Return of the Repressed

Comments

1. 

   May 6, 2006

   Dom

   Really terrific post. In my grad school days, I had to read Freud’s “DaVinci, a memory of his childhood”, and extended discussion of DaVinci’s dream of a vulture that inserted his tail into the child’s mouth. You can imagine what Freud made of it.
   But the intro mentions in a casual way that Freud had a bad translation of DaVinci’s notes, and virtually everything in the book is incorrect. Still, we were told, it was a classic of psychobiography.
   How do you top that?

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2. 

   May 6, 2006

   James Hamilton

   as the best-selling CBT guide would have it). Practically everything we know about the brain indicates the precise opposite, that emotion precedes conscious cognition and has a prevailing imperative over it.
   2. There are many studies backing CBT’s effectiveness, but there’s a very good reason for that – no other form of psychotherapy lends itself to conventional statistical study remotely as well, because, almost uniquely amongst the talking therapies, its adherents have been willing to downplay the importance of the client-therapist relationship, which is more commonly regarded as a stumbling-block to such studies. It’s also been significant that CBT maintains relief from symptoms as its raison d’etre, where psychoanalysis and the other psychodynamic therapies have long been more about some form of self-discovery (for good or ill).
   I’ve actually used CBT extensively with clients, and it has good points – simplicity being one, of course. But my really successful CBT clients have all seemed to undergo what I can only describe as a moment of emotional crisis and resolution during their therapy – something that resembled nothing in CBT literature, but that is dangerously close to that ancient and debunked idea of abreaction. Before that moment, and after it, were always as different as night and day, for the client, and I really can’t say for sure that CBT had anything to do with it other than that was what I’d been doing with them at the time. I’d also add that I felt the effectiveness of the therapy seemed dependent on the degree to which the client liked and trusted me – if they didn’t, the therapy did little for them; if they did, then it went very well. CBT isn’t meant to be like that.
   CBT’s also subject to the criticisms of what Richard Bentall calls the “neo-Kraepelinian paradigm” in his book “Madness Explained”. The paradigm contains two essential ideas, both hard to sustain now. One, that there are a specific number of mental disorders, individually-identificable and capable of being distinguised from one another. Two, that these have an organic origin in a stable, relatively unchanging brain environment. Over the last forty years, CBT has attempted, essentially, to construct a theory and a style of treatment around each separate neurosis, personality disorder and even psychotic disorder, the very same separate conditions whose distinguishing boundaries are now under such question.
   If I were unable to help a client myself, I would recommend CBT to them – simply because it would mean that someone would actually help them with their presenting problem, rather than divert them into some kind of therapy-as-lifestyle-choice dead end. But that’s not the same as saying that I think it stands up intellectually.

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3. 

   May 6, 2006

   Mick H

   Thanks for that James. I confess I know very little about CBT.

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4. 

   May 6, 2006

   Trofim

   But there is nothing – simply nothing – in contemporary neuroscience or anywhere else for that matter – to back up its core assertion that cognition precedes emotion.
   On the other hand, I have found that patients/clients find that CBT intuitively makes more sense than the Freudian paradigm, there are parallels one can draw between CBT and common aphorisms – “Every cloud has a silver lining”,”It’s an ill wind…”.

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5. 

   May 8, 2006

   dearieme

   It was the intellectuals who made much of Freud and the unfashionable who sneered. Maybe the intellectuals should have stuck to Marxism and adultery?

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6. 

   May 9, 2006

   James Hamilton

   There’s no “on the other hand” there, Trofim, as I wasn’t speaking up for what you’ve termed the Freudian paradigm.
   I agree with you that CBT makes – good phrase – intuitive sense. The trouble is, the mind doesn’t, and one only has to look over towards quantum physics to realise how short a distance apparent common sense can take you. We’re at a stage with studying the brain where everything we learn really only highlights that we don’t know anything, and that at each stage we’ve underestimated both the brain’s complexity and the philosophical problems inherent in its study.
   I’m writing (trying to write) a paper to explain some of the phenomena I’ve come across in my own consulting room, and at the moment I’m reading the literature on memory. If you do the same, you’ll realise quite early on that no one seems to have made much effort to define terms. There’s no agreement on what memory actually comprises, nor any effective means to distinguish it satisfactorily from other forms of thinking/cognition, let alone from the emotion that accompanies it.
   That, and other examples of the same kind, make me wonder if justifiable criticism of and moving on from Freud doesn’t actually in some way mask the very real shortcomings in the current therapy thought world.

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7. 

   May 10, 2006

   Backword Dave

   James, if I may put it like this, the James-Lange theory perhaps? William James was an experimentalist. To use James’s terms, you have to recognise that a bear is a bear, which is a cognitive process; the hippocampus (or whatever) doesn’t get involved until later. Your argument could be applied to penicillin. What was there in chemistry or biochemistry to suggest that it would work? It does. Newton defines gravity: he never explained how or why it worked like that (yes, large bodies have more of it, but why?)
   As to your second comment, it’s seemed for a long time that memory can’t be distinguished at all from “other forms of thinking/cognition”. All cognition involves memory, if only the memory of what I just cognated. Quantum physics isn’t a good comparison; it’s a particularly recondite science and well removed from both common experience and common sense.

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8. 

   May 12, 2006

   James Hamilton

   cognition, but as for that being apparent for a long time, all I would say is that from the papers I’m reading at the moment, for a lot of people in the field hope still burns high! I think it was Steven Rose who pointed out that what we are discovering via PET and MRI scanners is that certain parts of the brain use e.g. a lot of glucose in certain situations, which does not rule out other parts of the brain being involved but not using so much… marvellous red herring territory, in short.

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