Psychoanalysis, one of the most defining developments of the 20th century with a profound impact on medicine, psychology, philosophy and culturology, was initially focused on explaining the nature of neuroses. It was the first systematic, scientific attempt to create an integrated system of ideas about this phenomenon. Over time the approach developed, some of the details were modified, sometimes in very significant ways, but the basic thrust of the concept has remained unchanged.
Neuroses are a group of potentially reversible functional (i.e., not connected with an organic defect of the brain) disorders linked with emotional experiences and psychological trauma. They come in a variety of forms ranging from heightened irritability, anxiety, exhaustion, fixations, fears (phobias) and actions to the so-called hysterical symptoms: paralysis, loss of speech, vision or hearing, loss of consciousness and so on.
The concept of classic psychoanalysis, which I propose to challenge partially in this chapter, rests on the understanding that a person’s behaviour is dictated by the interaction between conscious and unconscious motives, which arise from basic needs. Conscious motives are closely connected with the requirements of the social environment. They are determined by these requirements, which reflect the interests not of the individual but of society as a whole and are, in a certain sense, external to a person’s deepest needs. These last are egotistical in character. Their uncontrolled satisfaction would lead to the violation of all social norms and to conflict with other members of society, and would threaten public morality and ethics. A person’s conscious behaviour, therefore, is basically determined by motives imposed on him by society, while those which are unacceptable to the community at large (and accordingly to individual consciousness) are subject to repression by the consciousness.
What is repression? I wrote about it in the first chapter, but to paraphrase Bernard Shaw, it never hurts to repeat something that everybody already knows once more.
Repression is the removal of motives from the consciousness (a motive being the driving force behind human behaviour). Examples of motives include the wish to humiliate or even destroy another person for personal gain, envy or jealousy which generate hatred towards him and so on.
Repressed motives cannot be realised (satisfied) in purposeful, conscious behaviour that is under a person’s control, but they stay in the subconscious and lose none of their intensity. They bubble away under the lid of consciousness, like water in a boiler, always threatening to explode, and become the source of various neurotic symptoms.
Thus, classic psychoanalysis saw hysterical conversion symptoms (such as hysterical paralysis, hysterical blindness and deafness, hysterical inability to swallow, hysterical sensitivity disorders) as symbolic expressions of repressed motives and unrealised conflicts. While a ‘free floating’ anxiety, one without any apparent cause, was understood as a reflection on the level of feelings of the emotional tension inevitably brought about by the constant turmoil of unsatisfied and unrealised passions. Since motives are not realised, a person does not understand the source of his worry, but that only makes him more worried still.
Now I want to show how the contradictions and omissions of classic Freudian psychoanalysis became apparent in these ideas.
So, if hysterical symptoms are the symbolic expression of repressed motives, what happens in this case to the motives themselves? Do they stay repressed? If yes, then the hysterical symptoms should match the ‘free floating’ anxiety, experienced as a strong and inexplicable inner tension.
But clinical observations do not support this: the more pronounced the hysterical symptoms are, the less ‘free floating’ anxiety is felt. Apparently, Freud himself was vaguely concerned by this contradiction and, unwilling to dump the idea of repression as the basis of hysterical conversion, claimed in his subsequent work that repression is a defence against anxiety.
But how, then, are we to deal with the first assertion (confirmed many times clinically) that repression provokes anxiety? And what is the source of vague, indeterminate anxiety, if not repression?
A few years ago I attempted to resolve these contradictions within the framework of a single, internally non-contradictory, consistent idea.
Repression, along with all other normal defence mechanisms, is required to protect a person not from anxiety, but from the disintegration of holistic behaviour and consciousness. Without these mechanisms behaviour would be dictated by motives pulling in opposite directions at once and would collapse.
