By Victor P. Iannuzzi, PhD
New York, NY
This essay shared shared Section V's 2006 Morton A. Schillinger Prize
Among psychoanalysts, the postulate that there is such a thing as the "unconscious" at all is a stance that originally and most directly derives from Freud. Freud's realization that human mentation proceeds predominantly from outside of subjective awareness stands as his most valuable contribution, surpassing even his comprehensive methodological approach to investigating the nature and effects of unconscious mentation (Gedo, 1999). The idea of an "unconscious," of one form or another, has remained central to psychoanalysis throughout its evolution. The "unconscious," it seems, was not only the de facto invention of psychoanalysis (de facto because the idea of automatism had been around for about 50 years before Freud) but, for a good part of the past 100 years, it seems to have been an almost constant preoccupation. It has been exhaustively surveyed and studied by psychoanalytic historians and cognitive psychologists (Ellenberger, 1970; Kihlstrom, 1987, 1995, 1998, 1999a, b; Kihlstrom, J.F., Mulvaney, S., Tobias, B.A., & Tobis, I.P., 2000; Westen, 1998a, b, 1999), apparently received not one but three "new looks" followed by "another new look" (Bruner, 1992; Greenwald, 1992), and at one time was considered to have been found, lost and regained (Kihlstrom, Barnhardt, & Tataryn, 1992). On at least one occasion, the specific question posed in this essay was asked and answered (Shevrin & Dickman, 1980); yet we continue to ask the question, revealing something of the remarkable metamorphosis that continues to take place in the discipline of psychoanalysis.
The "unconscious" was born into psychoanalysis as a mythopoetic metaphor that included imagery as diaphanous as the well known "cauldron full of seething excitations," but also included notions of topography and, as Freud revised his theory, the idea of specific structure. As psychoanalysis evolved as a discipline, there were many departures from Freud's early emphasis, not the least of which was his notion of the unconscious and its structure. This brief essay does not permit a detailed history of the evolution of psychoanalytic thought (see Ellenberger, 1970; Greenberg & Mitchell, 1983; and Gedo, 1999 for a few particularly informative historical treatises), but clearly the evolutionary developments stemming from the influences of ego psychology, self psychology, object relations and Interpersonal theory, as well as the influence of the Klienians and Lacanians have, in their own particular ways, constituted turning points in psychoanalytic history. Many of the newer approaches, some of them drawing on the rapid expansion of infant observation findings, have tended to relegate concern with endogenous structure, if not unconscious content, to a back seat. Still, throughout this period, the construct of an "unconscious" persisted, and continued, for the most part, to be construed in verbal and symbolic terms, and as inferior to consciousness. The further shift in clinical psychoanalysis over the past 20 years, accommodating a more relational perspective, represents yet another significant turning point in the intellectual evolution of the discipline. Departing from the hermeneutic tradition of uncovering the endogenous truth of an individual's experience, many contemporary relational analysts have been inclined toward a more phenomenological approach, depicting experience descriptively, and implicitly insinuating new meanings into the metaphor of the "unconscious." Although the differences in implied meanings are far from shallow, the vocabulary of psychoanalysis remains embedded with terms that have lost their original signification. Among psychoanalysts today, the concept of the "unconscious," for those that don't ignore it altogether, has morphed into such a diverse array of implied meanings that it often seems we don't mean what we say, even when we say what we meant. The concept of the "unconscious," once "the unifying concept for the understanding of mental processes" (Schwartz, 1999, p.135) has become a soft, wooly idea lacking any particular meaning; so muddled and devalued that it is in danger of becoming a narrative tchotchke.
There seems to be a tendency in psychoanalysis that once a structure or function of the mind is named (e.g. unconscious, id, ego, superego, transference, resistance, compromise formation, sublimation, etc.) it tends to become reified in our language and thinking until, before long, we lose sight of the origins of the metaphor. Yet, every theory – new or old, needs to be reexamined in light of the emerging data of observation. If we fail to do this, then theory as an allegorizing metaphor becomes an encumbrance to effective clinical work. As Donald Spence (1994) has said, we will have confused what we know with the metaphorical rhetoric we use to explain ourselves, confusing the map (the metaphor) with the territory which it is intended to describe (Korzybski, 1958). While it's generally wise to tread warily among epitaphs, it is worth noting that it was Freud, a century ago, who reminded us that the temporary expedient of metaphor needs to be replaced once phenomena can be observed more clearly (Spence, 1994). As Freud cautioned: "We are justified… in giving free rein to our explanations so long as we retain the coolness of our judgment and do not mistake the scaffolding for the building." (Freud, 1900, p. 536; quoted in Spence, 1994, p. 79, as quoted in Wurmser, 1977, p.473).
