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Psychoanalysis in evolution
P s y c h o a n a l y s i s in E v o l u t i o n By LEON SALZl~AN T ~ S Y G H O A N A L Y S I S is a t the crossroads. The brilliant a n d p r o d u c t i v e I - insights of F r e u d which have influenced t h e social sciences and the arts these past 20 years axe in d a n g e r of being strangled by rigid and mechanical application. Psychoanalysis developed out of the clinical problems of the neurotic and psycliotic, but the psychoanalytic Practitioners have moved further away from the science of medicine, and into an almost religious cultism and mystique. Now their choice is clear. T h e y can either accept the challenge of recent advances in psychology as well as in the physical sciences and become integrated into the medical community, or they can continue on the present disastrous course of intolerance of any c h a n g e and b e c o m e isolated, a small sect on a b y w a y of the broader psyahotherapeutic movement. 'With President Kennedy's proposal for community mental health centers, which will surely come to pass, the emphasis o n treatment for the mental disorders will no longer focus o n either the large mental hospital or the private psychoanalyst's office. Unless the psychoanalyst can be flexible enough to modify and revise his theories and techniques in line with developments in his own field as well as the practical needs of the population, he may end up sacrificing the vast and profound heritage of Freud. Freud's theories climaxed generations of philosophical and psychological concern with the problems of the mind and the processes of thinking and behaving. Inevitably they were influenced by ,the then prevailing theories in the physical sciences, particularly in physics, which was the model for all the other sciences. Energy, mechanics, absolute notions of time and causality were dominant in physics. The evolutionary theories o f Darwin and the simplified notions of causality of disease by noxious agents were also prevalent. The revolutionary changes in physics, however, heralded b y Heisenberg's Indeterrninancy Principle and Einstein's Theory of Relativity had little influence on Freud's work. Nor did advances in biology lessen Freud's adherence to the anatomical theories of sex differentiation. H e never abandoned the Lamarckian concept of the inheritance of acquired characteristics, which has been considered invalid by all evolutionists, because it helped provide an explanation for some of his concepts. Most of the dissension and contention in psychoanalytic circles is centered on Freud's mechanistic theories, particularly the Libido Theory and the related hypothesis .that the libido (sexual energy) is the main source of the human being's psychological development. This theory is framed in the language of 19th century physics and one may justly speculate that had Freud had the benefit of our present knowledge in physics and the biological science, he might not have t~ormulated his theories in the language of libido or instinct. Whereas Freud would have changed in the face of the enormous advances in the physical and biological sciences, the orthodox or classical psychoanalyst 304 COMI'BEIIENSlVE PSYCHIATRY, Vot,. 5, No. 6 (DEcEMBma), 1904
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h a s been reluctant t o accept, a n d at t i m e s fiercely opposed, any. alteration in Freudian theories. While such loyalty would be admired in a religious or social setting, it seems most inappropriate in a scienee~ In the past 30 years there have been rexfisions in psyclloanalytic theory a n d practice wllich have occurred in spite o f the strenuouS: restraining efforts of the so_called ",orthodox" group. These revisions have c o m e f r 0 m t h e ne 0Freudian, or c u l t u r a l psychoanalysts, and t h e y have d r a w n not o n l y : on Freud's original work, b u t c h the more recent development s in biology ~and : physics. Their greater flexibility and readiness to consider a n d try newer approaches may, in t h e long run, p r e s e r v e Freud's contributions r a t h e r than dilute t h e m . These new theories, w h i c h emphasize the r o l e o f culture rather than b i o l o g y in h u m a n d e v e l o p m e n t and stress the interactionall n a t u r e ! o f personality growth, are b u i l t o n Freudian theory. :They a r e not designed to s u p p l a n t i t . T r u t h in science does n o t c o m e simply b y sudden revelations, or by the brilliant explanations of :a :mystery, It comes from a : p r 0 1 o n g e d a n d serious application, r e v i s i o n a n d : e x t e n s i v e ; r e c o n f i r m a t i o n o f discovered i n sights. O n l y a itheological doctrine arrives fulll grown; scientific formulations g r o w and expand w i t h additional discoveries in related• fields o f knowledge. Albert Einstein said, "concepts that have p r o v e d u s e f u l in t h e constitution ok an order of t h i n g s r e a d i l y w i n s u d a autlaority over u s t h a t • ' w e forget itheir earthly o r i g i n s and take t h e m to be Changeless d a t a . . S u c h concePts then become stamped as necessities of t h o u g h t , as given ,a priori" so t h a t the path of scientific' progress often becomes impassable for a long period.'? This i s what happened with the w o r k of Sigmund Freud. In some psychoanalytic groups, all o f Freud's formulations a r e considered sacrosanct and any attempt t o examine o r review t h e m , except for purposes of reaffirmation, is considered heretical and disloyal. A n y serious disagreement produces violent reactions, with threats o f expulsion and excommunication. This atmosphere is carried down to the student, who, i n his psychoanalytic training, i s taught and indoctrinated in Freud's theories. I t is only the brave and the bold who venture alternative theories and t h e r a p e u t i c iteehniques. Despite these strictures, in the United States there were many psychoanalysts who offered alternative ~theories, notably among them Karen H o m e y and Harry Stack Sullivan/ Karen H o m e y reexamined the Freudian concepts when she left Germany and moved to a new cultural setting in the United States. She discovered that some of the concepts like Castration, penis envy, sibling rivalry and the Oedipus complex were not so clearly in evidence in the U. S. as they were in Europe. Thus she was forced to consider the whole issue o f culture as opposed to t h e innate biological factors in psychological development. H a r r y Stack Sullivan, who re.ceived all his training in the U. S. and who is the only native-born American psychoanalyst to rr~.ke basic contributions to the science, focused on the interpersonal factors in personality development, l i e found that it was not the libido, but anxiety as it involved individuals in relation to one another that motivated personality development. These two, along with Sandor Rado, Franz Alexander, Roy Grinker and •
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others have been leaders among the neo-Freudian or c u l t u r a l psychoanalysts. They, w i t h t h e i r students and followers, have been constantly reexamining their premises a n d discarding o r revising both Freud's views and their own earlier formulations. S i n c e we are a long w a y fi-om final answers in this y o u n g science, such a critical attitude is essential. I n this way, psychoanalysis becomes a science that can be i n t e g r a t e d into the sciences of the twentieth century rather than a historical development of the latter half of the nineteenth century. The b r e a d t h and importance of these developments was made c l e a r last sttmmer when more than 400 participants met in an International Psychoanalytic F o r u m in Amsterdam to a p p r a i s e them. This was the first time since the birth of psychoanalysis t h a t a n international congress was held under auspices other than those pursuing the orthodox, classical theories of Freud. The participants in the Amsterdam meeting devoted themselves to a study of the profound changes that have occurred on the scientific and social scenes in the past 30 years and the c h a n g e s they have brought about in psychoanalytic theories. W h a t are some of these changes? Learning theory and t h e concept of a d a p t a t i o n in human development stressed b y Sandor R a d o and F r a n z Alexander has taken a prominent place in thinking hitherto d o m i n a t e d by instinct and motivation theory. T h e r e h a s been a broader recognition of the effect of culture o n personality development. Animal experiments, both on a basic n e u r o p h y s i o l o g i c a l level and on a behavior level, have proved very helpful in resolving the culture-versus-instinct controversy. Recent biochemical research and the wide utilization of d r u g s to tranquilize, energize a n d for other purposes have greatly altered t r e a t m e n t procedures and expanded our understanding of neurotic and psychotic development. O u t m o d e d notions, such as the bisexual theory of h u m a n sexual development, which have long been doubted b y the biologists and psychologists have begun to recede in t h e i r significance. T h e original t h e o r i e s of F r e u d on masochism, homosexuality, depression, suicide and a host of other so-called "'basic" concepts have been altered and in some instances seriously revised Or abandoned. In almost ever~f instance where the libido theory, which assumes a libido or sexual driving force for all .personality development, has been u s e d to explain a mental disorder, an alternative explanation has been presented which is equally enlightening and in m a n y instances more useful. "vVhich of F r e u d ' s original views are acceptable today to psychoanalysts of all persuasions, backgrounds and schools of thought? W h i c h of his concepts have been revised or discarded b y m a n y psychoanalysts in the United Sfal:es and other parts of the world? In response to the first question, all psychoanalysts would agree with F r e u d that: 1. The character structure the personality of an individual is the result of a dynamic development of the inherited potentialities of the person as t h e y unfold in his life and experience. 2. The psyeahological development of man is influenced b y factors which are outside of his immediate awareness (unconscious).
