Escolar Documentos
Profissional Documentos
Cultura Documentos
To cite this article: Donald Charles Grant FRANZCP. MRCPsych. (2002) Becoming Conscious and Schizophrenia,
Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 4:2, 195-203, DOI:
10.1080/15294145.2002.10773397
To link to this article: http://dx.doi.org/10.1080/15294145.2002.10773397
195
Introduction
Freud's (1895) rst theory of consciousness in his
``Project for a Scientic Psychology'' was a
biological theory concerned with excitation of
what he called ``omega'' neurons. He abandoned
this biological model for lack of sucient
neuroscientic knowledge to justify it but he did
not abandon the principle that mental phenom* Don Grant is a psychiatrist and psychoanalyst in private
practice.
Acknowledgment. I wish to express my gratitude to Drs. John
Cocks, Norman Doidge, Ed Harari and Reg Hook for their helpful
comments about earlier drafts of this paper.
196
the potential to once more be complementary
elds of study. Coupled with the fact that imaging
of brain functioning as well as structure is now
possible, the time may indeed be right as Schore
(1997) has suggested to recommence Freud's
(1895) Project and seek the biological correlates
of our metapsychology. This possibility brings
into focus the need for psychoanalysis to formulate specic but tentative metapsychological
hypotheses, as Freud originally intended. It is in
this modest spirit that I want to put forward
some ``provisional ideas'' about consciousness.
My aim is to propose some metapsychological
conceptual ``scaolding'' whose strengths and
weaknesses will then be available for researchers
in psychoanalysis and neurobiology to assess and
perhaps test through clinical observation and
experimentation.
It is not my aim in this paper to try to
address big questions about the essential nature
of mental activity and its relationship to biology.
Despite the interesting nature of such questions
and the promising nature of new research
methods in neurobiology as a possible means of
investigating some of them, I want to turn aside
from them here and discuss a smaller question
about mental phenomena. The psychic mechanism by which we become conscious of our
subjective selves is a relatively small question
and this is what I propose to discuss in this paper.
Freud's Metapsychological Theory of
Consciousness
Freud had more to say about the experience of
consciousness than we sometimes think. Even
though I shall disagree with one aspect of it I shall
start by outlining Freud's theory of consciousness
because we often lose sight of it in the presence
of his more explicit theory of the dynamic
unconscious.
Freud (1915) himself referred to his metapsychological paper entitled ``The Conscious'' in
``The Unconscious'' but Strachey (Freud, 1915)
tells us in several footnotes that the paper was
never written or has been lost. We must therefore
glean Freud's thoughts on the nature of consciousness from a number of his papers on other
matters.
In ``Formulations on the Two Principles of
Mental Functioning'' Freud (1911b) wrote, ``The
increased signicance of external reality heightened the importance . . . of the sense-organs . . .
and the consciousness attached to them. Consciousness now learned to comprehend sensory
qualities in addition to the qualities of pleasure
197
contained, and I agreed to see her. H soon
focussed her life around coming to see me twice a
week. During the sessions she lay on the couch,
not because I considered her treatment to be
formal analysis but because she said with some
factual basis that she was too physically ill to sit
upright without becoming dizzy. On the couch
she would writhe and sob and moan ceaselessly.
Clearly she was having a powerful conscious
emotional experience in the transference in her
sessions. I am using the term ``transference'' in
Joseph's (1985) sense to mean ``the total situation'' of the session. My presence in the setting of
therapy seemed to be the trigger that released her
internal emotional experiences into consciousness. There seemed to be nothing useful I could
say to her at that time. On the occasions when I
tried, the writhing, sobbing and moaning continued as if I had not spoken.
Gradually this activity decreased in the
sessions and the patient recommenced some
activity within her profession outside of the
sessions. Something had happened within her,
causing these changes, but the experiences she had
had with me were not in a form readily available
for thinking and neither of us was really sure what
it was that had made her dierent. We knew that
she had had powerful emotional experiences in
relation to me but at that time, while they were
still what she later came to call ``raw'', we could
hardly begin to think about them. In that ``raw''
stage her feelings were direct and overwhelming
and required my presence for their full intensity.
Becoming conscious of these internal emotional
experiences preceded her ability to name them or
to think about them. She was only able to
experience them while in the sessions with me.
Although I had no way of knowing it at the time,
these internal emotional experiences were not just
varying levels of unpleasure. Later H was able to
tell me that these experiences were of starting to
feel alive, sometimes hating herself, and at other
times feeling that she had some value. She did not
and could not tell me this at the time it was
happening. She was not able to think this herself
at the time it was happening. It was a conscious
emotional experience she had in relation to a
material presence and it preceded ideation about
its nature.
