THEORY OF THERAPY
Lawrence Friedman , M.D.
In its broad mandate, the whole world of mind is the subject of psycho- analysis, and analysts usually pick their favorite continent to colonize.
I do not know another theorist who, like Lichtenberg, has been drawn to the full scope of analytic inquiry (which gives his unique publication, Psychoanalytic Inquiry , its right to the title). And, more signifi cantly, this is not the result of a grandiose ambition to punch in on every question – to cover the waterfront, so to speak – but rather because he has been succes- sively entranced by each question that leads outward from each problem, and is happily blessed with the required freshness, stamina, and enthusiasm to pursue it (with energy left over to promote the imagination of colleagues and students). Because he is involved so deeply in each component question, his syntheses have more plausibility than we fi nd in the sort of impatient synthesis that looks fi rst to the grand summary, and commissions the steps that will lead up to it. For the same reason, the horizons he explores are not selected by animus; he doesn’t choose one avenue in order to shut down another. Because of its richness and fi delity to experience at each level, his model will, I think, be usable even by analysts who are wedded to their own style. They may highlight certain facets of his model, experimenting with his insights in various combinations, just as he responds to different saliencies in his patient. (For example, analysts who like his way of blending general themes with momentary urgencies may try out their own ratios of large dramas vs. particular sub-programs. Or they may put more emphasis on the interplay between systems, preserving a “defense” orientation while still heeding Lichtenberg’s principle of equal respect for the specifi c needs, strains, and satisfactions in each system.)
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It is hard to fi nd a human subject matter that Lichtenberg has not stud- ied in some detail, and correlated with other subjects. We will each be grateful to him for contributions that touch most particularly on our own pressing questions. For myself, I am particularly grateful for his work on three, interrelated problems, which I shall call the problem of the miscellanousness of brain systems , the problem of the main meaning of patients’ actions , and the problem of therapeutic action of psychoanalytic treatment. “Lichtenberg” is a work in progress (in life, I think, as well as research). I do not pretend to take into account here the enormous detail and sophistication of his developing theory, a daunting task that I hope others will undertake. I will be dealing, rather, with the large aspects and general nature of his project.
Practicing analysts look for the meaning of a patient’s words and actions. Since “meaning” is a problematic term both as to its target and its claim, the search for meaning is always an unsettled project. Analysts take different stands on the issue. An analyst may think there are always many meanings in what the patient says and does, or that there are no pre-existing meanings before negotiation, or that there are, at least, false meanings to be avoided. Or an analyst may go about his business with- out giving it a worried thought. But since practitioners are always in a position of responding to an intentional agent before them, the selection of meanings is always an explicit or implicit problem. Participation in action over time automatically confronts us with a perceptual decision regarding main meaning. I say this rather presumptuously, but it is, after all, just a nod to the hermeneutic aspect of every human encounter and, most self-consciously, to every human science.
Many psychoanalytic theorists have tangled with this question, but only a few have worked out a rationale for prioritizing a main meaning in the patient’s display. Broad admonitions to attend to the affect, or focus on defense are scant help in defi ning the thrust of the patient’s intention. Even more specifi c formulas, such as reading the patient’s meaning out of the ana- lyst’s reaction (countertransference or enactment) do not say how the ana- lyst’s reaction itself should be read. The responsibility for teaching how to sort meanings is therefore left to an apprenticeship where one acquires habits through didactic analysis, supervision, and case conferences. It is a sensitive subject: No matter what habits an analyst acquires, he doesn’t want to think that he carries a stencil into his offi ce and uses it to smother the fl ailing, fl uc- tuating, unpredictable signs of life in his patient. But Lichtenberg is one of the few analysts to offer explicit clues to what might be called the immediate teleology of the patient’s momentary movement. And Lichtenberg does it by correlating specifi c affects with a specifi c theory of motivation. It is at once a major contribution to the fi eld, a major challenge that demands a response from colleagues, and a prime paradigm for focusing on this issue, not to
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mention a substantial grid for understanding process (and for understand- ing misunderstandings).
