INTRODUCTION

The present chapter will present a relatively comprehensive and synthetic statement of the
current state of psychoanalytic theory. The importance of that enterprise should not be
underestimated for the potential student of general psychiatry. Psychoanalysis has existed since
the turn of the century, and in that four score and more of years, it has established itself as a
fundamental discipline within psychiatry. The science of psychoanalysis is the bedrock of
psychodynamic understanding and it forms the fundamental theoretical frame of reference for a
variety of forms of therapeutic intervention, embracing not only the psychoanalytic technique
itself but various forms of psychoanalytically oriented psychotherapy, and other related forms of
therapy in which psychodynamic and other related concepts are employed. A case can even be
made that more recent theoretical approaches using modifications of systems theory embody
many of the suppositions of psychoanalytic theory, e.g. family dynamics and the operations of
Family emotional systems. Consequently, an informed and clear understanding of the
fundamental facets of the psychoanalytic approach and theory are essential for the student's grasp
of a large and significant segment of current psychiatric thinking.

This dimension of the psychoanalytic enterprise maintains is validity even in the face of the often
stringent criticisms made of psychoanalytic formulations on scientific grounds. In this sense,
psychoanalytic theory does not represent an amalgamation of dogmatic pronouncements. It
stakes its claim to validity on scientific grounds. It is therefore open to all the vicissitudes of
revision, reconsideration, and questioning in the light of new and pertinent data and has in fact
demonstrated throughout its long history a continual evolution and modification of its concepts.
The basic question concerns whether psychoanalysis can be regarded as a science, and if so,
what kind. The stringent criticism launched against psychoanalysis from the side of positivistic
philosophy, in which the model of science is based on an analysis of physical Sciences, have
found considerable fault with the methodology and the theoretical formulations proposed by
psychoanalysis. More recent reflections on this issue, however, have revised earlier
pronouncements and have tended to see the more puristic and positivistic criteria for authentic
science as being excessively rigid and narrow. Further study seems to suggest that even the
physical sciences have difficulty in adhering to the positivistic criteria. Notions of what in fact is
required for valid scientific work have evolved more in the direction of accepting the possibility
of subjective components. It is in this realm of mixed methodology that psychoanalysis
flourishes.

Many psychoanalytic theorists. Largely influenced by models of physical science, have insisted
that psychoanalysis is essentially an empirical observational science: that is, that it is based on
observable scientific data. The difficulties in such an approach have led other theorists to
completely abandon an objective "scientific" approach and to opt for a linguistic or hermeneutic
approach that places psychoanalysis not in the realm of science, but rather envisions it as a
fundamentally humanistic discipline, which concerns itself with meanings and the relationships
of meaning, rather than with observable events and causes. This latter approach, however, seems
to throw the baby out with the bathwater. The polarization seems to move toward another rather
rigid and narrow position that would deny psychoanalysis any scientific validity.

The approach on which the present account is based seeks a middle ground, one that of itself has
its complexities and difficulties, but one that seems somehow closer to the nature of
psychoanalytic work and the psychoanalytic inquiry. It presumes that psychoanalysis is indeed a
valid science, but it is a science of a very particular sort, one that seeks and embraces the inner
psychic life of man, an inner life that is impregnated with meaning and purpose, that is governed
by significance and intentionality, but at the same time both reflects and is influenced by a
variety of degrees and forms of causality.

One of the difficulties in presenting such a synthetic account is that it must draw its material
from more than three-quarters of a century of thinking and theoretical development. Although a
variety of approaches might be adopted to the diversity of such material, the author has opted to
organize this material along two distinguishable lines that at times are in conjunction, but at other
times are more or less out of phase. The one line is that of historical sequence, and the second
line of organization is conceptual. Consequently, although the material has an implicit historical
reference that spans the earliest beginnings of Freud's psychoanalytic thinking from even before
1900 until some of the most recent developments of object-relations theory and self-psychology,
there are numerous points in this accounting in which the historical framework is overridden by
the demands of conceptual integration. The reader, therefore, will have to keep one eye on the
historical dimension, while keeping a second eye on the patterns of conceptual integration. The
author will attempt to be explicit about these shifts in orientation as the material develops.

