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Ongoing Discussion of Yoram Yovell (Vol. 2, No. 2):

Commentary by Joseph W. Slap (Philadelphia) and
Jodi H. Brown (Philadelphia)
a

Joseph W. Slap M.D. & Jodi H. Brown M.D.

a

1601 Walnut Street, Suite 1312, Philadelphia, PA 19102, e-mail:

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Published online: 09 Jan 2014.

To cite this article: Joseph W. Slap M.D. & Jodi H. Brown M.D. (2001) Ongoing Discussion of Yoram Yovell (Vol. 2, No. 2):
Commentary by Joseph W. Slap (Philadelphia) and Jodi H. Brown (Philadelphia), Neuropsychoanalysis: An Interdisciplinary
Journal for Psychoanalysis and the Neurosciences, 3:1, 111-120, DOI: 10.1080/15294145.2001.10773344
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Ongoing Discussion
sciousness. In the case of purely psychic states, when
consciousness is not seriously impaired, the confusion
consists of impaired cognitive function and may include impaired memory. Attention is difficult or impossible and it cannot repair the cognitive dysfunction.
Simple unconsciousness, or coma, or coma vigil are
usually the result of severe brain dysfunction and ordinarily fall outside the psychiatric situation.
In the case of psychosis, consciousness remains
clear and attention can be deployed. What is altered
is contact with consensual reality, while reality testing
is perverted so as to validate the departure from perceived reality and the adversion to the delusional reality of the psychosis. The process parallels that of the
full mystical experience in which reality is abdicated
in favor of an illusory reality. The difference lies in the
reversibility of the process. The mystical experience is
reversible, brief in duration (minutes or hours), and
usually consistent with the subject's religious tradition
or some variant thereof. Psychosis is not really reversible (without intervention such as medication), enduring (often for years), and idiosyncratic in content.
The transition from realism to psychosis, the
"psychotic break," is often marked by a delusional
symbolic rebirth accompanied by the illusion that the
subject now sees what he should have seen all along:
"Now I see it alL" The delusion, usually a delusional
conspiracy, now reveals itself as the objective truth,
heretofore hidden from everyone's eyes. Similarly,
most mystical episodes are accompanied by a "revelation." In religious mysticism the revelation is a message from God, for example, the Revelation of St.
John. It is the transition (or transport) from reality

111

orientation to pseudoreality in each case that is described as the revelation. What is involved here is not
a change in the function of consciousness, attention,
or of the sense of familiarity, but primarily the sense
of reality and reality testing. It is the illusion or delusion of rebirth that is the affective component of the
alteration of ego function, but the instinctual, insistent
need for attachment that drives both the mystical and
psychotic fantasy.
I hoped, in this communication, to list some of
the variants of consciousness and its deformations
along with accompanying alterations in attention. I
hoped to show too that consciousness is invariably
linked to affect. In fact, I believe, that the facts support
the proposition that consciousness evolved concomitantly with affect as the perceptual organ for affect.
Some of the variants may provide data for the neuroscientific study of consciousness, attention, and affect.

References
Damasio, A. (1999), The Feeling of What Happens. New
York: Harcourt, Brace.
Nunberg, H. (1959), Principles of Psychoanalysis. New
York: International Universities Press.
Panksepp, J. (1998), Affective Neuroscience. New York:
Oxford University Press.
Watt, D. (2000), Emotion and consciousness. Part II. A
Review of Antonio Damasio's The Feeling of What Happens. J. Consciousness Studies, 7(3):52-73.
5021 Iselin Avenue
Riverdale, NY 10471
e-mail: mostow1234@aol.com

Ongoing Discussion of Yoram YoveIl (Vol. 2, No.2):

Commentary by Joseph W. Slap (Philadelphia) and Jodi H. Brown (Philadelphia)

Whether psychoanalysis can become a respected

member of the scientific community, or is destined
to be regarded as an early 20th-century intellectual
movement, may hinge on a principle enunciated by
Joseph Slap, M.D., is a Training and Supervising Analyst at The
Psychoanalytic Center of Philadelphia.
Jodi Brown, M.D., is a Lecturer of Psychiatry at the Thomas Jefferson
Medical College.
The central thesis of this response was presented in a paper titled
"Congruence of the Neuroscience of Perception and Memory with a Model

Dr. Yovell, namely, "psychoanalytic theory can and

should go beyond our current neurobiological understanding of the mind, but never contradict it" (pp.
1-2). He states further that psychoanalytic theory
"should be continuously reexamined and revised, to
ensure its coherence with emerging neurobiological
research findings" (p. 2). Here is the problem: As we
of the Mind" at the Spring Meeting of the American Psychoanalytic Association in Washington, DC, May 1999.

