PSYCHODYNAMICS THERAPY AND HOLISM

In this blog, I wish to show that although Freud never expressed it, the analytic programme which he developed when he set up practice as a physician in 1886 and created Psychoanalysis in 1896 is holistic. The programme was a gradual, but radical departure from the established physicalism of the medical opinion of his student days.

The blog is in three sections. In the first, I sketch out an account of holism that has affinity with psychodynamics therapy. In the second section, I give a brief account of the physicalist physiology in medicine when Freud started his analytic programme. Section three gives a brief synopsis of the holistic connotations of Freud’s analytic programme. This blog can be understood in relation to the notion of illness as a holistic concept.

• Holism

• The Physicalist Programme Before Freud

• Synopsis of Freud’s Analytic Programme

HOLISM

Holism is a compound of many theories ranging over issues on the logic of psychological explanations such as in the theories of analytic therapy, issues of fluidism and animism in hypnosis, systems theory in psychotherapy, the doctrine of emergent evolution (also known as organicism, issues in methodological individualism in the social sciences.

I am concerned here to sketch out the holism in the theories which have affinity with psychodynamics. This can be expressed as follows.

1. The mechanical approaches of the physico-chemical sciences are inadequate for explanations relating to biological organisms or to society.

2. The parts of an organic whole are dynamically interrelated or interdependent, thus a part cannot be understood in isolation from the whole.

The holism which is a hybrid of (1) and (2) above is the holism which has emphasis on the individual as a whole being with multi-faceted dimensions which should not be considered separately but in entirety as enhancing the individual’s wholeness. Within this holism a person is, as a whole, comprised of dimensions of mind and body that introact (acting within, internally, in the same organism), his mind and body being holistic organs of his personality.

This holism recognises that all disorders are psychosomatic in the sense that their aetiology necessarily involve both mind and body and it recognises that these disorders originate from the disturbances in the multi-faceted dimensions of the individual, including the social factors, physical and psychological stress, and the inability of the individual to adapt adequately to pressures and to the environment in which he lives.

Thus, illness can be seen as a holistic concept, as part of an adaptive response to a disturbance of the unified functioning of the various dimensions of the whole rather than the malfunction of a physical system. Plato was aware of this form of holism when he remarked that many maladies evaded the physicians of Greece because they tended to isolate the mind from the body and neglected the treatment of the whole on which they ought to concentrate (Plato, Charmides 156-157).

The holism which I sketch out here is psychodynamics orientated and deals with the individual and the interpersonal relations which combine to make up his personality. It is, therefore, a personality theory in the form of Freud’s Structural Theory which I have designated elsewhere (Maurice-Nneke 2022, 2013, 2003) as The Structure of Personality because it is a multi-aspect theory of personality and consciousness. It is far removed from the double aspect theory of Baruch Spinoza (1632-1677). I shall give more account of Freud’s structural theory as the structure of personality in section three below.

The double aspect theory of Spinoza is often confused with his theory of psychophysical parallelism. Both theories are, in a sense, isomorphous as they both advocate the occurrence of mental and bodily events but they, nevertheless, have their distinguishing traits. The double aspect theory functions primarily as an identity hypothesis as it posits the fundamental underlying identity between neural events and conscious events. In contrast, however, psychophysical parallelism claims that for every conscious event there is a corresponding or a parallel brain event and it is, on this account, not an identity hypothesis.

Both Baruch Spinoza and Gottfried Leibniz (1646-1716) endorsed holistic views. Their metaphysics embrace the idea that to understand the outward confusion of phenomenal events these must be conceived in terms of the universe as a whole. Aristotle expresses holistic views in his concern to characterise the part-whole relationship (Aristotle, Politicus) in detail. Gestalt psychologists have taken his views as anticipation of their work.

However, the holism which I sketch out here is developed from the principle of hypostasis as the fundamental reality behind human existence. This principle is that mind and body are so united in a person that we cannot conceive of a person either without a mind or without a body. The slight equivocation occasioned in the corrupt usage of the word ‘body’ as in ‘dead body’ should not mislead anyone into citing ‘dead body’ as an example of a body without a mind just in case the person has forgotten that a dead body is rightly called a corpse. A corpse is not a person.

