PSYCHOANALYSIS AS A "NORM AL" SCIENCE

HENRY KRYSTAL, M.D.*

WHICH PARADIGMS ARE COMPATIBLE WITH PSYCHOANALYSIS? It can be said that the epistemology of psychoanalysis were a life-long preoccupation and problem to Freud. But curiously, al­ though he was rejected by the medical establishment, especially by his chief and admired teacher Meynert (who turned violently against Freud’s early papers and attacked him as a “hypnotist”), Freud made only minimal defensive explanations in his papers. And, just about a hundred years ago, he turned to the endeavor which he carried on from the “project” to the end of his life: to create (i.e., to study) a scientific psychology. In 1891, in his book on aphasia, he clearly stated his convictions: The relationship between the chain of physiological events in the nervous system and the mental processes is probably not one of cause and effect. The former do not cease when the latter set in; they tend to continue but, from a certain moment, a mental phenomenon corresponds to each part of the chain, or to several parts. The psychic is, therefore, a process parallel to the physiological, a “dependent concomitant.” (1891, p. 55)

It would follow, from this early insight, that Freud would, as indeed he did, expect that as the knowledge of chemistry, physics, physiology, and all the things we now call neuroscience would progressively explain more of phenomenology, we would have to revise our views of the “dependent concomitant,” that is, the sci­ ence of psychological phenomena, and keep them in harmony with the biological substrate. In Freud’s letter to Fliess (No. 96) he wrote that he had “no desire at all to leave the psychology hanging in the air with no organic basis . . . I have no idea yet why I cannot yet fit it together” (1954). * »Professor Emeritus of Psychiatry, Michigan State University; Lecturer, Mich­ igan Psychoanalytic Institute. Presented at the Annual Meeting of the American Academy o f Psychoanaly­ sis, December 1990. Journal o f The American Academy of Psychoanalysis, 20(3), 395-412, 1992 © 1992 The American Academy of Psychoanalysis

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But Freud had a never-ending struggle with some of his close associates and collaborators, beginning with his mentor and senior colleague Breuer. The intended joint book Studies on Hysteria end­ ed up with a publicly conspicuous agreement to disagree, with each author putting his name only on the chapter he wrote. Freud con­ fided in Fliess, “The book with Breuer will include five case histo­ ries, a chapter by him—from which I dissociate m yself—on the theories of hysteria, summarizing and critical, and one by me on therapy” (Letter 19, dated June 22, 1894, Origins 94). And it turns out that what Breuer disagreed with Freud about was Freud’s em­ phasis on “actual neurosis, and the exclusive relationship between sexuality and neurosis” (Stewart, 1967). A lesser issue was Freud’s emphasis on pathogenesis through repression, whereas Breuer had a fondness for Janet’s idea of “hypnoid state” (Freud, 1925). Jones (1959) describes in considerable detail the story of the transition of the psychoanalytic movement into the International Psycho-Analytical Association (IPA). He states that during Sep­ tember 1909, Freud, Jones, and some of their associates decided that “Jung, who called together the Salzburg gathering in the pre­ vious year, should organize a Congress on a larger scale in 1910 and that this should then constitute itself the organ of a permanent International Psycho-Analytical Association” (p. 214). Jones also commented that Ferenczi was most inclined to control the ideas that were permitted to be presented to the Congress, in fact he proposed that no member of the Association be allowed to publish a paper before first submitting it to the president. There would be the strongest reasons against such a policy even with a small group, but the idea of imposing it on an international body was so absurd as to betoken a very unpractical mind. (P. 214)

Now, it is most instructive to see what ideas or theories Freud found incompatible with psychoanalysis and what he considered to be part of the progressive development of the new science. Again, we get a direct statement about it from Jones (1959) about the IPA Congress in Munich in 1913: I recollect vividly the moment when Freud told me that Jung had expressed his disbelief in the existence of childhood sexuality, one of the main factors o f psychoanalytical theory. I was astounded and said: “How is that possi­ ble? Why, it is not long since he published an analytic study o f his own

