For many, Hermann von Helmholtz (1821-1894) incarnates the birth of German experimental psychology. This philosopher physician intervened in significant ways in several sciences. At the time that Thompson and Maxwell were defining energy, von Helmholtz (1863) described how energy could neither be created nor destroyed but could be transformed. For example, the energy generated by a steam engine can transform itself into a kinetic energy (movement). He invented the ophthalmoscope, which makes possible a detailed observation of the retina. He was the first to find a way to measure the speed of a nerve impulse, and he contributed to the development of the psychophysiology of perception. One of his students, physician and philosopher Wilhelm Maximilian Wundt (1832-1920), established the first official laboratory in psychology in Berlin in 1879. This event is generally considered to be the date of the birth of psychology. Other researchers in the world, like Theodule Ribot1 in France and William James in the United States, established research laboratories that went in the same direction.
At that time, many neurologists believed that it would one day be possible to explain the behavior of thoughts by studying the brain. This project is still at the center of the neurosciences. Wundt2 proposed a soft parallelism to define the domain of psychology. His aim was to show that the science of psychology was distinct from neurology. He distinguishes the real world from our representations.3 Our representations are clearly distinct from what creatures perceive and what they think about. On the one side, we thus have the realm of psychologists, which consists of perceptions and the organization of perceptions, which is called the psyche. The mind is a closed world that functions according to laws regulating the interactions between thoughts, perceptions, intelligence, memory, and so on. Physicists use psychological procedures to try to create psychological representations that become increasingly close to the dynamics of the real world. These procedures rely on tools that enhance the power of the senses. Physicians apply such procedures to intervene with increasing precision on the material aspects of the organism. However, only the psychologist can understand how the psychological dynamics function. His procedures are necessarily adapted to its object (e.g., the realm of thoughts and affects) and the laws that govern its dynamics. The material and the psychological dimensions are part of the same universe. Therefore, there must exist some laws that apply to both domains and allow various forms of connections between the mental and the physical planes. Sensory-motor phenomena are manifest examples of psychophysiological dynamics. Mind and soma gradually differentiated during the evolutionary process described since Lamarck. Wundt’s psychological dynamics are thus clearly embodied. We shall soon see that certain arguments used by Wundt to distinguish psychology from other sciences are used by Freud to distinguish psychotherapy from other forms of medical intervention.
At the beginning of his career, Wundt was mostly interested in the development of the psychophysiology of perception. During the last twenty years of his life, he created a social psychology (Volkerpsychologie) that studied the psyche as the basis of language (1900), art (1908), myths and religion (1914), society (1918), as well as culture and history (1920). These developments had a profound influence on Freud and Jung, who began to propose a psychoanalytic perspective of these domains. For these first psychologists, thought is part of what the development of the brain has made possible; but thoughts have an emergent dynamic that is specific to them and constitutes itself in a field whose poles are the dynamics of the brain and society.
The first psychologists thought that they could establish their science through self-observation by using introspection as the basic tool. In a typical situation of the time, many people, one after the other, sit in the same chair to accomplish a rigorously defined task. They were then asked to explore through introspection what they perceived while doing the task. Other experimental methods, especially physiological ones, were used as a complementary source of information and a control to compensate for the excessive personal and variable aspects of self-exploration.4 Like the halo that circles above a saint’s head, the psyche was thought of as the aura of the brain, an aura capable of forming a virtual world that structures itself by linking everyone’s soul and immortalizes itself by influencing the thoughts of the generations to come.
In experimental psychology, methods based on introspection became obsolete with the revolution of the behaviorist. For the founder of this movement, John Broadus Watson (1878-1958), the only way to scientifically understand the psyche is to begin by studying behavior and then infer the algorithms that produce behavior.5 The psyche then becomes the system of organismic strings that make the body move and generate the behavioral reactions. The analysis of behavior is capable of being objective because it can be observed by many people and can be recorded (filmed). This way of proceeding has since generated video-analysis, especially focused on behavioral communication. Video-analysis, which is discussed in the last sections of this volume,6 is used both in research and in therapy.
Watson perhaps does not always recognize that he wants to refine the strategy of the viewers of silent movies. Each spectator believes he is able to understand the thoughts of manifestly fictional characters. Most behaviorists commit the error of believing that behavior correlates exactly with the algorithms of the mind because they believe in a direct link between thought and behavior.
In the meantime, psychoanalysis, and then most of the psychotherapeutic modalities it inspired, resisted such a view. They show that in strengthening the ties between therapist and patient, it is possible to continue to use introspection to explore the zones of individual experience inaccessible to the behaviorists.
By astutely correlating physiology and what is consciously perceived, the first psychologists soon discovered strong correlations between physiological dynamics and conscious perceptions that introspection could not detect. Around 1850, von Helmholtz and Wundt each tried, in a secret competition, to find a way to study the sometimes massive impact of physiology on thoughts that unfolds unbeknownst to the subject. To explain the works of this influence, they concentrate on the analysis of optical illusions, which had been already studied in many psychophysiological laboratories. The basic idea is that the nervous system automatically generates models that complete the sensory data and permits the building of conscious perceptions.7 Von Helmholtz and Wundt called these elaborate constructions in the nervous system of “unconscious inferences” (unbewusster schluss). Von Helmholtz also shows that the tendency to attribute psychological traits according to physical traits is a type of unconscious inference. These inferences impose themselves on consciousness like an almost exterior compulsive force to which thoughts are hardly able to escape:8 “Whatever interpretation the human perceptual apparatus may give to what meets the eye, the resulting impression is, Helmholtz concluded, not open to revision; the human eye, so to speak, cannot doubt” (Frey, 2001, p. 261). After including these notions in their textbooks, the two authors had to admit that they had not been able to find experimental procedures that could allow them to examine this topic with reliability. They abandoned this research and removed the chapters dedicated to this notion in the last editions of their textbooks. Until recently this research project was only known about by a few erudite scholars because today we are only able to find these last editions. This subject is undertaken today with more sophisticated9 methods of analysis. This neuronal or cerebral unconscious10 is more often qualified as nonconscious because it is inaccessible to introspection and is not always of a mental nature.
Having become a physician in Vienna, Sigmund Freud (1856-1939) worked from 1876 to 1882 in von Brücke’s research laboratory in physiology. Von Brücke had studied with von Helmholtz. In 1884, under the advisement of his mentor, Freud undertook a study of the effect of cocaine on nerve tissues as his thesis in neurology.11 At that time, cocaine was legal and fashionable. It was, for example, one of the original ingredients in Coca-Cola and featured in the life of the popular (but fictional) Sherlock Holmes.
Freud published a few articles in which he declared that cocaine is a medicine capable of treating a wide array of illnesses. It is presented as a relaxing agent that increases the force of motor activity, promotes the cessation of dependence on morphine without creating a dependency, and heals certain eye problems. These publications, supported by the students of the illustrious von Helmholtz, were read by numerous physicians in Europe and in the United States. Thus Freud participated in setting in place the idea that substances could contribute to the healing of psychic and somatic ailments. The reactions were negative. Many physicians complained about Freud’s article because after having followed his recommendations, they noticed that cocaine created a powerful dependence. Around 1903, the consumption of cocaine was forbidden.
Like many other physicians who had believed cocaine could be useful, Freud had consumed some himself and had become dependent. In his correspondence with his friend and colleague Wilhelm Fliess, he complains several times of the problems it creates in his nostrils (an irritated nose, swollen nostrils, weeping pus, etc.). It is not impossible that his need to hide his nose from his patients was one of the reasons he preferred to sit behind them.
Freud was ambitious. He absolutely wanted to become a genius.12 Cocaine had brought him to a career impasse. He set out to find other areas of research. He succeeded in having the University of Vienna finance his stay in Paris with the illustrious neurologist Jean-Martin Charcot (1825-1893). During this trip, he acquired knowledge in psychiatry: hysteria (Charcot was the authority on the subject at the time) and hypnosis.13
In 1883, having returned to Vienna, Freud was named to the post of researcher and instructor in one of the most famous laboratories in neurology in the world, directed by Theodor Meynert. He then discovered the works of Hyppolite Bernheim, who taught in Nancy, and he translated some of his writings. Bernheim modified Charcot’s theory on the relationship between hypnosis, psyche, and hysteria.14 Freud takes away from the whole of these studies the hypothesis that in the case of hysteria, mental problems create pathological somatic functioning.
Freud then specialized in the study of cerebral motor disabilities in children. In 1886, he directed the neurological service in the public children’s hospital and opened a private practice in which he hopes to develop what he has learned about hysteria and hypnosis. His position in the clinic allows him to refine his reflections on the relationship between body and mind and acquire a developmental view of the human being.15 All of his life, Freud retained the notion that what happens in early infancy influences the development of personality. His association with von Helmholtz’s students also taught him that the psychophysiological approach had its limits. It became evident that the neurological approach to thought had to be complemented with an approach based on the exploitation of the resources of introspection.
Freud apparently ended his use of cocaine at the time of the death of his father in 1896.16 It is possible that in his severance from the drug (no one knows how he succeeded or what interior price he paid), Freud became conscious that it could be interesting to relate the impact of cocaine on what he felt to the data that he had collected on this impact as a neurologist. In any case, at this time he set for himself the task of trying to find a formulation that would permit him to describe in what ways the psychological dynamics are different from the physiological dynamics. He also discovered what he calls the Oedipal complex.17 For him, this complex is manifestly a mechanism that only the psyche can generate. A neurologist would never be able to analyze this phenomenon by observing the brain. This period of personal crisis unleashed an intimate and creative conviction in Freud that encouraged him to funnel his energies in the systematic exploration of psychological therapeutic tools.