If psychoanalysis is to remain a vital interlocutor between conscious and unconscious experience, then the metaphor of the "unconscious" needs to be rescued from the oblivion of inconsistent and anachronistic meaning. With the utmost respect for the plurality of our varied psychoanalytic traditions, language – even psychoanalytic language – is symbolic of thought, and a referent as foundational as the "unconscious" ought to have more than a modicum of consistency of signification within the umbrella of psychoanalysis. If we want to be able to share understandings as psychoanalysts, then the terms we use need to have greater consistency of meaning; failing this, we may one day be seen claiming scornfully, like Humpty-Dumpty in Lewis Carroll's Through the Looking Glass, "When I use a word, it means just what I choose it to mean – neither more nor less."
Emerging Developments: Unconscious Re-visioned
The metaphor of the "unconscious" has served psychoanalysis well. At a time when the present day advances in neurobiology and cognitive neuroscience were unknown, the original scientific project of psychoanalysis had to be abandoned. Metaphorically described metatheory served as the connecting tissue between observable behavior and an inferred agency (the "unconscious"). All great scientific discoveries begin this way. But, at some point, evidence replaces metaphor; tentative theoretical models are revised or supplanted by empirically observable findings. The "unconscious," of course, has been considered unobservable and there has been scant hard scientific evidence to the contrary. But neuroimaging technologies, such as functional magnetic resonance imaging (fMRI), that observe brain functions as they operate in real time are now coming of age. They presage the dawning of a new era for the psychoanalytic conception of the unconscious and the clinical treatment models to follow. This is not to suggest that the "unconscious" is now directly observable. The proposition is simply that the notion of an inferior "unconscious," as an agency or container for unacceptable affect, needs to be overhauled because just about everything that psychoanalysis has ever assumed about the unconscious is being altered in fundamental ways by current advances in the neurosciences.
To a large extent, the scientific stage was set, or has been in the process of setting, for some time. Over 30 years ago, M.H. Erdelyi (1974) made a strong case for theoretical connections between cognitive psychology and psychoanalytic conceptions of unconscious cognition. Similarly, Drew Westen (1998a) concluded unconscious processes were not psychoanalytic voodoo, but good science. Evidence in cognitive psychology has been slowly eroding the myth of the unconscious as an entity or a place serving as the exclusive repository for repressed content; the unconscious mind revealed in cognitive studies of automaticity and implicit memory bears little resemblance to the unconscious mind of psychoanalytic theory (Kihlstrom, 1999a). Advances in cognitive neuroscience and the compelling recent neurobiological discoveries have resulted in observable phenomena that at one time could only be thought of as part of an ineffable "unconscious." Clearly, scientific study of unconscious mentation has come of age and is here to stay.
The field of cognitive neuroscience has repeatedly demonstrated the existence and separable functioning of two forms of memory, commonly labeled implicit and explicit, or procedural and semantic memory. As psychoanalysts, this is important because implicit forms of memory are not encoded in words initially; the verbal form is not how the mind usually functions (Siegel, 1999). Instead, what is encoded may be thought of holistically – the sum total of the vast array of semiotic and affective signals, hidden prosodic cues and visuoaffective exchanges that occur unwittingly, prior to deliberate thought. Again, implicit memory is always nonconscious and includes the vast array of knowing that everyday life is based on (Stern, D.N., 2004). There is no suggestion in the neuroscience literature that implicit nonconscious memory serves merely as a container for the unacceptable. On the contrary, the thrust is toward implicit, nonconscious experience that is all-inclusive – capturing intersubjective affective experience through the automatic operation of the right hemisphere of the brain. Early life experiences, all of them, are affectively registered, and encoded into the developing right hemisphere (Stuss & Alexander, 1999). Current neuroscience makes clear that implicit, nonconscious forms of representation are fundamental to complex adult functioning as well as to infant functioning. Furthermore, complex new learning continues throughout our lives through implicit mechanisms not mediated by translation of implicit knowing into symbolic or conscious form, even though words or images may be involved as part of the learning that is implicitly represented (Lyons-Ruth, 1999).