It is the holistic self-image, integrating behaviour and consciousness, that is primarily protected by the defence mechanisms. An enormous amount of work has been done on the self-image during the last few decades by Professors Erik Erikson, Heinz Kohut and other representatives of “personality psychology”. According to their ideas, social norms are not imposed on the personality from without, but are a natural part of the personality’s structure in the form of internal needs, and share in the formation of the self-image. What is more, in this quality as social motives they have a serious influence on the character and even the actual functioning of primary biological needs. It would be ridiculous to suppose that the human psyche is like a layer cake, where the primary needs (instincts of self-preservation and reproduction) are covered, without any mixing, by a stratum of social needs (for recognition, understanding, dominance and love), and on top of that a layer of ideal needs (for perception, creativity and the harmonisation of the world). It would be absurd to imagine that beneath the fragile crust of a creative artist’s spirituality lurks the omnivorous aggression of a crocodile in its primeval, primitive state.
All the psyche’s component parts influence each other. Once the higher ranking needs are formed, even primary needs do not remain in their original state. The self-preservation instinct in a person with a highly developed need for self-respect is not the same as before the formation of this need. It cannot be considered in isolation from the self-image.
This is why a person with a highly developed self-image would rather die than kill a child, would rather go hungry than steal.
Genuine inner conflicts are not conflicts between egotistical primeval urges and externally imposed social norms, but are much deeper. Social needs acquired in childhood and integrated by the personality during its long and painful development turn out to be no less ‘egotistical’, to define the personality to no less a degree, than any other egotistical needs. Because they are ‘built into’ the personality, the conflict is deep and prolonged, and repression, called on to preserve the integral nature of behaviour, really does provoke ‘free floating’ anxiety.
But what about hysterical symptoms? I think they should be understood as non-verbal, unconscious behaviour, in which repressed motives find not symbolic expression , but resolution, realisation. This happens in exactly the same way as resolution in the goal-oriented behaviour of conscious motives.
The basic premise is, at the same time, preserved. As before, a person knows nothing of his unacceptable motives, of the reasons and mechanisms of his hysterical behaviour, since this behaviour is non-verbal, unconscious, subordinated to the right hemisphere. It is far from coincidental that 9/10 of all cases of hysterical paralysis and losses of sensation are left-sided, i.e. affect the left half of the body, controlled by the right hemisphere.
Nevertheless, this is still a distinctive means of non-verbal solution of a conflict that is expressed through behaviour (for example, hysterical paralysis means the person affected cannot do something that he unconsciously doesn’t want to do, while hysterical blindness means he cannot see something it would be unpleasant to see, because it would make him feel guilty or ashamed). And while the hysterical symptom persists, i.e. while the conflict is resolved (not permanently, of course, and not in the best way), there is no anxiety, because there is no need for repression. The lack of awareness of a conflict here takes place not thanks to repression, but thanks to the disconnection of non-verbal right-hemisphere behaviour from conscious behaviour.
Of course, if you relieve a person of a hysterical symptom under hypnosis, without providing any psychotherapy, repression comes into play and anxiety surfaces with all its indications and consequences. This has been shown in a number of experiments. Vladimir Raykov once told me the following story. One day a man came to see him with his wife. She couldn’t swallow her food. She would choke while eating, and the food wouldn’t go down. Raykov quickly established that it was a hysterical condition and was able to remove the symptom under deep hypnosis. A couple of weeks later the man was back with an unusual request. “Doctor,” he said, “can you make it so she can’t swallow again? While she was like that, that was all that was wrong with her. Now she eats, but wanders about the house all day in a state. She’s anxious, cries, can’t sleep, and makes life hell for the entire family.”
‘Free floating’ anxiety really can provoke all these symptoms and is subjectively very hard to bear. A person finds it difficult to deal with the fact that his emotional tension has no obvious cause and, consequently, doesn’t know what to do to get rid of it. Nobody can live with such an indeterminate situation for long, and a person unconsciously looks for something to which he can ‘attach’ this ‘free floating’ anxiety. This is where neurotic defence mechanisms come in handy, providing pseudo-explanations for his state.
It is the neurotic defence mechanisms that help eliminate anxiety, not repression, and there are several variants of how such elimination is realised in behaviour.