Freud did not freely admit that he was influenced by Wundt’s ideas on unconscious processes, but he must have heard of these ideas while he worked with von Brücke. By studying the impact of cocaine on thoughts and physiology, he was working exactly on the dimension that von Helmholtz and Wundt wanted to analyze. This cocaine episode illustrates an important limit of Freud’s scientific ethics: a tendency to generalize hastily on the basis of observations made on a few cases.
This way of doing things is a classic procedure in neurology because most lesions are rare. However, a neurologist can count on colleagues who can verify such an observation on other patients, in other countries. In psychotherapy, this strategy is difficult to manage when there are few colleagues who can verify an observation, such as was the case at the end of the nineteenth century. Going from cocaine to the Oedipal complex, Freud seems to have retained his tendency to propose hasty generalizations.
In his book on dreams, Freud (1900) describes the psyche as a distinct system from the physiological dimension. The psyche is a virtual entity distinct from the brain but anchored in it by a symbiotic relationship. It is a kind of parasitic system that exists thanks to the brain. This First Topography had the advantage of imposing onto the medical world the idea that the psyche did not follow the same laws as the physiological dynamics and that it had, of necessity, the need to be treated with interventions that were adapted to it. This is Freud’s First Topography (unconscious, preconscious, and conscious). This proposition contained a series of intuitions that remain interesting but also posed all sorts of problems, like creating too sharp a distinction between the psychological and physiological dimensions.
Numerous aspects of the First Topography are attempts to give answers to clinical intuitions that remain interesting. These intuitions continue to stimulate the imagination of today’s psychotherapists because the questions they raise have not always received satisfying answers. Freud attempted to resolve some of these issues when he proposed a Second Topography (id, ego, and super-ego). Even though this Second Topography is also useful, it does not resolve any of the problems posited by the First Topography. Moreover, it is less often referred to outside of the psychoanalytic school.
If we try to imagine an idea as persisting beneath the limen of consciousness, we can as a matter of fact only think of it as still an idea, i.e., as the same process as that which it was so long as we were conscious of it, with the single difference that it is now no longer conscious. But this implies that psychological explanation has here reached a limit similar to that which confronts it in the question as to the ultimate origin of sensations. It is the limit beyond one of the two causal series,—the physical,—can be continued, but where the other, the psychical,—can be continued, but where the attempt to push this latter farther must inevitably lead to the thinking of the psychical in physical—i.e., material,—terms. (Wilhelm Wundt, 1892, Principles of Psychophysiological Psychology, 30.V, p. 453)
In the preceding section, we saw that during his studies, Freud learned to recognize two types of phenomena that influence the conscious dynamics unbeknownst to them:
Even today, most of the physicians who make use of hypnosis combine the models of psychiatry with the formulations of hypnotherapists. One of Freud’s most original contributions is to have used his knowledge of hypnosis to create a new form of intervention: psychotherapy. It then consisted of getting physicians to admit that there were two types of interventions:18
THE TOPOGRAPHY, THE SEQUENCING, AND THE DYNAMIC OF FREUD’S PSYCHOLOGICAL SYSTEM
Around this distinction between conscious and unconscious, Freud constructed a model about what the mental apparatus (or ψ system) could be. To impose his point of view, he had to present a sort of anatomical and physiological model of the psyche that could frame the psychotherapeutic cures. The “anatomical” aspect of this model distinguishes the unconscious, the preconscious, and the conscious; the “physiological” aspect describes the dynamic that permits a thought to circulate in the mental domain. The psychic system is described as a sort of geography or topography in which there would be the three following regions:
This topography has a direction:
This topography has a dynamic. The thoughts that enter into the unconscious have a weak intensity, very close to the intensity of the data treated by the nervous system. The psyche also has its own proper energetic system, which is greatly influenced by the affects. This energy will invest the unconscious thoughts and give them a charge. The more a thought is charged, the more it is intense, and the more it will approach consciousness. As the unconscious produces more thoughts than the conscious can manage, it belongs to the preconscious to manage the thoughts that try to become conscious.
The difference between a preconscious and an unconscious representation is that an unconscious representation cannot become conscious once it is repressed, whereas preconscious representations can. Thus, in a dream, unconscious drives activate preconscious material which can be perceived by consciousness.21
If all thoughts were necessarily conscious, we would be able to manage so few of them that the psyche would not be able to accomplish its function. It is therefore essential for the survival of the organism that what is perceived does not only depend on consciousness:22 “Nothing is more natural than to think of consciousness as a kind of stage upon which our ideas are the actors, appearing, withdrawing behind the scenes, and coming on again when their cue is given” (Wundt, 1892, XVI.I, p. 233). In this metaphor of the theater, it is evident that what is happening on the scene in front of the audience (in consciousness) may follow different rules as what is going on backstage (in the preconscious). The observation that there are preconscious phenomena corresponds to everyone’s experience, like a memory that we cannot retrieve in one minute and that reappears ten minutes later; or like a nervous movement of the foot of which we only become conscious once that it is pointed out by someone else.
This second example illustrates a preconscious phenomenon. A foot moves incessantly without the individual noticing it. This activity is accessible to consciousness if it directs its attention to the foot, but the activity remains in the preconscious as long as attention is distracted from it by other events. The notion of preconscious situates the fact that at a given moment, our awareness perceives only a part of what could be perceived, and the subject can have the tendency to avoid certain thoughts without having them necessarily maintained in the unconscious.23
Metaphor concerning the preconscious repression. King Arthur systematically avoids looking at Lancelot ever since his knight had an affair with Queen Guinevere, but he needs Lancelot to continue to be a knight of the Round Table. Arthur’s mental barrage is conscious. The problem this poses for the Knights of the Round Table is that it is difficult for them to talk about Lancelot with their king. Moreover, Arthur inhibits himself from taking note of Lancelot’s behavior when he is in the royal hall.
If the distinction unconscious/preconscious is often useful, it becomes a trap for Freud when he claims that all the examples of unconscious mechanisms that were described and that did not correspond to Freud’s unconscious were necessarily of the preconscious. Freud then spoke of two kinds of unconscious:24 (1) Freud’s unconscious, and (2) the unconscious of others, which would in fact be examples of preconscious thoughts. This remark was challenging. To understand why, let us come back to Wundt’s theatrical metaphor. One could distinguish two distinct types of mechanisms behind the stage:
Distinguishing at least two different types of psychological unconscious, one being more easily accessible conscious processes than the other, was useful. Psychologists and psychotherapists could explore different ways of refining such a distinction. But even today, we do not have the means of knowing exactly how to define the different mechanisms involved and how they interact with consciousness.
The intellectual context of the First Topography is close to the model established by Descartes. This is evident in Freud’s original texts.
The German language does not have an equivalent of the English word consciousness. Freud uses the term bewusst to designate a thought of which a person has knowledge, and unbewusst for a thought that is active without one knowing it. The terminology is thus the same as the one used by Descartes and Lamarck. Descartes’s and Freud’s vocabulary allow for a more subtle way of using Freud’s First Topography than the rigid categories that are often associated with the conscious/unconscious distinction.
In Freud’s time, a simplified version of Descartes’s model was the implicit model that nearly everybody had in their head relative to thoughts. That is why it is useful to remember the similarities between the models of Descartes and Freud—because they can in part explain how so many people immediately grasped the importance of Freud’s First Topography. The twentieth-century reader easily follows Freud when he explains that a thought cannot remain in the unconscious but for a dysfunction of the mental apparatus.
The topographical aspect of Freud’s psychic system is a case of pedagogical shrewdness. Freud was too good of a neurologist to imagine that the unconscious zone and the conscious zone were associated to distinct areas of the brain and that an idea changed properties as it circulated from one area to the other. The degree of consciousness of a thought is a qualitative change, but in becoming conscious, it does not change cerebral location.25 In other words, even unconscious, a thought already has a configuration that allows it to become conscious. In the language of this book, a thought has a “format” that permits it to become conscious, even when it remains unconscious. Freud’s model was conceived to help practitioners classify the often unbelievably complex mental phenomena they observe. He does not claim to describe the real functioning of the psyche. He facilitates the observation of the existence of conscious, preconscious, and unconscious phenomena and the isolation of certain dynamics that regulate the mobility of thoughts. It is therefore recommended not to fall into the well-known trap of taking a useful metaphor for a description of reality.
In mental functions, something is to be distinguished—a quota of affect or sum of excitation—which possesses all the characteristics of quantity (though we have no means of measuring it), which is capable of increase, diminution, displacement and discharge, and which is spread over memory-traces of ideas somewhat as an electric charge is spread on the surface of a body. (Freud, 1894, The Neuro-Psychoses of Defense, p. 60)
Spinoza spoke of power, Hume of intensity, and Freud of excitation. There would be, for the Freud of the First Topography, a psychic energy that renders the thoughts more or less intense. This energy follows laws close to nervous energy but would be purely psychological. Freud has a difficult time proposing a clear model of what he calls psychic energy. He is content to conjecture, in early writings discovered after his death,26 that physiological sexual energy “transforms” itself into psychological sexual energy when the information managed by the brain transforms into thoughts in the unconscious. In his work, Freud speaks of this psychic energy as if the notion is self-evident as soon as we admit that the psyche is distinct from physiology.