Converging work in the neurosciences now point toward the impact of early interpersonal relations on the brain structures that both process interpersonal interactions and also regulate intrapersonal experience. At the beginning of life, our relatedness to others is primarily through somatosensory stimulation, through face-to-face, skin-to-skin interaction consisting of processes that are visual, auditory, olfactory, gustatory, and vestibular (Tatkin, 2006). Within this secure relational system begins the planting of seeds necessary for social-emotional development, such as capacities for trust, empathy, love, playfulness, humor, patience, creativity, and vitality. This developing social-emotional system largely involves the right hemisphere of the brain, which has deep connections into the limbic system and body and is dominant for non-verbal communication, processing of emotional communication, and processing of the somatic aspects of communication (Tatkin, 2006). The right hemisphere dominates during overwhelming stress and activates the hypothalamic-pituitary-adrenal axis and production of stress hormones such as cortisol (Sullivan & Gratton, 2002). Siegel (1999) sees the constructed representational world of the right hemisphere as derived from intersubjective affective exchanges with others. Research continues to uncover more of the right brain mechanism of social-emotional cueing and the critical function of attending to implicit nonverbal social-emotional cues and shifts of arousal within a dyad (Schore, 2002). Schore has further suggested that the implicit self-system of the right brain, evolving from the preverbal phase of early life, "represents the biological substrate of the dynamic unconscious" (Schore 2005, p.831).
Allan Schore's Boston Change Process Study Groups in developmental affective neuroscience and clinical practice bring a developmental and attachment theory perspective to understanding current research on unconscious processes. Their focus on infancy has resulted in a turning away from the traditional view of an "unconscious" formed by repression, and toward behavioral patterns (e.g., of attachment or other relatedness) imprinted procedurally as implicit memories that are revealed through enactments and altered (as they were generated) in present, here-and-now relational encounters (Litowitz, 2005). Schore (2001) views attachment as fundamentally the interactive regulation of emotion, specifically the right brain-to-right brain regulation of biological synchronicity between psychobiologically attuned individuals. Right brain mechanisms, activated in dysregulating stressful interpersonal interactions, are seen to play a central role in the rapid, nonconscious appraisal of the positive or negative emotional significance of social stimuli. In addition, the right hemisphere, the base for implicit learning, is known to be dominant for affect regulation, the perception of nonverbal emotional expressions, and the processing of bodily based visceral stimuli. The rapid, nonconscious assessment of negatively charged social stimuli by the right hemisphere via the limbic system often underlies triggering of dysregulating affect patterns in relationships (Siegel, 1999). In early life, complex non-verbal right brain-to-right brain communications between mother and infant generate internal working models that may encode strategies of affect regulation and guide interpersonal behavior later on. These interactional exchanges become implicit, nonconscious procedural memories and at a later point may be evoked in interpersonal experiences, particularly attachment relationships.
Presented with the latest developments in cognitive neuroscience and neurobiology, the concept of an "unconscious" as a container of repressed wishes derivative of primitive impulses, or unacceptable affect, or rejected selfobject configurations, can hardly be sustained as the only way or even a necessary way to understand the intrapsychic domain. Current developments are radically altering the way many psychoanalysts think and value the study of unconscious mentation, but little has changed in the theories that guide and inform them.