The central focus of the holism as I sketch it out here is on the whole person including his life situations, his relationships, and all the factors that make up his personality: his emotional, psychological, physical, intellectual, and social dimensions. The holistic approach takes a broader view of a person and sees his physical, mental, and emotional states as related with each other and with the environment in which he lives. An individual is considered in his physical, and psychological dimensions in order to gain as much understanding as possible about his relationships within his total environment. This environmental consideration includes his family, job situations, living conditions, and his childhood background which has helped to form his character in the here and now.

It is clear from the forgoing that the general principle of psychodynamics therapy is quite clearly an appreciation of a holistic principle of health. Whenever a psychodynamics analyst takes time and care to include as part of his anamnestic investigation, inquiry into the muti-faceted dimensions of his clients, he is practising holistic therapy. Every part of an individual’s multi-faceted dimensions is a transformational process which partakes in the transformation of psychical ideas into visual images or into the development of psychoneurosis.

However, although there is strong evidence to show that Freud’s programme was a gradual but radical departure from the established physicalism of the mechanical medicine that was in general practice when he began work as a physician, there is no evidence to suggest that Freud was developing a holistic theory at the beginning of his practice. Nevertheless, after his separation from Josef Breuer, he became very experienced and more independent in his work.

From then onwards he chose the path to follow and his own description of what he was doing show his programme as holistic. He began to give both practical and theoretical application to the structural point of view in a holistic way. The process and procedure for the explanation of symptoms and the interpretation of dreams became more inclusive rather than isolationist. Compare his interpretation of his dream of Irma’s Injection (Freud 1900) and Alan Hobson’s description of his activation synthesis theory of dream and his dream of Mozart at the Museum (Hobson 1990)

 

2.THE PHYSICALIST PROGRAMME BEFORE FREUD

Today modern medicine has totally adopted a mechanistic view of its practice and has tended to regard the individual as a machine with interchangeable parts which could be removed, repaired, or artificially reconstructed. It seems that in opting for the scientific role of physiological research, medicine is abdicating its traditional role of medical care. Thus, it is left with psychodynamics therapy to offer the traditional care and empathy which is required by individuals needing treatment.

The mechanical approach to medicine has a long history as evidenced by Plato’s observation which I mention earlier in section one above. However, the current wave in medical physicalism has its roots in Rene Descartes (1596-1650). With Descartes’ separation of mind and body, his various laws of motion which were particularly appealing to Sir Isaac Newton, and his treatise of physiology (Descartes, 1644), came the idea in physiology and in medicine that medicine could be practised along the lines of physics. The medical group, the iatrophysicists, seeing a rich clinical harvest of bodily disorders to be ripped up through solid pathology quickly allied themselves to Descartes and held that mechanical principles were the basis of all bodily disorders and functions.

The iatrophysicists were mechanists, in Newtonian sense, who seeing the body through a Cartesian lens, regarded it as a machine with interchangeable parts and believed that the key to understanding disease and illness lies in the full understanding of the body. With the iatrophysicists, solid pathology replaced the humoral theory of pathology which predominated in medicine during the days of Hippocrates (c460BC-c375BC) and Galen (c130 AD-c210AD).

When the Cartesian programme is understood in the light of Descartes’ physicalist physiology it can be seen why the physicalist biomedical approach to illness leaves no room for the appreciation of the relevance of mental, social, and environmental factors in the aetiology and development of an illness.

This was the position when Freud began his medical practice. His teacher, Ernst von Brucker from whom Freud derived the scientific philosophy that governed his work was an exponent of the philosophy of the famous Helmholtz School of Medicine. The school’s founder, Hermann von Helmholtz, was a great exponent of the ideas of the iatrophysicists. He justified his mechanistic ontology of particles and forces acting at a distance by appealing to Immanuel Kant’s metaphysics of nature, seeking to demonstrate that nature conforms to the laws of Newtonian physics (Harman, 1982). Brucke, on the other hand, published his lecture notes in 1874 as Lectures in Physiology (Bernfeld, 1949).