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During the business meeting, Jung was reelected president of the IPA, but half of the members abstained, and Jung finally realized that he could not preside over an association with which he in­ creasingly disagreed, and about six months later he resigned. Although it is not immediately apparent, I believe in retrospect it can be recognized that what Freud felt had to be guarded against was not any particular theory, but the problem of Jung’s attitude, which was to become apparent in his later work, that he would treat all theories exactly like the rest of the universal mythology in which he was to be later immersed. The issue was not the mytholo­ gy itself, which indeed continued to provide inspiring metaphors, but rather Jung’s progressive detachment from science and his drift to a mixture of religious and mythological views without an an­ chor in clinical work, which therefore were increasingly dependent on the wisdom of the leading sage. Freud scholar Robert explained (1966): Freud himself opposed the idea of a psychoanalytical orthodoxy. What he wanted to defend in psychoanalysis was not a complete ideological structure, but a minimum number of conceptions without which work in common seemed to him not to be possible. Thus he wrote in Marcuse’s M anual o f Psychoanalysis [1926/1962], published in 1926: “Psychoanalysis is not like a philosophical system which starts from a few strictly defined fundamental principles, uses them to embrace the total­ ity of the world, and once perfected, has no room for new discoveries or improvements. On the contrary, it remains linked with the facts which are produced in its field of activity, it tries to solve the immediate problems of observation, tentatively continues its experience, it is always incomplete, always ready to correct or modify its theories. Like physics or chemistry it allows that its fundamental concepts are vague and its assumptions provi­ sional, it does not expect a more rigorous definition than future work.” (P- 173)

In the same M anual, Freud lays down his main foundations for 1926: The existence of unconscious psychical processes, the theory o f resistance or repression, the appreciation of the role of sexuality and of the Oedipus - complex are main contents of psychoanalysis and the foundation of its theory. Whoever does not accept them should not reckon himself to be a psychoanalyst. (Robert, 1966, p. 174)

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Interestingly, Freud wrote to George Grodeck—the author of the famous Buck vom Es, who described instant cures, especially precursors of psychosomatic medicine—that he (Freud) must “lay a claim on [him],” and incidentally borrow the term Es (more familiar to us as “id”), because Grodeck had recognized that “transference and resistance [were] the hubs of the treatment” (1960, pp. 322-323). Now we know that aside from Freud’s own major changes to psychoanalytic theory—such as those affecting his entire economic point of view as a result of his changing the model of anxiety and discovering the signal function of affects after he had constructed the structural model of the mind, dividing mental function accord­ ing to where we see conflict (1923, 1926)—he also was able to accept the early work of Abraham (1911/1954, 1924/1954) on mel­ ancholia, manic-depressive reaction, and obsessive-compulsive structures and neuroses. He was able to use these in working out his own views on mourning and melancholia, in which he pon­ dered the nature of object representation in relationship to the “ego” (thus opening the path to studies of self representation). When Rado in 1928 reworked his models o f melancholia, bringing them in better harmony with structural theory, Freud could also accept these paradigms as being compatible with psychoanalysis. PARADIGMS INCOMPATIBLE WITH CLINICAL PSYCHOANALYTIC FINDINGS From the early days of psychoanalysis on, phenomena have accumulated that have been in conflict with other previous theo­ ries. Some of them were noted by Freud, leading him to take steps to change some part of a theory and make an accommodation for the new view. Probably the outstanding example was his changing his view of anxiety from a “discharge” model to one recognizing, for the first time in psychoanalysis, the signal function of an af­ fect; this occurred in “Inhibition, Symptoms, and Anxiety” (1926). We might appreciate that this change was prepared by Freud’s increased formulation of the structural model and decreased de­ pendence on the topographic model. By contrast, Freud started with a dual model of the generation of trauma, and virtually on the same page proposed that the cause of trauma was the experi­ ence of overwhelming affect: “a single major fright (such as a railway accident, a fall, etc. . . . [as well] as other events which are