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112
shall show, the structural model is incompatible with
the neurobiological findings cited by Dr. Yovell.
The structural model enjoys a remarkable immunity in that it remains the paradigm for psychoanalysis
despite grievous theoretical and clinical deficiencies.
The id has dropped out of psychoanalytic discourse;
Brenner (1992) questions the validity of the superego
concept, and it appears to be diminishing in importance and frequency of citation. There is no internally
consistent way to define the id, ego, and superego.
At times these macrostructures appear to be reified,
causally effective entities, and at other times classifications of functions in situations of conflict. There is
confusion as to whether unconscious fantasy configurations belong to the id or the ego or are a product of
all three (Slap, 1986; Slap and Slap-Shelton, 1991).
The structural model is not a guide to the conduct
of psychoanalytic therapies. The majority of practitioners, and this appears to include Dr. Yovell, employ a bipartite model consisting of the realistic and
reasonable part of the patient, analogous to the ego of
prestructural theory, and a pathogenic dynamic unconscious. Sandler (1983) has contrasted the structural
model to which we pay lip service with the private
theories with which we work. This circumstance finds
a parallel in our institutes where there are two separate
curricula. Candidates study the structural model in theoretical courses and learn to ignore it in supervision
and clinical seminars. A candidate might receive
praise for his grasp of id or superego in one class
but would be looked at askance if he invoked these
structures in the discussion of clinical material in another. He would be labeled "too theoreticaL"
The result is a failure in communication. If we
employ our private models when we wor k with patients and talk about the structural model when we
discuss theory, there is little possibility for advance in
the field. We feel that the hegemony of the structural
model contributes significantly to the unhappy plight
of psychoanalysis described by Kandel (1999): "The
achievements of psychoanalysis in the past 50 years
have not been impressive and psychoanalysis enters
the new century with its influence in decline."
The question is, given the additional evidence of
its deficiencies coming from neuroscience, how long
will it take psychoanalysis to relinquish the structural
model as its overarching paradigm?

1
The hippocampal-based system is primarily neocortical. Perceptual data are processed by primary and as-

Slap-Brown
sociational sensory cortices prior to registration in the
hippocampus, and the hippocampus supplies the prefrontal cortext with associations derived from memory. The amygdala-based system is subcortical;
perceptual data from the thalamus are swiftly registered in the amygdala without processing by the neocortex.
The neurobiological literature (LeDoux, 1996)
indicates that the activity of the hippocampal-based
system is congruent with the functioning attributed to
the ego of prestructural theory, and that the activity of
the amygdala-based system is congruent with functions attributed to the dynamic unconscious. These relationships are implicit in Dr. Yovell's paper.
The Prefrontal Cortex and the Ego

In a review article on the functioning of the prefrontal

cortex, Weinberger (1993) indicates that the prefrontal
cortex has direct and indirect connections with heteromodal association cortices, sensory association cortices, the thalamus, and limbic structures, including the
amygdala and hippocampus. He states that these sites
are components of information processing networks
such as attentional, mnemonic, emotional, and intellectual organizations. He infers a supramodal, executive status for the prefrontal cortex. Information
arriving at the prefrontal cortex has undergone considerable associative processing. Thus the prefrontal cortex does not deal with the raw sensations of light or
sound but processes these percepts only in the context
of a situation or event. In a similar way, the prefrontal
cortex monitors motor behavior in terms of complex
programmed action rather than specific limb movements.
Damasio (1994), who like Weinberger has studied the functional interconnectivity of the brain, has
asked where brain and mind meet. Damasio explains
how the human brain is not designed to let sensory
information from the eye, the ear, the muscles, the
viscera, and other primary "sensory harbors" talk to
each other directly. Nor is it designed to let these sensory harbors talk directly to motor controls. In addressing the nature of our brains, Damasio explains
that sensory sectors must first talk to interposed neuronal regions, which then talk (i.e., send forward-projecting axons) to farther away regions. Damasio
indicates that these multiple, parallel pathways converse downstream at some apical areas, such as the
cortex nearest the hippocampus (the entorhinal cortex), or some parts of the prefrontal cortex (dorsolat-

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Ongoing Discussion
eral or ventromedial). Damasio asks what the
indirectness of communication and its complexity or,
to use the language of Weinberger and others, what
"heteromodal" and "supramodal" design buys us.
Damasio's answer is that interposed structures,
like the prefrontal cortex, allow for the momentary
construction and manipulation of images. "In between the brain's five main sensory input sectors and
three main output sectors lie the association cortices,
the basal ganglia, the thalamus, the limbic system cortices and the limbic nuclei, and the brain stem and
cerebellum" (pp. 93-94). Damasio refers to such an
in-between sector of the brain as an organ of information and government which "holds and manipulates
both innate and acquired knowledge about the body
proper and the outside world" (p. 94). He postulates
the existence of "dispositional representations" in the
in-between sectors. But when it comes to more specifically localizing where an integrated mind unites
reason and emotion, he turns to the prefrontal cortex.
While damage to other in-between sectors might cause
learning disabilities, damage to the prefrontal cortices,
specifically the ventromedial prefrontal cortex, causes
impairment in decision making, goal-oriented thinking, and social behavior. Damage to the prefrontal cortex changes personality and makes us unlike who we
are. As the most specific neocortical site for information processed in limbic circuits, the prefrontal cortex
is the crucial locus of interplay between intellect and
feelings.
While as Watt (1990) explains, many ego functions are supported in unimodal cortices and virtually
all brain structures, only bilateral damage to the prefrontal areas leads to "severe personality regression
and fundamental ego loss" (p. 493). Watt states that
there is "evidence that much of what psychoanalysis
has termed the executive functions of the ego are supported in the prefrontal cortices" (p. 513). Watt further explores how many functions associated with
object-relations are the operations of right hemispheric pathways involving the prefrontal cortex.
Given the above, there is a clear correspondence between some functions of the prefrontal cortex and the
ego of prestructural theory.
The Amygdala and the Dynamic Unconscious