For example, a person suddenly realises that in reality he is worried about his state of health, noticing unpleasant sensations in his internal organs. There are even real grounds for this: anxiety in itself causes the pulse rate and blood pressure to fluctuate, alters peristalsis in the intestine, accelerates breathing. These changes are all moderate and reversible, but they are enough to cause primary somatic sensations. The person focuses on them, he begins to wonder whether he is seriously ill, that this is the source of his anxiety and the root cause of all his emotional problems. He now has a real purpose for action: he goes from doctor to doctor, undergoes tests, watches his bodily sensations, looks for medicines, is not satisfied by assurances that there is nothing really wrong with him. Anxiety is replaced by a hypochondriac neurosis.
Another variant is the appearance of groundless fears (phobias). A person is afraid of open or closed spaces (take your pick), fears dying in his sleep or catching an infection from shaking hands. There are so many it is impossible to list all the possible phobias, what is important is that in every case the person makes heroic efforts to avoid situations which activate his phobia. He now has a real purpose and meaning in life (distorted, naturally), which requires active behaviour. Anxiety disappears, replaced by a phobic neurosis with absolutely concrete, albeit ridiculous, fears. Any attempt to convince him otherwise is futile, since what lies at the root of the fears is a transformed, unbearable, indeterminate anxiety.
How can one explain neurosis from a wider, psychobiological perspective? Let’s try to apply the concept of search activity here, too.
What is repression? It is a renunciation of the attempt to realise an unacceptable behavioural motive and, at the same time, a renunciation of the attempt to integrate this motive with others which are acceptable to the personality. Essentially, this is a purely human form of renunciation of search, a variant of passive-defensive behaviour.
Healthy people also experience this reaction in all sorts of circumstances, but they get help from dreams in which renunciation of search is overcome, search activity is restored and repression weakened. This is not abstract theory. Some remarkable experiments by my friend and colleague Professor Ramon Greenberg and his co-workers at Harvard University confirmed that depriving people with a strongly developed self-image, one not inclined to behavioural disintegration, of REM sleep and dreams strengthens defence of the repressive type. They carried out a very elegant experiment using the so-called “Zeigarnik effect”.
Bluma Zeigarnik, a leading Moscow scientist, studied with the great German psychologist Kurt Lewin in her youth and designed this experiment. Subjects were given a series of tasks and were not allowed to complete some of them. A long time later they were asked to recall the content of all the tasks set. It turned out they remembered best the details of the tasks they had not been allowed to complete.
It is probably the emotional tension resulting from failure that made healthy people remember those particular tasks. In my view, this is an important mechanism, allowing a person to learn lessons from past experience of failures and setbacks. It turned out, though, that the “Zeigarnik effect” is observed only when compensatory defence mechanisms and REM sleep are functioning. When deprived of REM sleep, Greenberg’s subjects forgot the unsolved tasks, i.e. the repression mechanism was strengthened.
In neurotics, the system of REM sleep and dreams is inadequate (as we have already noted), the reaction of renunciation of search (repression) is not compensated for, permitting the development of free floating anxiety and, on the basis of that, other neurotic disorders.
The appearance of hypochondriac, phobic and other forms of neurosis may be regarded as manifestations of incorrectly oriented search. This idea found confirmation in the results of some of my own research. I found that the more marked the hypochondriac disorders are, the less the objective indications of psychosomatic illnesses (for example, the smaller the size of duodenal ulcers). Hypochondria, which is characterised by search activity, as it were protects a person from the catastrophic development of this type of ailment.
The concept of search activity allows us to link the psychodynamic concept of neuroses with modern ideas about the biology of the brain. Freud insisted that neuroses have their origins in the conflicts and psychotraumas of early childhood. This observation fits in well with the fact that in early childhood there is an initial, physiological readiness to renounce search in response to any threatening situation. This is connected with insufficiently mature mechanisms of search behaviour. Gradually, during the process of the right kind of development and nurturing, this tendency is overcome. However, until that happens, given that renunciation of search dominates, should the child experience psychotraumatic experiences connected with conflict between the parents and the absence of appropriate support from close relatives, the tendency towards renunciation of search will be reinforced and can, as a result, be transformed easily into a reaction of repression. The defence mechanisms against repression (dreams), which are connected with the development of thinking in images, also suffer from a lack of emotional contact with close relatives.
In this way, the concept of search activity brings the problem of the origins of neuroses into the orbit of scientific concepts of the function of the brain and behaviour.