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equally well-calculated in their nature to operate as traumas (e.g., frights, mortifications, disappointments)” (1893, p. 152). Freud repeated this statement with greater finality: “Any experience which calls up distressing affects—such as those o f fright, anxiety, shame, or physical pain—may operate as trauma of this kind” (1893-1895, pp. 5-6). Alongside the above model of trauma, we are offered another one using the terms of the (later to be) struc­ tural theory: “The actual traumatic moment, then, is the one at which the incompatibility forces itself upon the ego and at which the latter decides on the repudiation o f the incompatible idea. That idea is not annihilated by a repudiation of this kind, but merely repressed into the unconscious” (1893-1895, p. 123). Freud was well aware of the incongruity of these two defini­ tions, but he was able to tolerate it and to use both, as we do the dual theory of light in physics: considering light to have the nature o f both the wave and the particle. But we also find evidence that Freud never stopped trying to reconcile this dilemma. For instance, in 1937 he addressed himself to the concept of the traumatic origin of hysteria by venturing the view that mental illnesses were either “constitutional” or “traumatic” (p. 224). Quite possibly, the key to understanding the history of psychoanalysis is that the entire eco­ nomic view o f metapsychology represented an effort to reconcile thèse two views. I find evidence to support this claim in observing that, as Freud went along through the years, he shifted his usage of the factor that overwhelmed the stimulus barrier from the original “affects” to “excitations” to “stimuli” (Krystal, 1978a). This pro­ gression gave the appearance that the problem had been solved, and at last there was a unitary theory of the cause of trauma. But we have since discovered that a mistaken notion had developed; some analysts had come to expect that just the intensity of stimuli could be traumatic. This idea not only created a dead-end street for progress on trauma research, but quite by accident was disproven by our witnessing a generation that seemed to thrive on music so loud that it caused pain in the inner ears. An experiment con­ ducted over almost 20 years proves definitely that unbearably in­ tense auditory stimulus, even when accompanied by any other intense stimuli, will cause loss of hearing, but not psychic trauma (Krystal, 1983). . The story was not as simple or satisfactory in a number of other conflicts discovered with the fabric of psychoanalytic theory. I have neither the time nor the fine scholarship to identify all of them, but another comes to mind immediately, one familiar to

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most analysts, and one that was recognized by Freud but that he simply would not (or could not) address. I am referring to Freud’s definition of affect as 'consisting exclusively of the physiological responses related to the affect experience with which he was famil­ iar. This is the part that we tend to call the “expressive” part of affects. We call it this in deference to Freud’s other mistaken no­ tion that if drives were prevented from being discharged “to the outside” by neurotic inhibitions, they would then be converted into affects (mostly anxiety, which he therefore called “a miniature hys­ teria”) and, by means of the glandular components of the affects, be discharged to the “inside” o f the body. As is well known, Freud later came to understand that emotions may have an unconscious component, and he demonstrated this insight in his paper on “Criminals From a Sense of Guilt” (1916). This time, however, Freud made no attempt to change his previous idea that, roughly, since affects were physiological responses, it would be absurd to entertain any thoughts about the possibility of them being unconscious. Of course, had he pursued this train of thought to any length, he would have discovered serious flaws in his economic point of view, and he still had no other way to explain the hedonic regula­ tion of the organism. This is an outstanding example of a common pattern in handling this kind of problem, many examples o f which can be demonstrated as operative in other sciences at present. The principle is that, although we are beginning to find instances in which a given paradigm does not work or in which findings are different from what one would have predicted on the basis o f a given paradigm, an inconsistency or conflict is merely noted, and the inadequate paradigm is not abandoned until enough informa­ tion can be accumulated so that a new paradigm becomes availa­ ble, one that better fits the new data. CONFLICTS WITHIN PSYCHOANALYTIC THEORY CORRECTED A conflict became apparent in regard to Freud’s theory of re­ pression. Freud’s conception and definition of repression was formed entirely in the framework of the topographic theory, and it accepted without question the idea that what was repressed was unconscious, and conversely that bringing an impulse into the conscious sphere meant that that impulse was no longer repressed