Memory is not a unitary process. There are different

kinds of memory subserved by different brain structures. The two memory systems essential to our thesis
are declarative memory and emotional memory. Neu-

113
roscientific evidence suggests that these memory systems operate independently. Declarative or explicit
memory refers to conscious recollection of past events
and experiences; this faculty is attributed largely to
the hippocampus, which is part of the mesial-temporal
cortex. LeDoux (1996) notes that hippocampal circuits
establish complex memories in which many events are
bound together in space and time. These circuits provide representational flexibility; they can be called on
in many ways and in many kinds of situations. The
principal sources of input to the hippocampus are the
major sensory processing systems of the neocortex.
After having processed this data the hippocampus
projects back to the neocortex making the information
available to the prefrontal cortex.
Emotional memory is attributed largely to the
amygdala, which makes affective evaluations of perceptual data prior to the processing of that data by the
prefrontal cortex. Raw perceptual data arrive at the
thalamus and are transmitted to the amygdala, the neocortex, and the autonomic nervous system. Transmitted data arrive at the amygdala earlier than at the
prefrontal cortex because the data going to the neocortex must be processed by the sensory and association
portions of the neocortex before being available to
the prefrontal cortex. The record of such emotionally
charged events is unconscious but the affects generated are consciously experienced and provide the emotional tone for conscious experience.
When the amygdala is confronted with an overwhelmingly frightening perception, the amygdala
arouses the autonomic nervous system by pathways to
the hypothalamus, which then causes release of ACTH
from the pituitary. The effect of stress hormones circulating back to the brain is to impair hippocampal and
prefrontal cortical functioning and to facilitate the activity of the amygdala. The organism is then more
prepared to react to danger rather than to take time
thinking about it. In so doing it lays down memories
of traumatic events, and at the same time tends to
dampen the ability of the hippocampus and prefrontal
cortex to modify these memories. The memories laid
down in the amygdala tend to be difficult to extinguish;
the term indelible is frequently used.
LeDoux (1992) notes that the instantaneous activation of the thalamo-amygdala systems is especially
useful in life-threatening situations such as being approached by a predator. The individual then responds
prior to receiving input from the thalamo-corticoamygdala projection route. In other circumstances the
earlier thalamo-amygdala route serves to prepare the
amygdala for inputs from the cortex, and the amygdala

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114
is able to evaluate the significance of complex information such as fully perceived objects and events.
Thus amygdala-encoded impressions may vary from
the crude and fragmentary to the complicated. LeDoux
speculates that individuals vary in their constitution
"in the extent to which the thalamic-cortical pathways
predominate in the initiation of emotional processing
through the amygdala" (p. 277). If so, the variations
may help explain the extent to which neurotic conditions may be resolved in different patients; that is "the
stickiness of the id" may be harder to change in the
case of thalamo-amygdala predominance. Such variations, if gene linked, would help explain the hereditary
predisposition to posttraumatic stress disorder (PTSD)
demonstrated by True and his colleagues (1993).
The amygdala matures earlier than the hippocampus. LeDoux (1996) feels that infantile amnesia is better explained by the immaturity of the hippocampus
than by the concept of repression. Children of 2 or 3
do have memory but are not able to lay down longterm declarative memories; continuous memory occurs later. Infantile amnesia may also involve the inhibition of the still nascent, and therefore weak,
hippocampus by the amygdala stimulating the pituitary
as outlined above.
Accordingly, a child of 2 or 3 exposed to the
parents' lovemaking may interpret the event as a brutal
assault or murder by the father. This impression is laid
down as an emotional memory by the amygdala. The
hippocampus is shut down by the stress reaction. The
child awakes in the morning without recollection of
the event and finds his mother healthy and going about
her routine in a normal manner. This observation does
nothing to modify the impression laid down a few
hours earlier. Years later the child, now an adolescent
or young adult, is at risk for sexual dysfunction by
the activation of this memory. As LeDoux observes:
"Later exposure to stimuli that even remotely resemble those occurring during the trauma would then pass,
like greased lightning, over the potentiated pathways
to the amydala, releasing the fear reaction" (LeDoux,
1996, p. 258).
Just as the prefrontal cortex appears to be a neuroanatomical counterpart to the ego of prestructural
theory, the amygdala-based system appears to have
some defining attributes of the dynamic unconscious:
Its contents are unconscious and difficult to extinguish; it is sensitive to trauma; it is the vehicle of
anxiety; it differs in its cognitive functioning from the
ego-prefrontal cortex.

Slap-Brown

II
Given this understanding of the functions of the prefrontal cortex and the amygdala, what are the minimal
specifications of a model of the mind, if the model of
the mind is to be compatible with these structures and
their relationships? We infer these characteristics: (1)
It would be a bipartite model: the prefrontal cortex/
ego and the amygdala/dynamic unconscious. (2) The
two structures would have distinct perceptual pathways. (3) The structures would have distinct cognitive modes.