There are, of course, significant risks in approaching material of this kind from such a
perspective. To begin with, there is a considerable degree of compression and collapsing of
material from a variety of sources. Although such an approach lends a degree of conceptual
clarity, it runs a risk of oversimplification and tends to generate an account that is excessively
abstract or removed from its roots in clinical data. It is not always possible to articulate the
connection of theoretical formulations with their underlying clinical substratum, so that the
reader must constantly bear in mind that the clinical basis lies behind the specific formulations
and that, unless one is able to bring one's understanding of the theory to the clinical situation and
apply it there in a meaningful way, the theory will have lost its significance and will have
become a relatively empty exercise in abstraction.
An additional risk that a synthetic and general account such as this might run is that it is in
danger of giving the impression that the theory has somehow arrived at a state of static
consistency and that the proposition involved are matters of general and unquestioned
acceptance. The fact is far removed from such a picture. Throughout its history, even in the
hands of Freud himself. Psychoanalytic understanding has gone through an endless cycle of
theoretical rethinking, reform Jason, and refocusing and has seen at various stages of its
development the emergence of new concepts, new theoretical formulations, and new views of the
complexity and infinite variability of human experience and behavior. The ferment in
psychoanalytic thinking has been particularly intense in the last score or more of years. The
focus in this chapter falls on developments in psychoanalysis primarily in the major body of
contemporary American psychoanalysts.

One of the difficulties in communicating psychoanalytic theory is that it is linked so closely with
clinical data of a very particular kind. To a large extent psychoanalysis concerns itself with
unconscious mental material and the derivatives of such material in a wide range of normal and
pathological expressions. The major approach to such material within the psychoanalytic setting
is gained through free association. Al though psychoanalysis has many common roots and
orientations shared with medical science in general and in particular with psychiatry, it is at this
point that it diverges in a significant fashion. The medical student is taught to take an active and
structured approach to eliciting the signs and symptoms of disease from patients. In contrast the
psychoanalytic approach emphasizes lack of structure and a relative passivity on the part of the
therapist in eliciting the significant information from a patient. The psychoanalyst is not
uninterested in the objective data of the patient's history and life experience. But is not inclined
to seek it out. The psychoanalyst is willing to wait, passively and patiently, for such information
to emerge gradually and to shape itself into a life story. More importantly, the psychoanalyst is
interested in the inner life experience of patients, the secret wishes and fantasies, the unconscious
dimensions of the patients' mental lives that are not immediately available even to the patients
themselves in their most self-reflective and sensitive moments.

Such information is difficult to achieve in any setting at best, but the analysts operate in such a
way as to maximize the availability of such material, primarily through free association. The
analyst seeks to engage the patient in such a way that the inner melody of the patient's
unconscious can begin to play itself out in a variety of derivative forms, most immediately and
sensitively within the context of the analytic setting with its neutrality and diminution of external
stimuli. The secrets of inner psychic life will not yield to question of any kind. One of the major
problems for psychoanalytic thinkers is that their data come not only from more extrinsic and
objective sources, as would be the case with general medical scientists or general psychiatrists,
but that they also have access to this other realm of patients' inner lives. It becomes a problem
theoretically and conceptually how to integrate these radically different sources of data within a
common conceptual framework
I seems obvious that the optimal situation within which one can gain some familiarity and
understanding of the nature of the process is the psychoanalytic situation itself. A textbook
account cannot achieve that goal, however complete and comprehensive it may be. It is best
discovered in the process of psychoanalysis itself; that is, in the experience of being analysed or
in the training of the psychoanalyst in the process of trying to analyze someone else.