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(Freud, 1900). Freud used to get angry at and would dismiss pa­ tients for refusing to accept his solutions to their problems (1900, and personal communication by John M. Dorsey [I960]). Howev­ er, later work, particularly by A. Freud (1936/1946), showed that many strongly defended impulses including, and especially impor­ tantly, ego defenses could be conscious, but were just as unavail­ able to insight and conscious volitional modification as was “re­ pressed” material. Arlow and Brenner undertook the signal task in order to bring repression into the context of the structural theory (1964). Now we could deal at ease with ideas that were conscious, but so heavily defended that they were in effect not available to the ego. I feel that some analysts have difficulty in making this change operational even though it is universally known to us and, for the m ost part, is accepted on an intellectual level. The reason for this difficulty is that the contributions of Arlow and Brenner (1964) are not com­ plete, and they are ineffectual because of what is still missing. Granted, they have made an important improvement by explaining that although a mental element not presently in consciousness can be made conscious by directing attention to it, the term preconscious is o f very little value for the following reasons. In the structural theory, the importance o f intrapsychic conflict in mental life is of paramount significance. As a theory it empha­ sizes that what we want to know concerning any particular mental element or function is its role in conflict or its relationship to conflict. Is it being defended against or is it on the side of the defenses? Is it perhaps removed from conflict altogether and thus autonomous, if an ego function, or an acceptable striving, if instinctual? (Arlow and Brenner, 1964, p. 112)

In my work with posttraumatic patients, I have observed that another condition has to be checked in addition to the question of the access to consciousness (structural theory). We have to answer one more question: Is it integrated? The lowest common denomi­ nator in posttraumatic states is intrapsychic splitting, and particu­ larly a tendency to dissociation during the traumatic state and in its sequels. In general, the damage derived from the traumatic experience is the dissociation in self representation, “ignoring and denying part of one’s human nature in which he cannot see his identity with composure” (Dorsey, 1965, p. 75). Some mental ma­ terial is experienced as so dangerous that its “penetration” and recognition as part o f self representation threatens to overwhelm one’s mind. These elements may be conscious and need not be

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conflictual so long as they are experienced outside of self represen­ tation. This reaction is most conspicuous in regard to the “other side” in a victim-oppressor relationship. A survivor of such a relationship will face just about anything rather than the uncon­ scious identification with the “other side.” If my oppressor (or victim) is dead and I can find him or her only in my own mind, then I am in great danger from the discovery that I may, on a most primitive level, also love the mental represen­ tation of the hated object that I have created (Charcot used to refer to the hypnotized person’s relationship with his hypnotist as “fasci­ nation”). The discovery of this profound inner disharmony may throw one into the depth of the most severe pathological mourning and/or depression. This phenomenon is well illustrated in an in­ spired novel by Shaw, which has also been made into a play and movie: The M an in the Glass Booth (1967). The play involves the trial in Israel of an alleged Nazi murder-troop and death-camp commander, Colonel Dorff, but the intrigue of the drama is that it cannot be determined whether the person on trial is actually the colonel or his cousin, the Jewish Holocaust and concentrationcamp survivor, Arthur Goldman. Whenever the trial gets close to any clue that could determine the identity (i.e., separate the uncon­ sciously identified cousins), the man in the glass booth starts talk­ ing “crazy”: People of Israel, let me speak, to you of our Fuehrer. Let me speak of him with love. How fortunate, how very fortunate we found him —he is our source. He who answered our deepest need, our unspoken and unspeakable need. He who rescued us from the depths. . . . At the end we loved him. In Goetter daemmerung, we loved him. With killers of the world at our throats, the hordes from the East and the West, the capitalists and the communists, the bombers o f the cities, the murderers o f children, with bullets in our guts, we loved him. With his head wobbling, his left arm slack, his hands atremble, totally exhausted, lied to on all sides, betrayed, we loved him. Great King. Brave King. Wait yet a little while and the days of suffering will be over. Already the sun of your good fortune stands behind the clouds and soon, beloved Fuehrer, soon this sun will rise on you . . . and if, if he were able to rise from the dead, he would prove it to you now. All over again. If only . . . if only we have someone to, rise to . . . throw out our arms to . . . love . . . and stamp our feet for. Some­ one . . . someone to lead. (Shaw, 1967, p. 204)

