Psychoanalysis and Psychotherapy
TO HUMAN NATURE?
THE CUSSEDNESS OF PSYCHOANALYSIS
We have had some version of psychoanalysis for almost exactly a century, yet its place in the firmament is still very much in doubt. Philip Rieff has called Freuds writings perhaps the most important body of thought committed to paper in the twentieth century (Rieff, 1959, p. x), while Hans Eysenck (1985), Karl Popper (1983, pp. 163-74), Ernest Gellner (1985), Adolf Grünbaum (1984, 1993) and others have cast varying degrees and species of doubt on its account of human nature and on its clinical efficacy. Within the psychoanalytic and psychotherapeutic movement, broadly defined, there is no agreement about one or even a small number of appropriate theoretical models. The press in North America, Britain and Europe has been having a field day slagging off psychotherapy, including a cover story in Time magazine (29 Nov. 1993) which cast doubt on psychotherapeutic anamnesis by criticising the excesses of false memory syndrome, while the novelist Fay Weldon issued a fictional polemic which fires a broadside at the bona fides of people who make their living from what she calls therapism (1994). She says the book was inspired by the fact that her husband left her on the advice of an astrological hypnotherapist. She also distinguishes the reputable from the disreputable psychotherapists, but this subtlety gets lost in the general melee. There have also been severely critical articles in The Independent, The Sunday Times and the New York Review of Books. Is all this just rightful criticism of bad science, or it something more interesting going on?
And here am I, late to be analysed, late to be trained, but committed ever since I heard of it to this dubious view of humanity and society. I had the same experience in 68. I got involved in the student movement just as it was going out of fashion and turned up, wanting to play, as it were, at the moment when Tom Sawyer finished whitewashing the fence or perhaps just when it was falling down from misuse. On top of that, I am guileless enough to want to defend psychoanalysis to philosophers and psychologists, on a continent where, as I understand it, this approach is utterly out of fashion. Actually, it could not be more out of fashion here than it is in psychology departments in Britain, where it never got a look in in the first place. People taking up psychology in Britain with an interest in human nature and personality will get practically no opportunity to learn about psychodynamic approaches. The menu is overcrowded with perception, learning, cognitive science, computer modelling and animal behaviour studies. When I argued for a place for psychoanalysis in a paper given to my old department in Cambridge (Young, 1989a), I was told that if they were to make room for psychoanalysis something would have to be dropped, and no one would make way to find the space in the curriculum at the expense of their own special interest.
If you become a clinical psychologist in Britain and begin to work with patients, you are almost certain to be taught and expected to offer cognitive or cognitive-behavioural therapy. You are not likely to undergo any form of personal psychotherapy or psychoanalysis as a prerequisite for conducting counselling or psychotherapy. Most psychotherapy in Britain is done by clinical psychologists. There are about 2000 of them. Psychiatrists are not required to learn much about psychotherapy, either; nor are they required to undergo it. There are about three hundred practising psychoanalysts, about two thousand psychoanalytic psychotherapists with reputable trainings and only about 120 consultant psychotherapists in the National Health Service this in a country of 55 million people. It is thought by their doctors that ten to fifteen per cent of the population have neurotic disorders; these are currently treated almost exclusively with drugs. The profession is turning out trained psychoanalytic psychotherapists at a rate which is likely to level off at providing therapy for one per cent of the population, i.e., a tenth or a fifteenth of the perceived need. Because of government policy practically all of this occurs in the private sector and is highly skewed toward London, the rich and white people.
The standing of psychoanalysis and related approaches in the universities and the general culture was very different when I was a student in the United States. In the mid-1950s I worked as a research assistant to Professor John Dollard at Yale on a project to quantify the variables in psychoanalysis. This was respectable, well-funded research. When I became a medical student with the long-term aim of training as a psychoanalyst, the Department of Psychiatry at the University of Rochester was dominated by eminent psychoanalysts who had hegemony over internal medicine, and psychosomatics was in full swing. I recall a Christmas play which included the ditty (to the tune of The Rain in Spain from My Fair Lady) The fear of loss is of disease the cause... I think shes got it, and so on. The work of George Engel, Arthur Schmale and William Greene on ulcerative colitis and leukaemia pointed toward a complete integration of psychological and somatic causation, leading to what Engel called A Unified Concept of Health and Disease (Engel, 1960, 1954, 1955, 1956, 1958, 1962, 1967; Engel and Schmale, 1967; Schmale, 1972; Greene, 1968).
Where are the psychosomatic integrations of yesteryear? From what I can gather, psychosomatic medicine is a waning speciality, as well, and the kinds of claims made by it and by biofeedback are now being made by a new wave of faith healers, far from the centre of orthodox medicine, nearer to religion. I am thinking of the best sellers of Bernie Siegel, whose number one best-seller sold millions, and of fringe medical institutions like the cancer centre in Bristol (Siegel, 1986, 1990, 1993; Thomson, 1989; Shorter, 1992).
I am told that unlike when I was a medical student being a psychoanalytic or psychodynamically oriented psychiatrist is now a positive disadvantage in someone applying for a professorship in The United States and Canada, as it always has been in Britain. Neurochemistry, psychopharmacology and molecular biology are in fashion, and serotonin (about which I wrote my first pharmacology paper in 1960) is the word on everyones lips, where cathexis and adaptation were in terms thirty-five years ago, when I left Rochester, planning to spend a year in Cambridge sorting out the scientific foundations of psychoanalysis. I never got back, and Im still digging for those foundations.
At the risk of seeming self-indulgent, I want to spend the rest of this chapter tracing my own odyssey in the hope of shedding some light on the cussedness of psychoanalysis. Before doing so, however, I want to give a glimpse of my conclusion. As I said in chapter one, I have spent a considerable chunk of my life on four ways of framing psychoanalysis through brain studies, through evolutionary biology, though the study of human nature as an ensemble of social relations and through a return to the psychoanalytic classics and clinical work. I am left with a rather mundane and unglittering conclusion, one which I dare say most psychologists and philosophers would not find congenial. It is that psychoanalytic truth is forged in the transference and countertransference, that is, in a two-person intimate space technically called the analytic frame, and that practically all attempts to put it on a more methodologically respectable foundation are something like wishful thinking, rationalisation or public relations. I think it is no accident that it took a century before the International Psychoanalytic Association mounted its first conference on validation and studies of outcome and that this perfectly respectable approach is not at the centre of interest of most practitioners. I find it a striking fact that outcome studies and other approaches which lie within the tradition of empirical research characteristic of academic psychology, although increasingly valued by academic psychoanalysts and therapists, dont gain the attention of practitioners. This approach has its own conferences and a new journal and may make a broader impact in due course, but I rather doubt that they will. I think there are increasingly well-understood reasons drawn from developments in philosophy, in the history and social studies of science and in cultural studies why this should be so and why psychoanalysis and other subjective approaches to psychology and other aspects of the so-called human sciences should stop being so methodologically defensive. So, in what follows I shall try to illuminate the cussedness of psychoanalysis in the light of an approach to what we might call the metaphysical foundations of methodological defensiveness in the disciplined study of human nature a tall order.