Freud does not really succeed in imagining how the psychic system could regulate the charge of each unconscious thought, even if this regulation plays an essential role in Freudian psychology. His thoughts on energetic dynamics were used to create a model of the mechanisms that regulate the behavior of thoughts by employing the capacity of the German language to create variations around a key word: besetzung. James Beaumont Strachey (1887–1967), who translated Freud’s work into English with Freud’s permission, translates besetzung with the Greek term cathexis. Reich mostly used the term charge to remain close to notions such as those of intensity and the quantity of energy associated to a thought.27 Freud distinguished the following mental energetic mechanisms:
There is a recathexis when an object remembered from a long time ago regains its intensity while it was hardly present in a person’s conscious thoughts. When there is a recathexis that links up with a hypercathexis, Freud often talks of a cathartic regression.28
Freud never took a definite position on the questions raised by the notion of psychological energy because he did not have the means to do so. The discussions on this aspect of his First Topography have been unending. Only when Freud indicated his dissatisfaction with the First Topography did analysts like Ferenczi explicitly reintroduce the idea that behind the mental operations there would be physiological dynamics. This idea has traveled far and wide since then without having yet taken a definitive form.29
The psychologist of today mostly retains the notions of conscious, preconscious, and unconscious from the First Topography because this categorization remains useful. Even if no one, to this day, has proposed a competing model to that of Freud, it becomes evident that it is more of a useful metaphor than a description of the functioning of the psyche. There are too many loose ends in this model for it to be retained in its entirety.
I enjoin you to take this expression to the letter: what is repressed does not disappear, it just does not stay in its place; it is pushed into some corner, where it is not treated justly, where it feels limited and disadvantaged. It then constantly rises up with all of its power to regain the place where it should be, and as soon as it sees a breach in the wall, it attempts to slip through. It may succeed, but when it reaches the foreground, it has expended all of its strength and any kind of attack from any authoritarian power sends it back. This is a very disagreeable situation and you can imagine the leap that such a repressed, crushed, broken being makes when it is finally liberated. (Georg Groddeck, 1923, The Book of the It, p. 85f)30
Freud called all of the mental operations that regulate the flow of thoughts in the psychic system the “defense mechanisms.” He ought to have named them the regulatory system of the psyche when he speaks of the psyche in general. But what interested him was the study of the psychic dysfunctions, and the key clinical elements that he had discovered in his patients was that consciousness is vulnerable, that it cannot deal with all of the information that exits in the unconscious. To ensure the sound functioning of consciousness, the regulatory systems of the psyche must, of necessity, protect and defend consciousness against the intrusion of thoughts that would destabilize it. Only that particular function of the psychological regulatory system should have been associated to “defense mechanisms.” Thus, Freud’s first patients suffering from hysteria had sexual desires that generated anxious conflict when they penetrated into consciousness and hurled themselves against the conscious moral rules of an individual who wants to be honest and coherent.
A vignette concerning desire and hysteria. In the case of one patient, the problem was that she loved her sister’s husband. This passion raised a wide variety of issues that threatened the equilibrium of her way of thinking. The first is that the biological sexual needs of the patient do not require that the patient relate to her brother-in law. The patient’s psyche has associated the power of her sexual instinct to the image of her brother-in-law. This association does not necessarily satisfy the demands of the instincts, but once this association has been forged, it imposes itself with an unrelenting force. The coupling between an instinctual force and a preconscious representation is what Freud calls a drive. The other difficulty for the patient was that she was reproaching herself so intensely for this desire that the conflict between her guilt and her desire was experienced as painful. It exhausted her. Her attempt to maintain this desire in the preconscious generated terrifying panic attacks. The patient’s psychic apparatus then repressed this desire into her unconscious. But to maintain such a powerful thought in the unconscious requires so much energy that the entire functioning of the organism is consequently troubled. Thus, according to Freud, the psychological and somatic symptoms of hysteria are formed. The entire organism, and a part of the patient’s entourage, are disturbed by the need to defend consciousness against such an unbearable thought.31
There would therefore be psychopathology every time the conscious procedures are incapable of managing a desire or all other forms of highly charged representations. If the defense system could really repress an undesirable thought effectively, there would be no need for neuroses. This implies that the defense systems also have a blend of capacities and limits. We are now going to see that like the circuit of stress, a massive utilization of the system of defense generates psychopathological functioning.
The defense mechanisms repress the thoughts that destabilize consciousness into the unconscious. A disturbing thought that appears only once in consciousness is not dangerous. The system of defense is mostly conceived to take care of the recurrent thoughts that are constantly resourced. They often become overinvested. Therefore, to push back such overcharged thoughts requires a large amount of energy.
To maintain an overinvested thought in the unconscious contradicts the modes of functioning of the unconscious. The maintenance of charged thoughts in a zone that can only manage thoughts that have a weak excitation creates dysfunctions (1) in the unconscious procedures, (2) in the interaction between the unconscious and the preconscious, and (3) in the interfaces that allow the psyche to interact with the physiological dimension (sensory in the case of the unconscious and motoric in the case of the preconscious). This explains why the necessity to repress, in a persistent fashion, creates psychopathology. In effect, charged psychic material unceasingly tries to rise to consciousness. This is inevitable if we suppose that the more a thought is charged, the more it inserts itself into the conscious dynamics. A repressed drive is a bit like a balloon a child tries to keep under water. Even if the child succeeds temporarily, the balloon tries to resurface. The child must be unceasingly stronger than the thrust of the balloon. If the child loses concentration, the balloon will surface. This is how an unconscious content animates a dream when the organism relaxes to sleep.
One of the strengths of Freud’s psychological theory is to have helped all of humanity to speak of the unconscious forces of the psyche in a more explicit way. It is also true that at the beginning, Freudians had to learn how to battle against a well-organized opposition. But they then benefited from their immense media success when they argued that their unconscious was the only plausible approach to the psychological unconscious. When psychologists defined the conscious and unconscious dynamics of the psyche differently than Freud had, numerous psychoanalysts accused their colleagues of adopting an intellectual strategy that permitted them to avoid the content they were repressing into their unconscious. This attitude was vehemently criticized by philosophers such as Wittgenstein, who admitted that Freud had indubitably something interesting to say,32 but that the psychoanalytical community defended itself more like a sect than like scientists who defend their theory. The violence of the blackmail exercised by this style of intellectual pursuit rendered every attempt to distinguish between many different types of psychic unconscious difficult. The situations were made even more complicated by the fact that many intellectuals had undergone psychoanalysis or were at least sympathetic toward psychoanalysis (like Wittgenstein, Vygotsky, Lévi-Strauss and Bourdieu). Inspired by Freud, they set about finding other forms of psychic unconscious—that is, a psychic mechanism that was activated independently of consciousness but which did not necessarily correspond to Freud’s unconscious. Up until the 1970s, when I began my studies, it was impossible to present a talk concerning the psychological unconscious without having some psychoanalysts tell you that you were not talking about the true unconscious. The Freudians refused to admit that their unconscious dynamic was not the only form of unconscious used by the psyche. Even so, the discussion can easily be divided into two types of issues that refer to distinct forms of knowledge:
Freud’s dynamic unconscious was soon accepted by a great number of researchers in the human sciences, whereas on the contrary the notions of resistance and the defense mechanisms are often ignored. Thus, when I used Ekman and Friesen’s FACS coding system of the face, I wanted to code the chronic muscular tensions of the face that, according to Reich and Fenichel, could be the manifestation of the system of defense established around an affect. Ekman insisted that I only code the observable movements because these were the only data that could be irrefutable facts. He was not entirely wrong, because there is no robust way to distinguish between chronic muscular tension and the innate traits of the face. In the course of discussions with Ekman’s colleagues, I noticed that the notion of defenses against the expression of an emotion is not used in most academic approaches of the emotional expression with the methods taken from ethology. The only exceptions were the psychoanalysts who used FACS to study interactions in psychotherapy.34
For 70 years, psychoanalytic and non-psychoanalytic psy unendingly discussed the topic in this way. Since the Freudians had kidnapped the term unconscious by depriving it of its natural multiplicity of meanings, the psy no longer knew what to call the unconscious impact of the physiological, relational, and social dynamics on the psyche.35 Everybody wanted to use the term unconscious, fashionable thanks to Freud, but to designate psychic phenomena manifestly unconscious with loose boundaries that did not resemble the dynamics of repressed memories. They did not know what to call the unconscious mechanisms that combine mental regulations and organismic regulations, or mental regulations and social regulations, or a combination of all three (as Bourdieu’s habitus). Some, like Lévi-Strauss and Bourdieu, could have proposed that the unconscious of the social sciences form another layer of the psyche that functions differently than the one described by Freud; but they did not dare take this step.36 It is the same with Vygotsky (1927) with regard to certain layers of the psyche which develop by synthesizing the mechanisms of thoughts and the impact of the learning of a language. All of these emerging entities that form themselves in the individual thought have a complexity that an individual conscious thought cannot apprehend.37
In body psychotherapy, no one dared affirm that a massage acted simultaneously on the unconscious in two ways:
Psychoanalysts often speak of the first effect and counsel against the massage of hysterical patients.38 Their argument is that whatever the expressed conscious reactions are, hysterical patients experience the massage unconsciously as a sexual intrusion, a form of imposed recathexis that often leads to hypercathexis. Body psychotherapists do not often observe this, when they massage hysterical patients. In many cases, an approach with a touch that takes into account the anxieties of the patient can be beneficial. This discussion continues to this day.39 Clinical practice (based on a discussion of real-life cases) has not permitted the closure of this discussion. As with all these methods, including psychoanalysis, massage is useful for some patients, but not for all. I see patients who were retraumatized by the silent distance of a psychoanalyst, and psychoanalysts see patients who were retraumatized by the intrusive methods of body psychotherapists. The ideal solution would be to exchange our observations to improve the calibration of our respective methods, instead of using the data to compete. This could be a debate that illustrates the difference between the unconscious impact of the physiological and the Freudian unconscious, but body psychotherapy was created around the idea that these two sometimes form an emerging entity in the psyche.
