Hyman - The Clinical Importance of the Unconscious
The Clinical Importance of the Unconscious
and of the Early Psychoanalytic Metapsychology
Analysts, I bring good news! The unconscious is alive and well and living in the minds of all sentient beings. We can find substantiation of its existence in whoever dreams, experiences a parapraxis, or free associates. And yet, as the titles of this panel and of the Division 39 theme remind us, this ubiquitous characteristic of humankind seems to be accorded less and less significance in a discipline which was founded upon its discovery and which contributed the concept of unconscious mental life to the intellectual discourse of the past I 00 years.
In the psychoanalytic literature of the 1980s and 1990s, one encounters infrequently the word "unconscious" or any of the metapsychological implications of the theory of unconscious mental processes. Manifestly, this is the result of psychoanalytic thinking and conceptualizing moving in other directions and away from the early metapsychology. From a psychodynamic perspective, another of the factors contributing to this lessening of interest in the unconscious has to do with the anxiety attendant upon encounters with unconscious manifestations, particularly those to which we have given pejorative labels such as neurotic or psychotic symptoms or psychopathology. Such encounters with the consequences of unconscious mental processes in others evoke uneasiness to the extent that they threaten the repression and continued unawareness of the contents and processes of our own unconscious. It can be disconcerting to entertain the notion, when encountering certain characteristics in an analysand, that there, but for the grace of my psychodynamics, go I.
There is yet another factor that could account for the decreasing involvement by psychoanalysts today with the idea of mental events unavailable to awareness. Psychoanalysis and its adherents have imposed upon themselves the burden of conceptualizing their enterprise as a "science". As such it is encumbered with all of the epistemological trappings that are a part of the "philosophy of science", particularly the search for cause and effect relationships and for the truths, (absolute truths if possible; probable truths if necessary) of those relationships. The finding of "truth" means the finding of certainty, and with that, escape from the anxiety which accompanies uncertainty.
The demand for certainty exists both within and without psychoanalysis. Its critics demand empirical validation, not only of the theory and methods, but of outcomes and results as well. And the analytic community defers to these critics and reproaches itself for not having demonstrated its truth in the form of empirically validated results and cures. This same demand for certainty exists within and without the individual analyst also. Analysts often enter the analytic situation with expectations regarding the outcome of the analytic work. They expect things like change, improvement, cure, or, at least, consequences of some sort from their interpretations, And since, as we will see below, there can be no fulfillment of their expectations, those analysts who harbor them are subject to the same experiences of uncertainty and, perhaps, anxiety that beset all searchers for those "scientific" truths which elude discovery. If, then, psychoanalysts seek to discover the truths about the unconscious of which they can be certain, the inevitable failure of such a search and the distress accompanying it seems to have led to a professed disinterest in the topic, a disinterest shared, apparently, by a substantial number of our colleagues.
ON THE NATURE AND VALUE OF THE CONCEPT OF UNCONSCIOUS
A defining characteristic of unconscious mental function, as originally conceived, was that phenomenon termed "unlimited motility of cathexes". Translating roughly from the language of metapsychology, this attribute means that in the unconscious anything can stand for anything else. Thus, the language of unconscious representation is infinitely variable, with anything able to mean anything else at any given moment and only for that moment. Time in the unconscious, therefore, is equally non-existent and there can be no consistency of meaning over time. And, when the always fluctuating nature of unconscious process is considered in combination with the concept of psychic reality, i.e., a "reality" that is generated only by a momentary psychodynamic constellation within the individual (albeit outside of that person's awareness), then the concepts of certainty and truth are without significance or relevance for the psychoanalytic enterprise at hand. Add to all that the given that the unconscious processes and psychic reality of both the analyst and analysand are operative within the psychoanalytic situation and we have uncertainty compounded to the ultimate degree.
Freud's postmodern deconstruction of reality and, thereby, truth, provided the wherewithal for the understanding of those otherwise incomprehensible phenomena which result from the psychodynamic processes, however threatening that procedure may be to those who require their repression to be absolute. When we listen to the free associations of an analysand, we suspend belief, if we have such, in the reality of the manifest content. Instead, we wait for our conscious and unconscious knowledge of the nature of the language of unconscious mental representations to provide a translation which, in turn, enables us to conjecture about the hidden motivation operative at the moment. Moreover, we do not have to believe that our conjectures are correct, true, incontestable, valid, or accurate. Certainly, at the conscious level, we know that what we heard was not what the analysand said (because we have to "translate" it); and, when we tell the analysand what we thought we did hear, we cannot know that that is what the analysand hears. I am sure that none of this is unfamiliar to you since it is, in a preclassical way, the analyzing of the psychic reality of the analysand.