FREUD
SCIENTIFIC ORIENTATION Psychoanalysis was the child of 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 car. He was a convinced empirical scientist whose
early training in medicine and neurology had been carried out at 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 of this entity.

With time and with his own increasing clinical experience, Freud was forced to modify the basic
scientific credo, but it is significant nonetheless that he was to maintain it in one or other 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,
which was contained in the long lost pages of the Project, 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.

Freud's early approach during his neurological period reflected two principal influences. On influence
stemmed from the Helmholtz school of physiology and from his distinguished teachers, particularly
Brücke, Meynert, and Charcot, who emphasized the importance of rational scientific understanding,
careful empirical study, and clinical observation. The second important influence came from the French
hypnotists, particularly Liebault and Bernheim. The study hypnotic phenomena taught Freud that in fact
the physician may play a significant role in any attempt to modify hysterical phenomena. His exposure to
the French hypnotist and the neurological clinics of Charcot left a profound impression that deep
psychological forces, which were not accessible ordinarily to consciousness, operate in ways that
profoundly affect human motivation and behavior.
Freud's early thinking was dominated by the empirical and scientific orientation of the Helmholtz school
and the doctrine of radical, physical empiricism. Much of Freud's early effort, particularly in the Project,
was directed to an attempt to integrate such physicalistic approaches with the dynamic forces of mental
life that he was coming to know in his clinical work. Despite these convinced scientific ideologies and
then inexorable influence, Freud did not lose his capacity for clinical observation and his sensitivity to
the nuances of psychological expression. It was ultimately his unique ability to integrate these diverse
approaches, together with his ex-traordinary gifts of psychological sensitivity and insight, that enabled
him to create the science of psychoanalysis, which came to represent a unique and scientifically
revolutionary approach to the study and the resolution of human conflict.

(Figure 8-1 through 8-10 illustrate highlights in the life of Freud.)

THE PROJECT

The predominance of neurological thinking and the extensive effort to bridge the chasm between
psychological processes and neurological mechanisms reached a peak of intensity in Freud's attempt to
construct a "scientific psychology"; that is, a psychology based on neurological principles. His Project
represents the culmination and highpoint of Freud's neurological commitment.

it should be remembered that at this time Freud was an established clinical neurologist and had made
substantial contributions to that area of medical study. Moreover, he was intensely dedicated to the
scientific ideals of the Helmholtz approach to physiology and psychology. He conceived the scheme of
elaborating a complete psychology that would be based on the physicalist supposition of the Helmholtz
school. For nearly 2 years from 1895 to 1897, Freud struggled with these ideas. Finally, in the white heat
of intense inspiration in a period of no more than 3 weeks, he wrote out what is known today as his
Project for a Scientific Psychology. When the intensity of his inspiration had begun to wane, Freud
became increasingly discouraged with what he had written and finally in disgust threw it into a desk
drawer where it was to remain for years. He wrote in discouragement and despair to his friend, Wilhelm
Fliess, in 1898:

I have no desire at all to leave the psychology hanging in the air with no organic basis. But, beyond the
feeling of conviction (that there must be such a basis), I have nothing, cither theoretical or therapeutic,
to work on, and so I must behave as if confronted by just psychological factors only.
I was his intention that the Project should be destroyed, but after his death his papers came into the
hands of those who recognized the importance of this piece of writing, and it was finally published
posthumously.

It would be a mistake to regard the Project as an aberrant interlude in the development of Freud's ideas.
Quite the contrary. Although Freud turned his back on an attempt to physiology is psychology, the basic
postulates and ideas that were built into the Project provided the basic foundations for his own thinking
and provided the substratum on which the superstructure of psychoanalysis was raised. From the
historical vantage point, one can look back and see the tremendous influence that the ideas of the
Project has on the development of Freud's ideas, even into the later stages of his career. At those points
in his thinking in which Freud was dealing with the economic and energy aspects of psychic functioning,
the influence of the Project was apparent, and it is for this reason a document of supreme importance.