These hypotheses remain plausible, but we lack analyses based on empirical observations (clinical and experimental) that allow for drawing them. The difficulty is that it is not even possible to reliably demonstrate the existence of conscious thoughts. It is consequently even more difficult to discern the shape of unconscious thoughts. The Freudian unconscious can at least claim for itself that its unconscious thoughts can become conscious again. Thanks to that fact, emerging repressed thoughts can be studied in a relatively robust way. What we do not know how to analyze reliably are the unconscious dynamics of the psyche, which never become conscious. Nevertheless, a series of robust inferences obliges us to suppose that there exist unconscious mental dynamics that do not seek to be become conscious.
Since the 1980s, to work in peace, a growing number of biologists, neurologists, and psychologists use the term nonconscious to speak of unconscious dynamics that escape introspection.40 From the point of view of consciousness, a nonconscious event is a fuzzy phenomenon that influences the periphery of our inner atmosphere, but not as something that can be grasped in an explicit way through introspection. This implies that there exists psychological dynamics that can never become conscious. The Freudian unconscious is henceforth one particular chapter in the study of unconscious processes, associated to the notion of the repression of thoughts that had been conscious. This attitude was summarized by the French professor of experimental psychology Paul Fraisse (1992) in the following way:
I refuse to talk about the unconscious because it is essentially a psychoanalytical concept. . . . For my part, I agree to talk about non-consciousness, which is anyway a manner of speaking. . . . One could say that the unconscious is nonconscious, but I prefer to speak about the non-conscious because I do not want to endorse the psychoanalytic interpretation of these phenomena.
My actual consciousness depends on all that I have been up until now. That is to say, it is an extraordinarily rich non-conscious totality that contains all that I have lived, all that I have been and which defines me today. . . . The non-conscious exceeds by far that which the psychoanalysts call the unconscious. (Paul Fraisse, 1992, “The Non Conscious,” pp. 174–175; translated by Marcel Duclos)
A number of psychoanalysts41 have courageously confronted the fact that the knowledge connected to the term nonconscious implies a reformulation of the role of the Freudian unconscious. Given that the Freudian unconscious has found a corresponding place in the theories of the psyche, body psychotherapists can now more explicitly establish the relationship between the nonconscious, unconscious, and consciousness, which they manage every day.
As much as we would want to count the grains of sand picked up by the wind at the sea shore during a stormy day; it would be equally impossible to enumerate the contradictory ideas that come, one after the other, hatched in the brain of Gorenflot before breakfast. (Alexander Dumas, 1846, La dame de Monsoreau [The Lady of Monsoreau], III, V, p. 370; translated by Marcel Duclos)
Not having been able to differentiate sufficiently the unconscious from the non-conscious, Freud did not succeed in situating the regulation systems of the psyche and the defense mechanisms. If a thought can be more or less conscious, can the mechanisms that put the defenses in place also function more or less consciously? The only plausible answer, for the moment, is that the content of the thoughts and drives can be more or less conscious, but that the regulation mechanisms that structure the psychic dynamics are mostly nonconscious. It is the same for the energetic dimension of the Freudian theory.
To clarify this discussion, I propose distinguishing two aspects of the defense mechanisms:
Having assimilated the idea that the defense mechanisms are part of the non-conscious dimensions of the psyche, Rene Roussillon proposes a useful reformulation of Freud’s psyche. Above all, he shows that every influence of the environment on the organism is necessarily transformed so it can be used by the mechanisms of the organism. Each organ (liver and lungs) and the physiological system (respiration and circulation) have a particular way of functioning. Thus, food is rapidly transformed in the digestive tract into a series of products that can be assimilated by the digestive mechanisms. When indigestible products are regularly ingested, the digestive mechanisms are gradually and profoundly deregulated. It is the same in the psyche. The psyche is not always able to digest all of the information the nervous system transmits to it:
This “prime matter” of the psyche, mixes and entangles multiple internal and external perceptions, sensations and driven motions. . . . It is multi-perceptive, multi-sensory, multi-affective, multi-instinctive: it mixes, given its position in the topography, the inside and the outside, the “Me” and the “non-Me.” (Roussillon, 2007, p. 341; translated by Marcel Duclos)
This “pandemonium”45 is digestible for the unconscious but not for consciousness. Each level of the psyche has its mode of functioning, exigencies, and limits. As it is for Spinoza’s imagination, coherence is not a requirement of Freud’s unconscious. However, consciousness does have this requirement. It is incapable of managing the lava that erupts in the unconscious. It needs to protect itself and reduce what enters into something it can digest or metabolize. The first function of the defense mechanisms is therefore to allow for a triage, a slowing down of the lava, which promotes the construction of a manageable subjective experience. The thoughts necessarily transform everything into representations because thoughts cannot organize themselves except through representations. These can have multiple supports, such as words, images, impressions, sensations, and gestures.46 When the regulatory systems of the psyche are flooded by the intrusion of powerful affects, consciousness generates an anxiety or a depressive feeling that inhibits the habitual behavioral dynamics and creates a sort of organismic disarray described by the studies on the biology of stress. This is what Freud observes by analyzing his first hysterical patients.
Freud was conscious that a relatively coherent global architecture was missing in his theory: architecture in which is it possible to situate all of the components of his model. The Freudian theory has a quasi-postmodern structure composed of constituent parts whose architecture has not yet been clarified.47 Like Plato, Freud prefers to approach themes about which he has something to say and leave aside—sometimes with regret—that about which he is unable to come to a conclusion.
Etymologically, since the eighteenth century, English and French psychiatrists use the term neurosis to designate “nervous” problems without a known physiological basis. It indicates functional problems of the brain that are not due to lesions or hormonal problems. With regard to language, it would have been wise to use the term psychosis to indicate the problems that are uniquely due to functional problems of the psyche. However, in Freud’s time, the term psychosis was already being used in psychiatry to indicate problems associated to symptoms such as hallucinations and delusions of grandeur. A psychotic was a type of patient who justified the existence of psychiatric institutions, while a person suffering from a neurosis could be followed and sometimes treated in the framework of private practice. The term neurosis therefore identifies a mixture of functional problems of the brain, the hormonal system, and the psyche. The blending of this mixture varies in function of the theory used, on the one hand, and also because the way a mental problem manifests depends on the constitution and on the life journey of each individual. Anxiety may be treated in part with tranquilizers or psychotherapy. But neither one of these two kinds of treatment can treat every anxious individual in a lasting way.
The discussions on the difference between these two large categories in psychiatry, neuroses and psychoses, continued up to the 1980s. It is impossible to read the writings to which I refer without knowing this distinction. Today, psychiatrists no longer use these terms; they prefer to use more detailed and operational definitions in their diagnostic systems (for example in the DSM-IV and the ICD-10, or De Lange et al., 2008).
It is difficult to define the word neurosis in a more precise way because its meaning changes every ten years, whether in the works of Freud or, generally, in psychiatry textbooks. The relationship between neurosis and psychosis in psychoanalysis only became stabilized after Jung participated in the elaboration of psychoanalytic concepts around 1910.48 For the following sections, it suffices to relate the term neurosis to the notion of behavioral problems that cannot be attributed to physiological dynamics, a psychosis, or depression, and that are associated with severe forms of anxiety. Among these neuroses, Freud first specialized in the study of hysteria, which he differentiates from the other forms of neurosis.
In psychiatry, the mental problems are often defined in function of behavioral problems. The originality of Freud’s endeavor was to want to distinguish between psychopathologies in function of the psychic mechanisms that engender behavioral problems. It is therefore possible, in the Freudian system, that a behavioral or affective symptom can be observed in individuals who suffer from distinct psychological illnesses. This endeavor is analogous to that which is followed to categorize the species of animals. Thus, even if they live in the water, biologists do not classify whales in the same category as fish because they have a distinct respiratory system, one that is close to that of other mammals.
The term hysteria has at least two meanings:
These two ways to use the term hysteria are only sometimes reconcilable. Having uncovered sexual abuse or intense fantasies of abuse in many of his hysterical patients, Freud proposed a model of hysteria in which sexual conflicts played a central role. The psychological interpretation of the causes of hysteria, detached from its symptoms, is one of the factors that encouraged several psychotherapists to gradually return to the popular sense of the term.
Today, most psychiatrists use the diagnostic term of dissociative convulsion when they describe Charcot’s hysterical attacks. To differentiate these convulsions from an epileptic attack is something that remains difficult. Thanks to video, it has become possible to isolate the following characteristic traits:56 balancing movements of the pelvis, lateral movement of the head (as is often done when one says “no” with a head movement), an arched back with facial grimacing (opisthotonus), a slow start but progressively lengthy duration of the attack, and closing the eyes. The traits of the epileptic attack are more manifestly convulsive, and its movements often escape every attempt to give them a meaning. On the other hand, the traits of a hysterical discharge are found in many forms of profound emotional discharges. It is possible to assign a functional expression to them, even if they can be explained otherwise. Recent studies show that at least 20 percent of patients who suffer from dissociative convulsions have suffered sexual abuse or emotional and or mental abuse. Balancing the pelvis and the head could be associated with this past, but it is also seen in a population for whom it has not been possible to establish that there has been abuse during childhood. Here again, as soon as we postulate a direct link between behavior and the affects, we are open to simplifications.57 The research by Karin Roelofs and her collaborators (Spinhoven et al., 2010, and Voon et al., 2010) confirms a strong percentage of sexual abuse either through violent physical abuse during childhood by the father and/or the mother in a population of patients classically considered as hysterics. We also find in the neurosciences the idea that when the parents abuse their children, they create profound problems with the coordination between representation, emotion, and behavior.58 Today, it is also possible to consider hysteria as a particular form of post-traumatic stress disorder due to abuse that occurred during childhood.
