In this book the psychoanalyst John E. Gedo takes a
position in the quarrel between two reciprocally incompatible views on
psychoanalysis, i.e. the biological and the hermeneutical. This quarrel has
been plagued by many instances of a lack of comprehension on both sides that
have confused the issue to the point that the views of independent critics like
Adolf Grunbaum and Malcolm Macmillan have been clearer than those of the
psychoanalysts themselves. Since I personally favor the hermeneutical
interpretation of psychoanalysis, it is important that I warn my readers in
advance: my views may be biased.

The hermeneutical school of psychoanalysis, developed by
philosophers like Paul Ricoeur and Jurgen Habermas, and by psychoanalysts like
George Klein, Merton Gill and Roy Schafer, maintains that psychoanalysis is a
human science, akin to the interpretation of texts (notably, but not
exclusively, sacred texts), and its only scope is to help the patient to modify
his opinions on himself, his own history and his problems. Hermeneutic
psychoanalysts imply that such a change of opinion may be helpful in curing the
disease or at least in reducing its symptoms. Obviously such a view undermines
any pretence to understand the causes of psychiatric disorders, and their biochemical
and anatomo-physiological basis, e.g. the relationship with one’s parent is not
any more viewed as an event of the infancy but as the present memory of it,
with all its uncertainties. Even neurological symptoms such as hallucinations
enter the picture only through the description of the subjective feeling of the
patient, and the psychoanalysts who adhere to the hermeneutic view try to
concentrate on the "now and here" of the patient, rather than to his
personal history. Hermeneutic psychoanalysis has been reluctant to fully
develop its premises, since this would result in a dramatic
"amputation" (the word is Grunbaum’s) of most widely held
psychoanalytic folklore. Gedo criticizes the hermeneutical version of
psychoanalysis exactly on these grounds, i.e. it still pretends to explain
causal relationships, but it lacks explanatory power for symptoms that have an
obvious neurological basis (p.16-22). This criticism is not unfounded but it
refers to the incomplete development of the hermeneutic premises, and the
correct objection should be that this school has been incapable of renouncing
completely to any reference to the neurological aspects of mental disease,
leaving them to biological psychiatry.

Biological psychoanalysis is the opposite of its hermeneutical
counterpart, in that it pretends to discover and describe psychological events
in relation to their anatomo-physiological basis. This was Freud’s very initial
approach, that culminated in the unpublished manuscript Project of a scientific
psychology (1895). In the Interpretation of dreams (1900), Freud partially
renounced to the pretence of anchoring his theory to the anatomy and physiology
of the brain, and laid the foundation of an intermediate level of explanation,
that he called "metapsychological". Freud’s metapsychology deals with
such concepts as psychic energy (probably the heir of previous century’s vital
force), the structures of mind (conscious, preconscious and unconscious, later
to be replaced or upgraded to Id, Ego and SuperEgo), the censorships and the
defenses and so on. Most of Freud’s metapsychology was obsolete in the very
moment in which it was formulated, and Gedo recognizes that it is now
untenable: hence (according to Gedo) the necessity of a new biological theory,
capable of integrating psychoanalysis and neurology:

"We must therefore face the disturbing fact
that psychoanalytic theories cannot be scientifically validated from within
psychoanalysis alone; competing analytic hypotheses will also have to be judged
on the basis of their congruence with data from cognate fields, such as
semiotics, cognitive psychology, and brain science." (p.29)

This phrase is revealing of the two major defects of Gedo’s
work: firstly, it at the same time recognizes the scientific inadequacy of
psychoanalytic clinical "data" and yet fails to take the appropriate
conclusion of discarding them. Gedo actually neglects to inform his readers
that psychoanalytic data are strongly criticized by the psychoanalysts
themselves, by psychologists (e.g. Dawes, The house of cards; Macmillan, Freud
evaluated), physicians and philosophers of the science (e.g. Popper,
Conjectures and Confutations; E. Nagel, Methodological problems of the theory
of psychoanalysis). It is important to stress that the hermeneutic interpretation
of psychoanalysis was proposed forty years ago exactly to overcome these
difficulties, and maintains that psychoanalysis is capable of subjective
persuasiveness, if not of objective validity, and that persuasiveness is
clinically important. In this respect it is also noteworthy the incongruence of
Gedo’s formal tribute to the father of psychoanalysis:

"… Freud most lasting and valuable
contribution was not conceptual … [it] was the development of a novel
observational method through which it became possible for the first time to
gain reliable data about the inner life of human beings." (p.5).