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3. The influence of early e x p e r i e n c e s play a v e r y significant role i n p e r s o n ality development and i n t h e p r o d u c t i o n of neuroses and psychoses( 4 . Sexuality and m a n ' s capacity fo r sylnb0lization and communication a r ~ crucial elements i n h i s psychic life. VVhile o n e can add m a n y other i t e m s to this l i s t the c o n c e p t :o f free asso' eiation, transference, t h e : significance o f d r e a m s , for i example: y they would b e teehnieal items that arise out o f t h e four main hypotheses. Dynamic psyehi L~ atrists, psychologistS, psychoanalysts, and students:of h u m a n beha4cior all over the World either consciouSly accept t h e s e hypotheses or unwittingly useYthem w i t h o u t recognizing t h e i r origins. These iieontributions: which : arose directly from Sigmund Freud's epochal discoveries h a v e become SO mueh a part:of o u r existence t h a t they :are no longer open t0 argument: But what are t h e Freudian liypotheses t h a t h a v e been : e x p l o r e d and :q(iestinned over the past 30 y e a r s ? First, there is the unconscious: n o t in t e r m s of i t s existence a s a f0ree i n h u m a n behavior b u t in terms of its eontent.i F r e u d Viewed tlae unconscious: as a place in t h e brain; not ~Specifically d e f i n e d : o r identified b u t w i t h d e f i n i t e characteristics. ~It:-was a receptacle :for man'S i~asie instinctual drives and h i s r e p r e s s e d feelingsl a n d attitudes. I t Was thought t o be l timeless,; b e y o n d : t h 6 i n f l u e n c e o f conscious activity and ~subjeet: t o i t s ° w n p r i m i t i v e l a w s l The" basic instinctual forces e0nsisted particularly o f sex' ( ! i b i d o ) : i a n d aggression. XYhile Carl l u n g b r o a d e n e d the concept of the unconscious b y eonsiderin t h e libido a total life force, more recent theorists have t e n d e d l t o d e - e m p h a s i z e the mechanical and s t o r a g e functions 0f t h e u n c o n s c i o u s and toll Seri0usly d o u b t Freud's description of its contents. This line of r e a s 0 n i n g n o t ! 0 n l y d i s agrees and discards t h e n o t i o n of instincts b u t also presents: alternative:views on how the unconscious functions in o u r day-to-day living. Rather t h a n posbalating an a r e a of bi:ain activity Separal:e a n d w a l l e d :offl by psychic guardians, s o m e theorists, namely Sander Rado,~ and Halxy~ -~Stack Sullivan, postulate that the perception s and Sychie~awareness'0f m a n can i ~ e place inside or outside of immediate awareness o In u this~wa r y. . . mental . . . . . . activity is e i t h e r b e i n g reported :to u s o r i t is n o t b e i n g 'rep0rted for ~a;X,arietyl of r e a s o n s among them mental economy, S i n c e if:all our~:!:rnental : activity Was being reporte~ t o u s we w o u l d be 0ver~vhelmed: with information a n d ::unable to act at a l l T h e expectation of psychic distress would also influence tll6 awarehess of our mental life2 Those areas of m e n t a l functioning whiel~ are not being r e p o r t e d a r e : a v a i l , I able t o us" u n d e r ~eertain c i r c u m s t a n c e s and t h r o u g h t h e U s e o£!;partieular techniques like free association, This Simple explanation covers all the dynamic value of the unconscious as F r e u d described it w i t h o u t g e t t i n g involved i n t h e metaphysical speculation about primal forces or untffmed instinets.~ I n addi, tion, it avoids all the serious disagreements r e g a r d i n g the philosophical nature of man and whether he i s good o r evil and t h e quasi=scientific speculations regarding the life and death instincts. Other recent theorists like Bernard Robbins have cast serious doubt on the timelessness and encapsulated n a t u r e of the unconscious in s p i t e of the a p parent verifications produced by hypnosis, dianeties and Bridle M u r p h y r e v i v -
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ifieations. W h i l e t h e y do n o t d e n y t h e existence of an "'out o f a w a r e n e s s " m e n t a l life, t h e y conceive these p s y c h i c activities as b e i n g s u b j e c t to t h e alterations of e x p e r i e n c e a n d g r o w t h . Thus, t h e i r m a i n concern is to s t u d y t h e states o f consciousness a n d the individual's reactions a n d emotions as r e l a t e d to h i s conscious f e e l i n g s r a t h e r t h a n his unconscious attitudes. Man's feelings, t h e y say, are a l w a y s a p p r o p r i a t e a n d a c c u r a t e reflections of h o w h e is v i e w i n g t h e w o r l d a t a n y p a r t i c u l a r instant. T|ae v a r i e t y of h u m a n emotions, i n c l u d i n g love, hostility a n d t h e like, are n o t d u e to unconscious forces b u t a r e r e s p o n s e t o a l t e r e d s t a t e s of c o n s c i o u s n e s s a n d reflect c u r r e n t issues a n d attitudes. T h u s t r a u m a i n c h i l d h o o d m a y p r o d u c e a c h a n g e in a t t i t u d e a n d feeling a n d alter an m d l v a d u a l s relation t o the w o r l d . I t n e e d not influence t h e m a n b y prod u c i n g a r e p r e s s i o n w h i c h remains e n c a p s u l a t e d a n d exudes t o x i n s , p o i s o n i n g t h e individual's f u t u r e relationships, a w a i t i n g release t h r o u g h psychoanalysis. This p o i n t of view emphasizes, as do m a n y o t h e r r e c e n t theoretical advances, t h e analysis of t h e individual's p r e s e n t living r a t h e r t h a n his p a s t experiences, Dr. F r a n z A l e x a n d e r i n h i s b r i l l i a n t technical revisions of t h e r a p y e m p h a s i z e s t h i s notion. T h e libido t h e o r y c o n c e p t of F r e u d is one of t h e original h y p o t h e s e s t h a t h a s either b e e n r a d i c a l l y a l t e r e d or e n t i r e l y d i s c a r d e d b y a large n u m b e r of p s y c h o a n a l y s t s i This t h e o r y p o s t u l a t e d t h e existence of a libidinal e n e r g y w h i c h w a s t h e m a j o r m o t i v e force in the p s y c h i c d e v e l o p m e n t of man. I t i s bften p r e s e n t e d a s t h e crucial test o f a d h e r e n c e to o r t h o d o x p s y c h o a n a l y t i c theory. M a n y of t h e a n a l y s t s K a r e n H o r n e y , C l a r a T h o m p s o n , H a r r y Stack SullivaN, S a n d e r l~ado, E r i c h F r o m m a m o n g t h e m .........w h o h a v e r e p u d i a t e d t h e libido t h e o r y h a v e in essence b e e n r e a d out of the original p s y c h o a n a l y t i c association. T h e m a j o r objection to this t h e o r y is t h a t it supplies answers to questions in w h i c h w e a r e no longer interested: It was n o t only a t h e o r y a b o u t t h e libido a n d i t s l i f e h i s t o r y a n d d e v e l o p m e n t b u t it also w a s u s e d to explain such d i s p a r a t e p h e n o m e n a as aesthetic skills, philosophical interests, religious cont e r n s a n d p s y c h o s o m a t i c ailments o f all kinds. It linked p l e a s u r e w i t h sex a n d t h r o u g h a s e m a n t i c leap a s s u m e d t h a t p l e a s u r e o f all kinds, from sex t o t h e joy of c o n t e m p l a t i o n , w a s basically a libidinal process. T h i s t h e o r y has n e v e r b e e n v a l i d a t e d , n o r has t h e r e been a n y clear e v i d e n c e for its p e r p e t u a t i o n , a l t h o u g h it w a s e n o r m o u s l y fruitful in t h e early y e a r s of psychoanalysis. "/'he a l t e r n a t i v e h y p o t h e s e s of n e o - F r e u d i a n theorists n o t o n l y a n s w e r t h e questions a n s w e r e d b y t h e libido t h e o r y b u t f r e q u e n t l y p r e s e n t t h e answers i n a scientific f r a m e w o r k w h i c h is m o r e congenial to p r e s e n t - d a y thinking. F o r example', H a r r y Stack Sullivan views t h e m a i n s p r i n g s of h u m a n developm e n t as t h e n e e d to utilize t h e m a t u r i n g capacities of t h e g r o w i n g i n d i v i d u a l . It Js t h e p r e s s u r e to utilize o u r p o t e n t i a l i t i e s t h a t m o t i v a t e s h u m a n development. T h u s t h e i m p e t u s is on a b r o a d front r a t h e r t h a n l i m i t e d to libidinal or sexual energy. R e c e n t animal experiments, p a r t i c u l a r l y those of Dr. H a r r y t t a r l o w of t h e University of Wisconsin, h a v e s u g g e s t e d t h a t the so-called "'oral" z o n e w h i c h is the s t a g e of psychosexual d e v e l o p m e n t in t h e libido t h e o r y m a y n o t be, as F r e u d suggested, t h e p r i m a r y source of infantile experiencing. His research d