This extreme example, on the very verge of insanity, shows that the last step in lifting repression is recognizing our own authorship of all our object representations, no less than our self representa.-

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tions. The act of recognizing and accepting all of one’s own psy­ chic reality as part o f one’s self is the ultimate step in one’s integra­ tion. It is the completion of our weaning and the renouncing of our externalizations. This achievement involves mourning or, more precisely, effective grieving. So this, in my opinion, is theoretically the ultimate step in lifting repression, for we will have arrived in an arena of potential perfection, which is a useful goal to strive for, and is as necessary for us as is the concept of absolute zero temper­ ature or absolute vacuum for the physicist. There are other intrinsic contradictions or deficiencies in the theory and technique of psychoanalysis. I have, in the past, called attention to the failure to incorporate, in our every day working models, the genetic view of affects that includes the developmental lines formed by the consequences of regression in affect, that is, provisions for nonsymbolic, preverbal affects (Krystal, 1974). I pointed out that posttraumatic, psychosomatic, and addictive pa­ tients in particular have severe inhibitions in regard to self-caring and self-regulation that are related to regression or arrests in psychosexual and psychosocial development on a symbiotic level. The inhibition is related to “idolatrous” primary object transference that is conflictual, regarding a distortion of self representation and object representation, and as a consequence of which all the power and goodness, and even the control of our vital and affective func­ tions and parts o f our bodies, are attributed to the maternal ob­ ject. The resulting conflicts are over one’s freedom to reclaim one’s body and soul (Krystal, 1977, 1978b). If we were to go back to an old usage, it could be said that we are missing the “Prometheus Complex” in our concentration on the “Oedipus Complex,” to the exclusion of preverbal conflicts. Many more such findings could be found in the work of other authors, and even my own, but these illustrate the problem sufficiently. DISPARITIES IN THE BODY OF PSYCHOANALYTIC THEORY AND THE CURRENT VIEWS OF OTHER SCIENCES Freud devoted himself, from 1890 until the end of his life, to creating a biological psychology, although at times he despaired of his ability to complete this task. He clearly expected that those who followed in his footsteps would follow his example and formu­ late a psychoanalytic explanation on the basis of the finest up-to-

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date scientific knowledge. In fact, the German word Wissenschaft makes it self-evident that science is merely a disciplined view of present knowledge. I shall, again, just mention a few examples where we must update our basic science. The Hedonic Regulation of the Organism In order to be as au courant with present-day science as Freud had been with the finest neurophysiology and physics of his day, we need a theory that explains the psychological aspect of the function of the pleasure and distress centers and the many neuro­ transmitters and receptors that have been identified and amply confirmed and explored in our day. In order to be able to do that, we have to “tool up” by including in our conceptions the following principles derived from several sources (Krystal, 1981,1988a). 1. We must distinguish pleasure from gratification, and the idea . of pain from suffering. We know that any combination of these four is possible, and each of these experiences can be blocked, enhanced, modified, or shifted independently from the other three. Therefore, it is common for us to work with people who have a strong habitual attachment to getting un­ conscious gratification from consciously painful or distress­ ing experiences. 2. Pleasure can be derived from appetitive or gratificatory expe­ riences separately and independently. 3. Not only can all those experiences be conscious or uncon­ scious, but, considering the quality of consciousness, in this context it makes one realize that our accustomed usage is very crude. A newborn baby has six states of consciousness (Als and Brazelton, 1980), adults have multiple gradients along which consciousness and arousal varies (Krystal, 1985), and when we consider the myriad drugs (including prescription antihypertensives, antihistamines, and cortical steroids) that alter the various aspects of consciousness selectively, and sometimes idiosyncratically, and on top o f that we add staterelated memory, it almost boggles the mind. We will at times have to consider very carefully and evaluate the multidemensionally determined state of consciousness of a partic­ ular individual in a specified situation. If we apply consistently what we now know about the complexity of every mental opera­ tion—for instance, in the multiple revisions of a precept before it reaches consciousness in its “stimulus proximate” way, we can ex-