H's direct aective self consciousness is the
issue that led me to think about a modication of
Freud's (1915) view of the process of becoming
conscious of one's own internal emotional experience. While Freud acknowledged direct consciousness of subjectivity as a level of anxiety
along the pleasure-unpleasure series, he viewed
that type of consciousness as having quantity
198
only, unless it was associated with a ``substitutive
idea''. This did not seem to be the case with H.
For her the direct physical experience of particular objects of her senses (the setting of therapy
and the analyst) evoked qualitatively new conscious self-experiences (feeling ``alive'' in her selfhatred or in her sense of worth). The implication
of this seems to be that for H these objects of the
senses played a crucial role in evoking consciousness not only of themselves as objects of the
senses but also consciousness of the qualitative
state of herself in relation to them.
Freud hypothesized that a ``substitutive
idea'' was necessary to bring internal emotional
states of the self into consciousness with a
particular quality. My observations with H lead
me to suggest a dierent proposal. This is that it is
having an internal emotional experience in relation
to an object of the sense, that brings the specic
quality of the internal emotional experience into
consciousness, along with the consciousness of the
object. I am not talking here about the internal
objects of Object Relations Theory but about
interaction with material objects of the senses as
detected by the perceptual apparatus. This
suggestion may sound new but it is not. It has a
long history in philosophy from Hegel (1807)
through Heidegger (1927) to Merleau-Ponty
(1945) all of whom argued that the subject must
engage with the object to achieve self-denition.
This seemed to be the case with H, whose
consciousness seemed to be activated through
the perceptual apparatus as Freud described, but
it illuminated not only the qualities of the objects
(the analyst and the setting) but also the state of
herself (feeling ``alive'') in relation to them. This
occurred with H before words or ``substitutive
ideas'' were present.
Consciousness of states of the self that were
rst experienced by H in this way in relation to
the analyst and the setting were subsequently reexperienced in relation to the visual memory of
those objects. The visual images acquired the
property of being able to re-evoke the subjective
states of herself now associated with them. This
capacity to represent her internal emotional
experiences with visual images brought H to what
I shall loosely call the second phase of her
treatment. Now H no longer had to be in my
actual presence to feel alive. She only had to
remember me. Although this was a conscious
experience it was not yet in language nor in a
form particularly suitable for use in thinking,
which was dened by Freud (1911b) as understanding the relationships between objects (to
which one must add ``and the self''). In this
second phase H seemed contentedly stuck at the
199
utterly on my presence to experience what was
after all a part of herself. It was as if that good
creative part of her was part of me. H seemed
comfortable with that but I was not and I
recognized that was the source of my disquiet. I
interpreted that it was as if H left the good
creative part of herself with me instead of taking
it with her when she left at the end of each session.
This of course is part of what Klein (1946)
described as projective identication. However I
think my interpretation came not directly from
some theory in me but from my becoming
conscious of and then being able to think about
my disquiet when H not only garaged part of
herself in me but also seemed very comfortable
with that arrangement.
H was receptive to that interpretation. In
subsequent sessions she went on to speak about
her feeling that she was full of something really
bad. When she thought about the inside of her
body she envisaged it as full of some disgusting
poisonous slimy black substance that would kill
anything alive. That was why she could not eat. It
would only nourish and strengthen the badness in
her. She believed that the badness in her was too
strong for anything alive and creative to survive
there. She said it was like she was leaving the
good part of herself with me where it would be
safe. These further associations gave me the
opportunity to interpret her idealization of me,
saying that she seemed to believe that everything
bad and awed was in herself and that I was
awless and full of nothing but good, like some
sort of Godlike being.
The interpretation of these defenses of
projective identication and idealization enabled
H to be more than just conscious of their
actualization in the transference. It enabled her
to understand and think about herself and me in
new ways. She realized that her deadness resulted
from having projected the alive part of herself
into me for safekeeping. Her anorexia was in part
at least her attempt to punish the bad self inside
her and starve it to death. She recognized that the
bad self was linked with a feeling of rage inside
her. She also realized that I am not God.