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with the infant rhesus monkey and the use of p s e u d o m o t h e r s suggests that closeness and intimate p h y s i c a l contact m a y : b e more significant f o r psycho' logical growth than t h e physiological needs m e t b y feeding. H i s i n f a n t m o n keys, while going to a wire m e s h artificial: another who: s u p p l i e d food wlmn 'they were "hungry, p r e f e r r e d t h e s o f t felt mother w h e n t h e y were upset even though it did not supply them with food. T h e y all developed a .closer . . relation. ship to the felt mother, and preferred her at all times. T h i s observation casts serious doubts on the zonal psychology of t h e libido theory. T h e newerl theories relate human d e v e l o p m e n t to human interactionl With o t h e r h u m a n s i n : t h e p:-rental situation and ultimately the culturel T h e y focus o n t h e exchanges o f man with his environment a n d w i t l l fellow man rather than on ' the i n n e r libidinal forces a n d instincts as they unfold regardless of the external :iworld. R e c e n t ethological investigations and a n i m a l e x p e r i m e n t s a i s o s u g g e s t t h a t the notion of instincts in man is both naive a n d oversimplified. T h e y : s u g g e s t t h a t instincts are enormously complicated Sets o f interrelated phenomena. As a result; we icannot speal~ of t h e sex instinct a s : i f t h e coinplex of b e h a v i o r t h a t ultimately results i n s e x u a l contact betweenindividuals::is a :single~nstinetual performance. In animals i t ma)): consistl o f hundreds of: s e p a r a t e performances triggered b y a v a r i e t y of somatic or e n v i r o n m e n t a l s t i m u l i ; in humans::it is e v e n m o r e c o m p l i c a t e d , since sex bel!avio r ~in man transcends :tlae/SimPle biological act. Most sex b e h a v i 0 r i s not:motivated by any;procreative n e e d . nor is it used exclusively for erotic pleasure o r the irelease Of g o n a d a l tension; Sex activity : s e r v e s a w i d e variety :of pu!~oses In fulfilling :m a n s n e e s f o r power, c o n t r o l , a n d hostility a s : w e l l as t h e expression o f tender,:? berievolen t feelings. For this reason, a n d because s e x i s the only biological function: t h a t requires the presence of another h u m a n forl i t s complete biologica ! expression; i t i s a n extremely fruitful s o u r c e of d a t a regarding:the psychology of man.iAli the sexual deviations and perversions can: be: understood :iin:::the l i g h t o f : t h e necessity for closeness; relationship .andlintimacy (0r~ lacki:of.:it)(: involved i n Sex behavior rather t h a n a s d i s t t t r b a n c e s i n tl~e Sex instinct:.i For:example, p r e m a t u r e : ejaculation can :be ::Understood as : a r e s p o n s e to anxiety on those o c c a s i o n s wtiere contr01 ox~:the total relationship:6f:thelmhn a n d woman i s a t stake. Attempts a t contr011;ifi,intere0urse:als0:i ~oceui" i n ! t h e s e people and premature ejacu!ati0n.resu!t s wheniilthere is i i a ; f a i l u r e t o ~ c o n ~ o l tlie Orgasm. This : m a y b e frustrating t o the femalei: ~It 10ceurs~ hen :the relations: s h i p b e t w e e n t h e sexes is disturbed asidefromi: sexil~P r 6 m a ~ r e ~ejaculat6rs naay have no difficulty with prostitutes; masturbation 0r:(fleetirig sexual: ene0unters where no relationship is involved. Freud, on : t h e other hand;::'vieWed:th~disorder a s a fixation o n the urethral stage iof psyehosexkml ~devel0pm6nt. T h e "'
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contemporary iapPr°ach puts the emphasis again on relafi0nship :inl h ~ a n psychology rather than: on instinets: Thereeogfilti0n :that intimacy may~exist in a sexual as well as: a non-sexual :sense? h a s g r e a t l y clarified the problem i of homosexuality and given impetus t o i t s treatability. I In the area of the psyehologyof the £emale we find t h e most drastic revisions of F r e u d ' s theories. T h e abandonmer~t b y t h e neo-Freudians o f t h e c0nception of the biological limitations of t h e female due to t h e primacy o f the m a l e
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g e n i t a l a n d ttle penis e n v y of the f e m a l e has o p e n e d n e w vistas in compreh e n d i n g t h e psyclaology of w o m e n . F r e u d ' s views w e r e not only m a l e - c e n t e r e d , b u t m a r k e d l y r e a c t i o n a r y and b o u n d b y his cultural limitations. H e a s s u m e d h e was stating biological, immt, table facts w h e n he was b e i n g p r e j u d i c e d b y h i s times a n d l i m i t e d b y the p r e v a i l i n g scientific ~Veltanschauung. T h e ass u m p t i o n of a p r e f e r r e d sexual organ in n a t u r e harks b a c k to the theological m y t h of creation a n d has no s u p p o r t in either anthropological, biological or p h y s i o l o g i c a l estimates of the superiority of one sex over another. T h e only clear s u p e r i o r i t y of the m a l e lies in his b o d i l y f r a m e a n d s u p p o r t i n g m u s c u l a ture. In every other respect, his physiological f u n c t i o n i n g is not s u p e r i o r to the f e m a l e . T h e specific p h y s i o l o g i c a l f unc tion of c h i l d - b e a r i n g a n d childr e a r i n g d e t e r m i n e s the f e m a l e ' s p s y c h o l o g y r a t h e r than a n y f e e l i n g of inferiority d u e to tile lack of a penis. T h e role of the w o m a n in this c u l t u r e as well as in e v e r y c u l t u r e since the d a w n of m a n m a k e s h e r p s y c h o l o g y e n tir e ly c o m p r e h e n s i b l e w i t h o u t a n y references to biological superiority" of the male. As m u s c u l a r strength is r e p l a c e d b y m a n ' s inte lle c tua l a c h i e v e m e n t s in automarion, for example, the m y t h of m a l e superiority slowly gives w a y in sp ite of historical p r e c e d e n c e a n d F r e u d ' s theories on f e m a l e psychology. As our i n v e s t i g a t i o n s lead us to rexdse or a b a n d o n some of the b r o a d e r theories, like the libido theory, the i m p l i c a t i o n s of these theories on the u n d e r l y i n g p r o b l e m s of the neuroses or m a s o c h i s m or the depressions, for e xamp le , h a v e also b e e n greatly altered. M a s o c h i s m , or the t e n d e n c y to berate, belittle, derogate, or even a b u s e oneself p h y s i c a l l y wa s t h o u g h t to b e a direct d e r i v a t i v e of the d e a t h instinct a n d to b e a m p l e proof of the existence of this instinct. F r e u d h i m s e l f c h a r a c t e r i z e d the de a th instinct as m y t h o l o g y , a n d most psyc h o a n a l y sts reject this f o r m u l a t i o n w h i l e c o n t i n u i n g to explain m a n y p s y c h o logical p r o b l e m s on the basis of it. H o w e v e r , m a s o c h i s m can b e clearly u n d e r stood in all its ramifications w h e n it is v i e w e d s i m p l y as an u n f o r t u n a t e a n d , at times, necessary a c c o m p a n i m e n t of an i n d i v i d u a r s a t t e m p t s to fulfill s o me n e u r o t i c goal. U n d e r these circu msta nc e s, it is only a b y - p r o d u c t in w h i c h o n e is w i l l i n g to accept p a i n in orde r to a c hie ve a g r e a t e r p l e a s u r e in the end. F r e u d ' s theories on depression a n d suic ide are o u t g r o w t h s of the d e a t h instinct h y p o t h e s i s and are deficient to the extent that the de a th instinct does not a c c u r a t e l y p o r t r a y m a n ' s d i l e m m a . It w a s a s s u m e d that s u i c i d e wa s t h e result of an act of hostility d i r e c t e d to,yards oneself w h e n it could not b e expressed towa r ds its true victim. Suicide f r e q u e n t l y looks like an act of r e v e n g e or hostility t o w a r d s s o m e o n e else, b u t r e c e n t studies of depression a n d suic ide reveal that hostility is a m i n o r p r o b l e m w h i l e other p s y c h o l o g i c a l issues, such as hopelessness a n d d e s p a i r are m o r e p r o m i n e n t . T h e r e is no n e e d to p o s t u l a t e a self-destructive ins tin c t w h e n w e can i d e n t i f y the motives of s u i c i d e as utter d e s p a i r of ever fulfilling orie's goals or ideals. W e can i d e n t i f y these f a c t o r s in m a n y suicides suc h as M a r i l y n Monroe's, w h e r e hostility factors arc m i n i m a l a n d d e s p a i r a p r o m i n e n t issue. "vVhile su icide occurs most f r e q u e n t l y in the d e p r e s s i v e states, it is not proportional to the severity of the depression since it is least likely in severe de-
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pressions a n d most likely in mild, or r e c o v e r i n g depressions. A n g e r a n d hostility in depressions is a s e c o n d a r y p h e n o m e n a p r o d u c e d b y the d e p r e s s e d individual's failure to achieve his d e m a n d s . T h e d e p r e s s e d i n d i v i d u a l suffers from a feeling of loss of s o m e person, v a l u e , or thing. His b e h a v i o r results f r o m an o v e r r i d i n g a t t e m p t to force t h e r e t u r n of the loss. His failure to a c h i e v e this results i n anger, despair, a n d at times, suicide. This v i e w of d e p r e s s i o n a n d suicide makes for a g r e a t e r o p t i m i s m with r e g a r d t o t h e control a n d : t h e r a p y of this a w e s o m e p r o b l e m . T h e d e a t h instinct c o n c e p t leads 0nly to pessimism and t h e r a p e u t i c nihilism. F r e u d d e v e l o p e d a consistent a n d c o m p l e t e t h e o r y of p e r s o n a l i t y developm e n t w h i c h was b a s e d on a set o f h y p o t h e s e s w h i c h w e r e r e m a r k a b l y p r o d u et i r e a n d c a p a b l e of a n s w e r i n g most of the q u e s t i o n s a b o u t t h e distortions of h u m a n behavior. H o w e v e r , t h e y w e r e too inclusive a n d b y s u p p l y i n g final answers too easily a n d universally t h e y t e n d e d to b e self-fulfilling t h a t is, they a l w a y s p r o v e d w h a t t h e y initially p o s t u l a t e d . Thus~ t h e y t e n d e d t o s h u t off research. T h e n e o - F r e u d i a n theories e m p h a s i z e t h e o b s e r v a t i o n a l e l e m e n t s i n p e r sonality t h e o r y r a t h e r t h a n t h e speculative m e t a p h y s i o l o g i c a l t h e o r i e s w h i c h p r o p o s e u l t i m a t e causes ~ d do n o t a l l o w either for verification or i n v a l i d a t i o n b u t m e r e l y for ictentification. T h e s e theories, c o n s e q u e n t l y , a r e m o r e operationaI a n d p e r m i t m o r e flexible a n d varied i n t e r p r e t a t i o n for the e v e n t s t u d i e d . In addition, t h e y allow a g r e a t e r r a n g e for e x p e r i m e n t a l studies. H o w e v e r , it m u s t be e m p h a s i z e d t h a t m o s t of o u r h y p o t h e s e s in t h e b e h a v i o r a l sciences are w o r t h y of serious attention since p r e s e n t l y w e are far from final answers. T h e n e o - F r e u d i a n h y