Lichtenberg’s clue to the main meaning of a patient’s action is a non-arbitrary division of motivations correlated with observable patterns of simpler developmental stages, and organized by demonstrably separate neurophysiological systems. But there is a gap to be fi lled. Motivation is one thing and motives are another. Biological motivations are general, causal mechanisms. How do we get from a system to (for example) a particular wish ? This is an agonizing question for Freudian theory in recent years as it tries to decide whether to digest or spit out certifi ed neurophysiological entities, wet structures, and specifi c circuits (the new faculty psychology, if you will). I call this the problem of the miscellaneousness of mind, because at the same time that new neurophysiology gratifyingly validates circuits of psychoanalytic interest, the brain is discovered to be a pile of bundled life forms tossed on top of one another produced by fortuitous evolutionary challenges, pasted over, at best, by a post-hoc story-line. It is a far cry from the single- (or perhaps polyphonic-) track Freudian mind. Nor is the con- trast primarily a matter of esthetic preference.
Physiological Miscellany and Unitary Mind
Freud’s theory is a way of speaking about separate types of interest and con- trol (thresholds, levels of refi nement, structures, fantasies, and ideas) within a single, personalized mind. While these are more or less stable “parts” of a single mind, each “part” has a bit of the same purposefulness that we attrib- ute to the whole mind. Philosophers who lack Paul Ricoeur’s ( 1970 ) sophis- tication may criticize this as confusing two modes of explanation, effi cient cause and fi nal cause, cause and reason, fact and meaning, blind structure and anthropomorphic element, etc. And newer terms of the argument have arisen as modern ego psychology took on the responsibility of elaborat- ing Freud’s ( 1937 ) late reminder that the various “parts” of the mind are really just aspects – albeit non-arbitrary aspects – of a single mind. But the tendency of contemporary neurophysiological and developmental psycho- dynamic research has been to emphasize the separateness of systems within the brain, and that sort of dissection is not at all the same thing as abstract- ing semi-purposeful aspects of mind (“structures”). To be sure, neurophysio- logical systems don’t stand alone; they have networks of their own, and they enter into various coordinations (as is inevitable with sub-systems of any organism), but, just as we can discuss the circulatory system separately from the pulmonary system, and can name a renal system and then a lymphatic system, so these brain systems can be coordinated with distinct behaviors and affects, and they have the sort of categorical distinctness that allows us to consider them as natural parcels. (I believe that “parcellizing” is a term
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used by neurophysiologists.) Dazzled by this galaxy of systems, we may come to regard Freud’s account of the single path of mind as, at best, a Creation myth, and at worst, a Just-So Story or a pineal theory of the Soul.
In either case, a new faculty psychology impatiently drums its fi ngers, wait- ing for the call to deconstruct the psychoanalyst’s unscientifi c sense of his patient as a person rather than an organism. Thus enlightened, tomorrow’s psychoanalysis might shape up as sophisticated habit-training focused on bits and pieces of circuitry.
This is another way of saying that Freud’s unique, meticulous instruction in how to acknowledge the intentionality of a person (a “he” or “she”) while at the same time regarding him as a biological mechanism (an “it”) – this recipe is threatened by today’s dispersion of mind into assorted cerebral mechanisms. Against this possibility, Lichtenberg’s way of putting parts of mental functioning back into the unitary person is a strategic bridge to a happier psychoanalytic future.
How does he do that? I think Lichtenberg’s solution is to give each homeostatic, biological system’s set-point a human (meaningful) history that imprints its personal sensitivities and determines its shifting relation- ship with other motivational systems and the rest of experience. In principle, it is not so far from Freud’s schema. Each system starts out like a Freudian instinct representative, and develops in a similar way, inasmuch as biological impetus sprouts biographical form by means of Piagetian (1951) assimila- tion and accommodation with outside reality. Both theories yoke impersonal, organic reactivity to dramatic, personal meaning. The most general, organic strivings are gradually shaped by their history of successes, frustrations, and sensitivities, and experiences with early care-givers, which gives motiv- ational systems their learned styles of effectiveness and their relative priority among fellow “drives,” all blended together by a unifying “self” equilibra- tion. A particular motivational system has a relative salience among other motivations in a confi guration that characterizes the personality, and it also has fl uctuating prominence as the person encounters certain kinds of chal- lenge. As for long-line interests of the whole person, Lichtenberg’s “model scenes” illustrate the prominence of a given motivational system (with its associated affect), in cooperation with other motivations, and at that point in the story we have reached the (Freudian) reunion we were looking for, namely, the refi nement of primordial urge into elaborated, interpersonal drama. With that bridge, Lichtenberg has met the challenge of recapturing the wholeness of a divisible mind. It is, after all, a single person with idio- syncratic meaning who draws on a variety of standard biological incentives to makes his way through time.
Of course, this is not Freud’s theory. What is discarded is a developmental line that spins a varied mental world out of the fewest possible ingredient variables. Between the two theories, evidence from biology surely favors