Theoretical and Clinical Implications for Psychoanalysis
A workable contemporary theoretical basis for considering neurobiological perspectives has yet to be fully articulated. However, the shift in clinical psychoanalysis over the past 20 years, accommodating a more relational perspective, has left the door open to developing a model of the unconscious that reflects the latest developments in the neurosciences using new language with meanings that fit current developments. Typically, contemporary relational analysts have avoided universal truths and the prescriptive formulaic assertions that follow, preferring a more provisional way of thinking (Hirsch, 1998). Perhaps as a result, relational analysts often seem to have more of a revisionist stance and, in a kind of reverse imitation, the relational movement seems to have been defining itself as much by what it is not as by what it is. Through processes of abstraction and conceptualization, theory provides a framework for developing our thinking and a sense of safety within which to deepen our applied experience. Lewis Aron (1998) suggests that our theories paradoxically serve two distinct and seemingly contradictory purposes. A principle may guide us either because it's concordant with our beliefs or because it complements them. On the one hand, good theory opens up possibilities, new ways of understanding and intervening, providing us with options when we've become stuck. On the other hand, theory helps us to narrow our options, establish priorities and become more consistent. Good theory doesn't require a comprehensive system of rules, but rather a set of dynamic clinical concepts serving as a framework for the analyst. Within this framework, we evaluate the potential benefits and drawbacks of any form of behavior within any individually unique interactive matrix. It is here that the analyst's sense of direction, some theoretical orientation of what to recognize in the patient's behavior, is operationalized, allowing in all of this an inescapable core indeterminacy in doing what we do.
New conceptual and descriptive approaches require new terminology to capture meanings specific to them. It is clear that most of the established psychoanalytic vocabulary has strong conceptual links to the dynamic unconscious. Traditionally, the dynamic unconscious, construed as verbal or symbolic, and as unconscious only by reason of repression, has been the locus of all affectively meaningful representations. As we have seen, this concept of an unconscious of repressed affect can no longer be sustained. Instead, we need to be thinking in terms of multi-determined processes by which experiential phenomena remain out of awareness. Such an approach could accommodate implicit knowledge that is nonconscious, has no verbal or symbolic label, and does not require repression to remain out of awareness (Stern, D.N., 1998). This approach suggests that shared verbal understanding of interactions between patient and analyst are likely to be insufficient in promoting meaningful change; instead, affectively rich implicit processes (which may or may not be explicitly verbalized) may be what brings about change in the moment (Stern, D.N. 2004). Perhaps one clinical implication of all of this may be the reformulation of the notion of a "talking" cure (left brain to left brain) to one that more broadly encompasses the totality of the human exchange including every aspect of being with another (right brain to right brain).
Among contemporary analysts, Edgar Levenson, drawing on the work of Daniel Siegel (1999) and Alan Schore (1994) among others, has added an unequivocal current neurobiological perspective to his understanding of the psychoanalytic process, offering the perspective that change in psychoanalysis arises from a deep out-of-awareness flow of affectively intense right hemisphere activity (encompassing the whole experience – visual, spatial, sensory) that is subsequently organized by the left hemisphere into a coherent narrative (Levenson, 2003). He explains psychoanalytic inquiry as essentially a non-linear, impressionistic use of language that conveys imagery recognized by the pattern recognition center in the right hemisphere of the brain. Psychoanalytic inquiry calls us to an act of curiosity in relation to experience that has remained unformulated (Stern, D.B., 1997), a way of knowing experience that is mitigated through the right hemisphere, allowing us to know the patient from the inside out (Bromberg, 1991). Yet, for many, psychoanalysis remains fundamentally a process of replacing irrational unconscious processes with consciousness, based on the premise that we are defined by intellect and language, and cured by our capacity for conscious awareness (Levenson, 1998). Even when we no longer require that the patient understand the process, we still expect that the therapist's interventions—implicit or explicitly defined—will be directed by his or her conscious awareness. Because we consider awareness as the superior state, we do not dare to think of the possibility that unconsciousness may, at times, be an advantageous state that is interfered with by consciousness (Levenson, 1998). The relevance for therapy may well be that the function of the transference-countertransference enactment is to supply the experiential component to the analytic discourse. As Levenson (1998, p.244) said "The interactional field of the therapist and patient obviously involves not only language, or even language qua behavior, but also a subtle and intricate choreography of affect, expression, semiotic cues …. It is possible that patients resist interpretations, not because of negativism or anxiety, but because no one learns anything by being told. When interpretation works … it is because it is reflecting a felt experience. Perhaps that is why interpretations only seem to work if they are mediated through the transference, where what is talked about is being simultaneously experienced… striking [a] correspondence between language and behavior." Perhaps the psychoanalyst's function may now be conceived as one in which she attends primarily to nonverbal cues and affective shifts within the therapeutic dyad, with understanding as a sort of afterthought – an idea which has radical implications for our concepts of insight and change (Levenson, 1998).