Essentially, Brucke taught that physiology is the science of all organism including man. Organisms differ from machines in possessing faculty of assimilation but they are all, nevertheless, phenomena of the physical world, system of atoms, moved by forces, according to the principle of the conservation of energy formulated by Hermann Helmholtz. Freud’s Principle of Constancy which I have designated as Psychodynamics Law (Maurice-Nneke 2022, 2013, 2003) is derived from Helmholtz’s principle of the conservation of energy.

The denial of perpetual motion was fundamental to Helmholtz’s commitment to the principle of the constancy of force (Harman, 1982 PP111-112). The sum of the total forces, motive forces and potential forces, remains constant in every isolated system. The less we know about these forces, the more kinds of them we distinguish such as mechanical forces, magnetic forces, light forces, heat forces, whereas progress in our knowledge reduces these forces into two, namely, attraction and repulson (Bernfeld, 1949). This is clearly in accordance with Helmholtz’s assumption that natural phenomena were reducible to central forces of attraction and repulsion.

As I mentioned in my blog, last month, on Psychodynamics and Hypnosis, there was a great dispute within the field of hypnosis and medicine, in the late 1880s and early 1990s. The dispute was between the Paris School of Hypnosis at Salpetriere led by Jean-Martin Charcot (1825-1893) and Joseph Babinski (1857-1932), and the Nancy School of Hypnosis led by Hippolyte-Marie Bernheim (1840-1919) and Ambroise-August Liebeault (1824-1904).

This dispute was over the physiological and psychological perspectives in medicine. It was, indeed, the same Cartesian controversy which I mentioned above, about the distinction of mind and body or the mental and physical. The dispute is rightly seen as a continuation of the old quarrel between the fluidists who insisted upon the physical elements in hypnotic phenomena and the animists who held that imagination was the essential factor (Chertok, 1967).

There is evidence that the dispute influenced Freud’s dissatisfaction with hypnosis much more than his publicised failure in the technique. He was torn between his intellectual allegiance to Charcot and Bernheim both of whom had taught him different ways in the use of hypnosis in therapy. His intellectual conviction favoured the psychological viewpoint of the Nancy School. Freud provided the German translation of two of Bernheim’s books on hypnosis and psychotherapy and these German translations were published between 1888 and 1892, indeed, during the period of the hypnotic dispute.

Many theorists who took sides with Charcot and Babinski felt, erroneously, that the way to make hypnosis respectable and scientific was through a description of its nature in quasi neurophysiological language. The essential element of Theodore Barber’s polemic on hypnosis (Barber, 1969) is a resurrection of the old dispute. I think that a conscientious psychodynamics practitioner who really considers what is actually involved in hypnosis may come to realize that the positions in the dispute can be reconciled along holistic lines.

3. SYNOPSIS OF FREUD’S ANALYTIC PROGRAMME

When Freud began his analytic programme the influences of the Helmholtz School of Physiology derived from Brucke’s teachings were clearly visible in his work. His earliest theories were couched in the physicalist language of his neurophysiological background but his theories, in their explanatory content, were contextually holistic. From the moment that his collaboration with Josef Breuer ended, he began to depart from the overt mechanism of his peers and proceeded to present a holistic account of the individual, trying to account for the whole organism: man, consisting of his body, brain, brain cells, environmental situations and potentials of physical energy between them tending to a final equalisation.

For him human needs, emotions, sleep, wakeful purposive behaviour, are all thought of as definite energy situations, determined by the amount and direction of potential, and by the systems between which the potentials exist. For example, perceptions are connected within the brain, hunger, sexuality and similar needs with a potential between body and brain. The behaviour of the individual, external and internal, direct and symbolic, conscious and unconscious is in the last analysis directed by the, macro, need to remove in appropriate ways the, micro, accumulation of energy produced by the metabolism of brain cells. For him, then, all behaviour is carried out with energies available by the potentials thus created. If appropriate actions do not exist or if they are inhibited the individual will have to invent substitutes or have recourse to improper ones, which may well have the character abnormalities especially of neurotic symptoms (Bernfeld, 1944).