I have allowed myself to emphasize the psychiatric definition of hysteria because it clearly shows that to discuss this condition necessarily requires that we investigate the rapport between the psyche and the organism.
When Freud returned from Paris, he was still a young physician without significant means who was beginning to acquire a modest reputation. He wanted to establish himself so that he might practice what he had learned relative to the treatment of hysterical patients. He also wanted to earn enough money to marry his fiancée, Martha Bernays. He counted among his acquaintances a renowned generalist, Dr. Joseph Breuer (1842-1925). They had known each other for a dozen years. Breuer, with others, financially supported Freud. Between 1880 and 1882, Breuer had attempted to treat a hysterical patient, known under the name of Anna O. He let her talk, seeking to find in what she said indicators that would permit him to reconstruct her past and understand the particularities of her sentiments. He thus invented what he called the “talking cure” (to heal oneself by talking).59 During this treatment, Breuer noticed that Anna O. had similar forms of dissociation as the ones associated with hypnotic states.60 In 1887, Breuer asked Freud to collaborate with him by hypnotizing his hysterical patients. Their collaboration led to the creation of what they called the cathartic method. It consisted in blending the talking cure and hypnosis to induce regressive states, during which patients relived the traumatizing moments of their childhood. This form of regression could be sustained by hand pressure on a part of the body, for instance, the forehead. The therapist asks the patient what she experiences when she is touched.61 Freud sometimes insistently tried to persuade her that she should become aware of the contradictions in her story and that these were probably generated by her mind to hide painful memories she wants to forget. During this work, the physician and the patient establish a particular form of relationship: “intensely emotional, of a suggestive-hypnotic type. . . . Physician and patient join the forces of their efforts to attempt to reconstruct in some way the repressed causes of the illness from disparate fragments of associated material” (Ferenczi, 1930, p. 84).
According to Breuer and Freud, each time these patients were able to recover the repressed situations that had traumatized them, the mind and body symptoms activated by the repression disappeared once and for all, as if the pathogenic effect of the repressed memories were chased out of the patient’s organism. This type of remembering is so strong that no possible suggestion by the therapist could induce it; the patient can therefore have but one scene in mind.62 This work was disclosed and expounded in the famous Studies on Hysteria which Breuer and Freud published in 1895.
In his hysterical patients, Freud noticed dysfunctions of consciousness so manifest that he did not need to invoke the notion of the unconscious to talk about them. These patient are haunted by desires that create so many contradictions that what is experienced as a “central conscious me”63 cannot function anymore. Let us take the case of Elizabeth Von R. to illustrate this mechanism.64
Vignette concerning Elizabeth Von R. When she comes to see Freud in 1892, this young woman, age 24, has been suffering for 2 years from inexplicable pain in her legs; she complains of often being fatigued. She has just come out of a painful period of time during which she had to take care of her father and a sister who died after having been ill, and her mother, who had eye surgery. Apart from her symptom, she seems to function adequately, with intelligence, good humor, and courage. She is even quite lovely. Freud associates this apparent well-being to the belle indifference that then characterized hysterical patients. He accepts her as a patient for psychotherapy, while ensuring that she follows a physical therapy treatment for her legs.
When her father became ill for 18 months, it was mostly Elizabeth who took care of him. She slept in the same room with him. That was when the patient’s leg pain began. But the pain was only episodic then. A year after the father’s death, once the period of mourning was over, her oldest sister married a man that Freud described as gifted and energetic. His arrival into the family’s life occurred in a manner that Elizabeth experienced as disagreeable. She regularly showed him her irritation.
Subsequently, a second sister got married. This new brother-in-law, “though less outstanding, intellectually, was a man ‘after the heart’ of these cultivated women” (Breuer and Freud, 1895, II.5, p. 209). Then the mother had serious eye problems and had to be cared for in a dark room for months before the operation. Again, it was mostly Elizabeth who took care of her mother’s needs. After the operation, two years after the death of the father, Elizabeth’s leg pain reoccurs. The second sister became pregnant but did not make it through the pregnancy. She became ill and died.
In the course of her treatment with Freud, Elizabeth ended up talking to him about a young man, known to her family, for whom she held secret romantic feelings. She could not stop herself from thinking about him while she took care of her father, but she did not give herself the right to have these feelings in such circumstances. Then her organism learned to transform her desire into the leg pain for reasons that Freud only vaguely understood. This conflict was nonetheless less serious than when she began secretly to fall in love with her second sister’s husband. When this sister, whom she loved very much, died, she could not stop thinking that she could now marry her brother-in-law.
This case shows a scrupulously honest and moral woman who cannot prevent herself from feeling desires incompatible with her moral standards. Her conscious thoughts do not know how to integrate the contradictions set in place between her beliefs and her desires. To protect the coherence of her central conscious me, she feels obliged to repress her romantic needs. This strategy is relatively conscious, but she does not take into account that a desire is not only a thought, it is also a physiological mobilization linked to sexuality. By refusing to become aware of the physiological charge that enlivens her desires, she prevents some physiological propensities from coordinating with her thoughts. Yet such a connection is a necessary part of the mechanism that regulates the propensities of her organism.65 There is consequently not only a repression of a thought but also an inhibition and a deviation of a physiological dynamic. This deviation, according to Freud, finally lodged in her leg, which became painful, and in the regulatory mechanism of sleep.
The organism does not do well when the dialogue between dimensions and regulators of the organism is interrupted to preserve the apparent good functioning of a single dimension. Here, the organism is sacrificed to secure, for consciousness, a feeling of self-esteem and coherence. The general implication of this case study is that a propensity can only express itself by being able to count on a certain type of collaboration with the conscious dynamics of the psyche. There was healing, according to Freud, as soon as Elizabeth Von R.’s conscious dynamics had a way to integrate the existence of what for her was an incestuous love66 and the fact that this love was not possible. We also see in this example that what is perceived as a central me can be reinforced and learn to better manage the material that forms in the person; on the other hand, the needs that manifest themselves to the person do so without asking advice of her conscious procedures. To not be able to admit the existence of a need not only weakens what I have momentarily called a “conscious central me” but also handicaps the whole of the organism.
This involves some psychological preparation of the patient. We must aim at bringing about two changes in him: an increase in the attention he pays to his own mental perceptions and the elimination of the criticism by which he normally sifts the thoughts that occur to him (Freud, 1900, The Interpretation of Dreams, II, p. 101)
To heal analytically signifies above all to recognize the developmental failures, and in the measure possible, to benefit from this understanding to rectify these failures. (Wilhelm Reich, 1927a, The Impulsive Character, I, p. 247)
I still have patients who come to me thinking that the goal of psychotherapy is to recover the memory of an event repressed in the unconscious and then they will be cured. Some even believe that this repressed memory is necessarily that of a sexual abuse that occurred in their childhood. In some cases, these patients are psychologists with a good training in psychodynamic psychotherapy. They attribute this view of psychotherapy to Freud. Such a view was indeed presented by Freud in three articles published in 1896 (1896a; 1896b; 1896c). He speaks of the first thirteen cases of hysteria that would have been healed after being able to recover the memory of “a precocious experience of sexual relations with actual excitement of the genitals, resulting from sexual abuse committed by another person; and the period of life in which this fatal event takes place is the earliest years—the years up to eight or ten, before the child has reached sexual maturity” (Freud, 1896a: 152). If Freud plainly explored this trail, he did not defend it later on—mostly because he did not think that he had enough evidence to prove this hypothesis. For example, the case of Elizabeth Von R. is a manifest exception to this rule, as Freud does not report that she had been abused in her childhood.
On this fragile base is constructed the myth according to which every neurosis is caused by a sexual trauma in childhood and that it suffices to revive the repressed traumatizing memory to be healed. Freud imagined that once repressed, these memories became more intense when the traumatized child became an adult and fell in love. The events of the present resonated with the repressed memories and affects, creating a work overload for the defense system, which destabilized the individual. Every time the person fell in love, a whirlwind of thoughts and feelings arose and rendered him or her so ambivalent and anxious that the organism preferred to organize symptoms that would render the romantic relation less pleasing, or even impossible.
Today, psychiatric institutions and the social services have showed that Freud’s first intuition was indeed founded. Sadly, we know that there is much more abuse of children than even Freud could have imagined. Probably because of this fact, some psychoanalysts have questioned themselves about what would have become of Freud’s theory if he had supported his first hypothesis.67
Between 1906 and 1908, Freud analyzed a child born in 1903 using a psycho-analytically informed type of intervention adapted to what can be done with a child. It is the case of Little Hans. When he was three years old, a little sister was born. His father explained to him that she was a gift from a stork. However, children are not stupid. They know that funny things happen in the parent’s bedroom when father is there, because they cannot sleep with mama on those nights. They have seen their mother’s belly blow up like a balloon and then deflate as soon as the sister arrived. They have perhaps seen a calf come out from between the legs of a cow or a stallion mount a mare. But they have no tools to explain what they see. Consequently, they invent some fanciful explications. Hans told himself that children come out of the mother’s belly like poop and that he is probably a bit of special poop. If he would have seen his father put his penis between his mother’s legs, he would have maybe imagined that his father was urinating. In brief, he fabricates for himself an unsavory image of sexual life and his origins, which he prefers to repress to continue to value what goes on in his home and to value himself. Freud analyzes an entire series of events of this type that lead to a manifest phobia when Hans was five years old—a phobia of horses that Freud ends up healing.