When I first became interested in trying to establish the validity of psychoanalysis, I got involved in two projects, neither of which won the day. The first was an ambitious attempt by John Dollard and Frank Auld at the Institute of Human Relations at Yale to code and quantify every sentence in therapy sessions. Every session was taped, converted to transcript, checked, coded, linked to a system of emotional categories and compared to another observers assessment. It was, in the title of the stillborn monograph Scoring Human Motives (Dollard and Auld, 1956), and I dare say that few current psychologists will have heard of this work. (My job was the most empirical of all to sit behind the one-way mirror and make tape recordings of the psychotherapy sessions and then to check the transcripts against the tapes.) The sieve did not have the right size and shape of holes, that is, one could not capture the rhythms and meanings of the transference and countertransference with this approach. Quantification and analysis into units is good science, but the empirical domain was recalcitrant. As we used to say in Texas, that dog wouldnt hunt: the funding of the project was withdrawn, and it was abandoned.
The next approach with which I got involved was even more scientifically respectable. When I was in medical school there was much talk about the limbic system, the rhinencephalon or primitive smell brain. There had been developments in the late 1950s of a thesis originally put forward by J. W. Papez (1937) and developed by my professor and mentor, Wilbur Smith (1945), Paul MacLean (1949, 1958, 1959) and others, which suggested that primitive emotional functions could be localised in that part of the brain providing a physiological basis for the emotions. It also seemed at the time that the study of stimulation, ablation and lesions from accidents and surgery might provide a localization of functions which could sort out the fundamental variables in emotional life and bring about an integration of the psychoanalytic with the physiological. One of the leading figures in this work, Paul, MacLean, wrote at the time, I was very much influenced by psychodynamic concepts when I wrote the visceral brain paper in 1949, as I think anyone in this day and age is bound to be influenced by Freudian psychology (personal communication, 31 May 1960).
It is difficult to recapture or convey just how exciting many people found these heady possibilities. We saw films of electrical stimulation of penile erections (MacLean et al., 1959) and others of electrically-induced orgasms (Olds, 1955, 1858, 1977). The foundations in natural science of the psychology of the unconscious seemed near at hand. There were symposia all over the place; all sorts of collections appeared. Even though I was a an impecunious medical student, on a scholarship, with a wife and baby to support, I somehow managed to acquire all sorts of books as they came out. They are extensively annotated and underscored; I sent off for endless offprints, which are also heavily annotated. I built up an extensive collection of classical papers from the 1930s onwards (using the first Xerox machine ever available in a university library: the company which perfected the process of electrostatic photocopying was in Rochester, and the university owned lots of shares in it). I set out to make an integration of the neurophysiological and psychoanalytic literatures and submitted a first section as a term paper in psychiatry: Freud and Psychoanalysis in a Physiological Perspective: A Study of Some of the Historical and Philosophical Aspects of the Mind-Body Problem from the Viewpoint of Psychoanalytic Metapsychology (Young, 1960). My teachers were kind enough to give this grandiose project the benefit of the doubt (a staggering undertaking, which you have begun with admirable...) and to help me obtain funds to pursue it with a fellowship at Cambridge University. The names of the people who were important in this tradition were like those of gods to me. They still resonate in a special way: Cannon, Bard, Fulton, Lashley, Penfield, Harlow, Hebb, Pribram, the last of whom made specific efforts to tie his research to the original vision of Freud (Pribram, 1962).
I thought this work was truly wonderful. Papers appeared with titles such as Is the Hypothalamus a Center of Emotion? (Masserman, 1941); On the Neurology of Thinking (Pribram, 1959); Experiments on Localization of Genital Function in the Brain (MacLean et al., 1959). These attempts to juxtapose and perhaps integrate the physiological and the psychoanalytic made a great deal of sense in the light of the terms of reference of the then-prevailing conceptualisation of psychoanalysis, a tradition which began in 1895 with Freuds Project for a Scientific Psychology and extended through ego psychology to the systematic writings of David Rapaport and Merton M. Gill. When I say systematic, I mean quite literally that attempts were being made within ego psychology to set out the points of view and assumptions of psychoanalytic metapsychology as formally as possible. These were spelled out in a short paper in the International Journal of Psycho-Analysis and in a longer monograph in 1959. What is important about this work is its conceptual framework. It took up one aspect of Freuds thinking which stemmed from the Helmholtz School of physicalist physiology associated with Ernst Brücke, Dubois-Reymond and Freuds mentor, Theodor Meynert (Bernfeld, 1944, 1949, 1951; Kris, 1950; Riese, 1958; Rioch, 1958; Amacher, 1965; Young, 1986, 1994, ch. 3). Freud trained and practised as an experimental neuroscientist until he found he could not make a decent living that way, and he carried physicalist thinking into his work with neurotics. Mind was represented in physiological terms. Freuds goal in The Project was quite clear from the first sentence: The intention is to furnish a psychology that shall be a natural science: that is, to represent psychical processes as quantitatively determinate states of specifiable material particles, thus making those processes perspicuous and free from contradiction. Two principal Ideas are involved:  What distinguishes activity from rest is to be regarded as Q, subject to the general laws of motion. (2) The neurones are to be taken as the material particles (Freud, 1895, p. 295). Although the precise nature of Q is the subject of considerable uncertainty and merits an appendix in the Standard Edition (pp. 392-7), there is no doubt that what is being sought is a reductionist explanation in terms of matter and energy.
The German émigrés who fled to America in the 1930s into a context where you had to be a physician to be a psychoanalyst (over Freuds strenuous protest: Freud, 1926) found this conceptual framework utterly familiar and congenial and extended it to include biological and social adaptation (Hartmann, 1958, 1964; Kris, 1950a; Lowenstein, 1963; Hartman, Kris & Lowenstein, 1946, 1953). The result, in the hands of Rapaport, the codifier of this approach, was a set of five points of view: dynamic, economic, structural, genetic, adaptive, with corresponding mental forces, energies, structures, origins and development and relations with the environment (Rapaport and Gill, 1959). These were spelled out at some length in one of Sigmund Kochs volumes on Psychology: A Study of a Science and set out in formal, semi-axiomatic terms (Rapaport, 1959). This formulation of psychoanalysis left out al the messy bits about the depths of unconscious phantasy but was easy to juxtapose with the conceptual framework of physiology, and it was tempting to think that a scientific basis for psychoanalysis was within reach.