The Structural Model

It may be argued that the structural model meets criteria 1 and 3. Freud (1923, p. 34) made clear that he
regarded the superego as a modified part of the ego.
Thus the tripartite structural model can easily become
a bipartite model for those not too invested in the superego as a distinct structure. Clearly, the structural
model passes the test for criterion 3; the ego operates
with mature reason and judgment, the id with primary
process. The structural model, which has other problems to be specified below, fails the test for criterion
2, which holds that there are separate perceptual pathways for the ego and the dynamic unconscious. Freud
repeatedly expressed the view that perceptions enter
the psychic apparatus through a single portal, a notion
that possibly originated from his early concept of neurosis arising from interference in a reflex arc between
stimulation and discharge (Breuer and Freud, 1895).
Thus, according to Freud's first topographic
model, perceptions enter the psychic apparatus via the
unconscious. Freud (1915) wrote that "Normally all
the paths from perception to the Ucs. remain open,
and only those leading on from the Ucs., are subject
to blocking by repression" (p. 194). However, in The
Ego and the Id (Freud, 1923), Freud reversed himself
on how perceptions enter the psychic apparatus. We
read: "All perceptions which are received from without (sense perceptions) ... are Cs. from the start" (p.
19). Freud's diagram of the psychic apparatus (p. 24)
makes clear that perception is a function of the ego
and is linked to consciousness in that the perceptual
system (Pcpt.) is joined with Cs. to form Pcpt.-Cs.
which forms the ego surface, that is, its interface with
the external world. The repressed unconscious is now
part of the id which is "cut off from the external
world" (Freud, 1940, p. 198).

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Ongoing Discussion
Neuroscience aside, there are clinical difficulties
with understanding that perception is exclusively a
function of the conscious part of the ego and that there
is no direct perceptual pathway to the unconscious
layers of the mind. It is an everyday observation in
analytic practice that individuals react to seductive,
hostile, and other behaviors on the part of others without consciously recognizing these behaviors. The impingement of external events on the unconscious
affects the formation of dreams. Registration of tachistoscopic and other subliminal stimuli are demonstrable
under experimental conditions. Even more troublesome for this theory is the problem of accounting for
the stimulation of unconscious drive derivatives, guilt,
and other elements of intrapsychic conflict by the
events of the external world. If the ego stands between
the external world and the repressed, why does it not
block these percepts from the repressed? If the ego is
unable to function in this way and percepts have an
easy path to the repressed, how can one maintain that
the id is cut off from the external world?
While a major thesis of The Ego and the Id was
that much of the activity of the ego took place outside
of consciousness, Freud was quite clear that perception took place on a conscious level. He reiterated
this understanding in "A Note on the 'Mystic Writing
Pad' " (1925), in which he stated that the functions
of perception and memory were divided among separate but interrelated systems: "The layer which receives the stimuli-the system Pcpt.-Cs.-forms no
permanent traces; the foundations of memory come
about in other, adjoining systems" (p. 230). This division of functions between two different systems had
appeared previously in Studies on Hysteria (Breuer
and Freud, 1895, pp. 188-189n), The Interpretation of
Dreams (1900, p. 5), and Beyond the Pleasure Principle (1920, p. 25).
Schimek (1975) in a critical examination of
Freud's views on cognition observed:
For Freud, in line with the association theory of the
19th century, perception is essentially the passive,
temporary registration of a specific external object.
The perceptual apparatus functions like the lens of a
camera. In order to keep its unlimited receptive capacity for new registrations, it retains no permanent
traces of them; it is "without the capacity to retain
modifications and thus without memory" (1900, p.
539). This means that perception is uninfluenced by
past experience and is not subject to a developmental
and learning process. Freud often equates the two
terms "perception" and "external reality" and uses

them interchangeably. Such a view (sometimes labeled a "copy" theory of knowledge or the principle
of "immaculate perception") implies an innate capacity for veridical objective registration of discrete
external objects, and a direct and intrinsic correspondence between the "real" external object and the
perception of it [pp. 172-173].

Thus in is handling of perception Freud's structural

model is incompatible with the neuroscience described above.

III
The Schema Model

There is a model, formulated in 1980, which we believe is congruent with the neuroscience described
above. It has appeared in several journal articles (Slap
and Saykin, 1983, 1984; Slap, 1986, 1987; Slap and
Slap-Shelton, 1994) and as a monograph (Slap and
Slap-Shelton, 1991). Here is a brief summary of the
model:
According to this model, which owes much to the
ideas of Klein (1976), the mind is understood as a
unitary schema-an organization of memories, appetites, moral values, factual knowledge, cognitive skills,
and affects-which, in the ideal condition, is generally
interconnected. In neurosis, situations or events which
cannot be mastered become the nidus for an organization of these traumatic experiences and reactive fantasies with their associated affects, which is also a
schema but one that is sequestered from the general
or unitary schema. The unitary schema is conceptually
analogous to the ego of prestructural theory, and the
sequestered schema to the repressed or dynamic unconscious. The sequestered schema may be latent;
when it is active and disruptive, the term pathogenic
schema is appropriate.
In Piagetian terms, the unitary schema, which
will be referred to as the ego, assimilates and accommodates; that is, such a schema is able to interpret
fresh data (perceptions) in terms of past experience
(assimilation) and is able to adapt to or accommodate
to fresh data which differ from past experience (accommodation). The sequestered schema assimilates
but does not accommodate; that is, it functions
throughout life interpreting current events in terms of
templates of past experience. Thus the neurotic goes
through life remaking the same film or play with people from current life cast into roles originally created

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116

by parents and other important figures of childhood.