Freud then supposed that when the child grows up and falls in love, the present events resonate with what is repressed. The infantile imagery concerning sexuality becomes more intense. The defense system has more work. A whirlwind of ambivalent and anxious thoughts inexplicably invade the consciousness. The individual’s behavior becomes increasingly inappropriate. Symptoms arise. The relationship with the loved one becomes less pleasant and sometimes impossible. The individual feels anxious but is able to continue to function as before. Within a conflicted life of this type, a particularly intense one, symptomatic hysteria can come about.68 In this example, there is no abuse, but there is an inability to manage what is perceived in a constructive fashion. Freud concluded that the best way to prevent a neurosis is a good sexual education. The sexual trauma is thus mostly a psychological phenomenon that constructs itself around a weakness of the mind rather that around real traumatic events.
This new elaboration of the traumatizing aspect of sexual life already began in 1895 when Freud noticed that there is no initial trauma for what he calls the anxiety neuroses.69 This type of neurosis blends (as does hysteria) physical symptoms (excessive cardiac palpitations, respiratory and digestive problems, bodily shaking and trembling, cravings, vertigo, etc.) and mental symptoms (fear and anxiety), but they are caused by other mechanisms. The anxiety neuroses can also have a sexual cause. But it consists this time of recurring frustrating behaviors. For example, as there was no reliable form of contraception at the time, a husband would withdraw before ejaculating when he made love, to avoid having a child. This is the model that Freud uses henceforth to analyze most of the neurotic problems.
In his 1900 The Interpretation of Dreams, Freud shows that his treatment is always founded on an exploration of the unconscious:
[For] certain psychopathological structures—hysterical phobias, obsessive ideas, and so on . . . unraveling them coincided with removing them. . . . If a pathological idea of this sort can be traced back to the elements in the patient’s mental life from which it originated, it simultaneously crumbles away and the patient is freed from them. (1900, II, p. 100)
However, it now consists, as the case of Hans so well illustrates, in analyzing the meanderings of the false reasoning that are lodged in destructive ways in the mental life of an individual. It now consists of undertaking a reconstruction of the psyche that permits more lucidity and more self-confidence and confidence in one’s surroundings. This exploration fosters the reconstruction of a person’s history so as to understand how the inadequate schemata that constituted an imagined personal history came about and stabilized.
The classic psychoanalytic method is based on a fundamental contract with the patient that is built around two rules:70
The second rule is a technique used by the hypnotists of the nineteenth century. It is the foundation of the psychoanalytic method of free association.71 It consists in associating out loud, not hiding any thought from the therapist at any given moment, even if it seems insignificant and irrelevant: the sound of the street cars, the smell of the room, the internal comments related to the therapist, the ironies concerning the price of the session, the pride in having worn a nice shirt, and so on. When the patient embarks on a structured narrative, he avoids associating and he dissociates from these little facts that build what is going on for him in the present moment. The structured discourse is a particularly powerful defense when the patient relates such moving and dramatic memories that the therapist does not dare interrupt.
A structured discourse (a narration, for example) deprives the therapist of a mine of information:
When a patient gives an account of a dramatic event, he informs the therapist, and he lets off steam, which is useful, but it draws the attention of the therapist and the patient to something that is not happening here and now. The therapist is certainly interested in knowing that the patient was beaten. But when this complaint is repeated, the therapist would like to know why the patient wants the focus of their attention to revolve around this event. The therapist tries to understand why the patient prefers to talk about the past instead of focusing on his need to complain. The past cannot be changed. The goal of psychotherapy is to help the patient better understand his present behavior so as to prepare for the future. An individual’s history explains who he is, but the story that a person tells himself is certainly not all of his history.
Interpretation is the psychoanalyst’s second basic tool. Interpretation can be related to context and content.
In exploring what is not said, in these twilight zones of the mind, the psychoanalyst not only finds the zones of timidity, affection, and irritation toward oneself and therapy but also the doors that allow the patient to enter anew in contact with the repressed thoughts and the defense mechanisms that structure his functioning.
The body, according to Freud, combines the physiological and bodily dimensions of the organism, such as I have described them in the System of the Dimensions of the Organism. The organism is still, for him, a coordination between mind and body. He claims that psychoanalysis is a mental treatment that takes its origin in the soul, begins by healing the soul, but can then also influence physiology.73
In Freud’s time, the soul/matter polarity was becoming increasingly difficult to defend. Scientists were all looking for a new theory concerning the organismic dimensions that could fit the data. Freud’s psyche elegantly fit into the spirit of the time as the mind is simultaneously integrated into the regulators of the organism but remains distinct from the other dimensions (body, behavior, physiology, etc.) with which it constantly interacts in an intimate way. His study of hysteria permits him to detail this view. By deciding to center his attention on the analysis of the content of what is being said, Freud focuses his attention on the mind more that on what he calls the body. Like all choices, it implies a gain and a loss. Some analysts go so far as to justify this choice by minimizing bodywork, like La Fontaine’s fable on the fox who finds appetizing grapes too sour because he cannot jump high enough to eat them. Others maintained the course fixed by Freud. The organism is constantly part of their peripheral vision. This was the case of Otto Fenichel, who reaffirmed in 1945 that “Mental phenomena occur only in living organisms” (Fenichel, 1945a, Introduction, p. 5).
Psychopathology, according to Freud, is certainly a dysfunction of the psyche, caused by a context to which an individual’s mind is incapable of accommodating itself other that in creating chronic repression in the unconscious. If a certain dose of chronic unconscious is inevitable, the dose found in Freud’s patients is too important to allow the psyche to adequately accomplish its function as an organismic regulator. Now the repressed has an impact not only on the mind but also on the organism; it can, for example, unleash functional problems of physiological and sexual behavior.74
Although the organism was part of Breuer’s and Freud’s thinking, they thought that a trauma, due to one or many events of sexual abuse, could be treated with psychotherapy, that is, by working only on mental dynamics (hypnosis, memory, understanding, regression, etc.). In short, the idea is that a woman’s body suffers just momentarily from being raped, because the physical wounds heal, whereas the wounds of the soul are often lasting. This analysis rests on some experience of hypnosis in which the unconscious seems to have a total control of the body mechanics, like the soul on the body in healing movements:
If we put a person into deep hypnosis and suggest the idea to him that he sees nothing with one of his eyes, he will in fact behave as though he has become blind with one of his eyes, like a hysteric who has developed a visual disturbance spontaneously. ... In a hysteric the idea of being blind arises, not from the prompting of a hypnotist, but spontaneously—by autosuggestion, as people say; and in both cases this idea is so powerful that it turns into reality, exactly like a suggested hallucination, paralysis, etc. (Freud, 1910a, p. 107)
The hysterical revulsions are therefore “nothing else but phantasies translated into the motor sphere, projected on to mobility and portrayed in pantomime” (Freud, 1909a, A, p. 97).75 The observation that a mental suggestion can have an enormous power over the body is an indisputable fact, but there are many ways to understand it. In the mind of many psychoanalysts, a mental representation can have a direct impact on the functioning of the organs. There would then be a direct parallelism. Freud knew enough to sense that this was not a direction to take. We must, in effect, explain the relative efficacy of hypnosis because it is more effective (that is, more powerful, longer lasting, etc.) with some people than with others. Hypnosis is effective when a series of mechanisms (mental, organismic, and bodily) are able to align themselves around a representation. As soon as a representation becomes what activates a schema, it acquires a stunning power. I have the impression that these “sudden cures” can inscribe themselves in the organism if there is already an organismic schema that uses this representation as a stimulus of reference, as in the case of the conditioned reflexes described by Pavlov (1927). This alignment around a representation can sometimes happen all of a sudden, as hypnotists demonstrate;76 or by a gradual construction as shown by the analysis of the anxiety neuroses that seems to create a mechanism that is close to conditioned reflexes already in place.
For a number of body psychotherapists, trauma often inscribes itself into the organism, in the functioning of the nervous system, in muscular tension, in the tissues that no longer respond as they should.77 In these cases, the wounding of the soul does not explain all of the suffering that builds up in an abused organism.78 Since Reich, it is admitted that the orgasm is an organismic conduct, not only a fantasy. The hysterical convulsion, when it resembles a stimulation of the sexual act, certainly would not be the play of an actor that activates the body. A convulsion activates psychophysiological remnants of the orgasm reflex that revives past pains.79 This vision is close to Descartes’s living body, capable of being wounded as profoundly by a physical intrusion (rape, violence) as by what is going on at the level of the representations. I do not believe that the psychoanalysts of today, like Francois Sironi (1999), who has helped people who have been tortured, could entertain a position like the one that Freud held early on. Since the work done on stress and oxytocin, we know that the body reacts as much as the thoughts do to trauma and that healing can rarely be only mental. The disorganizations induced by trauma in the innate reactions of the organism are one of the reasons that render the treatment of serious trauma so difficult and only rarely completely effective. This type of argument justifies the inclusion of interventions on body dynamics in a therapeutic treatment plan for traumatized persons.80
It is not necessarily words that frighten children: certain attitudes, involuntary gestures, a hardly noticeable annoyance may sometimes have much more impact. (Georg Groddeck, 1923, The Book of the It, p. 217)81
The interview of the patient must be as objective as possible. We limit ourselves to asking the patient to focus attentively on one of the images of the dream and to express the ideas that they evoke as they appear. (Jean Piaget, 1920, Psychoanalysis and Child Psychology, p. 20; translated by Marcel Duclos)
In the case of hysterical patients, free association had centers of clear attention because there was a crisis and manifest symptoms. By “center of attention,” I mean phenomena around which the associations organize themselves repeatedly and which facilitate the pinpointing of the themes that link the symptoms to the underlying mental dynamics. Each association becomes a note in the musical score of the mental dynamics that the psychoanalyst is then able to apprehend. In the case of neuroses that are not caused by a specific trauma, there are no clear symptoms that serve as a point of departure for the patient’s associations. The analyst is then inundated by associations with which he does not always know what to do. No musical form (fugue, sonata, etc.) allows for structuring all the notes that takes hold of the atmosphere in the therapy room, of the soul of the patient and that of the therapist.