The influence of the Project, then, permeates Freud's thinking and writing on many levels. During the
period of his struggles with the ideas in the Project, he was working with Breuer on the problem of
hysteria. In 1893, they published a Preliminary Communication in which they sketched some of their
ideas about the nature of hysteria. Finally, they published The Studies on Hysteria in 1895. In both the
Preliminary Communication and the Studies, the influence of the ideas of the Project can be seen,
particularly in the notions of cerebral excitation and of discharge of affect. Later on, in 1900, in Freud's
famous seventh chapter of The Interpretation of Dreams, the model of the mind he proposed there has
direct links to the concepts of mental functioning formulated in the Project. Still later, in his
development of a theory of sexuality and in his collaboration of his instinct theory, even as late as 1920
in beyond the pleasure Principle, the influence of the Project is explicit and identifiable. Also, it is now
clear that many of the formulations that Freud reached in the writing of the Project were revived and
found their way into his thinking, once again, in his later development of an ego theory

Consequently, the Project must be seen as an extremely important and seminal work. If it brought
Freud's neurological period to a brilliant close, it also opened the way to the broad vistas of
psychoanalysis and, in extremely important and significant ways, determined the shape that
psychoanalytic principles were to take Freud stages his intention from the very beginning:

The intention is to furnish a psychology that shall be a natural science: that is, to represent psychical
processes as quantitatively determinant states of specifiable material particles, thus making those
processes perspicuous and free from contradiction.
The Project was an ambitious attempt to be as scientific in the 19th-century sense of Helmholtz as
possible. Freud based his thinking on two principal theorems. The first was a quantitative conception of
neural activity that he referred to as Q. Q was a quantity of neural excitation that could be transmitted
from cell to cell in the nervous system and from neural system to neural system. The second principle
theorem was the neurone doctrine, according to which the nervous system was composed of distinct
and similarly constructed neurones that were separated from each other yet in contact with one
another through contact barriers" (synapses).

Freud postulated that there were at least two systems of neurones. which had different characteristics
that affected psychological functions. The -system of neurons consists of permeable elements, whose
function was to transmit Q to other neuronal systems without any significant alterations of the -
neurons themselves. The –neurons were, by way of contrast, impermeable; that is, their function was
not the transmission of Q but rather the reception of Q and the storing of it in such a way as to change
the neuron and build up a level of internal charge. Freud saw these combined properties of the
respective neuronal systems as explaining one of the peculiarities of the neural system, namely the
capacity for retaining and storing excitations, and yet at the same time remaining capable of receiving
further excitatory input.

Freud described one of the fundamental principles of the operation of the nervous system as the
principle of neuronic inertia." According to this principle, neurons tend to divest themselves of Q, the
quantity of excitation. This property, by which the nervous system tended to keep itself free from
excitation, led to the process of discharge as one of the primary functions of neuronal systems. Freud
called this the "constancy principle," more familiarly known as homeostasis. In 1893, Freud had
formulated the principle in these words:

If a person experiences a psychical impression, something in his nervous system which we will for the
moment call the sum of excitation, is increased. Now in every individual there exists a tend ency to
diminish the sum of excitation once more, in order to preserve his health.

The principle of constancy serves as the economic foundationstone for Freud's instinctual theory (Table
8-1).
Freud envisioned excitation not as arising spontaneously in the nervous system, but rather as being put
into it from the outside. Q was delivered to the nervous system from two sources. The first was external
reality, which excited the sensory organs by way of external physical excitation. The second was from
the body itself, which provided endogenous stimuli that impinged on the mental apparatus and called
equally for discharge. These endogenous stimuli were related to the major needs of the body, including
hunger, respiration, and sexuality. Thus, Freud explicitly stated at the root of his thinking a theory of the
nervous system as passive responsive to external sources of stimulation, and a notion of motivation in
terms of drive or tension reduction.