Transference is the consequence of the assimilation
of persons from current life into these roles, and the
phenomena which led Freud to conceptualize the repetition compulsion are accounted for by the ongoing
activity of the pathogenic schema. Analogous to the
principle of multiple function (Waelder, 1936) is the
understanding that everything one experiences is parallel processed; that is, mental experience and behavior are the resultant of forces of the activity of the
unitary and the pathogenic schemas.
The mode of cognition of the pathogenic schema
is consistent with what Piaget called preoperational
thought (1926), which is intuitive and syncretic, and
by which is meant that diverse elements are intimately
associated on the basis of concurrence or juxtaposition: Events are registered in loosely connected and
disorganized ways; primitive modes of reasoning control current reasoning without recognition of their influence. Thus idiosyncratic schemas of analogy and
visual schemas prevail over logical reasoning and deduction. Because this is the kind of reasoning that
characterizes the child during the years in which infantile neuroses are established, one would expect this
type of reasoning to characterize the organized residues of those neuroses. This characterization of the
cognitive mode of the pathogenic schema appears to
be consilient with LeDoux's (1992) description ofthalamo-amygdala projections. He described them as being relatively crude and based on fragments rather
than' 'full-blown perceptions of objects and events"
(p. 277).
This is a simple model. Essentially all that is
claimed is that the painful impressions and situations
of childhood, those which are not mastered by the
immature mind, become nidi for the formation of separate organizations of the mind, here called pathogenic schemas. The pathogenic schema is a freeze
frame of the mind during the painful periods in its
development and encompasses traumatic impressions,
reactive fantasies, associated affects, and infantile
cognition; over time this organization accretes to itself
later experiences which have been perceived egocentrically. The model dispenses with highly abstract,
metapsychological concepts and is wedded to the dynamic and genetic points of view. It easily reconciles
such concepts as trauma, transference, and repetition.
It is not troubled by the serious conceptual difficulties
which afflict the structural model.
The model is trauma based and is consistent with
Yovell's belief that hysteria and PTSD fundamentally
have the same etiology. This view is shared by Le-

Slap-Brown
Doux (1996). In dealing with the etiology of hysteria
Freud had a narrow choice: fantasy or actual sexual
abuse. With the understanding that any strongly frightening circumstance can be traumatic, a traumatogenic
model becomes plausible. In our experience, primal
scene exposure, for example, can be highly traumatic
and playa crucial role in the pathogenesis of neuroses.
The schema model meets the compatibility for
the criteria above. It meets criterion 1, in that it is a
bipartite model. The ego of prestructural theory is the
clinical manifestation of the functioning of the prefrontal cortex; the pathogenic schema is the clinical
manifestation of threatening perceptions registered by
the amygdala and their associated affects, fantasies,
and subsequent assimilated experience.
It meets criterion 2 in that from its first formulation the schema model assumed separate perceptual
pathways for the ego and the sequestered or pathogenic schema. This understanding correlates with the
transmission of perceptual data from the thalamus to
the neocortex, and to the amygdala. It should be noted
that transmission from the thalamus to the neocortex
is not directly to the prefrontal cortex; the transmission is first to the primary sensory cortex and passes
through the posterior association cortex before arriving at the prefrontal cortex (Fuster, 1995). This circuitous path contributes to the circumstances that
percepts arrive at the amygdala more quickly than at
the prefrontal cortext.
LeDoux refers to the subcortical, amygdala-related perceptual pathway as being' 'quick and dirty"
(1996, pp. 163,255,257); by this he means that there
is a rapid assessment of the emotionally significant
percept but that the assessment is apt to be inaccurate:
A stick may be perceived as a snake. The characterization of the subcortical pathway as quick and dirty is
consistent with the concept of transference as treated
by the schema model. The perception of a person in
a patient's current life as a significant childhood figure
(assimilation) is characteristic of the pathogenic
schema. Transference is a misperception mediated by
the subcortical, amygdala-related/pathogenic schema
perceptual pathway. 1 The conventional psychoanalytic
I The pathogenic schema has been related to the amygdala before:
"In the kindling animal experiment, a one second shock delivered to the
amygdala once per day initially produces no electrophysiological effects.
Repetition of shocks over time, however, lowers the threshold for afterdischarge development and afterdischarges spread throughout the neural axis,
leading to bilateral seizures, and eventually to spontaneous seizures in the
absence of external stimulus. Post et al. (1992) suggest that psychosocial
stressors may act in a similar manner through different neurobiological
systems to alter the brain over time in such a way as to lead to spontaneous
affective disorders; i.e., an early childhood traumatic event may produce
a period of dysphoria and establish vulnerability. Later psychosocial stressors which match the initial trauma will 'kindle' manic or depressive