Each time a researcher is inundated with data, he follows Descartes’s method. He first concentrates on what can be most easily assimilated. There is hope that once the researcher has clarified the more simple mechanisms, he will be able to confront the increasing complexity. To achieve this, the psychoanalyst typically uses a small repertoire of sexual behaviors as a reference point for associations, because at least he has a theory to support this choice. The reference point is then a key instinctual drive for psychoanalysts. This repertoire of sexual metaphors (castration, primal scene, etc.) often activates strong explicit reactions in the patient, which can be used like a symptom, like a reference for a wide range of associations.
Another manifestation that can serve as a center of organization for the associations is a dream. This is even one of the most useful centers, because the dream brings metaphors produced by the patient to the therapist. These metaphors can be used to build a ground of shared associations between the patient and the therapist.82 This is one of the reasons why I think that dreams remain a “royal road” to the unconscious.83
I proceed concentrically, instead of by free association that sort of zigzags away from the dream and lands in some place or another. So the question to the dreamer is: “What comes to mind about X, what do you think of it? And what else comes to mind about X?” Whereas the question in free association is: “What comes to mind about X? And then? And then?”. And so on. In this way the associations are about other associations, instead of about X. In contrast to this method, I stay with the original image of X. (Karl Gustavjung, 1940, Children’s Dreams, 1, p. 26)
Freud uses the method of free association to find the latent content of a dream.84 He first writes down the dream the patient tells him. Then he cuts it up into little “bricks” that contain one or several words.85 He then presents a first brick to the patient while asking him to say every thought that comes to mind. Freud presents the next brick and again asks for the associations. The first phase of the analysis of the dream is complete when all the pieces have been presented for the spoken associations of the patient and for the internal associations of the therapist. The latent content emerges once all these associations have been heard. These associations form the pieces of a puzzle that can then be perceive as forming a scenario.
A vignette on dreams. I had a patient for whom the latent content was always the opposite of the manifest content. For months, she presented frightening nightmares of monsters that attacked her during the night. Through the associations, she rediscovered her love for her father. Afterward, for many months, she came with dreams that made her happy because she saw herself with her lover on a wonderful sandy beach on a Pacific isle. Each time, she rediscovered in her associations the anxiety of loving someone who can disappoint you and even abandon you. The horrible dreams led to the need to love and to the pleasure of being loved: then, having found someone to love, the heavenly dreams led to the anxieties of love.
An astute technique is to ask the patient what is the first thing that comes to him when he hears the therapist read a brick of the dream, then free associate uniquely on this first association by forgetting the pieces derived from the manifest dream. The difference between the manifest and the latent content is made clearer because we can often reconstruct a “hidden history” by putting the first associations together. For example, the therapist says “beach” and the patient associates “shark.” The therapist then asks the patient to free associate on the shark instead of the beach.
The material gathered in this way leads to the second phase of the analysis, which is the integration of the latent content into the mental dynamics of the patient. One of the difficulties when you use this technique is that the latent content has been repressed because it could not be integrated without creating chaos in the mind. In Freud’s time, for example, a number of patients followed a religious morality that did not tolerate sexual or violent fantasies. Freud helped his patients reconstruct a moral vision capable of including these fantasies without having the impression of acting immorally. In carrying out this work, psychoanalysis put into question the foundations of the official morality in European countries.
It became necessary to clearly differentiate delusions of the mind from behavior. From the point of view of psychoanalysis, the content of a sadistic dream becomes reprehensible as soon as it acted on, but not before. To dream that we are torturing a sexual partner, rendering him totally submissive, is one thing; becoming sadistic is something else. Thus the psychoanalysts showed that to apply the same moral laws to thoughts as to behaviors often leads to deeply rooted neuroses. The neurotic criticizes his thoughts as if they were behaviors. He represses his “unacceptable” thoughts for fear of what others would think of him. He censures these fantasies before they reach awareness. In this way, he need not feel guilty for having them and feels assured that they will not influence his behavior. On the contrary, a pervert is compelled to act out what he imagines and is often incapable of stopping himself. The common element between neurosis and perversion would be a poor differentiation between the requirements of the mind and those of behavior. This lack of differentiation is one of the weak points of certain forms of humanistic psychotherapy, notably certain body psychotherapy approaches, that encourage, in a simplistic way, all manner of self-expression.
One of the recurrent themes in the psychoanalytic literature is that the unconscious dynamics fabricates fantasies, without taking into account the moral requirements of the cultural environment of the individual. This production is submissive to intra-organismic modes of functioning. To want dreams to avoid imagining reprehensible behavior according to the social environment would be to deny that biological needs do not follow the same rules as the legal system of the state. Psychoanalysts want to know all the fantasies produced by the mind so as to understand how the psyche functions and then prevent the patient from acting out the fantasy. Only once the dynamics of an individual’s drives are understood, is it possible to approach the inevitable issues posed by the behavior, which, by definition, is a bridge between drives and social practices. This procedure allows one to know what aspects of the individual a society needs to support and what aspects of the individual’s inner dynamics cannot be integrated in a type of society that demands the respect of other people. This example, like so many others, shows why it is important to postulate that behavior and mind do not follow the same modes of functioning. In psychoanalytic jargon, when the mental content automatically becomes behavior, there is “acting out.”86 Other forms of psychotherapy, like most body psychotherapies, require that one understands how thoughts and behaviors are related. Some types of coordination between thoughts and behavior are useful and need to be supported, whereas others are destructive. These therapies are therefore against the psychoanalytic stance that all forms of coordination between mind and behavior should be negatively connoted as a form of acting out. Most of the humanistic psycho-therapies, in effect, encourage the attempts that the patient makes to explore new ways of coordinating feelings and expressions.
In what concerns this patient, we were really able to celebrate, that day when after a session where he had expressed himself in a particularly superficial, insincere and affected way; he said, “During all of this session, I experienced something like a weight on my stomach.” It was important at that moment to show him that it was this impression of weight, and not his words, which represented the “associations” that we searched for during this session; in other words, the real offshoots of the unconscious.
“It was not anxiety,” he says, “only a sort of vague pressure.”
“Like a stomachache?”
“Not like that either. It was something mental but not like anxiety. More like a nightmare when we have the impression that there is someone sitting on your chest.” (Otto Fenichel, 1941, Problems of Psychoanalytic Technique, pp. 8–9; translated by Marcel Duclos)
Filled with wonder by the effectiveness of this way to combine the free associations and the centers of attention, Freud (1901) used the same method to find the latent content carried by a lapse, mistakes, awkwardness, and failures. The body psychotherapists also use free association to create ways to read body dynamics. These developments allow psychotherapists to include gestures in a chain of associations. To explore a gesture can sometimes generate thoughts and associations87 as effectively as exploring a dream. A gesture can be associated to another movement, and that movement to a thought and/or an affective dynamic. The fundamental idea is that a gesture can sometime be the center around which is organized an entire series of thoughts; these thoughts are not necessarily those that consciousness spontaneously includes in a verbalized chain of associations. A chain of verbalized associations is necessarily linear (one word at a time), whereas imagination often manages several impressions simultaneously.
Vignette concerning the associative systems of gestures and words. Here, I take, as an example of dream analysis, the technique in which I ask the patient to tell me the first association that comes up when I read a brick of his dream to him. The difference with the classic psychoanalytic technique is that a conscious thought or gesture is considered an association. Thus, when I present the brick to a patient, I am attentive to what the body does as much as the first words. If, after a brick, a patient laughs, then gives me a verbal association, I assign to the smile the status of first association. Then, on this smile, I will ask the patient to associate, with gestures and words, to seek the latent content of the dream. Experience has showed me that this method often leads to useful discoveries for the development of the patient and the understanding of his functioning.
Here is an example of an analysis of the three bricks of a patient’s dream for which the first association was a reaction of the body.
The text of the dream: I jump in my car to run away. A man, on the bridge that crosses this small square, shoots at me.
Piece I: I jump in my car. While I read this brick, the patient slightly raises her eyebrows. I ask her about what this slight raising of her eyebrows might remind her. The affect associated with it is surprise. Surprise to find herself thinking of her first lover, to the mixture of pleasure and shame with which she was filled the first time she made love, even though it was pleasant enough.
Piece II: Run away. As soon as I finished reading these two words, she exhales deeply. She attempts to control a rising anxiety, a feeling of depression, followed by anger against everybody.
Piece III: A man. This time she laughs. She sees her father’s expression of mockery when he made everyone laugh. She then remembers vacations when she was six years old. The family is about to laugh in an inflatable boat on the sea. At that time, the father took care of the children. It was fun.