I certainly thought so and set out to examine the larger theoretical context of this way of thinking, in particular, the idea that functions are localised in discreet regions of the brain. It was soon apparent that one reason for the promising fit between Freudian concepts and those of cerebral localisation was that Freud himself thought of the brain and the topography of mind in those terms. His first book, written in 1891, was an examination of theories of aphasia (Freud, 1891), and his topographic way of thinking was carried over into the theoretical approach taken in the masterful concluding chapter of his masterpiece, The Interpretation of Dreams (Freud, 1900), chapter seven on The Psychology of the Dream-Processes, where he expresses his decision to speak of pathology in purely psychological terms, as he puts it: I shall remain upon psychological ground (Freud, 1900, p. 536). Even so, he never ceased to think in spatial and topographic terms, even though he deliberately abandoned the attempt to spell out the physiological bases of his psychological findings. He adopted the philosophical position of psychophysical parallelism from the British neurologist John Hughlings Jackson, an approach to the mind-body problem which he continued to hold throughout his mature writings until his death (Freud, 1891a; Kuhlenbeck, on parallelism, Kuhlenbeck, 1957, 1958; Levin, 1960). He died confident that the physiologists would eventually fill in the base cleft, so to speak, which accompanies the melody of conscious, thought and the resonances and harmonics at the level of the preconscious and the unconscious.
Another way of telling this part of the story is that he soon found that cerebral anatomy and physiology did not provide a sieve with the right sort of holes for his discoveries from working with neurotic patients. The same can be said of the new cerebral localisers in the 1950s and beyond. Just as Freud found that there was no simple one-to-one correlation with what was known about the brain and his psychoanalytic findings, the neurophysiologists found that the subtle and complex workings of the brain took them further and further away from psychological theory of any complexity. There were dramatic findings in certain spheres of perception and even aspects of emotionality, but nothing which could either reassure the analysts or send them off to re-train in some other branch of the helping professions. When I asked a contemporary of mine, who was immersed in the exciting brain and behaviour work of the 1960s and has remained in the field, just how far they have got with the ambitious project that we all envisaged in those days, he said that the larger vision is gone, while many small areas have been illuminated.
My historical and conceptual researches led to a book, entitled Mind, Brain and Adaptation (1970), which has endured and is called a classic in some quarters, but I dont think many people have been struck by the most interesting conclusion of that research. The reason is that I only dimly grasped it myself at the time and failed to state it boldly, even though it has become the template for everything else I have ever found out. It is so simple but so important that if you blink you might miss it, even though I have already sketched it in chapter one. What is interesting about the history of brain studies is not what answers the brain gives when we poke, poison, shock, and cut it up. What is interesting is the questions we ask it and where they come from. The brain mediates all experience and behaviour. We can conceptualise it in all sorts of different terms. Put another way, we can have many psychologies, many theories of human nature, or a mixture of them, which for the most part is what we do have. Pluralism in psychology is not due to the primitive state of the field. It is because people see humanity and society in terms of different sets of values, and this will lead to different psychologies. Ask about perception in terms of the five senses, and you may discover how the nervous system mediates perception. Ask about sensory-motor function, and you will get answers in those terms. Indeed, there was a period from 1876 to the second decade of this century which was something of a golden age when it was persuasively argued by Hughlings Jackson (1931), David Ferrier (1876) and other pioneer neuroscientists that mental life was merely the subjective side of sensory and motor substrata (Ferrier, 1876, pp. 256-7; cf. Young, 1990, pp. x, 241 sqq.), and that was the whole story. And it could be if you managed to persuade people to conceptualise human nature in those impoverished terms. If we turn to data from temporal lobe epilepsy we can generate a theory which links up to psychiatric literature on psychopathic behaviour, and Jose Delgado and others have tried to explain criminality in those terms (Chorover, 1979, ch. 6; Postle and Young, 1981, along with some peculiarly draconian measures for restraining so-called psychopaths. Im glad to say that he had to emigrate, but I believe is still alive and experimenting on people in Spain. The thriller writer Michael Crichton told a version of this story in The Terminal Man (1972). Then there was the famous orgasm centre of Olds (1955, 1958); animals were so gratified that they would continue to stimulate themselves until they dropped. All of these approaches and findings, among many others, are well-attested, but they do not add up to a single, coherent framework for thinking about human nature in physiological and biological terms. They provide one important level of explanation, but that level is one overlay, among many other actual and possible ones, for understanding that part of the domain of the manifold of nature we call human.
I could go on listing examples. The point abut the brain, like the rest of nature, is that it is a manifold or plenum and that it is open to innumerable frameworks of analysis, depending on what aspects of how people and other organisms experience and behave you want to investigate. My study of the history of ideas about mind and brain led me quite naturally by a series of expanding contexts to look at where biology got its questions and led on to a study of the categories of analysis of physiology and the human sciences which developed under the generic theory of functionalism, the ruling meta-theory in much of psychology, sociology, anthropology, economics, architecture, history of science, and some versions of Marxism up to the 1950s and in some disciplines to the present. For example, cybernetics and systems theory are meta-functionalisms. Analysis of structures, functions and other analogies drawn from physiology and biology, especially equilibrium, homeostasis, negative feedback and ultrastability lead one into a particular way of thinking about individuals, families, groups, institutions, communities and historical change (Young, 1981).
I was also led to a close study of the development of Darwins theory of evolution by means of natural selection and to the ideological forces at work on his thinking, in particular natural theology (a precursor of functionalism), Malthusian population theory, economics and welfare theory (Young, 1985, chs. 2, 5). This framework of ideas combined with a crucial anthropomorphic analogy between the artificial selection of animal breeders and the concept of nature selecting to provide Darwin with what is generally acknowledged to be the theory which links humanity to the rest of life and living nature to the rest of the natural and physical worlds. What is striking and of great philosophical interest about the concept of natural selection is that it is teleological, anthropomorphic and breaks all the supposed rules of explanation in the orthodox philosophy of science which are reductionist and based on and accountable to norms of explanation in the physico-chemical sciences (Young, 1985, ch. 4, 1993).
You could be forgiven for thinking that I have strayed too far from the cussedness of psychoanalysis and into the topic of my final chapter on Darwinism and Social Darwinism. The connection is what I said above about that one discovery I made while trying to base psychoanalysis on a theory of brain function. In doing so I was trying to say that we need not find psychoanalysis so ornery, so bereft of scientific respectability, so methodologically embarrassing. I thought that if we could show that the elephant stands on the turtle and the turtle stands on the ground, there is terra firma. Scientific respectability would be passed up the line from biology to physiology to brain physiology to the understanding of the unconscious. What I found in explanations in physiology and biology and at the heart of Darwins own theory was anthropomorphic, teleological and otherwise evaluative language and modes of reasoning. That is, what I found was that the natural sciences were, at bottom, as problematic as the human ones.