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Ongoing Discussion
understanding of transference as displacement or perhaps projection has little additional explanatory
power.
Criterion 3, which is easily met by both the structural and schema models, raises the question of how
the cognitive processes of the pathogenic schema (or
dynamic unconscious) are to be understood. There is
this paradox: The system unconscious of the topographic model and the id of the structural model are
characterized by fluidity; they use unbound energy and
employ primary process. At the same time, the repressed is said to be fixed, perhaps indelible. We agree
with the position that the content of the dynamic unconscious-pathogenic schema tends to be fixed and
difficult to extinguish. In our view, primary process is
an interface phenomenon lying between the ego and
the sequestered material and is a manifestation of the
communication between these structures. As has been
pointed out, the "same mechanisms at work in the
primary-process mentation of the unconscious are also
to be found in the dream work and the defensive organization" (Slap and Slap-Sheldon, 1991, p. 114), both
functions being attributed to the ego.
A Note on Positive Affects
LeDoux's work is concerned with fear conditioning
and does not deal with emotions in general. How then
can a model of the mind so closely tied to his work
account for the variety of affects we encounter in the
derivatives we find in neurotic patients?
As stated above, the pathogenic schema is an organization of traumatic events and reactive fantasies
with their associated affects. These affects are positive
or negative in accordance with the fantasy active at
the time. The affects will be positive if the fantasy is,
for instance, one of mastery, vindication, or triumph
episodes; sufficient repetition of such episodes will lead to further alteration in the brain to the point where episodes will occur out of the blue."
This line of reasoning is consistent with an understanding of neurosis
as the activation of an initially self-contained and sequestered record of
early childhood trauma, the pathogenic schema. It seems plausible that the
same sort of underlying biochemical and genetic mechanisms described
for affective episodes may underlie the formation of neuroses. Thus, a
severe initial trauma may create a limited area of altered brain physiology
or structure and the organic substrate for recording and sequestering the
experience. If aspects of the trauma are repeated over time, physiological
or structural changes of more extensive nature occur, eventually leading
to the activation of pathogenic schema. Once activated, there will be less
need for a good match between a particular psychosocial stressor and
early trauma. The pathogenic schema will function spontaneously and
pervasively color the individual's perception of events and relationships"
(Slap and Slap-Shelton, 1994, pp. 689-690).

117
over a rival; it will be negative if it deals with inadequacy or punishment.
A clinical example: The patient, so far as could
be determined, was well loved and cared for during
his infancy but experienced the transition to the phallic
phase as an overwhelming catastrophe. Suddenly he
felt that he could not hope to retain his mother's love
or even interest, as his little button of a penis could
not compare with the organs of his older brother and
his father. The pathogenic schema as it emerged in his
analysis had at its center the conviction that he was
hopelessly inadequate. The fantasies he developed in
reaction to this belief were several. He could find a
"wonder woman" who would show him how to satisfy a lover; he could find an omniscient mentor who
could enhance his development enabling him ultimately to win a Nobel Prize; he could acquire powerful weapons with which he could destroy his rivals,
that is, his father and brother or their transferential
reincarnations; or he could hold onto his mother by
regressing to infantile dependency.
When this patient had a successful experience
such as giving a grand rounds that went well he became elated, at times verging on hypomanic. In spite
of attempts to control himself, he would seek to elicit
compliments by bringing the event up repeatedly. He
would envision newspaper headlines proclaiming his
achievement or congratulatory banners hanging across
the avenue outside his office. These positive affects
were related to the central traumatic issue of his illness
and it seems highly likely that the amygdala made a
contribution to their generation.
LeDoux (1996), in chapter 9 (devoted to emotional feelings in general, not just fear conditioning)
cites the central importance of the amygdala and its
connections. The subtext of Figure 9.7 reads as
follows:
Conscious emotional experiences are made up of a
number of ingredients. Some of the factors that contribute are
direct inputs from the amygdala to cortical areas
, inputs from the amygdala to
nonspecific arousal systems and from these to wide
areas of the forebrain ... , and feedback to the amygdala and cortical areas from the bodily expression of
emotion. Note that the bodily expressions (visceral
and muscular) are themselves controlled by the amygdala [po 297].

Remarks on the Interface between the Prefrontal

Cortex/Ego and the Amygdala/Pathogenic Schema
Clinical manifestations of the connections and disconnections between amygdala-encoded memory circuits

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118

and the prefrontal cortex are not clear and may evade
clarification for a long time. Still, there are hints of
congruence between psychoanalytic concepts of defense and brain functioning. For example, in a discussion of the connections between the prefrontal cortex
and the limbic system, we find that there is a pattern
suggesting "that the prefrontal cortex can to some
degree'gate' information flowing into and out of these
systems. The fact that most of the projections are reciprocal suggests further that this 'gating' is informed,
in the sense that it occurs in the context of other information funneling into the circuits as well as in the
context of the net output. Thus in terms of limbic
information, the prefrontal cortex influences and assesses such information before and after it is processed... " (Weinberger, 1993, p. 243). Looking at
the interface from the clinical vantage, the structural
model tells us that drive derivatives arise in the id and
are met by defenses mounted by the ego. Given the
rich complexity of the connections within and between
the neocortex and the limbic structures, it seems unlikely that the interface between the ego and the dynamic unconscious/pathogenic schema involves single
impulse/single defense couplings. It appears more reasonable that this interface juxtaposes larger organizations of data; that is, the prefrontal cortex on the one
hand and amygdala encoded memory circuits on the
other.
According to the structural model, drives or drive
derivatives arise in the id; defenses are assigned to the
ego. The conflictual interface then resides between the
ego and the id, or in less abstract language, between
the drive derivatives and the defenses provided by the
ego. Conceptualized in this way, there is but one conflictual interface. According to the schema model, such
conflictual interfaces lie within the pathogenic
schema; that is, in the unmastered conflictual situations of the patient's childhood there were drive derivatives that were defended against by the immature ego;
in addition a second kind of conflictual interface exists; that between the pathogenic schema/amygdala
and the ego/prefrontal cortex.
The analyst who is guided by the schema model
will understand that old scenarios are being acted out.
He will strive to demonstrate to the patient how the
past is being repeated (both within the analytic transference and without), sometimes in exquisite detail,
with the same plots and affects, although the time,
setting, and actors have been replaced. In so doing he
will be addressing the interface between the realistic
ego and the pathogenic schema. If an analyst, guided
by the structural model, perceives the conflictual inter-