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pect “intersubjective agreement” from our “outside” object—we must also ponder that in the process of deciding “what is that?” we have to introduce our associations and, with them, signal affects. In other words, when we consider the dynamics of information processing (Westerlundh and Smith, 1983), then we may have to reconsider the subjective nature of our object representations (Kry­ stal, 1990). Reconciliation of psychoanalysis with the “explosion o f knowl­ edge” in cognitive science, neuroscience, and information process­ ing has been under way for some time. As usual, it cannot be done by a committee, but rather by individual workers who have the capacity and are intrepid enough to undertake the task of con­ fronting two or more disciplines and indicating what updating is required. Generally, such an effort will be answered by negative reaction. Both the innovations and the innovators are condemned for disturbing the peace (or disturbing the slumber) o f those who have been lulled into a state of consciousness of an “involutional” nature, characterized by a withdrawal of interest from the everchanging “outside world.” In psychoanalysis we have the particular defensiveness of the “establishment” and see ourselves as the modern bearers of the identical rings that Freud gave to his protective “committee” of disciple/friends, and this is left over from the time when Freud experienced being forced into a defensive position. He was afraid that undisciplined theorizing, not derived from solid scientific data but motivated by “sibling rivalry,” started treating and characteriz­ ing psychoanalysis as a “movement.” Such problems plague us to this day, with residues of various transferences acting as limitations to our freedom to be as flexible and innovative as our teachers were. The nature of our work produces one of our more serious occupational hazards: the problem of orthodoxy. Thus, we must be ever alert to maintain a balance between necessary skepticism and the slavish and maladaptive clinging to paradigms and models that were taught to us by our admired teachers as if they were immutable “holy writs.” Among the psychoanalytic pioneers who have undertaken the thankless, even hazardous, but necessary work of keeping us up to date with the progress in other sciences that requires rethinking and modification of our paradigms, I might mention Basch (1976, 1985), Gedo (1979), and many others. Bucci (1985) demonstrated that dual coding in sensory and cognitive modalities can be found to be operative by methods acceptable and understandable to ana-

