Kaplan, Psicoanalisis

Part of "6 - Theories of Personality and Psychopathology"

Psychoanalysis has existed since before the turn of the 20th century and, in that span of years, has established itself as one of the fundamental disciplines within psychiatry. The science of psychoanalysis is the bedrock of psychodynamic understanding and forms the fundamental theoretical frame of reference for a variety of forms of therapeutic intervention, embracing not only psychoanalysis itself but also various forms of psychoanalytically oriented psychotherapy and related forms of therapy using psychodynamic concepts. Likewise, current efforts are being directed to connecting psychoanalytic understandings of human behavior and emotional experience with emerging findings of neuroscientific research. Consequently, an informed and clear understanding of the fundamental facets of psychoanalytic theory and orientation is essential for the student's grasp of a large and significant segment of current psychiatric thinking.

One of the difficulties in presenting such a synthetic account is that it must draw its material from more than a century of thinking and theoretical development. Although there is more than one way to approach the diversity of such material, the material in this chapter is organized along historical lines, tracing the emergence of analytical theory or theories over time but with a good deal of overlap and some redundancy. But there is an overall pattern of gradual emergence, progressing from early drive theory to structural theory to ego psychology to object relations and on to self-psychology, intersubjectivism, and relational approaches.

ROOTS OF PREPSYCHOANALYTICAL THINKING

Psychoanalysis was the child of Sigmund Freud's genius. He put his stamp on it from the very beginning, and it can be fairly said that, although the science of psychoanalysis has advanced far beyond Freud's wildest dreams, his influence is still strong and pervasive. In understanding the origins of psychoanalytic thinking, it is useful to keep in mind that Freud himself was an outstanding product of the scientific training and thinking of his era.

Scientific Orientation

Freud was a convinced empirical scientist whose early training in medicine and neurology had been in the most progressive scientific centers of his time. He shared the conviction of most of the scientists of his day that scientific law and order and the systematic study of physical and neurological processes would ultimately yield an understanding of the apparent chaos of mental processes. When he began his study of hysteria, he believed that brain physiology was the definitive scientific approach and that it alone would yield a truly scientific understanding.

With his own increasing clinical experience, Freud was forced to modify that basic scientific credo, but it is significant nonetheless that he maintained it in one or another form throughout the whole of his long career. His own efforts to elaborate a scientific physiology of mental phenomena were, in the end, to prove frustrating and disappointing. After abandoning that attempt, contained in the long-lost pages of the Project for a Scientific Psychology (1895), he continued to believe that, although the clinical material he dealt with forced him to work on a level of psychological reflection, there was a close and intimate connection between physical and psychical processes.

On Aphasia

Although a good deal of attention has been paid to Freud's Project as expressing his early model of the mind, more recent attention has been drawn to his important neurological work On Aphasia (1891), in which Freud advanced his earliest views of the relation between structure and function in the brain. Following John Hughlings Jackson's emphasis on the complex relations between thought and language, Freud challenged the prevailing notions of brain localization of function advanced by Pierre Broca, Karl Wernicke, Theodor Meynert, and others. Rather than thinking in terms of brain centers, à la Broca's speech center, Freud related the functions of speech to functional capacities in a widespread network of visual, acoustic, tactile, and even kinesthetic associations reflecting generalized changes in the functioning of the brain as a whole. Thus, he viewed simple psychological functions, such as perception or memory, as physiologically complex and involving multiple brain systems. In his view, it was the disruption in the associative network that was responsible for various forms of aphasia rather than destruction of specific centers.

Following Jackson's differentiation between mind and brain and his concept of functional retrogression from higher levels of organization to lower, Freud regarded aphasia as reflecting retrogression to earlier developmental states of speech development. He attributed speech functions to a “zone of language” that was independent of anatomical location, a position that resonated with his later stipulations regarding hysteria in which symptoms were not related to anatomical lesions but had to do with meaning and symbolization related to a network of associations. In any case, the concepts he developed in his study of aphasia later reemerged in his psychological theory, specifically, concepts of association, mental representation, cathexis, symbol formation, and word and object representation. The view of retrogression from higher to lower levels of functioning seems to foreshadow his later doctrine of regression, and his comments on forms of paraphasia read like a preliminary draft of the psychopathology of everyday life.

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