For all the faults and shortcomings attributed to it by myriad critics, the early psychoanalytic metapsychology was a pretty simple (but not simplistic) system that attempted to explain the universal discontinuities that occur in the life of all individuals all the time. In spite of conceptualizing those discontinuities as the product of psychopathology (in those days, what was conscious was normal; and what was unconscious was pathological), the system recognized them as attempts at the solution of dilemmas intrinsic to the human condition. Motives and intentions that were distressful were forced out of consciousness, and kept out, by the process of repression (the metapsychology of which is, in itself, a fascinating subject for study). Within the unconscious realm, those motives continued to press for expression in consciousness. Using the accouterments of unconscious mental life, alternative forms and representations were unconsciously selected to express the repressed motive in alternative form. This alternative expression enabled the individual to remain unaware of and, therefore, undistressed by, the original repressed motive or intention even as it was being expressed in substitute form.
It seems from the foregoing that what was considered psychopathological could be viewed alternatively as resourceful, creative, ingenious, and admirable. It is only an application of our biases that we consider such psychodynamic resolutions of inner conflict to be symptoms of some disease-like process. Indeed, the work of analysis would be unable to proceed without the assistance of the unconscious since from it come such facilitating contributions as: the "positive" transference which enables the analysand to continue in the analysis; the unconscious selection of associations designed to communicate the ongoing contents of the unconscious fantasies; and the utilization of the analytic process, including using interpretation, to alter, if desired, motivational patterns of conflict resolution.
There is another benefit for the analysand, the analyst, and the analysis that emerges from the encounter with and utilization of the concept of unconscious mental processes as we have been discussing it. When an analysand participates in an analytic consultation, it is usually because that person is experiencing some distressful manifestation.. Even for those who are participating in a psychoanalysis ostensibly to fulfill an academic or intellectual requirement this is the case when they come upon some persistent or repetitive but undesired behavior or upon some noteworthy character trait. As part of the experience, the analysand is convinced that the phenomenon is psychically autonomous, the product of some force beyond control, conscious or otherwise, and, in the face of which, the individual is helpless. The experience is identical to that of one who is informed that a lump or growth is cancerous. And a corollary part of the experience is that the helpless victim will be rescued by an omnipotent and omniscient analyst who will relieve the distress and remove the undesired source of it.
But, in contrast to the cancer patient, the analysand discovers that she or he is not helpless. The analysis makes clear that the person is, first of all, not in the grip of some malignant, unknown entity over which the person has no control. Rather, the analysis demonstrates that the individual is pursuing an agenda which is alternative to the conscious one, albeit in a form which obscures the nature of that agenda. That knowledge, aside from its specific content, is in itself powerful and enabling. Regardless of whether the analysand chooses to exercise it, the understanding provides the opportunity for choice, i.e., the choice between continuing to pursue the once unconscious intention or replacing it with a different one. In addition, the analysand can forego the belief that the analyst has taken on the obligation of relieving the distress and the cause of it. As one analysand put it, "Since I now know what I have contrived for myself, I can do something about it". And, whether or not the analysand does "do something about it" is recognized as the responsibility of the analysand alone. This recognition is useful in situations where the person is consciously experiencing her distress as the consequence of the actions of another.
Recognizing that unconscious motivations are discoverable, and, thereby, perhaps mutable if the analysand so chooses, enables the analyst to define his or her function in a remarkably simple, neutral, and natural way: he or she is there in the analysis only to analyze (however defined) and nothing more. Since all that the analyst can "know" is the perceived psychic reality of the analysand as inferred from the associations, the analyst is unable to assume any responsibility or obligation to report, to protect, to inform, to warn, or to manage. Further, there is no basis for the analyst to feel obliged to cure, make better, change, improve, or fix the analysand, since, at any given moment, that individual is psychodynamically the best he or she is able to be. For the analyst to view the analysand differently is to risk intruding the analyst's personal values as to how a person ought to be, regardless of whether or not those judgments are made consciously as an exercise of the analyst's "diagnostic" function.