The initial problem which Freud set out to solve was how to deal with the baffling question of the relationship of the biological-physiological level of observation to the psychological level. His teachers thought that physicalism provided the answer but Freud’s goal was to develop a system of explanation, through his understanding of psychopathology, whereby this baffling question is resolved and the two observational levels of biological-physiological versus psychological are united into a whole. Freud puzzled over the baffling question and complained in a letter to his friend Wilhelm Fliess (Freud, 1954) about his difficulty in fitting the psychological together with the organic.

Earlier he had thought, unwittingly, that the path leading to the achievement of his goal of the unification of the organic and the psychological was through psychophysical parallelism. His work in this field (Freud, 1891) is a rejection of physicalism for in stating the parallelism of the mental and the physical he is clearly saying that the mental is not physical and the physical is not mental. Psychophysical parallelism is not a holistic doctrine. Nevertheless, in this work in which Freud accepts the ideas of the neurologist, John Hughlings Jackson (1835-1911), he expresses two important ideas of his own which, though he never described as holistic, can be given holistic interpretations in their contextual sense.

The first idea argues for the unity of mind and brain along the lines of the hypostatic union which I argued for in section one above. He says that there was no evidence of psychical processes occurring apart from physiological ones; that is, that no mind could exist without a brain. Since, by hypostasis, no brain can exist without a body this indicates an existential unity of mind and body. The second idea, though less holistic, asserts the precedence or priority of physiological processes over psychological ones; that is, that data arriving to the mind, whether from the outer world through the sense organs or from the body through chemical stimuli, must begin as physical excitations (Jones, 1953).

Later, he began to reject many of his early ideas but he never truly arrived at what seemed to him to be a final solution of the baffling question and never arrived at a complete explanation. He became content to formulate complex and intricately interrelated ideas, abandon, revise and modify them as clinical observation falsifies them. He was generally opposed to a preoccupation with consistency. Thus, his critics take pleasure in discovering Freudian inconsistencies with ease.

However, Freud preferred his own fragmentary style in treating a topic, that is, fragmentary in a way that leaves room for further exploration of the topic, rather than an early closure that forestalls further work on the topic. He argues that there is no incongruity in analytic theories if the concepts lack clarity and if the postulates are provisional since by being incomplete this leaves the job of precise definition for future work (Freud, 1923).

Freud’s many theories are the result of his life long unwavering attempts at various explanations of the operation of the mind. He stated that the mind could be looked at from four viewpoints as follows.

There is the Topographical Viewpoint, also known as the topographical theory or the topographical model of the mind. This introduces the tripartite concepts of the conscious, preconscious, and unconscious aspects of the mind. I have designated the topographical theory as The Quality of Consciousness (Maurice-Nneke 2022, 2013, 2003). Although some amateur psychologists, and some uninitiated commentators today continue to use the term subconscious, Freud rejected this term as incorrect and misleading more than 100 years ago.

He rejected the term subconscious in The Unconscious (Freud 1915), The Interpretation of Dreams (Freud, 1900). He alluded to the incorrect and misleading term in lecture 19 of The Introductory Lectures on Psychoanalysis (Freud, 1916-1917). He gave his reasons for rejecting the term as incorrect and misleading in The Question of Lay Analysis (Freud, 1926). He had used the term in his French papers on hysterical paralysis (Freud 1893) and in his work with Josef Breuer, Studies in Hysteria (Breuer and Freud 1895).

There is, also, the Economic Viewpoint which is also, known as the Economic theory, or Economic model of the mind. This deals with the primary and secondary mental processes which are dominated by the pleasure principle and the reality principle.

There is the Dynamic Viewpoint which is also known as the Dynamic theory, or the Dynamic model of the mind. This deals with mental processes in relation to the theory of neurosis.

Another viewpoint upon which the mind could be looked at is the Structural Viewpoint. This is also known as the Structural theory, or the Structural model of the mind. It introduces his tripartite segments of the mind, the id, the ego, and the super-ego. I have designated the structural theory as of The Structure Personality (Maurice-Nneke 2022, 2013, 2003). I believe that the Structure of Personality is a symbol of holistic connectedness in its intrinsic wholeness.