p o t h e s e s are n o t b e t t e r or w o r s e t h a n t h e original F r e u d i a n conceptions. T h e y are different a n d benefit f r o m t h e d e v e l o p m e n t s in t h e physical as well as biological sciences of t h e p a s t 40 years. P a r a l l e l i n g t h e clarifications in t h e o r y are variations a n d alterations in technique. F o r e x a m p l e t h e r e is t h e device of t h e couch, b o r n o f F r e u d ' s initial experiences i n t h e r a p y a n d later a p r i m e s y m b o l of p s y c h o a n a l y s i s . W h i l e t h e p r o n e position m a y be helpful in a c c e l e r a t i n g recall a n d s t i m u l a t i n g regression it also increases d e p e n d e n c y a n d p e r p e t u a t e s an i n f a n t i l e a t t i t u d e t o w a r d s the therapist. Sitting b e h i n d t h e p a t i e n t , w h i c h served F r e u d ' s n e e d n o t to b e looked at for ten hours a day, b e c a m e e n s h r i n e d as an a b s o l u t e t e c h n i q u e . H o w e v e r , a c o u c h a n d a chair b e h i n d it does n o t constitute p s y c h o a n a l y s i s , a n d face-to-face e n c o u n t e r s w i t h p a t i e n t s f r e q u e n t l y serve to e n h a n c e therap e u t i c possibilities. As t h e r a p y has shifted from t h e p r i m a r y goal of t h e g e n e t i c r e c o n s t r u c t i o n of t h e past to a clarification of t h e p r e s e n t a n d an e m o t i o n a l r e - e x p e r i e n c i n g of the ar.eas of t r a u m a , a m o r e d i r e c t e d t y p e o f analysis b e c o m e s possible. W h i l e n o t a b a n d o n i n g t h e t e c h n i q u e s of free association, t h e t h e r a p i s t is m o r e active a n d p a r t i c i p a t e s m o r e directly in the t r e a t m e n t process. T h e t h e r a p i s t does m o r e than facilitate recall. H e b e c o m e s a collaborative p a r t n e r . This has i n e v i t a b l y altered the c o n c e p t of transference, w h i c h is an i n t e g r a l p a r t : o f p s y c h o a n a l y t i c treatmont. W h i l e t r a n s f e r e n c e is still c o n s i d e r e d to b e an essential d e v e l o p m e n t in
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treatment, it is no longer v i e w e d as s i m p l y a revival of p a r e n t - c h i l d attitudes. F r e q u e n t l y strong reactions and r e s p o n s e s are s t i m u l a t e d towa r d i m a g i n a r y or distorted i m a g e s of the therapist~ It n e e d not a l w a y s be an i n d i c a t i o n of a p a r e n t , child relationship; f r e q u e n t l y i t mirrors a c ur r e nt realistic or distorted relationship. In this f r a m e w o r k a n o n y m i t y a n d lack of activity o f the the r a p is t is no longer considered essential, since every reaction of the p a t i e n t .....not only those stirred up in fantasy is impor ta nt. A realistic reaction of anger, f e a r , affection or distrust m a y be just as fruitful an area of i n q u i r y as a r e a c t i o n b a s e d on entirely unrealistic causes. A s the activity of the therapist increases, there tends to b e a n i n c r e a s e in counter-transference reactions. I n these situations the reactions of the therapist to the p a t i e n t b e c o m e the subject o f inquir y. F r e u d c o n s i d e r e d these to b e artifacts a n d a s s u m e d that it would b e possible for p s y c h o a n a l y s t s to b e det a c h e d a n d objective like surgeons p e r f o r m i n g an operation. It has b e c o m e a b u n d a n t l y clear t h r o u g h the years t h a t not only is the the r a pist a h t u n a n bei n g who does get involved in the t h e r a p y b u t t h a t his reactions can b e the richest source of data about the patient's complexes a n d neurotic tendencies. T h e effect o f the patient's b e h a v i o r on the tl~erapist can e l i m i n a t e endless hours o f description of the patient's effect o n others. T h e p i c t u r e flaat t h e patient tries to p r e s e n t of h i m s e l f is f r e q u e n t l y colored b y his n e e d to b e acc e p t a b l e and liked. H ow ever, in the context of the therapist's reactions w e often get a truer p i c t u r e of h o w the p a t i e n t b e h a v e s socially. Thus, r a t h e r th a n carefully a v o i d i n g an interaction w i t h the patient, the n e o - F r e u d i a n therapist not only examines the patient's b e h a v i o r b u t scrutinizes his own responses for c l u e s t o the n e u r o t i c difficulty. Dr. F r a n z A l e x a n d e r h a d e x p e r i m e n t e d vcith t h e s e issues a nd proposed m a n y variations in t h e t r e a t m e n t process. Just prior to his r e c e n t death, h e was e n g a g e d ' i n a research project at Mr. Sinai Hospital in Los Angeles to test the v a lidity of F r e u d ' s views in contrast to the n e o - F r e u d i a n variations a n d alternatives. Brief t h e r a p y as well as group t h e r a p y are also b e i n g explored in order to shorten the t r e a t m e n t process as we ll as to m a k e it m o r e accessible to la r g e r n u m b e r s . Such variations are possible w h e n a flexible a n d e x p e r i m e n t a l attitude towards psychoanalysis prevails. Existential analysis c u r r e n t l y is in great vogue in E u r o p e and has b e e n w i d e l y a p p l i e d to the t r e a t m e n t of neuroses as well as psychoses. Existential analysis attempts to view m a n not only as a biological entity b u t as a creature w h o lives in a w orld that creates p r o b l e m s for h i m to deal with. It e m p h a s i z e s the p r o b l e m s of love, death, pa r tic ipa tion a n d c o m m u n i t y . V~Zhile existential analysis has some follow ing in t h e U. S., its influence on the direction of p s y c h i a t r y a n d p s y c h o a n a l y s i s is m i n i m a l . It is c o n c e i v a b l e that its w i d e s p r e a d influence in E u r o p e m a y b e due to the reaction against the rigid, m e c h a n i c a l a n d objectivistic formulations of F r e u d . In the U. S. this reaction expressed itself in the g row th a n d d e v e l o p m e n t of n e o - F r e u d i a n theories ~and an e m p h a s i s on the d e v e l o p m e n t of p s y c h o a n a l y s i s as a m e d i c a l science. I n Europe, w h e r e t h e w a r d i s r u p t e d the d e v e l o p m e n t of psychoanalysis, the existential philo-
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sophical m o v e m e n t , which flourished after the war, also stimulated the utilization of phenomenology i n the psychological sciences. T h e emphasis o n subjectivity, , participation, c o m m i t m e n t and: responsibility in the existentiallphilosophies also i s e v i d e n t in t h e t h e r a p y which g r o w s out c f them. This i s Very similar t o t h e :concepts f o s t e r e d / b y i the n e o - F r e u d i a n therapists,~ who alsolemphasize t h e significanthuman-isSues like involvement and c o m m i t m e n t to living. H o w e v e r , the therapeutic techniques of existential analysis are o f t e n so minutely' directed towards: t h e elucidation o f mOments o f awareness t h a t they p r o d u c e tomes 0 f m a t e r i a l which Clutter u p t h e p r o C e s s of unravelling the neurosis. While existentialism a s a : philosophy highlights m u c h of the •dilemma of modern m a n which•is •reflected in his n e u r o t i c : p r o b : lems, it cannot be translated into a t h e r a p y o r a m6dieal discipline~ • • In the past 3 0 years t h e r e h a v e lbeen c h a n g e s i n the t r a i n i n g of psychoanalysts. T r a i n i n g as part o f an a c a d e m i c setting, as in a U n i v e r s i t y or M e d i c a l School, is becoming a . .d o. m. i n. a.n t concern and man~y p y n e w s c h o a n a l y t i c instit u t e s have b e e n i n a u g u r a t e d as p a r t !of :a to[a]:medical :training p r o g r ~ j rather than in private i n s t i t u t e s . W h i l e suchl Coordinated t r a i n i n g h a s been functioning in p l a c e s like Columbia• . U n i v e r s i t y a n d l B e l i e v u e 4 V I ~ c a l C011eg~ in N e w York for some time; it: is o n l y i n recent years that the anomolous situation that psychoanalytic training as a n aspect• of a medical ~speciality is still carried o n by i p r i v a t e a u t o n o m o u s corporations, a situation that:: was abolished by the Flexner:report on Medical Training i n t h e early 1900's. The n e w arrangements will go a l o n g way towards establishing psychoanalysis a s a medical science disciplined and stimulated by the other medical sciences in a setting where the traditions of r e s e a r c h , validation, a n d scientific i n q u i r y are more i m p o r t a n t than adherence and loyalty to a particular point of view, It will overcome in a large measure the isolationist and exclusivist tendencies now so a p p a r e n t in psychoanalytic training and practise. B u t most o f all,' it will achieve w h a t promises t o be the most vital c o n t r i b u t i o n psychoanalysis can make, t h a t is the integration of psychodynamic principles into the entire medical curriculum a n d practise. This n e w development i n t r a i n i n g is largely an o u t g r o w t h of t h e dissident groups who felt constrained in the original training institutes and t e n d e d to set up n e w training centers. M a n y o f these centers w e r e set u p i n medical schools. I n t h e u l t i m a t e evolution of psychoanalysis, its survival will d e p e n d upon its b e c o m i n g part of t h e medical discipline with a scientific standing and integrity which can be achieved only when its students are trained in this orienta, tion. W h e n psychoanalysis ~-an integrate the diverse a n d fruitful theories of personality now in existence a n d yet to come, its evolution will be completed and it will become a true science taking its full a n d deserved place a m o n g the medical and social sciences.