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lysts. But we cannot rest on our laurels, for a new dialectic distin­ guishing between cognitive versus habit operations (the latter be­ ing related to what was recognized by Hartman as autonomous ego function [1951]) has now been anatomically demonstrated by Mishkin (Mishkin and Appenzeller, 1987; Mishkin, 1990). In addi­ tion, another form of human unconscious memory has been iden­ tified, called “priming.” It seems to concern the perceptual identi­ fication of words and objects. It appears to be the manifestation of a perceptual representation system that operates at a presemantic level (Tulvig and Schachter, 1990). The researchers in this perceptu­ al representational system point to the significant advantages of identifying multiple memory systems, both psychological and physiological. It is an essential prerequisite for the empirical pur­ suit of empirical and theoretical understanding of memory pro­ cesses and mechanisms. “The systems approach combined with appropriate processing theories seems to provide the most direct route to the future” (TUlvig and Schachter, 1990, p. 305). Hadley (1983, 1985) has been working on attention and affect from the psychoanalytic point of view as reconciled with present-day scien­ tific views. She has also used already available mathematical mod­ els and attempts to model some functions related particularly to the representational system and the nature of attachment. And, speaking of object representation, a very helpful, new, “purely psychoanalytic” exploration was contributed by Kumin (1986), which has helped us to loosen aspects of object relations theory that were beginning to become rigid. I also tried to broaden the basis of our concept of object representation by adding an “infor­ mation processing” view of it (Krystal, 1990). Incidentally, this paper illustrates the reverse process that can be found in the work of Bowlby. His .demonstration, that attachment of the infant to the mother was not secondary to her gratifying of the baby’s partial drives, but was a primary and imperative need of every newborn mammal (1969, 1977), has stimulated countless researchers in the field of developmental psychology (for a review, see Ainsworth et al., 1978; Parkes and Stevenson-Hinde, 1982). An example of studies by developmental psychologists that yield very relevant information for psychoanalysts is a study done by Main (1977), and another by Main and Weston (1982), using exper­ imental playroom situations designed to study the behavior of 12month-old children arriving with their mothers, meeting a strang­ er, staying with the stranger for 2 minutes without the mother, and

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then reacting to the return of the mother. They made a classifica­ tion of the nature of the toddler’s attachment that corresponded to the findings of other researchers and were confirmed, quantified, tested for stability, and coded (Ainsworth et al., 1978). But Main, in finding that although some children were securely attached, others had an anxious, ambivalent, or even avoidant tie, selected to interview and study those mothers whose infants had reacted to their mother’s return with very definite avoidance responses, show­ ing clearly that they did not want to go back to mother. Main found that these mothers had one characteristic in common, which they would often describe as that they were "not physical”—they did not like hugging or to be hugged, and some did not even like touching. The process of attachment, however, turned out to have other “invisible” components. Hofer demonstrated that, from the moment attachment is achieved, mother and baby directly influ­ ence each other’s physiological state. For instance, when the moth­ er nurses the baby, the baby’s heart rate slows down and the baby secretes growth hormones and lecithin transmethylase, the latter being essential for the normal development of the brain. The healthy baby’s nursing stimulates the mother’s secretion of prolac­ tin and oxytocin. The infant rat, separated from its mother, emits an ultrasonic sound. If a piece of fur is put down in the nest, the young calm down and their agitation ceases (Hofer, 1978, 1981, 1982, 1984; Hofer and Weiner, 1971; Lehman, 1961). Ihylor has made extensive use of this material in his new, integrated approach to psychosomatic medicine in general (1987a) and in his study of the psychodynamics of the so-called Panic Disorder (1987b).* I have linked these observations with Gaddini’s work on transi­ tional object precursors (1975) and Horton’s work on solacing (1981; Horton and Kreutzer, 1988), and concluded that transition­ al objects start out as simple “into-the-mouth” activities intended to produce the same physiological effects that a mother’s ministra­ tions do, and later become increasingly abstract and verbal or *1 disagree with the DSM-III-R terra and concept, which is not a true panic, but an “attack” o f mixed physiological elements o f dysphoric affects. This is a perfect example o f regression in affects to their infantile, somatic, undifferentiat­ ed form. Thylor’s work, which places the dynamics o f this condition in the early phase, what we might call the “symbiotic” phase, is in perfect harmony with my views, and the peculiarity that this condition often responds to small doses of antidepressives also supports my view.