With these new insights H's consciousness of
herself and me changed and developed into
something more realistic. She became more able
to re-own good creative parts of herself, to work
and to have better relationships that now made
more sense to her. She became able to question
her earlier rigidly held view that the analyst's
presence or memory was necessary for her to feel
alive and worthwhile. She began to feel worthwhile in relation to some of the products of her
own work. This led her to begin to think the
200
unthinkable. If she could feel worthy in a
situation that was not directly dependent on the
``cocoon'' but was in relation to things which she
herself had produced then there must be something worthwhile in her. From this it seemed a
short step to think that perhaps colleagues would
nd something of value in her work and by
extension in her. She took steps to share and
discuss some of her work with one or two much
admired colleagues. Their conrmation of the
value of her work strengthened her ability to
value herself.
For the purposes of this paper there are two
main points that I want to draw from this
discussion of patient H. Firstly, for H consciousness of certain states of her subjective self, albeit
distorted by defenses, arose in relation to certain
material objects of the senses detected by the
perceptual apparatus and preceded their nonverbal or verbal representation and the capacity
to think about them. This is my point of
dierence from Freud's theory of consciousness.
He postulated that it was a ``substitutive idea''
(Freud, 1915) that brought an unconscious
internal state of the self into consciousness with
a specic quality. Secondly this new consciousness of her subjective self did not seem to promote
change and development in itself. It seemed more
like simply becoming conscious of her internal
state as it was, including its distortion by
defenses, without any capacity to separate distortion from reality. It was not until H and I
developed verbal representations facilitating
thinking and discourse about the relationships
between these states of herself and her objects
including her defenses in the transference-countertransference relationship that this separation
became more possible.
Schizophrenia Revisited:
Impaired Consciousness of the Subjective Self
The modication of Freud's theory of consciousness that I have just outlined enabled me to think
about another patient (whom I shall call E), in a
new way. I now want to describe this patient
who was not treated by me personallyand the
new way I came to think about him and the illness
of schizophrenia from which he suers.
Patient E
E has a diagnosis of chronic severe schizophrenia.
He believes that aliens control his world. They
send secret coded messages to him via the
201
background state of excitation than a specic
subjective reaction to specic fears about specic
things. This lack of subjective emotional responses appropriate in quality and quantity to
dierent situations could also be understood as a
direct result of the failure of the process of
becoming conscious of the state of his subjective
self.
If this process of becoming conscious of the
subjective self were faulty, as seemed to be the
case with E, one might ask, ``what then happens
to internal excitations which cannot achieve
normal consciousness as aects''? Freud (1920)
in ``Beyond the Pleasure Principle'' pointed to a
possible answer. He wrote, ``. . . a particular way
is adopted in dealing with any internal excitations
which produce too great an increase in unpleasure: there is a tendency to treat them as though
they were acting, not from the inside, but from
the outside . . . This is the origin of projection''
(p. 29).
Freud (1920) was referring to the projection
of an idea but it is also possible to project parts of
the self into objects. This is what Klein (1946)
introduced the term projective identication to
convey, in distinction to projection (of an idea).
Bion (1967) considered that projective identication was a major psychopathological mechanism
in schizophrenia and was a means of attacking
hated reality. I wonder if in some patients at least
the pathological process is less purposeful than
that and might be secondary to the failure from a
variety of causes of the process of becoming self
conscious as I have tried to describe it. That
failure might in some cases be in the associated
biological processes rather than being primarily a
mental process of a defensive nature as suggested
by Bion (1967). In either case the result is likely to
be high levels of unconscious internal excitation.
This would be partly experienced in consciousness
as anxiety and partly dealt with by projecting
unconscious excited parts of the self into objects,
leaving the conscious self depleted and creating an
ever-increasing number of fantastic objects
crowding into consciousness. Clinical observations with E seemed to suggest this. His consciousness of his own aects was impoverished,
leading to a at relatively xed level of anxiety. At
the same time he consciously experience himself
as increasingly surrounded by a variety of
fantastic objects such as the mince meat mother
and the aliens to whom he attributed his
experiences.
Activation of projective identication in
response to high levels of internal excitation also
oers a possible explanation of E's auditory
hallucinations and delusions. If, through projective
202
identication, E's own capacity to think were
partially experienced as relocated outside himself
he would mistake some of his own thoughts for
perceptions received via his auditory apparatus
from objects outside himself. Clinical evidence for
this was not so clear in E's material but with
another patient, whom I shall call F, it was.
F also suered from schizophrenia but had
been in remission for some time. During her
regular visits while she was well she told her
therapist that if she was relapsing and becoming
ill again she usually noticed a change in her
subjective experience of herself. She was in the
habit of conducting debates with herself in her
mind. When she was well her experience of this
was that the thoughts on both sides of the debate
were clearly hers. If her schizophrenic illness were
starting to relapse, however, she would feel as if
she was losing control of one side of the debate
and it seemed to take on some sort of life
independently of her. If the relapse could not be
halted at that stage the experience would develop
further. One side of the debate would become
consciously experienced as if it were not only
independent and something foreign in her mind
but as if it were a perception of a voice from
outside of herself.