Leon Salzman, M.D., Professor of Clinical Psychiatry, Georgetown University Medical School, Washington, D. C. •
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h a s been reluctant t o accept, a n d at t i m e s fiercely opposed, any. alteration in Freudian theories. While such loyalty would be admired in a religious or social setting, it seems most inappropriate in a scienee~ In the past 30 years there have been rexfisions in psyclloanalytic theory a n d practice wllich have occurred in spite o f the strenuouS: restraining efforts of the so_called ",orthodox" group. These revisions have c o m e f r 0 m t h e ne 0Freudian, or c u l t u r a l psychoanalysts, and t h e y have d r a w n not o n l y : on Freud's original work, b u t c h the more recent development s in biology ~and : physics. Their greater flexibility and readiness to consider a n d try newer approaches may, in t h e long run, p r e s e r v e Freud's contributions r a t h e r than dilute t h e m . These new theories, w h i c h emphasize the r o l e o f culture rather than b i o l o g y in h u m a n d e v e l o p m e n t and stress the interactionall n a t u r e ! o f personality growth, are b u i l t o n Freudian theory. :They a r e not designed to s u p p l a n t i t . T r u t h in science does n o t c o m e simply b y sudden revelations, or by the brilliant explanations of :a :mystery, It comes from a : p r 0 1 o n g e d a n d serious application, r e v i s i o n a n d : e x t e n s i v e ; r e c o n f i r m a t i o n o f discovered i n sights. O n l y a itheological doctrine arrives fulll grown; scientific formulations g r o w and expand w i t h additional discoveries in related• fields o f knowledge. Albert Einstein said, "concepts that have p r o v e d u s e f u l in t h e constitution ok an order of t h i n g s r e a d i l y w i n s u d a autlaority over u s t h a t • ' w e forget itheir earthly o r i g i n s and take t h e m to be Changeless d a t a . . S u c h concePts then become stamped as necessities of t h o u g h t , as given ,a priori" so t h a t the path of scientific' progress often becomes impassable for a long period.'? This i s what happened with the w o r k of Sigmund Freud. In some psychoanalytic groups, all o f Freud's formulations a r e considered sacrosanct and any attempt t o examine o r review t h e m , except for purposes of reaffirmation, is considered heretical and disloyal. A n y serious disagreement produces violent reactions, with threats o f expulsion and excommunication. This atmosphere is carried down to the student, who, i n his psychoanalytic training, i s taught and indoctrinated in Freud's theories. I t is only the brave and the bold who venture alternative theories and t h e r a p e u t i c iteehniques. Despite these strictures, in the United States there were many psychoanalysts who offered alternative ~theories, notably among them Karen H o m e y and Harry Stack Sullivan/ Karen H o m e y reexamined the Freudian concepts when she left Germany and moved to a new cultural setting in the United States. She discovered that some of the concepts like Castration, penis envy, sibling rivalry and the Oedipus complex were not so clearly in evidence in the U. S. as they were in Europe. Thus she was forced to consider the whole issue o f culture as opposed to t h e innate biological factors in psychological development. H a r r y Stack Sullivan, who re.ceived all his training in the U. S. and who is the only native-born American psychoanalyst to rr~.ke basic contributions to the science, focused on the interpersonal factors in personality development, l i e found that it was not the libido, but anxiety as it involved individuals in relation to one another that motivated personality development. These two, along with Sandor Rado, Franz Alexander, Roy Grinker and •
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others have been leaders among the neo-Freudian or c u l t u r a l psychoanalysts. They, w i t h t h e i r students and followers, have been constantly reexamining their premises a n d discarding o r revising both Freud's views and their own earlier formulations. S i n c e we are a long w a y fi-om final answers in this y o u n g science, such a critical attitude is essential. I n this way, psychoanalysis becomes a science that can be i n t e g r a t e d into the sciences of the twentieth century rather than a historical development of the latter half of the nineteenth century. The b r e a d t h and importance of these developments was made c l e a r last sttmmer when more than 400 participants met in an International Psychoanalytic F o r u m in Amsterdam to a p p r a i s e them. This was the first time since the birth of psychoanalysis t h a t a n international congress was held under auspices other than those pursuing the orthodox, classical theories of Freud. The participants in the Amsterdam meeting devoted themselves to a study of the profound changes that have occurred on the scientific and social scenes in the past 30 years and the c h a n g e s they have brought about in psychoanalytic theories. W h a t are some of these changes? Learning theory and t h e concept of a d a p t a t i o n in human development stressed b y Sandor R a d o and F r a n z Alexander has taken a prominent place in thinking hitherto d o m i n a t e d by instinct and motivation theory. T h e r e h a s been a broader recognition of the effect of culture o n personality development. Animal experiments, both on a basic n e u r o p h y s i o l o g i c a l level and on a behavior level, have proved very helpful in resolving the culture-versus-instinct controversy. Recent biochemical research and the wide utilization of d r u g s to tranquilize, energize a n d for other purposes have greatly altered t r e a t m e n t procedures and expanded our understanding of neurotic and psychotic development. O u t m o d e d notions, such as the bisexual theory of h u m a n sexual development, which have long been doubted b y the biologists and psychologists have begun to recede in t h e i r significance. T h e original t h e o r i e s of F r e u d on masochism, homosexuality, depression, suicide and a host of other so-called "'basic" concepts have been altered and in some instances seriously revised Or abandoned. In almost ever~f instance where the libido theory, which assumes a libido or sexual driving force for all .personality development, has been u s e d to explain a mental disorder, an alternative explanation has been presented which is equally enlightening and in m a n y instances more useful. "vVhich of F r e u d ' s original views are acceptable today to psychoanalysts of all persuasions, backgrounds and schools of thought? W h i c h of his concepts have been revised or discarded b y m a n y psychoanalysts in the United Sfal:es and other parts of the world? In response to the first question, all psychoanalysts would agree with F r e u d that: 1. The character structure the personality of an individual is the result of a dynamic development of the inherited potentialities of the person as t h e y unfold in his life and experience. 2. The psyeahological development of man is influenced b y factors which are outside of his immediate awareness (unconscious).