Where to go from here? Where I went and not altogether by following my nose in the history and philosophy of the biological and human sciences was to the sociology of knowledge. Youll recall that I said that I was a late developer in 1968. Well, one thing that came up in that period was that intellectual preoccupations reflected the values and priorities of the establishment. Another way of saying this is that knowledge is not above the battle, i.e., that knowledge has a sociology just like everything else (Mannheim, 1929-31; Berger and Luckmann, 1967). Another way of saying this is that social and political and economic and ideological forces operate in academic life, just as they do in consumer behaviour and the family, and that this approach should also be applied to science. They were being critically examined in new studies and new dissident and subversive periodicals concerned with philosophy, sociology, politics, economics, anthropology and so on. Ours sought to think about science, technology, medicine and other forms of expertise. It began life as the Radical Science Journal in 1971 and after twenty issues underwent a cosmetic change to Science as Culture. in 1987, to reflect the times and to highlight its affinity with a new generation of periodicals concerned with, for example, gender studies and cultural studies.
If these social, cultural, economic and ideological forces operate in science, then they must operate in biology and the sciences which use biological and physiological analogies. It behoves us, then, to look at the forces which determine, evoke, constrain and constitute research, theorisation and knowledge what counts as knowledge, whats respectable, consensual, fashionable, sexy (a term which I think was originally used by physicists about admired particles and topics). In psychology today, cognitive studies and computer modelling are sexy. In biology genetic engineering is. These trends reflect research priorities in granting agencies, in particular the agencies which got their approaches to research from the Rockefeller charities (Abir-Am, 1982; Fisher, 1978; Brown, 1979, 1979a; Kohler, 1991). They set out to create social and biological sciences in a certain mold functionalist and molecular and have shaped the landscape of the biological and human sciences quite fundamentally. I pursue this topic at greater depth below in chapter seven.
You are still wondering how I will ever get back to psychoanalysis, arent you? Well, I will do it in two steps a leap and a bound. The leap is that truth is made, not found (Rorty, 1980, 1982, 1989), that the investigations I have been sketching (along with many more I could tell you about) demonstrate to those who have eyes to see in these terms that all facts are theory-laden, all theories are value-laden and that all values are part of an ideological framework or world view. There is not some touchstone which lies at the bottom of a hierarchy of disciplines or discourses to which all others are answerable. In the case of scientific discourses, as Ive said, the path would go from psychology to neurophysiology to biology to physics to scientific respectability. I trod the paths and found evaluative frameworks at every level. Nature does not speak its own order. There is no truly and unequivocally natural classification. Many are feasible. Nature, insofar as we humans can know it, is a cultural category. What we mean by it depends on the purposes being served by our enquiry.
Thats the leap. The bound is that if that is true, then the heats off psychoanalysis, because it is in no worse or less reputable a conceptual space than many another discipline. If you dont like the path of intellectual autobiography I have taken to get to this point, try the more general and fashionable highway which leads to philosophical postmodernism which de-privileges natural science as a discourse which claims to provide a model and reference point for other forms of knowing. I am not a postmodernist, although I do believe in the social construction of reality and the de-privileging of scientific discourse and the re-valuation of narrative and story-telling discourses. But I part company with postmodernism over the question of relativism. That is, I do not think the depriviledging of science leaves us with no reference point. I think it leads to the centrality of moral discourse.
And that takes us back to the cussedness of psychoanalysis. I have left myself half of a chapter to make sense of that claim. I want to draw your attention to three concepts, ones which I have found to be of fundamental importance in my clinical work and which do not conform to empiricist notions of scientific respectability. They are psychotic anxiety, projective identification and transitional objects. All are cussed from the point of view of scientific respectability. The first two depend on a belief in a fundamental distinction between life and death instincts at the heart of humanity which are anathema to conventional psychology and to most psychoanalysts. Together they provide three basic elements of human nature which play as profound a role as the building blocks of matter do in physics. They can be said to be, as it were,. fundamental particles of humanity.
Psychotic anxiety is a Kleinian notion and refers to an utterly primitive fear of annihilation, and it is part of an account of unconscious processes which plays havoc with traditional views of rationality. In her pioneering essay On the Genesis of Psychical Conflict in Early Infancy (1952), Joan Riviere writes that from the very beginning of life on Freuds own hypothesis, the psyche responds to the reality of its experiences by interpreting them or rather, misinterpreting them in a subjective manner that increases its pleasure and preserves it from pain. This act of a subjective interpretation of experience, which it carries out by means of the processes of introjection and projection, is called by Freud hallucination; and it forms the foundation of what we mean by phantasy-life. The phantasy-life of the individual is thus the form in which his real internal and external sensations and perceptions are interpreted and represented to himself in his mind under the influence of the pleasure-pain principle (Riviere, 1952, p. 41). She adds that such misinterpretation of perception for the sake of satisfaction retains the upper hand in adult life and goes on to emphasise that, in addition, helplessness against destructive forces from within constitutes the greatest psychical danger-situation known to the human organism; and that this helplessness is the deepest source of anxiety in human beings (p. 43). Other names for it are primal anxiety, nameless dread and, in its ultimate form, fear of death (ibid.) It is also the ultimate source of all neurosis. At this early stage of development, sadism is at its height and is followed by the discovery that loved objects are in a state of disintegration, in bits or in dissolution, leading to despair, remorse and anxiety, which underlie numerous anxiety situations. Klein concludes, 'Anxiety situations of this kind I have found to be at the bottom not only of depression, but of all inhibitions of work' (Klein, 1975, vol. 1, p. 270).
According to this account of primitive functioning, there is no neutral experience, no conflict-free sphere of the ego (beloved of the ego psychologists). The primitive is omnipresent and never transcended. Moreover, I think that, with some equivocation, Kleinian analysts have come to take full responsibility for the implications of the term hallucination which Riviere took from Freud in the above quotation. Klein described schizoid mechanisms as follows: 'in the baby's development in the first year of life characteristically... the infant suffered from states of mind that were in all their essentials equivalent to the adult psychoses, taken as regressive states in Freud's sense' (Meltzer, 1978, part 3, p. 22). Klein says in the third paragraph of perhaps her most famous paper, 'Notes on Some Schizoid Mechanisms', 'In early infancy anxieties characteristic of psychosis arise which drive the ego to develop specific defence-mechanisms. In this period the fixation-points for all psychotic disorders are to be found. This has led some people to believe that I regard all infants as psychotic; but I have already dealt sufficiently with this misunderstanding on other occasions' (Klein, 1975, vol. 3, p. 1). Klein's views on these matters are based on Freud and Karl Abraham's notions of oral libido and fantasies of cannibalism (Gedo, 1986, p. 94). She refers to sadistic impulses against the mother's breast and inside her body, wanting to scoop out, devour, cut to pieces, poison and destroy by every means sadism suggests (Klein, 1975, vol. 1, p. 262). Once again, the projective and introjective mechanisms of the first months and year give rise to anxiety situations and defences against them, 'the content of which is comparable to that of the psychoses in adults' (ibid.). Meltzer comments that 'Although she denied that this was tantamount to saying that babies are psychotic, it is difficult to see how this implication could be escaped' (Meltzer, 1978, part 3, p. 22).