If "psychoanalytic theories cannot be scientifically
validated from within psychoanalysis alone", then probably its
"reliable data" are not so reliable after all and Freud’s most
valuable contribution vanishes.

The second defect of Gedo’s comprehensive theory is that
the cognate fields have rarely, if ever, confirmed the hypotheses of
psychoanalysis. This argument brings us to the logical center of the book, namely
Gedo’s biological theory. Based on the collection of scattered information from
psychoanalysis on the one hand, and neuroanatomy and related sciences on the
other, Gedo proposes a five step model of neurological and psychological
development of the infant, in which step I is dominated by lower (subcortical)
centers, step II by the right hemisphere, step III by the left hemisphere, step
IV by the integration of the hemispheres and step V by the prefrontal cortex
(p.55). The time progression between the steps of the model is linked to the
development of the corresponding neurological structures, e.g. myelinization of
the corpus callosum (the most important inter-hemispheric connection) would
favor or determine the passage from step III to step IV. Since Gedo is not
concerned with the identification of the different steps and their progression,
neither shall I, but is is hard to avoid questioning the meaning of right or
left hemisphere dominance and its manifestations, since the anatomo-physiological
evolution of the brain in the newborn is harmonic and continuous rather than
localized and stepwise. Even is we skip this problematic part of the theory,
and stick to its psychoanalytical implications, which Gedo discusses at length,
problems and inconsistencies abound, and the final theory is more obsolete
today than Freud’s original was in 1900. To demonstrate this point, we can
compare the neurological development with the evolution of psychical defenses,
a cornerstone of psychoanalysis. Thus we learn that withdrawal is
characteristic of step I, projective identification of step II, disavowal of
step III, repression of step IV and, finally, renunciation of step V (p.88). Gedo
mantains that adult patients may present any of these defensive mechanisms in
relation to their fixation to the corresponding phase of their infancy, in the
best Freudian tradition; however, a grave inconsistency of the theory follows
immediately, for how is it possible that an adult, with a fully myelinized
corpus callosum can regress to the function of an infant whose corpus callosum
is immature? In Gedo’s theory regression and fixation are impossible because of
their very link to anatomical conditions of the newborn or the infant child;
nevertheless, they are constantly invoked as an explanation of nevrotic
symptoms. Moreover, the theory suggests that regression is induced by those
pathological conditions in which the corpus callosum is damaged, e.g. the Wernicke-Korsakoff
syndrome, or surgically cleaved, e.g. to prevent the diffusion of recurrent
untreatable epileptic crisis. Regression does not occur in these instances, or
at least no psychoanalyst ever described it, but an even greater problem it is
that Gedo fails to address the point.

It is unnecessary to multiply the examples of the inconsistencies
between the different parts of the theory, but it may be worth noting that
Freud had been wise enough to introduce metapsychology as a flexible joint
between neuroanatomy and psychology, exactly to allow room for a florid,
overgrown theory that could not be nailed to the limitations of an unyielding
science like neuroanatomy. If metapsychology is untenable and needs be
abandoned, either one switches to the hermeneutic side, cutting on the
pretences of scientific objectivity, or one trims the theory to a level
compatible with neurology, psychiatry and psychology. Gedo does neither and
pretends to root psychoanalysis directly on neurology, e.g.:

"… better reality testing and greater affect
and frustration tolerance … are changes in basic biological functions. These
can only take place through the gradual establishment of new arrangements
within the central nervous system …" (p.42)

He leaves to the "cognate sciences" the burden of
the proof, and neglecting that these sciences have already demonstrated that
psychiatric diseases are not associated to characteristic lesions of the brain.
Overall, the book is representative of a current of psychoanalytical theorizing
that we may define oblivious: he writes as if no criticism had ever been raised
against the theory, and is only concerned with the disagreements internal to
the community of psychoanalysts.

 

© 2006 Andrea Bellelli

 

Andrea
Bellelli has an MD and a degree in psychology, and teaches biochemistry in theMedical
School of the University of Rome, Italy.

Categories: Psychoanalysis