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3. The influence of early e x p e r i e n c e s play a v e r y significant role i n p e r s o n ality development and i n t h e p r o d u c t i o n of neuroses and psychoses( 4 . Sexuality and m a n ' s capacity fo r sylnb0lization and communication a r ~ crucial elements i n h i s psychic life. VVhile o n e can add m a n y other i t e m s to this l i s t the c o n c e p t :o f free asso' eiation, transference, t h e : significance o f d r e a m s , for i example: y they would b e teehnieal items that arise out o f t h e four main hypotheses. Dynamic psyehi L~ atrists, psychologistS, psychoanalysts, and students:of h u m a n beha4cior all over the World either consciouSly accept t h e s e hypotheses or unwittingly useYthem w i t h o u t recognizing t h e i r origins. These iieontributions: which : arose directly from Sigmund Freud's epochal discoveries h a v e become SO mueh a part:of o u r existence t h a t they :are no longer open t0 argument: But what are t h e Freudian liypotheses t h a t h a v e been : e x p l o r e d and :q(iestinned over the past 30 y e a r s ? First, there is the unconscious: n o t in t e r m s of i t s existence a s a f0ree i n h u m a n behavior b u t in terms of its eontent.i F r e u d Viewed tlae unconscious: as a place in t h e brain; not ~Specifically d e f i n e d : o r identified b u t w i t h d e f i n i t e characteristics. ~It:-was a receptacle :for man'S i~asie instinctual drives and h i s r e p r e s s e d feelingsl a n d attitudes. I t Was thought t o be l timeless,; b e y o n d : t h 6 i n f l u e n c e o f conscious activity and ~subjeet: t o i t s ° w n p r i m i t i v e l a w s l The" basic instinctual forces e0nsisted particularly o f sex' ( ! i b i d o ) : i a n d aggression. XYhile Carl l u n g b r o a d e n e d the concept of the unconscious b y eonsiderin t h e libido a total life force, more recent theorists have t e n d e d l t o d e - e m p h a s i z e the mechanical and s t o r a g e functions 0f t h e u n c o n s c i o u s and toll Seri0usly d o u b t Freud's description of its contents. This line of r e a s 0 n i n g n o t ! 0 n l y d i s agrees and discards t h e n o t i o n of instincts b u t also presents: alternative:views on how the unconscious functions in o u r day-to-day living. Rather t h a n posbalating an a r e a of bi:ain activity Separal:e a n d w a l l e d :offl by psychic guardians, s o m e theorists, namely Sander Rado,~ and Halxy~ -~Stack Sullivan, postulate that the perception s and Sychie~awareness'0f m a n can i ~ e place inside or outside of immediate awareness o In u this~wa r y. . . mental . . . . . . activity is e i t h e r b e i n g reported :to u s o r i t is n o t b e i n g 'rep0rted for ~a;X,arietyl of r e a s o n s among them mental economy, S i n c e if:all our~:!:rnental : activity Was being reporte~ t o u s we w o u l d be 0ver~vhelmed: with information a n d ::unable to act at a l l T h e expectation of psychic distress would also influence tll6 awarehess of our mental life2 Those areas of m e n t a l functioning whiel~ are not being r e p o r t e d a r e : a v a i l , I able t o us" u n d e r ~eertain c i r c u m s t a n c e s and t h r o u g h t h e U s e o£!;partieular techniques like free association, This Simple explanation covers all the dynamic value of the unconscious as F r e u d described it w i t h o u t g e t t i n g involved i n t h e metaphysical speculation about primal forces or untffmed instinets.~ I n addi, tion, it avoids all the serious disagreements r e g a r d i n g the philosophical nature of man and whether he i s good o r evil and t h e quasi=scientific speculations regarding the life and death instincts. Other recent theorists like Bernard Robbins have cast serious doubt on the timelessness and encapsulated n a t u r e of the unconscious in s p i t e of the a p parent verifications produced by hypnosis, dianeties and Bridle M u r p h y r e v i v -
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ifieations. W h i l e t h e y do n o t d e n y t h e existence of an "'out o f a w a r e n e s s " m e n t a l life, t h e y conceive these p s y c h i c activities as b e i n g s u b j e c t to t h e alterations of e x p e r i e n c e a n d g r o w t h . Thus, t h e i r m a i n concern is to s t u d y t h e states o f consciousness a n d the individual's reactions a n d emotions as r e l a t e d to h i s conscious f e e l i n g s r a t h e r t h a n his unconscious attitudes. Man's feelings, t h e y say, are a l w a y s a p p r o p r i a t e a n d a c c u r a t e reflections of h o w h e is v i e w i n g t h e w o r l d a t a n y p a r t i c u l a r instant. T|ae v a r i e t y of h u m a n emotions, i n c l u d i n g love, hostility a n d t h e like, are n o t d u e to unconscious forces b u t a r e r e s p o n s e t o a l t e r e d s t a t e s of c o n s c i o u s n e s s a n d reflect c u r r e n t issues a n d attitudes. T h u s t r a u m a i n c h i l d h o o d m a y p r o d u c e a c h a n g e in a t t i t u d e a n d feeling a n d alter an m d l v a d u a l s relation t o the w o r l d . I t n e e d not influence t h e m a n b y prod u c i n g a r e p r e s s i o n w h i c h remains e n c a p s u l a t e d a n d exudes t o x i n s , p o i s o n i n g t h e individual's f u t u r e relationships, a w a i t i n g release t h r o u g h psychoanalysis. This p o i n t of view emphasizes, as do m a n y o t h e r r e c e n t theoretical advances, t h e analysis of t h e individual's p r e s e n t living r a t h e r t h a n his p a s t experiences, Dr. F r a n z A l e x a n d e r i n h i s b r i l l i a n t technical revisions of t h e r a p y e m p h a s i z e s t h i s notion. T h e libido t h e o r y c o n c e p t of F r e u d is one of t h e original h y p o t h e s e s t h a t h a s either b e e n r a d i c a l l y a l t e r e d or e n t i r e l y d i s c a r d e d b y a large n u m b e r of p s y c h o a n a l y s t s i This t h e o r y p o s t u l a t e d t h e existence of a libidinal e n e r g y w h i c h w a s t h e m a j o r m o t i v e force in the p s y c h i c d e v e l o p m e n t of man. I t i s bften p r e s e n t e d a s t h e crucial test o f a d h e r e n c e to o r t h o d o x p s y c h o a n a l y t i c theory. M a n y of t h e a n a l y s t s K a r e n H o r n e y , C l a r a T h o m p s o n , H a r r y Stack SullivaN, S a n d e r l~ado, E r i c h F r o m m a m o n g t h e m .........w h o h a v e r e p u d i a t e d t h e libido t h e o r y h a v e in essence b e e n r e a d out of the original p s y c h o a n a l y t i c association. T h e m a j o r objection to this t h e o r y is t h a t it supplies answers to questions in w h i c h w e a r e no longer interested: It was n o t only a t h e o r y a b o u t t h e libido a n d i t s l i f e h i s t o r y a n d d e v e l o p m e n t b u t it also w a s u s e d to explain such d i s p a r a t e p h e n o m e n a as aesthetic skills, philosophical interests, religious cont e r n s a n d p s y c h o s o m a t i c ailments o f all kinds. It linked p l e a s u r e w i t h sex a n d t h r o u g h a s e m a n t i c leap a s s u m e d t h a t p l e a s u r e o f all kinds, from sex t o t h e joy of c o n t e m p l a t i o n , w a s basically a libidinal process. T h i s t h e o r y has n e v e r b e e n v a l i d a t e d , n o r has t h e r e been a n y clear e v i d e n c e for its p e r p e t u a t i o n , a l t h o u g h it w a s e n o r m o u s l y fruitful in t h e early y e a r s of psychoanalysis. "/'he a l t e r n a t i v e h y p o t h e s e s of n e o - F r e u d i a n theorists n o t o n l y a n s w e r t h e questions a n s w e r e d b y t h e libido t h e o r y b u t f r e q u e n t l y p r e s e n t t h e answers i n a scientific f r a m e w o r k w h i c h is m o r e congenial to p r e s e n t - d a y thinking. F o r example', H a r r y Stack Sullivan views t h e m a i n s p r i n g s of h u m a n developm e n t as t h e n e e d to utilize t h e m a t u r i n g capacities of t h e g r o w i n g i n d i v i d u a l . It Js t h e p r e s s u r e to utilize o u r p o t e n t i a l i t i e s t h a t m o t i v a t e s h u m a n development. T h u s t h e i m p e t u s is on a b r o a d front r a t h e r t h a n l i m i t e d to libidinal or sexual energy. R e c e n t animal experiments, p a r t i c u l a r l y those of Dr. H a r r y t t a r l o w of t h e University of Wisconsin, h a v e s u g g e s t e d t h a t the so-called "'oral" z o n e w h i c h is the s t a g e of psychosexual d e v e l o p m e n t in t h e libido t h e o r y m a y n o t be, as F r e u d suggested, t h e p r i m a r y source of infantile experiencing. His research d