In addition to the four viewpoints above, Freud implied the adaptive and genetic viewpoints and took these for granted in his programme. It was in his attempt to fuse the dynamic and the genetic viewpoints that he was able to deal with the mind wholly in psychological terms. He did this first in the 7^th chapter of The Interpretation of Dreams (Freud,1900) which gave full account of the working of the unconscious without using neurophysiological language.

The structural viewpoint gives a truly holistic picture of personality, accounting for the multi-faceted dimensions of the individual, his mind and body, interpersonal relations, and his cultural and social developments, in the way that I have sketched here in section one above. Proof that the structural viewpoint is holistic can be found in Freud’s assertion that “I perceived ever more clearly that the events of human history, the interactions between human nature, cultural development and the precipitates of primaeval experiences…are no more than a reflection of the dynamic conflicts between the ego, the id, and the super-ego, which psychoanalysis studies in the individual – are the very same processes repeated upon a wider stage” (Freud, 1935).

With the growth of knowledge of clinical data, the structural viewpoint enabled Freud to describe, in micro and macro terms, internal processes as viewed from clinical data. His explanation of this is that, “I have set about the task of dissecting our mental apparatus on the basis of analytic view of pathological facts and have divided it into an ego, an id, and a super-ego” (Freud, 1935 P109).

Thus, on the structural viewpoint human personality is seen as a structural system with tripartite segments of the individual’s multi-faceted dimensions and mental and physical life involve a continuous introaction (action within) in the structure among those segments. This system of holistic introaction would be better understood by considering that within the Cartesian programme interactionism is particularly relevant as it refers to the function of two states that are entirely separate. In the holism that I sketch out here, the two states are for ever united by hypostasis and perpetually introact in harmony for the individual’s well-being, health and wellness.

Now, when Freud began to give a holistic account of analytic treatment, accounting for the unified effect of the mental and the physical in the aetiology of illness and disease processes his, then, revolutionary ideas were less welcomed by practitioners at the time. Later, the intellectual responses to his psychosomatic ideas of illness tended to be bipolar: theorists either take the podium as uncritical apologists or they perch on the intellectual scaffold as ignorant objectors, seeking to evaluate those theories on the lines of the programme of mechanical medicine within which background Freud commenced his analytic programme as a way of breaking free from orthodox mechanistic practices in medicine.

Today, if we consider the structural theory of psychodynamics along holistic lines, evidence for their consistency can be found in the new physics of Albert Einstein as opposed to the classical physics of Isaac Newton. This is because recent researches in atomic and subatomic physics have brought the realisation that the constituents of matter and the basic phenomena involving them are all interrelated; that they cannot be understood as isolated entities but only as integral parts of a unified whole (Capra, 1975).

The holistic structure of personality shows such interconnections and interconnectedness, that is to say, that the structure of personality is the combination of the harmonious introation of the id, the ego, and the super-ego; that a conflict or an imbalance in their harmony leads to illness. That harmony and peace of mind are among the hopes of psychodynamics therapy is shown by Freud’s letter to ANON who was worried about her son’s homosexual tendencies. Freud says to her as follows. “What analysis can do for your son runs in a different line. If he is unhappy, neurotic, torn by conflicts, inhibited in his social life, analysis may bring him harmony, peace of mind, full efficiency, whether he remains homosexual or gets changed” (Freud, E.L.1970).

The holistic connections of psychodynamics therapy which I have sketched out in this blog are consistent with certain of Albert Einstein’s theory, for instance, with its insistence that it is the behaviour patterns of the subatomic particles which constitute the true reality. Einstein’s letter to Freud on the occasion of Freud’s 80^th birthday (Freud, E.L. 1970 letter 283) seems to suggest that he saw some connection between his work and Freud’s work or, at least, something of which he approves in Freud’s work.