Kleinian thinking evolved in three stages. As in the above quotation, Klein saw schizoid mechanisms and the paranoid-schizoid position as fixation points, respectively, for schizophrenia and manic-depressive psychosis. Then the paranoid-schizoid and depressive positions became developmental stages. Her terminology included 'psychotic phases, 'psychotic positions' and then 'positions' (Klein, 1975, vol. 1, pp. 275n-276n, 279). Thirdly, in the work of Bion and other post-Kleinians, these became economic principles and part of the moment-to-moment vicissitudes of everyday life. The notations 'ps' and 'd' were connected with a double-headed arrow to indicate how easily and frequently our inner states oscillate from the one to the other and back again (Meltzer, 1978, part 3, p. 22). In Bion's writings on schizophrenia an ambiguity remained as to whether or not the psychotic part of the personality is ubiquitous or only present in schizophrenics, but Meltzer concludes his exposition of Bion's schizophrenia papers by referring to the existence of these phenomena in patients of every degree of disturbance, even 'healthy' candidates (p. 28). Going further, he and colleagues have drawn on the inner world of autistic patients to illuminate the norm; Frances Tustin has essayed on autistic phenomena in neurotic patients, while Sydney Klein has described 'autistic cysts' in neurotic patients.
The psychotic processes characterise the inner world. The role of unconscious phantasy extends from the first to the most abstract thought. The infant's first thought of the existence of the external world comes from sadistic attacks on the mother's body (Klein, 1975, vol. 1, p. 276; vol. 3, p. 5). 'Phantasies - becoming more elaborate and referring to a wider variety of objects and situations - continue throughout development and accompany all activities; they never stop playing a great part in mental life. The influence of unconscious phantasy on art, on scientific work, and on the activities of everyday life cannot be overrated' (Klein, 1975, vol. 3, p. 251; cf. p. 262). These anxieties are not only ubiquitous: they interact in complicated ways. As Riviere points out, 'It is impossible to do any justice here to the complexity and variety of the anxiety-situations and the defences against them dominating the psyche during these early years. The factors involved are so numerous and the combinations and interchanges so variable. The internal objects are employed against external, and external against internal, both for satisfaction and for security; desire is employed against hate and destructiveness; omnipotence against impotence, and even impotence (dependence) against destructive omnipotence; phantasy against reality and reality against phantasy. Moreover, hate and destruction are employed as measures to avert the dangers of desire and even of love. Gradually a progressive development takes place... by means of the interplay of these and other factors, and of them with external influences, out of which the child's ego, his object-relations, his sexual development, his super-ego, his character and capacities are formed' (Riviere, 1952, pp. 59-60).
I want to emphasise that these are quite general claims about human nature and set preconditions in unconscious functioning for all thought. This general function is repeated in Susan Isaacs' definition. The '"mental expression" of instinct is the unconscious phantasy... There is no impulse, no instinctual urge or response which is not experienced as unconscious phantasy' (Isaacs, 1952, p. 83). The first mental processes... are to be regarded as the earliest beginnings of phantasies. In the mental development of the infant, however, phantasy soon becomes also a means of defence against anxieties, a means of inhibiting and controlling instinctual urges and an expression of reparative wishes as well... All impulses, all feelings, all modes of defence are experienced in phantasies which give them mental life and show their direction and purpose' (ibid.).
From that point, Kleinians went on to propose elements of a general psychology, including the claim that there is 'an unconscious phantasy behind every thought and every act' (Riviere, 1952, p. 16). That is, the mental expression of primitive processes 'is unconscious phantasy' (ibid.). It is not only a background hum, as it were. Isaacs claims that 'Reality thinking cannot operate without concurrent and supporting unconscious phantasies' (Isaacs, 1952, p. 109). And again: 'phantasies are the primary content of unconscious mental processes' (pp. 82, 112). 'There is no impulse, no instinctual urge or response which is not experienced as unconscious phantasy' (p. 83). 'Phantasies have both psychic and bodily effects, e.g., in conversion symptoms, bodily qualities, character and personality, neurotic symptoms inhibitions and sublimations' (p. 112). They even determine the minutiae of body language (p. 100). The role of unconscious phantasy extends from the first to the most abstract thought. The infant's first thought of the existence of the external world comes from sadistic attacks on the mother's body (Klein, 1975, vol. 1, p. 276; vol. 3, p. 5). 'Phantasies becoming more elaborate and referring to a wider variety of objects and situations continue throughout development and accompany all activities; they never stop playing a great part in mental life. The influence of unconscious phantasy on art, on scientific work, and on the activities of everyday life cannot be overrated' (Klein, 1975, vol. 3, p. 251; cf. p. 262. I have considered the role of the psychotic elsewhere and have drawn on other writings of mine in the above account: 1994, ch. 5, 1994a, 1995).
I turn now to the second basic element or fundamental particle of human nature: projective identification. This is the concept from Kleinian psychoanalysis which has attracted the most interest and enthusiasm among analysts of other persuasions. It is also a concept the definition of which is least settled, largely because North Americans seem to want to restrict it to two-person interactions, while the British claim that you can be in projective identification with another part of your own mind or a person with whom you are not physically in interpersonal contact. What I want to say about it is not dependent on sorting this matter out (see discussion in Young, 1994, ch. 7, on which I have drawn here). The essence of projective identification is that it is an unconscious process whereby one splits off and projects unwanted or taboo parts of ones own mind into another (or another part of ones own mind) and elicits a reprojection hooked and reeled in, as it were, from the repertoire or manifold or plenum of the potential responses of the object. There is a large literature on this mechanism, and large claims are made for it, for example, that it is the basis of all normal communication as well as for empathy (Torras de Beà, 1989, p. 266), love, leadership, group identity and in virulent forms for racism and virulent nationalism (Young, 1994, ch. 6).
In the key passage where she named this mechanism, she referred to it as the prototype for all aggressive object relations, i.e., the basis for human destructiveness. Klein concludes seven pages on the fine texture of early paranoid and schizoid mechanisms as follows: 'So far, in dealing with persecutory fear, I have singled out the oral element. However, while the oral libido still has the lead, libidinal and aggressive impulses and phantasies from other sources come to the fore and lead to a confluence or oral, urethral and anal desires, both libidinal and aggressive. Also the attacks on the mother's breast develop into attacks of a similar nature on her body, which comes to be felt as it were as an extension of the breast, even before the mother is conceived of as a complete person. The phantasied onslaughts on the mother follow two main lines: one is the predominantly oral impulse to suck dry, bite up, scoop out and rob the mother's body of its good contents... The other line of attack derives from the anal and urethral impulses and implies expelling dangerous substances (excrements) out of the self and into the mother. Together with these harmful excrements, expelled in hatred, split-off parts of the ego are also projected onto the mother or, as I would rather call it, into the mother. These excrements and bad parts of the self are meant not only to injure but also to control and to take possession of the object. In so far as the mother comes to contain the bad parts of the self, she is not felt to be a separate individual but is felt to be the bad self.