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with the infant rhesus monkey and the use of p s e u d o m o t h e r s suggests that closeness and intimate p h y s i c a l contact m a y : b e more significant f o r psycho' logical growth than t h e physiological needs m e t b y feeding. H i s i n f a n t m o n keys, while going to a wire m e s h artificial: another who: s u p p l i e d food wlmn 'they were "hungry, p r e f e r r e d t h e s o f t felt mother w h e n t h e y were upset even though it did not supply them with food. T h e y all developed a .closer . . relation. ship to the felt mother, and preferred her at all times. T h i s observation casts serious doubts on the zonal psychology of t h e libido theory. T h e newerl theories relate human d e v e l o p m e n t to human interactionl With o t h e r h u m a n s i n : t h e p:-rental situation and ultimately the culturel T h e y focus o n t h e exchanges o f man with his environment a n d w i t l l fellow man rather than on ' the i n n e r libidinal forces a n d instincts as they unfold regardless of the external :iworld. R e c e n t ethological investigations and a n i m a l e x p e r i m e n t s a i s o s u g g e s t t h a t the notion of instincts in man is both naive a n d oversimplified. T h e y : s u g g e s t t h a t instincts are enormously complicated Sets o f interrelated phenomena. As a result; we icannot speal~ of t h e sex instinct a s : i f t h e coinplex of b e h a v i o r t h a t ultimately results i n s e x u a l contact betweenindividuals::is a :single~nstinetual performance. In animals i t ma)): consistl o f hundreds of: s e p a r a t e performances triggered b y a v a r i e t y of somatic or e n v i r o n m e n t a l s t i m u l i ; in humans::it is e v e n m o r e c o m p l i c a t e d , since sex bel!avio r ~in man transcends :tlae/SimPle biological act. Most sex b e h a v i 0 r i s not:motivated by any;procreative n e e d . nor is it used exclusively for erotic pleasure o r the irelease Of g o n a d a l tension; Sex activity : s e r v e s a w i d e variety :of pu!~oses In fulfilling :m a n s n e e s f o r power, c o n t r o l , a n d hostility a s : w e l l as t h e expression o f tender,:? berievolen t feelings. For this reason, a n d because s e x i s the only biological function: t h a t requires the presence of another h u m a n forl i t s complete biologica ! expression; i t i s a n extremely fruitful s o u r c e of d a t a regarding:the psychology of man.iAli the sexual deviations and perversions can: be: understood :iin:::the l i g h t o f : t h e necessity for closeness; relationship .andlintimacy (0r~ lacki:of.:it)(: involved i n Sex behavior rather t h a n a s d i s t t t r b a n c e s i n tl~e Sex instinct:.i For:example, p r e m a t u r e : ejaculation can :be ::Understood as : a r e s p o n s e to anxiety on those o c c a s i o n s wtiere contr01 ox~:the total relationship:6f:thelmhn a n d woman i s a t stake. Attempts a t contr011;ifi,intere0urse:als0:i ~oceui" i n ! t h e s e people and premature ejacu!ati0n.resu!t s wheniilthere is i i a ; f a i l u r e t o ~ c o n ~ o l tlie Orgasm. This : m a y b e frustrating t o the femalei: ~It 10ceurs~ hen :the relations: s h i p b e t w e e n t h e sexes is disturbed asidefromi: sexil~P r 6 m a ~ r e ~ejaculat6rs naay have no difficulty with prostitutes; masturbation 0r:(fleetirig sexual: ene0unters where no relationship is involved. Freud, on : t h e other hand;::'vieWed:th~disorder a s a fixation o n the urethral stage iof psyehosexkml ~devel0pm6nt. T h e "'
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contemporary iapPr°ach puts the emphasis again on relafi0nship :inl h ~ a n psychology rather than: on instinets: Thereeogfilti0n :that intimacy may~exist in a sexual as well as: a non-sexual :sense? h a s g r e a t l y clarified the problem i of homosexuality and given impetus t o i t s treatability. I In the area of the psyehologyof the £emale we find t h e most drastic revisions of F r e u d ' s theories. T h e abandonmer~t b y t h e neo-Freudians o f t h e c0nception of the biological limitations of t h e female due to t h e primacy o f the m a l e
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g e n i t a l a n d ttle penis e n v y of the f e m a l e has o p e n e d n e w vistas in compreh e n d i n g t h e psyclaology of w o m e n . F r e u d ' s views w e r e not only m a l e - c e n t e r e d , b u t m a r k e d l y r e a c t i o n a r y and b o u n d b y his cultural limitations. H e a s s u m e d h e was stating biological, immt, table facts w h e n he was b e i n g p r e j u d i c e d b y h i s times a n d l i m i t e d b y the p r e v a i l i n g scientific ~Veltanschauung. T h e ass u m p t i o n of a p r e f e r r e d sexual organ in n a t u r e harks b a c k to the theological m y t h of creation a n d has no s u p p o r t in either anthropological, biological or p h y s i o l o g i c a l estimates of the superiority of one sex over another. T h e only clear s u p e r i o r i t y of the m a l e lies in his b o d i l y f r a m e a n d s u p p o r t i n g m u s c u l a ture. In every other respect, his physiological f u n c t i o n i n g is not s u p e r i o r to the f e m a l e . T h e specific p h y s i o l o g i c a l f unc tion of c h i l d - b e a r i n g a n d childr e a r i n g d e t e r m i n e s the f e m a l e ' s p s y c h o l o g y r a t h e r than a n y f e e l i n g of inferiority d u e to tile lack of a penis. T h e role of the w o m a n in this c u l t u r e as well as in e v e r y c u l t u r e since the d a w n of m a n m a k e s h e r p s y c h o l o g y e n tir e ly c o m p r e h e n s i b l e w i t h o u t a n y references to biological superiority" of the male. As m u s c u l a r strength is r e p l a c e d b y m a n ' s inte lle c tua l a c h i e v e m e n t s in automarion, for example, the m y t h of m a l e superiority slowly gives w a y in sp ite of historical p r e c e d e n c e a n d F r e u d ' s theories on f e m a l e psychology. As our i n v e s t i g a t i o n s lead us to rexdse or a b a n d o n some of the b r o a d e r theories, like the libido theory, the i m p l i c a t i o n s of these theories on the u n d e r l y i n g p r o b l e m s of the neuroses or m a s o c h i s m or the depressions, for e xamp le , h a v e also b e e n greatly altered. M a s o c h i s m , or the t e n d e n c y to berate, belittle, derogate, or even a b u s e oneself p h y s i c a l l y wa s t h o u g h t to b e a direct d e r i v a t i v e of the d e a t h instinct a n d to b e a m p l e proof of the existence of this instinct. F r e u d h i m s e l f c h a r a c t e r i z e d the de a th instinct as m y t h o l o g y , a n d most psyc h o a n a l y sts reject this f o r m u l a t i o n w h i l e c o n t i n u i n g to explain m a n y p s y c h o logical p r o b l e m s on the basis of it. H o w e v e r , m a s o c h i s m can b e clearly u n d e r stood in all its ramifications w h e n it is v i e w e d s i m p l y as an u n f o r t u n a t e a n d , at times, necessary a c c o m p a n i m e n t of an i n d i v i d u a r s a t t e m p t s to fulfill s o me n e u r o t i c goal. U n d e r these circu msta nc e s, it is only a b y - p r o d u c t in w h i c h o n e is w i l l i n g to accept p a i n in orde r to a c hie ve a g r e a t e r p l e a s u r e in the end. F r e u d ' s theories on depression a n d suic ide are o u t g r o w t h s of the d e a t h instinct h y p o t h e s i s and are deficient to the extent that the de a th instinct does not a c c u r a t e l y p o r t r a y m a n ' s d i l e m m a . It w a s a s s u m e d that s u i c i d e wa s t h e result of an act of hostility d i r e c t e d to,yards oneself w h e n it could not b e expressed towa r ds its true victim. Suicide f r e q u e n t l y looks like an act of r e v e n g e or hostility t o w a r d s s o m e o n e else, b u t r e c e n t studies of depression a n d suic ide reveal that hostility is a m i n o r p r o b l e m w h i l e other p s y c h o l o g i c a l issues, such as hopelessness a n d d e s p a i r are m o r e p r o m i n e n t . T h e r e is no n e e d to p o s t u l a t e a self-destructive ins tin c t w h e n w e can i d e n t i f y the motives of s u i c i d e as utter d e s p a i r of ever fulfilling orie's goals or ideals. W e can i d e n t i f y these f a c t o r s in m a n y suicides suc h as M a r i l y n Monroe's, w h e r e hostility factors arc m i n i m a l a n d d e s p a i r a p r o m i n e n t issue. "vVhile su icide occurs most f r e q u e n t l y in the d e p r e s s i v e states, it is not proportional to the severity of the depression since it is least likely in severe de-
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pressions a n d most likely in mild, or r e c o v e r i n g depressions. A n g e r a n d hostility in depressions is a s e c o n d a r y p h e n o m e n a p r o d u c e d b y the d e p r e s s e d individual's failure to achieve his d e m a n d s . T h e d e p r e s s e d i n d i v i d u a l suffers from a feeling of loss of s o m e person, v a l u e , or thing. His b e h a v i o r results f r o m an o v e r r i d i n g a t t e m p t to force t h e r e t u r n of the loss. His failure to a c h i e v e this results i n anger, despair, a n d at times, suicide. This v i e w of d e p r e s s i o n a n d suicide makes for a g r e a t e r o p t i m i s m with r e g a r d t o t h e control a n d : t h e r a p y of this a w e s o m e p r o b l e m . T h e d e a t h instinct c o n c e p t leads 0nly to pessimism and t h e r a p e u t i c nihilism. F r e u d d e v e l o p e d a consistent a n d c o m p l e t e t h e o r y of p e r s o n a l i t y developm e n t w h i c h was b a s e d on a set o f h y p o t h e s e s w h i c h w e r e r e m a r k a b l y p r o d u et i r e a n d c a p a b l e of a n s w e r i n g most of the q u e s t i o n s a b o u t t h e distortions of h u m a n behavior. H o w e v e r , t h e y w e r e too inclusive a n d b y s u p p l y i n g final answers too easily a n d universally t h e y t e n d e d to b e self-fulfilling t h a t is, they a l w a y s p r o v e d w h a t t h e y initially p o s t u l a t e d . Thus~ t h e y t e n d e d t o s h u t off research. T h e n e o - F r e u d i a n theories e m p h a s i z e t h e o b s e r v a t i o n a l e l e m e n t s i n p e r sonality t h e o r y r a t h e r t h a n t h e speculative m e t a p h y s i o l o g i c a l t h e o r i e s w h i c h p r o p o s e u l t i m a t e causes ~ d do n o t a l l o w either for verification or i n v a l i d a t i o n b u t m e r e l y for ictentification. T h e s e theories, c o n s e q u e n t l y , a r e m o r e operationaI a n d p e r m i t m o r e flexible a n d varied i n t e r p r e t a t i o n for the e v e n t s t u d i e d . In addition, t h e y allow a g r e a t e r r a n g e for e x p e r i m e n t a l studies. H o w e v e r , it m u s t be e m p h a s i z e d t h a t m o s t of o u r h y p o t h e s e s in t h e b e h a v i o r a l sciences are w o r t h y of serious attention since p r e s e n t l y w e are far from final answers. T h e n e o - F r e u d i a n h y p o t h e s e s are n o t b e t t e r or w o r s e t h a n t h e original