I would argue that being focused, of necessity, only upon the unconscious mental process and the psychic reality, of the analysand, and of herself, optimizes the methodological requirement that the analyst enter the analytic situation with neither memory nor desire. Parenthetically, it is one of the continuing dilemmas of analytic life as to how one reconciles this requirement with the analyst's desire to be paid, to maintain a schedule, and other such "realities", unless, of course, one analyzes only for the love of the timeless enterprise. And even if one is psychoanalyzing solely for that reason, other phenomena intrude which are difficult to embrace as a part of the psychic reality of the situation, e.g., an experience of mine in which a police officer in pursuit of a bank robber burst into my consulting room armed with a submachine gun.
However difficult and solipsistic it may be to live psychoanalytically in a world defined by the vicissitudes of all that we think goes on in the unconscious --- instinctual drives, defenses, repression, etc.---I believe that the results of the effort to our analysands and to ourselves, personally and professionally, make it worthwhile. Besides, living in that world is one way to define doing psychoanalysis so, if we do psychoanalysis, it becomes a given of our existence whether we like it or not.
The manifestation we call transference is not simply the relationship which exists between analyst and analysand, if indeed such a relationship could exist outside of transference. (I remind you of the debate in days long past between Brenner and Greenson regarding transference vs. the "real relationship" and the "working alliance"). Transference entails using the analysis to interpose elements from the unconscious of both the participants in the situation. The psychoanalytic examination of such intrusions is a key component of the psychic investigation. In order to optimize that examination, it is necessary to establish as neutral a background as possible against which to recognize and study the transference phenomena that have made their appearance. That neutral background is prepared by the continued conscious appreciation by the participants in the effort that it is the unconscious process which is the major if not sole focus of it. The fact that, because psychoanalysis is a human enterprise rather than a mechanical one, there will be occasions when minor departures from that focus will be present does not negate the value of centering on the unconscious.
A mentor of mine, Richard Sterba, believed that the curative (his concept) element in psychoanalysis was the humane interaction between the analyst and the analysand. Thus, in addition to analyzing, in the manner in which I have been discussing it here, he would introduce analysands to each other, feed them on occasion, let them run up large bills, show them his slides of Vienna, lend them books, etc. before and after, but not during the associating and interpreting, of which last he was a master. In Sterba's view, psychoanalysis could be compared to distilled water in that the analyzing required a purity of dedication to the study of the unconscious process. But, as he also pointed out, distilled water cannot carry a current; and, in order for it to do so, it has to have impurities in it. The interactions that Sterba characterized as humane are the impurities that carry the current in psychoanalytic work.
As valid as Sterba's metaphor may be, his conception raises the everpresent question, "How many impurities and what kind?". My concern today is that so many impunrties have made their appearance over the years that what had been a pure and elegant process may now be contaminated. I hope that by emphasizing, perhaps even overemphasizing, the importance and value of the unconscious and of other metapsychological considerations I might restore to the psychoanalytic enterprise some of the purity about which Sterba spoke.
During the first decades of this psychoanalytic century, the theoretical, clinical and research efforts in the psychoanalytic community were focused on the question of how the individual got along with himself or herself. Thereafter, the trend was increasingly on how well the individual got along with herself and himself and on how the individual got along with others. In the course of studying the first question, psychoanalysis developed a powerful theory and methodology for the examination of intrapsychic process. As the focus of psychoanalytic work shifted, the theory and method lessened in import and rigor. I believe that now is the time to recapture that methodology, appreciate its utility, and restore it to the armamentarium of both the modern and the postmodern psychoanalyst. It is my hope that we can return to advising our analysands that if one can get along with oneself, then one can get along with anybody; and if one is not getting along with others, it is a good sign that one is not getting along with oneself. From that viewpoint the selection of which psychoanalytic methodology to use is obvious.
Classes, Seminars, Tutorials and Supervision with several senior analysts, notably Siegfried Bernfeld and Richard Sterba. Personal analysis. Education self-directed.
Associate Professor, Department of Psychiatry and Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, Michigan (Retired 31, December 1998).
Former President, International Federation for Psychoanalytic Education.
Former President, Division of Psychoanalysis, American Psychological Association
Former President, Psychologist-Psychoanalyst Practitioners
Former President, Michigan Society for Psychoanalytic Psychology
Former President, Michigan Psychological Association
Current Professional Activities
Private Practice of Psychoanalysis, West Bloomfield, Michigan (Retired 31 December 1998)
Faculty, Center for Psychoanalytic Studies, Michigan Society for Psychoanalytic Psychology
Co-Author (with B.F. Auld): Resolution of Inner Conflict: An Introduction to Psychoanalytic Therapy