Modern physics regards the whole of matter as being composed of a gigantic web of energy relations, interconnections and interactions. Applied to human beings this means that a person’s reality lies in the interconnections and introactions of cells and organs within his body, his mind and mental faculties, and his own interactions and interconnections with other people, things, and events in the environment around him. Such relations are described in the structural viewpoint which presents a holistic theory of personality with its tripartite segments of the ego, the id, and the super-ego.

There is strong evidence to show that psychodynamics theory and therapy are holistic. Freud’s theory and methodology of practice are all about the whole person. For example, an explanation of the psychodynamics of dreams through the transformational processes in psychoanalysis gives inclusive treatment to the individual in dealing with the psychodynamics of dreams and the relationality of events and situations in the dream and the events and situations in the life of the patient.

During the days of his On Aphasis (1891), Freud rejected the localist neurological theories of Carl Wernicke (1874), Ludwig Lichtheim (1865), and Paul Broca (1861). He rejected them because they were localizationist, separatist, and isolationist. In rejecting those theories, Freud was proposing a pervasive transformational explanation which was centred on giving inclusive treatment to patients by dealing with the whole person and the relationality of events and situations in the person’s life.

Certain points in this blog merely graze on topical issues on physicalism and medicine and issues on the methodology of psychodynamics therapy. An elaborate treatment of these issues would require a different focus other than the condensed sketch which I have presented here to initiate discuss ion on psychodynamics therapy and holism.

REFERENCES

ARISTOTLE, Politicus

BARBER, Theodore X. 1969. Hypnosis. A Scientific Approach V. N. Reinhold. New York

BERNFELD, S. 1949. Freud’s Scientific Beginnings. The American Imago Vol.2 PP163-196

BERNFELD, S. 1944. Freud’s Earliest Theories. Psychoanalytic Quarterly Volume 13

BREUER, Josef and FREUD, Sigmund. 1895. Studies in Hysteria. Penguin Freud Library 3

CAPRA, Fritjof. 1975. The Tao of Physics Flamingo Paperbacks.

CHERTOK, L. 1967. The Theory of Hypnosis to 1889. American Journal of Psychotherapy Volume 21.

DESCARTES, Rene. 1644. Principles of Philosophy Part 2

FREUD, Ernst L. 1970. Letters of Sigmund Freud. Hogarth Press, London.

FREUD, Sigmund. On Metapsychology. Pelican Freud Library Volume 11. P184

FREUD, Sigmund. Complete Psychological Works, Standard Edition Volume 18. P254

FREUD, Sigmund. 1954. Origins of Psychoanalysis P264 letter 96

FREUD, Sigmund. 1944. Letter to Wilhelm Fliess

FREUD, Sigmund. 1935. An Autobiographical Study Hogarth Press, London.

FREUD, Sigmund. 1923. Complete Psychological Words Standard Edition Volume 18

FREUD, Sigmund. 1900. The Interpretation of Dreams. Penguin Freud Library Voume 4.

FREUD, Sigmund. 1891. Studies on Aphasia New York International Universities Press Inc.

FREUD, Sigmund. 1891. On Aphasia

HARMAN, P.M. 1982. Metaphysics and Natural Philosophy. The Harvester Press

HOBSON, J. Allan. 1990. T he Dreaming Brain. Penguin Books. London

JONES, Ernest. 1953. Sigmund Freud, Life and Works Volume 1. Hogarth Press.

MAURICE-NNEKE, Antony. 2022. Sex and Psychodynamics Psychiatry. An Introduction to the Psychodynamics of Sexual Health. Amazon Kindle Publications. Available to Buy Now.

MAURICE-NNEKE, Antony. 2013. Sex and psychosexuality. Xinjian Press, China.

MAURICE-NNEKE, Antony. 2003. The Psychodynamics of the Unconscious. The Origins, Controversies, Disputes, Principles and Practice of Psychodynamic Psychotherapy. Intapsy Publications, London. Available to Buy Now. Go to Order Form.

PLATO, Charmides Sections 156-157

SMUTS, Jan. 1926. Holism and Evolution. The Macmillan Company. New York.

I borrowed the word introaction from Jan Smuts. It has the same significance as endopsychic forces which contribute to the development of symptoms and the transformation of unconscious materials within the individual.