophomore doing a double major at Brown wrote to me. He has read my autobiography [all three volumes!] and wanted to know what I thought about Freud today, inasmuch as I have had twenty years of psychotherapy in my life. It occurred to me that I might attempt a "Thought of Sigmund Freud" like the series I did on Marx, though doing it from here I would pretty much have to write it from memory.

It would be useful to know whether there is any interest in that out there in the blogosphere.

J'ARRIVE

After a long flight from Atlanta, and some rather bad food courtesy of AirFrance, we are here at our pied a terre in Paris. The big news here is that the streets are filled with piled up garbage -- there is a strike on, of course. I have no idea what that is all about.

On the flight over, I spent some time reading LIBERATION, the newspaper of the Socialist Party. There was a long story about Marine le Pen, the new leader of the far right Nationalist Party [and daughter of its founder.] This is the new face of fascism in France, and very disturbing. I shall try to say something about it in the next day or two.

FAREWELL TO ALL THIS

I am doing my last check of my packing, and preparing tomorrow morning to head out the door for the plane to Paris. Despite the resurgence of right wing crypto-fascist sentiment in France, I am drawn to Paris as a moth to a flame. For three weeks, the voice in my head that tells me that I ought to be working in some unspecified ways will be stilled, and I shall enjoy the beauties and delights of the quartier latin. I shall shop in the open air market, cook delightful meals in our tiny apartment, attend early music concerts, picnic in the jardin du Luxembourg and walk everywhere, revelling in the Hausmanian buildings. I shall blog from Paris, but I am afraid the hard edge of my commentary will be blunted by the beauty around me. a bientot.

UPDATE FROM THE HOT STOVE LEAGUE

GT, Marco Rubio has just stated unequivocally that there is no way he will be on the 2012 Republican ticket in either slot. The rules both of American politics and of Hot Stove League speculation make it quite clear that you need not give that any credence at all, especially since, at this point, it does not really appear as though anyone will be on the 2012 ticket! Furthermore, Obama has played Donald Trump like a fifty dollar violin, with the result that he is now -- to change metaphors -- toast. Tim Pawlenty, anyone?