'Much of the hatred against parts of the self is now directed towards the mother. This leads to a particular form of identification which establishes the prototype of an aggressive object-relation' (Klein, 1946, in Klein, 1988, pp. 7-8). I say again that we have here the model - the template, the fundamental experience - of all of the aggressive features of human relations. Six years later Klein adds the following sentence: 'I suggest for these processes the term "projective identification"' (ibid.).
She goes on to say that if the infant's impulse is to harm, the mother is experienced as persecuting, that in psychotic disorders the identification of the object with hated parts of the self 'contributes to the intensity of the hatred directed against other people', that this process weakens the ego, that good parts are also projected and that 'The processes of splitting off parts of the self and projecting them into objects are thus of vital importance for normal development as well as for normal object-relations' (pp. 8-9). In the course of all this, Klein makes it quite clear that the very same processes involve 'anxieties characteristic of psychosis' (p. 2). I am relating these matters in the way that I am in order to make it apparent once again that the very same mechanisms are at work in a wide range of internal processes.
Thomas Ogden presents the ideas of Harold Searles, Robert Langs, A. Malin and James Grotstein and describes projective identification as the essence of the therapeutic relationship. Therapy is said to consist of dealing with it. It is the basic unit of study of the therapeutic interaction (Ogden, 1979, p. 366). He also tells us that Bion 'views projective identification as the most important form of interaction between the patient and therapist in individual therapy, as well as in groups of all types' (p. 365). In his paper on 'Attacks on Linking', Bion confirms this general use of the concept: 'Thus the link between patient and analyst, or infant and breast, is the mechanism of projective identification' (Bion, 1967, p. 106). Hinshelwood says that for Bion it became 'the basic building block for generating thoughts out of experiences and perceptions' (Hinshelwood, 1991, pp. 189-90). At this same level of generality Segal has described projective identification as 'the earliest form of empathy' and 'the basis of the earliest form of symbol-formation' (Segal, 1973, p. 36). Looking to later developments and more broadly, Hinshelwood describes Bion's notion of 'container-contained' as 'an attempt to raise the concept of projective identification to a general theory of human functioning of the relations between people, and between groups; of the relationships between internal objects; and of the relationships in the symbolic world between thoughts, ideas, theories, experiences, etc.' (p. 191).
These claims for the role of the concept of projective identification in human nature are very exciting, uplifting, constructive. Yet this same mechanism is seen to be operative at the heart of autism by Meltzer and his co-workers. He also describes it as 'the mechanism of narcissistic identification... and the basis of hypochondria, confusional states, claustrophobia, paranoia, psychotic depression and perhaps some psychosomatic disorders' (Meltzer et al., 1975, p. 228), as well as the sovereign defence against separation anxiety (Grinberg, 1990, p. 64). Relinquishment of excessive projective identification is described as the precondition of achieving a fully-dimensional inner world. (Meltzer et al., 1975, pp. 226-7). As he says in his essay on 'The Relation of Anal Masturbation to Projective Identification', 'The feeling of fraudulence as an adult person, the sexual impotence or pseudo-potency (excited by secret perverse phantasies), the inner loneliness and the basic confusion between good and bad, all create a life of tension and lack of satisfaction, bolstered, or rather compensated, only by the smugness and snobbery which are an inevitable accompaniment of the massive projective identification' (Meltzer, 1966, p. 104). Meltzer also describes it as central to the most social Darwinist forms of ambitious competitive, survivalist conformism, in his concept of 'the claustrum', in which patients use excessive projective identification a desperate defence against schizophrenic breakdown (Meltzer, 1992). Another Kleinian, Leslie Sohn, recalls that the original thoughts on projective identification in the British Psycho-Analytical Society conceived of it 'as a defence against intolerable envy and as an outcome of hatred of dependence' (Sandler, 1989, p. 190).
I now want to look both more broadly and more narrowly at projective identification. It can be seen as part of the wide network of fundamental developments in the history, philosophy and social studies of science and related subjects which I mentioned earlier and will consider again in chapters seven and eight. Positivist and empiricist epistemology is in full retreat. In its place is developing a way of thinking about what we know which is not based on the empiricist sequence, whereby we suffer sensations which lead to perceptions and then to ideas. Rather, experience is coming to be seen as constructed from the consequences of what we put forth into the world what we project (Haraway, 1989, 1991; Young, 1993). As I said earlier, truth is made, not found. Nature is not a given; it is a social construct. Similarly, human relations are the consequences of how we act toward others and what comes back.
In cybernetics this is called 'negative feedback' (Wiener, 1950). This is information theory's analogue to the psychoanalytic concept of reality testing. In learning theory, it is called an 'operant'. We modify our behaviour, depending on whether our spontaneous acts of foraging are rewarded or not. This is not passive conditioning from stimuli but 'operant conditioning' from the feedback from spontaneous acts (Atkinson et al., 1990, pp. 253-62). In the study of human physiology, research on postural control has indicated that we are constantly making subliminal adjustments, depending on the proprioceptive impulses which result from sensing our last movements. I have sketched these related developments to indicate analogies which I believe show that Klein's idea of projective identification is in good company. It is part of an epochal change in how we think about knowledge and about nature, human nature and human relations. These approaches are also in resonance with phenomenological and hermeneutic thinking in philosophy.
Under another name, one aspect of projective identification is a central feature of the cussedness of psychoanalysis. That name is countertransference, a concept whose history I have told elsewhere (Young, 1994, ch. 4). That history exactly parallels the waning of empiricist models and the rise of proactive or constructionist ones. For Freud, countertransference was a symptom of incomplete analysis, something to be got rid of. There was a transitional period from the late 1940s up to the mid-1960s where the message from key papers by Winnicott, Little, and Heimann was that it became something to be heeded. The unconscious resonances in the analyst to the patients material was important, since it was a projection of pathological object relations from the patient into the unconscious of the therapist. But in the present period, it has become clear that countertransference a special case of projective identification. is the basic form of communication. In the analytic relationship. This was presciently adumbrated in a pioneering paper by Harold Searles, written in 1949, but no one would publish it until 1979. Roger Money Kyrle also referred to normal counter-transference in 1955.