E's auditory hallucinations like those of F
could be understood as the result of the projection of some of his own thinking resulting in a
pathological state of consciousness in which the
boundary between self and other has moved to an
abnormal setting. Since there were no visual
stimuli corresponding to the pathological auditory experience thus created, E attributed the
voices to mysterious unseen aliens. Although E
could not see them he heard their voices so he
knew they were there. His belief that these heard
but not seen aliens were the source of the voices
was E's primary delusion. This delusion can be
seen as his attempt to explain and make some
sense of the pathological conscious experience
that resulted from projection of part of his own
thinking.
Formal thought disorder in schizophrenia
involves the fragmentation of the form or
structure of thinking as opposed to its content.
It is understandable in the pathological model I
am suggesting as a consequence of the projection
and objectication of parts of the Ego or Self
including the capacity to think. The remaining
fragments of subjectivity and capacity for thinking are expressed in the fragmentary thinking and
speech.
Fragmentation and weakening of one's self
experience as a result of projective identication
seems to be less in focus than the pathological
References
Bion, W. (1962), Learning From Experience. London:
William Heinemann Medical Books Ltd.
(1967), Second Thoughts. London: William
Heinemann Medical Books Ltd.
Fonagy, P. (1991), Thinking about thinking: Some
clinical and theoretical considerations in the treatment of a borderline patient. International Journal
of Psycho-Analysis, 72: 639656.
Freud, S. (1895), Project for a scientic psychology.
Standard Edition, 1: 281397. London: Hogarth
Press, 1981.
(1900), The interpretation of dreams. Standard
Edition, 45: 1627. London: Hogarth Press, 1981.
(1911b), Formulations on the two principles of
mental functioning. Standard Edition, 12: 215226.
London: Hogarth Press, 1978.
(1911c), Psychoanalytic notes on an autobiographical account of a case of paranoia (dementia
paranoides). Standard Edition, 12: 982. London:
Hogarth Press, 1978.
(1914), On narcissism: An introduction. Standard
Edition, 14: 69102. London: Hogarth Press, 1978.
(1915), The unconscious. Standard Edition, 14:
159209. London: Hogarth Press, 1978.
(1920), Beyond the Pleasure Principle. Standard
Edition, 18: 164. London: Hogarth Press, 1981.
(1923), The Ego and the Id. Standard Edition, 19:
166. London: Hogarth Press.
(1924), Neurosis and Psychosis. Standard Edition,
19: 149153. London: Hogarth Press, 1981.
203
(1938), An outline of Psychoanalysis. Standard
Edition, 23: 141207. London: Hogarth Press, 1981.
Hartman, H. (1956), Essays on Ego Psychology. New
York: International Universities Press.
Hegel, G. (1807), The Phenomenology of Spirit, trans.
A. Miller. Oxford: Oxford University Press, 1977.
Heideger, M. (1927), Being and Time, trans. J.
Macquarie & E. Robinson. Oxford: Blackwell,
1962.
Joseph, B. (1985), Transference: The total situation.
International Journal of Psychoanalysis, 66: 447
454.
Klein, M. (1946), Notes on schizoid mechanisms. In:
Envy and Gratitude and Other Works. New York:
Delta, 1977.
Kohut, H. (1971), The Analysis of the Self. New York:
International Universities Press.
Lacan, J. (1966), Ecrits, ed. J.-A. Miller. Paris:
Editions du Seuil.
Merleau-Ponty, M. (1945), The Phenomenology of
Perception, trans. C. Smith. London: Routledge &
Keegan Paul, 1962.
Opatow, B. (1997), The real unconscious: Psychoanalysis as a theory of consciousness. Journal of the
American Psychoanalytic Association, 45: 863890.
Pally R., & Olds, D. (1998), Consciousness: A
neuroscience perspective. International Journal of
Psychoanalysis, 79: 971989.
Shore, A. (1997), A century after Freud's Project: Is a
rapprochement between psychoanalysis and neurobiology at hand? Journal of the American Psychoanalytic Association, 45: 807840.
(2000), Aect Regulation and the Repair of the
Self. Guilford Press, in press.
Solms, M. (1997), What is consciousness? Journal of
the American Psychoanalytic Association, 45: 681
703.