Slap-Brown
face as being between the adult ego on the one hand,
and the impulses and painful affects of the repressed
on the other, the patient is in the same situation as in
the traumatic childhood situation.
For example, a young attorney was extremely
sensitive to any situation that could be perceived as
his being displaced by a younger rival. When he was
2 years old, the patient's mother required a hospitalization of several months following an auto accident.
He reacted poorly to this separation and was unfriendly to his mother when she returned. She soon
became pregnant and delivered a brother whom the
patient despised. Another brother, born a few years
later, was better tolerated by the patient.
After the birth of the first brother, the patient was
trapped in a painful situation for which he could not
find a resolution. His brother was there to stay, and
his rage at this sibling and at his parents for having
him was not acceptable to his parents and engendered
guilt and fears of punishment. He was unable to resolve the matter and the configuration of traumatic
distress, fantasies of murder and punishment, and associated affects of anger, fear, and remorse remained
as a separate organization within the patient's psyche
and constituted a freeze frame of this period of his
life. The activity of this organization in processing
events and relationships in his adult life was abundantly clear.
When given the files of several law students who
were applying for a summer position in the firm for
which he worked, the patient left them in the locker
room of his squash club. He had been impressed with
the background and achievements of these prospects
and felt that he would be overshadowed were they to
join the firm. When he was asked if he would mind if
a space he intended to move into were given instead
to two paralegals, he created a storm which hurt his
standing in the firm. When a junior associate complained about an assignment that would encroach on
what would otherwise have been a long holiday weekend, the patient became enraged and screamed at the
complainer, calling him, among other things, a spoiled
brat. When the entire city was excited about the local
team playing in and winning the World Series, the
patient secretly rooted against them; they were, after
all, everyone's darlings. When his wife became pregnant, he dreamed of encountering a stranger in his
favorite childhood play spot and fighting with him.
Thus his adult situation replicated his childhood in
that he could not tolerate a situation in which he was
being displaced by a younger rival and he could ill
afford to express his rage at being forced to do so.

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Ongoing Discussion
It is not unusual for patients over time to oscillate
between untenable positions. Thus a patient may take
an aggressive attitude in dealing with a superior at
work or in an academic setting only to worry that he
is pushing things too far and may suffer unpleasant
consequences. In response to this anxiety, he may
adopt a meek, conciliatory posture in the hope of appeasing the now dreaded authority and escaping retribution. In time, feeling that such self-castrating
behavior is unbearable, he reacts by once again taking
an aggressive attitude. Such patients frequently say
they wish to find a "middle position." Some analysts
may understand such see-saw situations as instinctual
conflicts between, for example, activity and passivity
or between heterosexuality and homosexuality. Arlow
(1963) wrote that: "where there appears to be a conflict between opposing drives, the ego takes sides with
the expression of one set of drives, i.e., permits the
discharge of the cathexis of one drive, in order to fend
off the expression of the other, the more objectionable
drive representation. Conflicts of this type ... in actuality represent a conflict between the ego and the id,
with the superego apparently in accord with the defensive position taken by the ego" (p. 16).
Such a view of how the neurosis is structured is
not apt to be helpful because there is no escape. If the
patient adopts a passive, submissive attitude out of
fear of the consequences of his aggressiveness, one
might say the ego is taking sides with the passive drive
derivatives; and if the passivity becomes intolerable
one might say the ego is taking sides with the aggressive drives in order to defend against the passivity. It
is understandable that the patient who swings back
and forth between such polarities should wish he could
find a middle position.
The analyst who is guided by the schema model
will view the situation differently. He will understand
that the aggressive and passive fantasies and behavior
and the reasons for oscillating between them are all
within the pathogenic schema. He will work to understand what elements of this organization are being
manifested in these oscillations. Thus, he may discover that as a child a patient had reacted to his father's absences with fantasies of his father's death and
taking his father's position with his mother, only to
become terrified when his father returned. Given this
perspective, the patient will no longer be trapped into
alternating between the positions, but will have the
alternative of seeing both positions, the reasons for
shifting from one to the other, and the associated affects as elements of an anachronistic, pathogenic residue. He will then have the option of striving to deal

119
with the situation from the perspective of mature reason and judgment.