It's becoming increasingly difficult to remain a mentalist in this period of rapid neurobiological discoveries. Today, the emerging findings in neuroscience offer complex and overlapping neurobiological correlates to psychoanalysis and challenge us to integrate them in our theories and practice. Psychoanalysts of all persuasions are facing the challenges of integrating these new findings and can no longer afford to respond to current neurobiological developments with awe followed by amnesia. Some, wedded to the dogma of their traditions, will manage to overcome their anxiety and indifference to current developments simply by bending science in the direction of explaining worn out metaphors. While metaphor that relies heavily on static theoretical interpretation may indeed be comforting, it's a bit like looking at old movies – all repetition, no surprise. The unconscious, as we once thought of it, can no longer remain safely ensconced among the furniture of old metaphors. It is time to separate from the dogma of theory and to attempt embracing the unconscious from the standpoint of empirical findings. Today, the broader, deeper questions relate to how experience becomes unconscious and how unconscious processes function. There is substantial physiologic evidence suggesting that basic principles of unconscious processes be retained, although they must be reformulated. The time has come for psychoanalysis to adjust its focus on the unconscious to a level closer to the scientific data as we now know it. As always, the difficulty is to do so without feeling as though we have to dissociate from our psychoanalytic sensibilities. Psychoanalysts have the opportunity to avoid a conflict of cultures and, in its place, set the foundation for a renewed psychoanalytic sensibility rooted, not in past metaphors, but in present empirical findings; shifting our horizons to the frontiers of neurobiological discoveries. This implies we must learn to see more, to hear more, to feel more. If we do, then psychoanalysis will be well positioned to provide a renewed promise of an inclusive and comprehensive model of the essential capacity to enter into fulfilling relationships with others.
Conclusion
To paraphrase Jean Baudrillard, psychoanalysts have carried on for a long time doing our conjugal duty to the original metaphor of the unconscious – long after the surprises have worn out. There will always be a dialectical tension between the poetic (metaphor) and the pragmatic (science); however, continuing the status quo increasingly constitutes a retreat from the real world. The aim of psychoanalysis should be to make experience more, rather than less, real to us. We risk perpetuating a concept and indeed an entire vocabulary weighed down by its history-mindedness, a language that is becoming irrelevant, except for its vague nostalgic value. When the language of psychoanalysis fails to reflect the action of what we do, our lived experience as psychoanalysts, then we will only succeed in obfuscating, instead of illuminating the mutative value of psychoanalysis. Instead of looking backward and defending our traditions, we could be looking forward and generating more complex models of change that explore the mutative effects of psychoanalysis in terms of current neurobiological data integrating evidence from the mind, brain, and body. The new neurobiological findings are not a threat to the psychoanalytic enterprise. On the contrary, they promise to enliven it. As Schore (2005, p.830) has said: "The current dialogue between biological and psychological sciences is allowing for a realization of Freud's prediction of a rapprochement between psychoanalysis and the natural sciences." This dialogue constitutes a scientific basis for an emerging pragmatic consensus. We are presented with a rare opportunity for a convergence of world views among psychoanalysts of all persuasions. The opportunity is here to integrate psychoanalytic understanding of how the mind works with new knowledge of how the brain works. The only real question that remains is whether we will embrace it with timidity or temerity. The future of psychoanalysis may well belong to those whose sensibilities incorporate and reflect the compelling findings of today's research.
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Victor P. Iannuzzi, PhD
Victor Iannuzzi's training as a psychologist has emphasized both cognitive-behavioral psychology and psychoanalysis. Following completion of a post-doctoral fellowship at Columbia-Presbyterian Medical Center, he received a certificate in psychoanalysis from the William Alanson White Institute.
Following 9/11, he worked closely with the effects of trauma on various populations, including emergency service personnel. In October 2001, he was appointed Director of the Trauma Response Service for the William Alanson White Institute. He is an adjunct staff supervisor in the Columbia-Presbyterian psychology internship program, and is presently in private practice as a psychologist and psychoanalyst in New York City.
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