A psychiatrist replies to Yudofsky's "Psychoanalysis, psychopharmacology, and the influence of neuropsychiatry".
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Biomedical subjects
Publications and source records attributed to D V Forrest.
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The synthesis of psychodynamic and neuroscientific data may be advanced by the study of similarly configured specific patterns of defense along continua from the normal and neurotic mental mechanisms of defenses, through what might be termed neuropsychiatric defenses influenced by the neurological state, to the more clearly neurological cortical reactions. These similar patterns and continua are the particularly human way brain adds its flavor of organism to mind, and the way in which all the psychodynamic mechanisms are specifically imbedded in brain. A purely psychological psychodynamics lacking this medical perspective fails to model human mental processes and reflects problems with artificial intelligence models that do not model brain. The pathological reactions that we address in psychiatry and neuropsychiatry interfere with and thereby reveal parallel processing features in (1) analogical and metaphorical thinking; (2) reduplication, redundancy, and repetitiveness; (3) self, person, and environmental recognition, including transference processes; (4) approximation and statistical inference; (5) spatiality and motor control; (6) affectivity, perception of sensations and sexuality; (7) projective mechanisms; and (8) problem solving by optimization, vectorial summation, and the mutual interaction of interconnected agencies. The new concepts in artificial intelligence built upon brainlike structures called neural nets portend great economies, emergent natural features that are more like human processes, and hierarchical and cyclic organizational demands. Medical psychoanalysts who comprehend dynamic and brain mechanisms and can describe them in terms that refer to both domains and their interaction should find increasing theoretical and practical convergence of their work with the emerging study and modeling of these processes by new forms of computers.
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Ferenczi, in his psychoanalytic classic on the ontogenesis (development in the individual) of the interest in money, without designating it as such, traced a phylogenetic or evolutionary sequence that took us by a series of transformations from the anal-cloacal erotism of valuation of a fecal body product (the infant's love of feces) to deodorized (like mud), dehydrated (like sand), decolorized, hardened, smooth (like stones and buttons) fecal substitutes that finally as coins are made to shine. This is to consider money as shiny possessable objects that would be of equal interest to simian species. Surely money can be analogized to other body products; and I have previously suggested (1969) that words also are a treasury of wealth that are valued as body products and also archaically associated with feces. But the youngest of the 18 suburban children in this pilot study seemed already to have related money to the love of their parents and grandparents. Further developmental stages of the human interest in money, here only suggested, appear to proceed as follows: curiosity about money as a belonging of the parents in oedipal-stage grasp of family politics (which may persist if childhood selfishness remains unleavened); money as a reward and exchange in latency trading (whether by boys and girls or grown-up "traders" in the financial "game"); money as a measure of status and class and as an indication of group identity in adolescence (which may persist in senses of group entitlement); and various levels of mature appreciation of money as a system of universal agreement, as a translatable, fungible form of information to register relative value, and as capital, an ingredient of productivity. Further study of the mental stages of the appreciation of money is warranted, but the social context appears unavoidably central. Ultimately money may be purely a mean that finally (harking back to its symbolic body origin) will be fully separated from the self in acts of riddance and gifting that vary from exercising power to loving bestowal (Kolb), and from jealous greed to generosity. Piagetian cognitive stages are exemplified by the children's approach to money at different ages; for example, even in this limited sample there is indication of a principle of conservation of value (here proposed) that appears in latency as an equivalent of the principle of conservation of volume. Neuropsychiatric impairment may lead to increasing concreteness in the representation of money as feces (which I have termed "the return of Ferenczi").(ABSTRACT TRUNCATED AT 400 WORDS)
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Tremor resists quantification of the ordinary level of clinical observation, where an objective record of tremor severity is desirable to evaluate patients' statements about effects of medication or pathophysiological states. The tremometer is an easily made device that measures amplitude of postural tremor in any radial direction by a graded series of round holes in which a probe is held and contact (which closes a circuit with an indicator light) is avoided. The observation of various types and features of tremor may be aided by the tremometer.
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Psychoanalytic medicine can incorporate information from the neurosciences to expand anatomic characterology through new knowledge of brain function. One focus of interest that is not currently targeted by research into specific pathological conditions is that of the highly intelligent, scientific person. This paper designates by the ambivalent popular term "nerds" persons whose brain development enables them to manipulate very abstract concepts such as those in math and physics. This ability, which may be in the direction of human brain evolution, contributes to personality development in a way that is not conflicted but leads to investments of mental abilities with intense interest. Personality traits may result that are misunderstood and unpopular despite the crucial need for such persons at this point in our society's history. Portrayals of the nerd type in films, neurological, mental, and social factors favoring the development of nerds, and biographical and case materials round out this description of the type, for which further refinements of our neuropsychiatric and psychoanalytic understanding may be sought.
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A promising new "ecumenical" movement in psychiatry attempts to synthesize the two great intellectual traditions, psychoanalysis and neurobiology, so that we may avoid splitting the care of the patient into the partial domains of biotherapy that lacks the understanding of mental interrelations and purely psychological psychotherapy that lacks an appreciation of the embeddedness of mental processes in brain function. Recent synthetic work is assessed, taking as a point of departure an historic symposium in Pittsburgh, October 26-27, 1984, entitled "Neurobiology and the Unconscious: Psychoanalysis Looks Toward the Future." The means of representation of meaning (whose description was begun by Freud) in such unconscious material as dreams and folklore show the imprint of the brain function in which they are imbedded. Our afferent and efferent processes, including language, are patterned by their neuromedical basis. Linkages will be sought of representational images to visual, vestibular, and neuromotor traces: evidence that the human "thinking machine" is a very human body rather than some disembodied psychological self or computer simulation by artificial intelligence programming. Illustrative material is in part drawn from the popular dream episodes cartooned by Winsor McCay, which were considered graphic masterpieces, and incorporated representations of many normal unconscious brain mechanisms, including unusual perspectives, vestibular sensations, neuromotor inhibitions, transformations; visual and linguistic distortions, bizarre bodily intrusions, and sexual symbols. J. Allen Hobson and R.W. McCarley's 1977 arguments for the determining the significance of the pontine dream generator may have been anticipated by McCay's 1905 Dreams of the Rarebit Fiend in which, at the end of each very Freudian nightmare, the dreamer wakes and swears off eating welsh rarebits as if they caused all his unconscious images. To avoid a biological reductiveness, Freud, whom Sulloway (1983) has described as a biologist of the mind, resorted to presenting psychoanalysis as a pure psychology, not because he ever doubted the neurological imbeddedness of mind, but only because he felt medical psychoanalysts were too easily seduced and distracted by neurological mechanisms of his day to appreciate properly the importance of psychodynamics. Increasing recognition of the imbeddedness of psychoanalysis in brain function is now timely and likely, providing fresh directions for both medical psychoanalysis and the neurosciences.(ABSTRACT TRUNCATED AT 400 WORDS)
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More than sharpening our tools or making them sterile, our task in psychotherapy and analysis is to enliven them, find in them the organic, the animate, and the fecund. For our tools are formed of language, more like living nets than like knives, dies, taps, or templates, and our familiary with them might as well be a marriage of love as one of convenience. One's own onymy (Forrest, 1973) of words and phrases that seem to be one's property and private treasury will include, in the case of a doctor who uses words, several such verbal tools that have acquired greater frequency of use and richer and deeper meanings with experience. For me the word play in its affinity for very spatial senses has grown increasingly helpful in meeting both the practical demands of therapeutic communication and the personal need to maintain theoretical structures to support therapeutic work. I wish here to explore the concept of play--contributions to its definition, its developmental stages, applications of play, and its extended properties.
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