Conclusion
Within the past decade, discoveries in the field of neuroscience have demonstrated that functions of the prefrontal cortex are congruent with functions attributed
to the ego of prestructural theory and that the amygdala functions in a way congruent with aspects of the
dynamic unconscious (or pathogenic schema in terms
of the schema model). These findings, along with others relating to perception and memory, have implications for any neuroscientifically valid model of the
mind. Freud's structural model is incompatible with
these findings. The schema model, which was formulated in 1980 and has been the subject of a monograph
and several journal articles, is more compatible with
the findings. Neuroscience aside, it is argued that the
schema model reflects the clinical situation more accurately than does the structural model.
We congratulate Dr. Yovell on a groundbreaking
paper and feel privileged to have had the opportunity
to respond to it.

References
Arlow, J. A. (1963), Conflict, regression, and symptom formation. Internat. J. Psycho-Anal., 44:12-22.
Brenner, C. (1992), The mind as conflict and compromise
formation. Paper delivered at the Fall meeting of the
American Psychoanalytic Association in New York, December.
Breuer, J., & Freud, S. (1895), Studies on Hysteria. Standard Edition, 2. London: Hogarth Press, 1955.
Damasio, A. (1994), Descartes' Error. New York: Grosset/Putnam.
Freud, S. (1900), The Interpretation of Dreams. Standard
Edition, 4&5. London: Hogarth Press, 1953.
- - - (1915), The unconscious. Standard Edition,
14:159-204. London: Hogarth Press, 1957.
- - - (1920), Beyond the Pleasure Principle. Standard
Edition, 18:1-64. London: Hogarth Press, 1965.
- - - (1923), The Ego and the Id. Standard Edition,
19:1-59. London: Hogarth Press, 1961.
- - - (1925), A note on the "mystic writing pad." Standard Edition, 19:225-232. London: Hogarth Press, 1961.
- - - (1940), An Outline of Psychoanalysis. Standard
Edition, 23:139-207. London: Hogarth Press, 1964.
Fuster, J. M. (1995), Memory in the Cerebral Cortex. Cambridge, MA: MIT Press.

Downloaded by [Adelphi University] at 00:28 23 August 2014

120
Kandel, E. R. (1999), Biology and the future of psychoanalysis: A new intellectual framework for psychiatry revisited. Amer. J. Psychiatry, 156:505-524.
Klein, G. S. (1976), Psychoanalytic Theory: An Exploration
of Essentials. New York: International Universities
Press.
LeDoux, J. (1992), Emotion as memory: Anatomical systems underlying indelible neural traces. In: Handbook of
Emotion and Memory, ed. S. A. Christianson. Hillsdale,
NJ: Erlbaum, pp. 269-288.
- - - (1996), The Emotional Brain. New York: Simon & Schuster.
Piaget, J. (1926), The Language and Thought of the Child.
New York: Basic Books.
Post, R. M., George, M. S., Ketter, T. A., Denicoff, K.,
Leverich, G. S., & Mikalauskas, K. (1992), Mechanisms
underlying recurrence and cycle acceleration in affective
disorders: Implications for long term treatment. In: Psychopharmacology of Depression, ed. S. Montgomery.
Oxford: Oxford University Press, pp. 141-169.
Sandler, J. (1983), Reflections on some relations between
psychoanalytic concepts, and psychoanalytic practice.
Internat. J. Psycho-Anal., 64:34-40.
Schimek, J. G. (1975), A critical re-examination of Freud's
concept of unconscious mental representation. Internat.
J. Psycho-Anal., 2:171-187.
Slap, J. W. (1986), Some problems with the structural model
and a remedy. Psychoanal. Psychol., 3:47-58.
- - - (1987), Implications for the structural model of
Freud's assumptions about perception. J. Amer. Psychoanal. Assn., 35:629-646.

Slap-Brown
- - - Saykin, A. J. (1983), The schema: Basic concept in
a non-metapsychological model of the mind. PsychoanaI. & Contemp. Thought, 6:305-325.
- - - - - - (1984), On the nature and the organization
of the repressed. Psychoanal. Inq., 4:107-124.
- - - Slap-Shelton, L. (1991), The Schema in Clinical
Psychoanalysis. Hillsdale, NJ: Analytic Pres.
- - - - - - (1994), The schema model: A proposed replacement paradigm for psychoanalysis. Psychoanal.
Rev., 81:677-693.
True, W. R., Rice, J., Eisen, S. A., Heath, A. F., Goldberg,
J., Lyons, M. J., & Nowak, J. (1993), A twin study of
genetic and environmental contributions to liability for
post-traumatic stress symptoms. Arch. Gen. Psychiatry,
50:257-264.
Waelder, R. (1936), The principle of multiple function: Observations on overdetermination. Psychoanal. Quart.,
5:45-62.
Watt, D. F. (1990), Higher cortical functions and the ego.
Explorations of the boundary between behavioral neurology, neuropsychology and psychoanalysis. Psychoanal.
Psychol., 7:487-527.
Weinberger, D. R. (1993), A connectionist approach to the
prefrontal cortex. J. Neuropsychiatry, 5:241-253.
Joseph W. Slap, M.D.,
1601 Walnut Street, Suite 1312
Philadelphia, PA 19102
e-mail: joslap@aol.com
Jodi H. Brown, M.D.
325 Chestnut Street, Suite 1308
Philadelphia, PA 19106