A recent paper by Irma Brenman Pick takes the normality of countertransference to its logical extreme, without a trace of seeing it as something to be got rid of. She carefully considers is as the basis of understanding throughout the session: 'Constant projecting by the patient into the analyst is the essence of analysis; every interpretation aims at a move from the paraniod-schizoid to the depressive position' (Brenman-Pick, 1985, p. 37). She makes great play of the tone, the mood and the resonances of the process: 'I think that the extent to which we succeed or fail in this task will be reflected not only in the words we choose, but in our voice and other demeanour in the act of giving an interpretation' (p. 41). Most importantly, she emphasises the power of the projections and what they evoke counterrtansferentially: 'I have been trying to show that the issue is not a simple one; the patient does not just project into an analyst, but instead patients are quite skilled at projecting into particular aspects of the analyst. Thus, I have tried to show, for example, that the patient projects into the analyst's wish to be a mother, the wish to be all-knowing or to deny unpleasant knowledge, into the analyst's instinctual sadism, or into his defences against it. And above all, he projects into the analyst's guilt, or into the analyst's internal objects.
'Thus, patients touch off in the analyst deep issues and anxieties related to the need to be loved and the fear of catastrophic consequences in the face of defects, i.e., primitive persecutory or superego anxiety' (p. 41). As I see it, the approach adopted by Brenman-Pick takes it as read and as normal that these powerful feelings are moving from patient to analyst and back again, through the processes of projection, evocation, reflection, interpretation and assimilation. These feelings are all normal, as it were, in the processes of analysis. More than that, as she puts it, they are the essence. And at the other end of the analysis lies the ability of the patient to take back the projections. This is an important criterion of improvement. Bearing projections is the whole basis of containment: the therapist can bear to take in and contain the projections, to hold them and give them back, in due course, in the form of accessible interpretations.
I am suggesting that countertransference is not only the basis for analytic work but as a special case of projective identification is an important exemplar of the basic process in all human communication and knowing. We only know what is happening because we are moved from within by what we have taken in and responded to from our own deep feelings. The space between people is filled when it is and to the extent it is by what we evoke in one another. But projective identification and countertransference are also consumately cussed, since they are unconscious processes, intimate, difficult of access, ineffable, truths constructed in intimate interaction, hard to bring into contact with the notions of experience and objectivity which are characteristic of experimental method and validation studies. Like psychotic anxieties and unconscious phantasy, they identify the essence of human nature as profoundly subjective and intersubjective. The fact that this makes them cussed from the point of view of positivist models of knowledge is a pity, but the gains in understanding human nature far outweigh the losses in positivist respectability.
My third and last fundamental feature or particle of human nature is likely to be more familiar to many. It is not a Kleinian idea. In fact, Donald Winnicott was banished from the court of Melanie Klein for having it. His most famous essay on Transitional Objects and Transitional Phenomena (1951; reprinted as ch. 1 of Winnicott, 1971) was written for inclusion in the book of essays which formed the position papers of the Kleinians in the wake of their Controversial Discussions with the Freudians in the 1940s. He would not alter it to suit her, so she withdrew the party whip from him. I suppose you all know what Winnicott had to say about teddy bears and Linus blankets that they are the first not-me, that they are in a transitional space which he beautifully described as neither subjective nor objective but partaking of both. I do not have the space here to spell out his idea or the role of the transitional in infant development (see Grolnick et al., 1978; Young, 1989, 1994, ch. 8). I want, instead to draw your attention to the violence his notion does to the subject-object and inner-outer dichotomies of traditional philosophy and psychology.
Winnicott makes claims as large as those I have reported for psychotic anxieties, primitive phantasies and projective identification. He refers to the transitional space as a third world, one which opens out from the teddy bear or whatever into play and becomes the whole cultural field. That is, he says that our experience of religion, literature, science and other forms of creativity is an expansion of a mental realm which is no respecter of the distinctions which lie at the heart of our traditional notions if both identity and knowledge.
Winnicott says that in addition to the inner world and external reality 'there is the third part of the life of a human being, a part that we cannot ignore, an intermediate area of experiencing, to which inner reality and external life both contribute. It is an area which is not challenged, because no claim is made on its behalf except that it shall exist as a resting-place for the individual engaged in the perpetual human task of keeping inner and outer reality separate yet inter-related' (1951, p. 230). 'This third area might turn out to be the cultural life of the individual' (1989, p. 57). But he means something more than the inner world, external reality and the commerce between them: 'But I think we really do find a third area, an area of living which corresponds to the infant's transitional phenomena and which actually derives from them. In so far as the infant has not achieved transitional phenomena I think the acceptance of symbols is deficient, and the cultural life is poverty-stricken' (ibid.).
Here is the heart of his account: 'There is a wide variation to be found in sequence of events which starts within the new-born infant's fist-in-mouth activities, and that leads eventually on to an attachment to a teddy, a doll or soft toy, or to a hard toy... I have introduced the terms "transitional object" and "transitional phenomena" for designation of the intermediate area of experience, between the thumb and teddy bear, between the oral erotism and true object relationship, between primary creative activity and projection of what has already been introjected, between primary unawareness of indebtedness and the acknowledgement of indebtedness ("Say: ta!")' (1951, pp. 229-30).
He then speaks about the development from playing with one's hands and lips to relating to part of a sheet, blanket or bit of cloth which is sucked or caressed. He continues, 'One may suppose that thinking, or fantasising, gets linked up with these functional experiences. 'All these things I am calling transitional phenomena. Also, out of all this (if we study any one infant) there may emerge some thing or some phenomenon perhaps a bundle of wool or the corner of a blanket or eiderdown, or a word or tune, or a mannerism, which becomes vitally important to the infant for use at the time of going to sleep, and is a defence against anxiety, especially anxiety of the depressive type. Perhaps some soft object or cot cover has been found and used by the infant, and this then becomes what I am calling a transitional object. This object goes on being important. The parents get to know its value and carry it round when travelling. The mother lets it get dirty and even smelly, knowing that by washing it she introduces a break in continuity in the infant's experience, a break that may destroy the meaning and value of the object to the infant.
'Patterns set in infancy may persist into childhood, so that the original soft object continues to be absolutely necessary at bed-time or at time of loneliness or when a depressed mood threatens. In health, however, there is a gradual extension of range of interest, and eventually the extended range is maintained, even when depressive anxiety is near. A need for a specific object or a behaviour pattern that started at a very early date may reappear at a later age when deprivation threatens' (p. 232).
The outcome of the child's relationship to this object is that 'Its fate is to be gradually allowed to be decathected, so that in the course of years it becomes not so much forgotten as relegated to limbo. By this I mean that in health the transitional object does not "go inside" nor does the feeling about it necessarily undergo repression. It is not forgotten and it is not mourned. It loses meaning, and this is because the transitional phenomena have become diffused, have become spread out over the whole intermediate territory between "inner psychic reality" and "the external world as perceived by two persons in common", that is to say, over the whole cultural field' (p. 233).
Winnicott adds, 'the term transitional object, according to my suggestion, gives room for the process of becoming able to accept difference and similarity. I think there is use for a term for the root of symbolism in time, a term that describes the infant's journey from the purely subjective to objectivity; and it seems to me that the transitional object (piece of blanket, etc.) is what we see of this journey of progress towards experiencing' (pp. 233-4).