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artistic (a nursery rhyme or lullaby starts the process and it pro­ gresses to our use of music, art, and poetry to help regulate our affective state). So here we have an important root of creativity (Krystal, 1988b). Actually, this discovery explained for the first time why in alexithymia we have an affective disturbance (regres­ sion) and also a cognitive disturbance sometimes referred to as “operative thinking” (after la pensée opératoire, Marty and David, 1963; Marty and de M’Uzan, 1963). My work with alexithymies has shown that severe inhibition in self-caring, self-soothing, and self-regulation involves a regression to an infantile, preverbal, and “idolatrous” maternal transference. The conflict is whether it is permissible for the child to develop and exercise its self-caring and self-regulatory capacities or whether all of one’s vital and affective functions “belong” to the mother, who has the monopoly on life preserving, caring, and soothing (Krystal, 1978b, 1988a). The pre­ mature interruption of the illusion of symbiosis stops the child’s capacity to delude itself that it is exercising magical control over its own well-being, and prematurely introduces the mother as an ex­ ternal, uncontrollable, and dangerous object. Naturally, the moth­ er’s behavior has a powerful influence on these developments, but we all carry the residue of these developmental adventures by hav­ ing a condition exactly parallel to a hysterical paralysis in regard to the huge part of ourselves controlled-by the “autonomic” nervous system. Our research on alexithymia, with its connections to anhedonia and its relationship to posttraumatic states and psychosomatic and addictive problems, has received help from Hoppe, who has worked with neurosurgeons cutting the corpus callosum, primarily for the treatment of uncontrollable seizures. Hoppe has contrib­ uted much to the integration of the psychoanalytic view of alex­ ithymia and neurophysiological findings (1977, 1978, 1979, 1981, 1984; Hoppe and Bogen, 1977). In the process, Hoppe has also discovered the way in which the brain hemispheres collaborate in creativity and the creation of abstract and symbolic mental repre­ sentations, a process that he calls thymolexia. In addition, the work elucidates the details of the role of the corpus callosum in creativity and in affect (Bogen and Bogen, 1988). All of these findings provide a wide scientific confirmation of the epigenetic view of affect to which psychoanalysis did not pay attention until 1955 (Schur, 1955), and which is still largely ignored by “official” psychoanalysis. However, McDougall has managed to get around the psychoanalytic establishment’s dislike for novelty by writing a

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fine paper about “dis-affected” patients and publishing it in the Psychoanalytic Quarterly (1984). CONCLUSION Psychoanalysis, like other sciences, naturally resists any attempt to keep its paradigms static, past their point of usefulness, and in the face of demonstrated invalidity. We are approaching the '100th anniversary of Freud’s devotion of his efforts to the creation of a biological psychology that includes the recognition of the uncon­ scious part of the mind, provides psychotherapeutic means of ther­ apy, and researches normal, as well as problematic, human func­ tions. Having used all the available information and metaphors from contemporary sciences, he hoped that his followers would keep updating it with the best knowledge of their day, even if it should mean that psychoanalysis would no longer be useful. For­ tunately for we who are “making a living” from practicing psycho­ analysis, it has turned out that his pessimism was not warranted. The more we learn and the more we check our views against the new developments in other sciences, the more we can solve our hitherto insoluble problems, and we are more able to refine our views and approaches. For instance, we knew that psychoanalytic therapy did not work well with psychosomatic patients and ad­ dicts, but we did not know why. Now we can clearly see that we cannot treat these patients with techniques developed for psycho­ neurotics. But despite the explosion in neuroscience and psy­ chopharmacology, there is still a great need for a psychoanalytic contribution to the understanding and treatment of these patients. A review of several examples shows that development does contin­ ue to take place, that a science is like a river that will not be stopped, for it can get around any obstacle and find a new channel for itself. References Abraham, K. (1954), The influence o f oral eroticism on character formation, in Selected Papers o f Karl Abraham , Basic Books, New York, pp. 393-406. (Original work published in 1924) Abraham, K. (1954), Notes on psychoanalytical investigations and treatment o f neurodepressive insecurity and allied conditions, in Selected Papers o f Karl Abraham , Basic - Books, New York, pp. 137-156. (Original work published in 1911) Ainsworth, M. D. S., Blehar, M. S., Walters, E., and Wall, S. (1978), Patterns o f A ttach­ m ent: A Psychological Study o f the Strange Situation, Erlbaum, Hillsdale, NJ.

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