This dream analysis was important for the patient because she had pushed away from her thoughts the father who had abandoned her. She gradually rediscovered that this father is not only bad. There had been a happy time between the two of them. Technically, in this example, the first reaction—the stimulus association, as we sometimes say—is a body reaction from which the associative chain returns to the verbal level. I chose this example because it is easy to transcribe, but all sorts of combinations are possible. For example, the first association is verbal, which then opens up on the exploration of a gesture that unleashes an affective reaction.
In this precise case, this memory of the pleasure that she had of wonderful vacations with her father did not “cure” the patient, but this memory is part of a process that permitted her to reconstruct a more accurate and helpful image of her father and who she is.
Psychoanalysts like Wilma Bucci have recently combined empirical and theoretical research to explore in a particularly detailed way the link between the nonverbal and the verbal expression of a thought. The goal of this study is to propose a psychodynamic view, inspired by the research in the neurosciences, which facilitates the inclusion of movement in the psychoanalytic technique.
Wilma Bucci is especially inspired by the studies taken up by the neurologist Michael S. Gazzaniga (1985) in the laboratory directed by the Nobel Laureate, Roger Wolcott Sperry.88 Gazzaniga participated in the research concerning what happens when a surgeon severs the corpus callosum. The corpus callosum is composed of nerve fibers that connect the two lobes of the neocortex. The aim of this surgery was to diminish the impact of violent epileptic attacks of one hemisphere on the rest of the brain. At first, these operations did not seem to have a discernible impact on the mental functioning of the patients. Nevertheless, they complained of difficulties that were difficult to describe. Sperry decided to investigate. The first result of this research was to specify the different functions of each lobe. Sperry confirms, for example, that language is mostly organized by the left brain, even though certain linguistic mechanisms are also associated to the right brain,89 and images would be mostly dealt with by the right brain. That said, there are neurological pathways that link the two hemispheres of the neocortex through subcortical pathways. These nerves remain intact after the pathways of the corpus callosum have been severed. The right visual field is linked to the left brain, and the left visual field is linked to the right brain.
Michael Gazzaniga joined Sperry’s team to explore what is going on at the level of thoughts when the two hemispheres can no longer coordinate with each other. One subject of investigation was to find out how this intervention influences the coordination of images and words. He used different strategies to test combinations between objects and words. For example, a subject must touch an object with one hand. He cannot see the object, given that it is hidden by a screen. The object is easy to describe. It is round or square, big or small:
Gazzaniga then wanted to know if the movement of the left hand is conscious. He repeats the same experiment as before, except that he asks the subject not to verbally name what he touches. Instead, he presents a drawn picture of all the objects used in the experiment. When the subject touched an object with his left hand, he was able to point to the corresponding image. Even when the subject is right-handed, he can more easily make a drawing of the object that had been touched by his left hand. He can also recognize the object. In short, the subject can perform a series of apparently conscious operations with his left hand, but he is not able to say what he is doing.
I heard about these studies while I was a student. Yet even today, I cannot begin to imagine that I am capable of performing some conscious operation about which I would not be able to speak. There are some feelings that I have difficulty describing in words, like a musical experience, but in this case I am able to say that I had such a musical experience that I am unable to describe in words. Sperry and Gazzaniga’s subjects are different. They can remember an object and then point to it, or they can see an image and choose the appropriate object. But if they performed this task without seeing what they were doing with their left hand, they are unable to say that they touched an object, or that they recognized an object. The researcher asks them to take up the same object, and they do so. But they are incapable of saying what they are doing. Here we have a situation that is difficult to grasp; even if we can reason about it. Conscious movements cannot be stored by the type of memory used for speech. Sperry’s team, in these cases, speaks of an intermodal transfer of information.
In Kant’s time, the reference model was that a concept could be expressed in many ways (with words, movements, a painting, etc.) without being modified. The modular models that researchers like Sperry introduced supports another theory. Each sensory modality is linked to distinct dynamics of the brain. This implies that each modality (movement, image, or word as it happens) is associated to a particular form of conceptualization. The representation of a doorknob varies in function of the modality employed. A doorknob touched, looked at, or verbally described would not be represented the same way in the brain. Furthermore, each type of representation inserts itself into different ways of thinking. When I think of the doorknob with my hands, I think of this doorknob differently than when I talk about it. I think differently when I dance than when I write or paint.90
Sperry ends up asking himself whether each modality engenders different types of conscious awareness. Each type of consciousness, in combination with others, participates in the formation of a sort of general impression that is multimodal. This form of consciousness allows for structuring what is going on into forms of thought associated to each modality. For body psychotherapy, this research reinforces the necessity to develop a multimodal approach in psychotherapy.
The notion of intermodality has entered into the domain of psychotherapy above all with The Interpersonal World of the Infant by psychoanalyst and researcher Daniel N. Stern (1985). He shows that the newborn poorly differentiates the modalities and only with the advent of speech does the child begin to distinguish clearly and explicitly what is seen from what is heard, felt, or touched. This notion became widespread and is found today in the discourse of many movements in psychotherapy.
Wilma Bucci91 is a psychoanalyst who has studied how intermodality, as defined by Gazzaniga and Stern, is involved in the relationship between patient and psychoanalyst. With methods different that those used by neurologists, she specifies the following points:
To draw from the language of computers, everything happens as if a thought expressed with gesture was “formatted” differently than a thought expressed with words. To manage these different forms of thoughts, each person must develop within himself interfaces that permit the association of the constructed content with each modality. Bucci’s studies shows that these interfaces are more or less developed, and they can be refined if an individual lives the experiences that allow for the calibration of these interface. Here, Bucci rejoins Bruner (1966, 1973) who distinguished two modes of representation:
For Daniel Stern, when there is an “affect attunement” between mother and child, the mother can respond to the infants’ communication in another modality.95
AFFECTS WITHOUT AN OBJECT
In speaking of Kurt Goldstein, I discussed the difficulty of working with affects “without objects.” These affects manifest at the level of feelings and behavior, but the representations that can be associated with them either remain in the unconscious or have never been able to establish themselves in the conscious mind. They can influence behavior but do not act on the thoughts, save in a nonconscious fashion. Goldstein’s patients were soldiers who had experienced trauma in such a confusing war that they were not able to relate the representation of an aggressor to their fear.
Beatrice Beebe (2005) describes the same kind of phenomenon concerning a patient who had undergone a long series of traumatic events, especially sexual ones, ever since birth. These events had occurred before the formation of her explicit memory. As an adult, this person, a brilliant academic, could not apprehend the crumbling state of her affects.
John May (2006a),96 a body psychotherapist in the United States, has taken up the hypotheses of Bucci, Beebe, Downing, and Heller to talk about a patient who experiences strong emotions but cannot connect them to any meaning or words.
ARCHAIC BODY/SYMBOLIC LANGUAGE
More and more often, psychoanalysts include the body in their reflections, and they continue to assign to it modes of thought that are archaic, subsymbolic, and infantile. In other words, the body is closer to the vegetative layers, while speech permits the integration of the complex functions of the mind. The body psychotherapist more easily integrates an adult, creative, and intelligent body into his reflections, like the one of the lover, the dancer, the gymnast, and the craftsman. This brings us to a picture with at least two entry points (it is always possible to refine this by adding additional categories):
Wilma Bucci’s model is centered on the coordination between the cases 1A-2A (the archaic layers elaborated by passing through motor activity) and 1B-2A (the symbolized layers that are elaborated thanks to language), and it leaves the other possibilities aside. John May takes up this discussion by presenting the case of a patient (JL) who suffers from alexithymia.97 This case makes it possible to illustrate how the 1B-2A axis is built.
Vignette on JL. JL is unable to relate the representative aspect of the emotions with the vegetative dimension of the emotions. In the session described in his article, May proposes to the patient that he take a bioenergetic posture98 that allows him to feel the tension that inhibits respiration. He asks the patient not to control what will happen with his mind and to have confidence that the posture that he is proposing will do all of the work. In less than a minute, the patient’s diaphragm distends, and the patient begins to cry. The tears gradually transform into a demonic rage. In this session, the patient clearly feels his violent emotions and expresses them in a way that the therapist can have a clear impression of what is experienced, but the patient has no image, no words to describe what has just happened. This does not prevent the patient from feeling better and being more relaxed at the end of the session, as if he had expressed something that had been built up in him. May knows by experience that these emotions will return with force in the weeks to come.
By working this way for several years, the patient could “recognizes somatic sensations and events that he was not aware of previously. He has learned that they sometimes indicate that he is sensing some sort of emotion, and in many cases he can directly experience the emotion.” This work of calibration goes on at the level of the body without opening up onto the representations at first. Here, May uses Bucci’s notion of “subsymbolism” to explain this work of calibration. He does not try to create a direct link between body feelings and representations. His strategy is to help the patient increasingly feel clear links between his emotions and his expressions, which he could describe verbally. May explicitly works from the notion that an emotion is elaborated by the treatment of different neurological, organismic, and mental circuits that are “formatted” in different “machine languages,” most of which do not use representational systems to function.99 The aim of John May’s work is to support different forms of coordination between the subsymbolic systems to create the conditions that will support the emergence of the mechanisms that allow explicit connections between affects and representations. To create a link with the systems of representation, he set about to take the same postures as JL’s in front of a mirror. JL is then able to verbally describe what he perceives in his therapist. This technique creates a system of reference between the verbalized representations of the patient, John May’s posture, and the patient’s posture.100 This type of mirror play can also awaken circuits from early infancy when the baby rejoiced every time his parents imitated him. With this type of approach and concepts, gradually the rapport between body representations and verbal representations was able to relate anew in JL’s mind when he felt an emotion.