In conclusion, he says, 'The transitional objects and transitional phenomena belong to the realm of illusion which is at the basis of the initiation of experience... This intermediate area of experience, unchallenged in respect of its belonging to inner or external (shared) reality, constitutes the greater part of the infant's experience and throughout life is retained in the intense experiencing that belongs to the arts and to religion and to imaginative living, and to creative scientific work' (p.242).
I hope that you are seeing the forest as well as the trees. I began by ruminating on the current cultural location of psychoanalysis as under fire and out of scientific fashion. I then told a story of my own odyssey, searching for scientific respectability and finding that a profound change is going on about what counts as knowledge as a result of important work in the history, philosophy and sociology of knowledge of science, as well as other trends in cultural studies. This change of intellectual climate makes it appropriate for psychoanalysis to be a great deal less on the defensive than it was in earlier decades. In the second half of my paper I addressed three aspects of psychoanalysis which I find exciting and moving and central to my current understanding of human nature and the human condition. (I should add parenthetically that each of them has aspects relevant to groups, institutions, societies and nations which I have considered elsewhere but could not fit into this account: Young, 1994.) In each case I took us to the key passage or locus classicus where the concept was expressed. All of them fly in the face of received notions of science and epistemology, which is why they are cussed. But I find them all sobering and hopeful in that they help me to see into the human heart and to understand how and why we are so flawed and distressed and hard to reach and to help. I think the ideology of modern science is Promethian and triumphalist while the ideas I have canvassed today are more of a mixed bag, each sad in its way, and remind one more of Sisyphus and of the Stoics, returning again and again to the same task but without losing hope.
(Place of publication is London unless otherwise specified.)
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______ (1978) The Kleinian Development Part I: Freuds Clinical Development; Part II: Richard Week-by-Week; Part III: The Clinical Significance of the Work of Bion. Strath Tay: Clunie.
______ (1991) Lecture on Projective Identification and the Claustrum (tape).
______ (1992) The Claustrum: An Investigation of Claustrophobic Phenomena. Strath Tay: Clunie.
______ et al. (1975) Explorations in Autism: A Psycho-Analytical Study. Strath Tay: Clunie.
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______(1958) 'Self-stimulation and the Brain', Science 17:315-23.
______(1977) Drives and Reinforcements: Behavioral Studies of Hypothalamic Functions. N. Y.: Raven.
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Postle, Denis and Young, R. M. (1981) Behaving Ourselves, television film, Central Television to Channel 4.
Pribram, Karl H. (1959) On the Neurology of Thinking, Behav. Sci. 4: 265-87.
______ (1962) The Neuropsychology of Sigmund Freud, A. J. Bachrach, ed., Experimental Foundations of Clinical Psychology. N. Y.: Basic, pp. 442-68.
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______ (1967) The Collected Papers of David Rapaport. N. Y.: Basic Books.
______ and Gill, Merton M. (1959) 'The Points of View and Assumptions of Metapsychology', Int.. J. Psycho-Anal. 40: 1-10.
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Riviere, Joan (1952) 'General Introduction', in Klein et al. (1952), pp. 1-36.
______ (1952a) 'On the Genesis of Psychical Conflict in Early Infancy', in Klein et al. (1952), pp. 37-66.
Rorty, Richard (1980) Philosophy and the Mirror of Nature.. Oxford: Blackwell.
______ (1982) Consequences of Pragmatism (Essays: 1972-80). Minneapolis: University of Minnesota Press.
______ (1989) Contingency, Irony, and Solidarity. Cambridge University Press.
Sandler, Joseph, ed. (1989) Projection, Identification, Projective Identification. Karnac Books.
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Siegel, Bernie (1986) Love, Medicine and Miracles. Rider; reprinted Arrow, 1988.
______ (1990) Peace. Love and Healing. Rider; reprinted Arrow, 1991.
______ (1993) Living, Loving and Healing: A Guide to a Fuller Life, More Love and Greater Health. Aquarian.
Smith, Wilbur K. (1945) The Functional Significance of the Rostral Cingular Cortex as Revealed by Its Responses to Electrical Excitation, J. Neurophysiol. 8: 241-55.
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Weldon, Fay (1994) Affliction. Harper Collins
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Winnicott, Donald W. (1951) Transitional Objects and Transitional Phenomena, in Winnicott (1975), pp. 229-242.
______ (1971) Playing and Reality. Tavistock Publications; reprinted Penguin, 1971.
______ (1975) Through Paediatrics to Psycho-Analysis. Hogarth.
______ (1989) The Fate of the Transitional Object, in Psycho-Analytic Explorations. Karnac, pp. 53-8.
Young, Robert. M. (1960) Freud and Psychoanalysis in Physiological Perspective: A Study of Some of the Historical and Philosophical Aspects of the Mind-Body Problem from the Viewpoint of Psychoanalytic Metapsychology, term paper submitted for Second Year Psychiatry, University of Rochester School of Medicine and Dentistry.
______ (1968) The Functions of the Brain: Gall to Ferrier (1808-1886), Isis. 59: 251-68.
______ (1970) Mind, Brain and Adaptation in the Nineteenth Century : Cerebral Localization and Its Biological Context from Gall to Ferrier. Clarendon Press; reprinted Oxford University Press, 1990.
______ (1979) Review of E. O. Wilson, On Human Nature, Rad. Sci. J. no. 9: 126-27.
______ (1981) 'The Naturalization of Value Systems in the Human Sciences', in Problems in the Biological and Human Sciences, Milton Keynes: Open University Press, pp. 63-110.
______(1985) Darwin's Metaphor: Nature's Place in Victorian Culture. Cambridge University Press.
______ (1986) Sigmund Freud: Scientist and/or Humanist, Free Assns. no. 6: 7-35.
______ (1989) 'Transitional Phenomena: Production and Consumption', in B. Richards, ed., Crises of the Self: Further Essays on Psychoanalysis and Politics. Free Association Books, pp. 57-74.
______ (1989a) The Role of Psychoanalysis and Psychotherapy in the Human Sciences, paper presented to Zangwill Club, Department of Experimental Psychology, University of Cambridge.
______ (1992) 'The Vicissitudes of Transference and Countertransference: The Work of Harold Searles', J. Arbours Association, 9: 24-58.
______ (1993) Darwin's Metaphor and the Philosophy of Science, Sci. as Culture (no. 16) 3: 375-403.
______ (1994) Mental Space. Process Press.
______ (1994a) Across the Borderline, keynote address, conference on Psychosis: Treatment of Choice?, University of Essex, 1994.
______ (1995) The Ubiquity of Psychotic Anxieties, in J. Ellwood, ed. Psychosis: Treatment of Choice? Jessica Kingsley.
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