F r e u d i a n conceptions. T h e y are different a n d benefit f r o m t h e d e v e l o p m e n t s in t h e physical as well as biological sciences of t h e p a s t 40 years. P a r a l l e l i n g t h e clarifications in t h e o r y are variations a n d alterations in technique. F o r e x a m p l e t h e r e is t h e device of t h e couch, b o r n o f F r e u d ' s initial experiences i n t h e r a p y a n d later a p r i m e s y m b o l of p s y c h o a n a l y s i s . W h i l e t h e p r o n e position m a y be helpful in a c c e l e r a t i n g recall a n d s t i m u l a t i n g regression it also increases d e p e n d e n c y a n d p e r p e t u a t e s an i n f a n t i l e a t t i t u d e t o w a r d s the therapist. Sitting b e h i n d t h e p a t i e n t , w h i c h served F r e u d ' s n e e d n o t to b e looked at for ten hours a day, b e c a m e e n s h r i n e d as an a b s o l u t e t e c h n i q u e . H o w e v e r , a c o u c h a n d a chair b e h i n d it does n o t constitute p s y c h o a n a l y s i s , a n d face-to-face e n c o u n t e r s w i t h p a t i e n t s f r e q u e n t l y serve to e n h a n c e therap e u t i c possibilities. As t h e r a p y has shifted from t h e p r i m a r y goal of t h e g e n e t i c r e c o n s t r u c t i o n of t h e past to a clarification of t h e p r e s e n t a n d an e m o t i o n a l r e - e x p e r i e n c i n g of the ar.eas of t r a u m a , a m o r e d i r e c t e d t y p e o f analysis b e c o m e s possible. W h i l e n o t a b a n d o n i n g t h e t e c h n i q u e s of free association, t h e t h e r a p i s t is m o r e active a n d p a r t i c i p a t e s m o r e directly in the t r e a t m e n t process. T h e t h e r a p i s t does m o r e than facilitate recall. H e b e c o m e s a collaborative p a r t n e r . This has i n e v i t a b l y altered the c o n c e p t of transference, w h i c h is an i n t e g r a l p a r t : o f p s y c h o a n a l y t i c treatmont. W h i l e t r a n s f e r e n c e is still c o n s i d e r e d to b e an essential d e v e l o p m e n t in
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treatment, it is no longer v i e w e d as s i m p l y a revival of p a r e n t - c h i l d attitudes. F r e q u e n t l y strong reactions and r e s p o n s e s are s t i m u l a t e d towa r d i m a g i n a r y or distorted i m a g e s of the therapist~ It n e e d not a l w a y s be an i n d i c a t i o n of a p a r e n t , child relationship; f r e q u e n t l y i t mirrors a c ur r e nt realistic or distorted relationship. In this f r a m e w o r k a n o n y m i t y a n d lack of activity o f the the r a p is t is no longer considered essential, since every reaction of the p a t i e n t .....not only those stirred up in fantasy is impor ta nt. A realistic reaction of anger, f e a r , affection or distrust m a y be just as fruitful an area of i n q u i r y as a r e a c t i o n b a s e d on entirely unrealistic causes. A s the activity of the therapist increases, there tends to b e a n i n c r e a s e in counter-transference reactions. I n these situations the reactions of the therapist to the p a t i e n t b e c o m e the subject o f inquir y. F r e u d c o n s i d e r e d these to b e artifacts a n d a s s u m e d that it would b e possible for p s y c h o a n a l y s t s to b e det a c h e d a n d objective like surgeons p e r f o r m i n g an operation. It has b e c o m e a b u n d a n t l y clear t h r o u g h the years t h a t not only is the the r a pist a h t u n a n bei n g who does get involved in the t h e r a p y b u t t h a t his reactions can b e the richest source of data about the patient's complexes a n d neurotic tendencies. T h e effect o f the patient's b e h a v i o r on the tl~erapist can e l i m i n a t e endless hours o f description of the patient's effect o n others. T h e p i c t u r e flaat t h e patient tries to p r e s e n t of h i m s e l f is f r e q u e n t l y colored b y his n e e d to b e acc e p t a b l e and liked. H ow ever, in the context of the therapist's reactions w e often get a truer p i c t u r e of h o w the p a t i e n t b e h a v e s socially. Thus, r a t h e r th a n carefully a v o i d i n g an interaction w i t h the patient, the n e o - F r e u d i a n therapist not only examines the patient's b e h a v i o r b u t scrutinizes his own responses for c l u e s t o the n e u r o t i c difficulty. Dr. F r a n z A l e x a n d e r h a d e x p e r i m e n t e d vcith t h e s e issues a nd proposed m a n y variations in t h e t r e a t m e n t process. Just prior to his r e c e n t death, h e was e n g a g e d ' i n a research project at Mr. Sinai Hospital in Los Angeles to test the v a lidity of F r e u d ' s views in contrast to the n e o - F r e u d i a n variations a n d alternatives. Brief t h e r a p y as well as group t h e r a p y are also b e i n g explored in order to shorten the t r e a t m e n t process as we ll as to m a k e it m o r e accessible to la r g e r n u m b e r s . Such variations are possible w h e n a flexible a n d e x p e r i m e n t a l attitude towards psychoanalysis prevails. Existential analysis c u r r e n t l y is in great vogue in E u r o p e and has b e e n w i d e l y a p p l i e d to the t r e a t m e n t of neuroses as well as psychoses. Existential analysis attempts to view m a n not only as a biological entity b u t as a creature w h o lives in a w orld that creates p r o b l e m s for h i m to deal with. It e m p h a s i z e s the p r o b l e m s of love, death, pa r tic ipa tion a n d c o m m u n i t y . V~Zhile existential analysis has some follow ing in t h e U. S., its influence on the direction of p s y c h i a t r y a n d p s y c h o a n a l y s i s is m i n i m a l . It is c o n c e i v a b l e that its w i d e s p r e a d influence in E u r o p e m a y b e due to the reaction against the rigid, m e c h a n i c a l a n d objectivistic formulations of F r e u d . In the U. S. this reaction expressed itself in the g row th a n d d e v e l o p m e n t of n e o - F r e u d i a n theories ~and an e m p h a s i s on the d e v e l o p m e n t of p s y c h o a n a l y s i s as a m e d i c a l science. I n Europe, w h e r e t h e w a r d i s r u p t e d the d e v e l o p m e n t of psychoanalysis, the existential philo-
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sophical m o v e m e n t , which flourished after the war, also stimulated the utilization of phenomenology i n the psychological sciences. T h e emphasis o n subjectivity, , participation, c o m m i t m e n t and: responsibility in the existentiallphilosophies also i s e v i d e n t in t h e t h e r a p y which g r o w s out c f them. This i s Very similar t o t h e :concepts f o s t e r e d / b y i the n e o - F r e u d i a n therapists,~ who alsolemphasize t h e significanthuman-isSues like involvement and c o m m i t m e n t to living. H o w e v e r , the therapeutic techniques of existential analysis are o f t e n so minutely' directed towards: t h e elucidation o f mOments o f awareness t h a t they p r o d u c e tomes 0 f m a t e r i a l which Clutter u p t h e p r o C e s s of unravelling the neurosis. While existentialism a s a : philosophy highlights m u c h of the •dilemma of modern m a n which•is •reflected in his n e u r o t i c : p r o b : lems, it cannot be translated into a t h e r a p y o r a m6dieal discipline~ • • In the past 3 0 years t h e r e h a v e lbeen c h a n g e s i n the t r a i n i n g of psychoanalysts. T r a i n i n g as part o f an a c a d e m i c setting, as in a U n i v e r s i t y or M e d i c a l School, is becoming a . .d o. m. i n. a.n t concern and man~y p y n e w s c h o a n a l y t i c instit u t e s have b e e n i n a u g u r a t e d as p a r t !of :a to[a]:medical :training p r o g r ~ j rather than in private i n s t i t u t e s . W h i l e suchl Coordinated t r a i n i n g h a s been functioning in p l a c e s like Columbia• . U n i v e r s i t y a n d l B e l i e v u e 4 V I ~ c a l C011eg~ in N e w York for some time; it: is o n l y i n recent years that the anomolous situation that psychoanalytic training as a n aspect• of a medical ~speciality is still carried o n by i p r i v a t e a u t o n o m o u s corporations, a situation that:: was abolished by the Flexner:report on Medical Training i n t h e early 1900's. The n e w arrangements will go a l o n g way towards establishing psychoanalysis a s a medical science disciplined and stimulated by the other medical sciences in a setting where the traditions of r e s e a r c h , validation, a n d scientific i n q u i r y are more i m p o r t a n t than adherence and loyalty to a particular point of view, It will overcome in a large measure the isolationist and exclusivist tendencies now so a p p a r e n t in psychoanalytic training and practise. B u t most o f all,' it will achieve w h a t promises t o be the most vital c o n t r i b u t i o n psychoanalysis can make, t h a t is the integration of psychodynamic principles into the entire medical curriculum a n d practise. This n e w development i n t r a i n i n g is largely an o u t g r o w t h of t h e dissident groups who felt constrained in the original training institutes and t e n d e d to set up n e w training centers. M a n y o f these centers w e r e set u p i n medical schools. I n t h e u l t i m a t e evolution of psychoanalysis, its survival will d e p e n d upon its b e c o m i n g part of t h e medical discipline with a scientific standing and integrity which can be achieved only when its students are trained in this orienta, tion. W h e n psychoanalysis ~-an integrate the diverse a n d fruitful theories of personality now in existence a n d yet to come, its evolution will be completed and it will become a true science taking its full a n d deserved place a m o n g the medical and social sciences.
Leon Salzman, M.D., Professor of Clinical Psychiatry, Georgetown University Medical School, Washington, D. C. •