PSYCHOPHARMACOLOGIA Y TERRITORIO FREUDIANO
Teoría y clínica de un abordaje interdisciplinario
Psychopharmacology and Freudian Territory
Theoretical and clinical aspects from an interdisciplinary viewpoint
Julio Moizeszowicz and Mirta Moizeszowicz
Buenos Aires/Barcelona/Mexico: Paidos; 2000. (292 pages)
Reviewed by Hector Warnes
Information on Content: This 292 pages book attempts to integrate psychoanalysis and psychoneuropharmacology. In approximately, 106 pages the authors elaborate on the neurobiological basis of Freudian psychoanalysis in the light of contemporary neurosciences. In the second part of the book starting on page 115 the authors present six clinical vignettes (panic attacks, delusional disorders, depressive disorder, bipolar disorder, schizoaffective disorder and borderline personality disorder). On page 9 and 10 there are forty pictures, figures, illustrations and diagrams including Sigmund Freud’s, Santiago Ramon y Cajal’s and Charles Scott Sherrington’s pictures. They cover neuroanatomy, neurochemistry, genetic transcription, the limbic system, sleep stages, apoptosis and the Freudian diagnoses comparing it with the DSMV, the mechanism of action of psychotropic drugs, the latest advances in the neurosciences regarding PET scanning and so on. Between pages 275 and 292 a glossary of technical terms is presented.
There are two prefaces to the book: one written by David Maldavsky which draws attention to epistemological and methodological issues, and the other by Gregorio Klimovsky that deals with “mind-body theories”. They are followed by the authors’ Introduction.
The monograph is divided into seven chapters: 1. Neuronal circuits; 2. Panic attack; 3. Delusional disorders (paranoid types); 4. Depressive disorders; 5 Bipolar Disorders; 6. Schizoaffective disorders and 7. Borderline disorders.
Freud’ basic assumption is that the organism attempts to keep stimulus at a manageable level (via a stimulus barrier or protective shield) otherwise it would be overwhelmed by overstimulation which would lead to a breakdown of its defenses and adaptive capabilities.
Within Freud’s frame of reference between the structures responsible for receiving (afferent structures) and emitting (efferent structures) impulses there is the “black box (chapter VII) involved in the transformation of quantity into quality, i.e., impulses into perceptions, mnemic traces, etc..
According to Freud stimuli proceed through phi (permeable) neurones to psi (impermeable) neurones to omega (perceptual) neurones. The mind is ruled by several principles: the pleasure (Lust-Unlust) principle, the reality principle, the constancy (not unlike homeostasis) principle and the nirvana principle (death instinct).
The authors present Freud’s concept of “instinct” and cite from Freud the following: “an instinct appears to us as a concept on the frontier between the mental and the somatic. The word Instinct has been a matter of debate and replaced by the word drive mostly because every innate psychophysical tendency or impulse to action is based on learned patterns of behavior. Instincts have a pressure or quantity (energy or excitation), an aim (which could be displaced), an object which could be changed and a source which is somatic”. They suggest that Freud was wondering whether as a ‘general rule the somatic source of the instinct was chemical’ (p.62). They also suggest that death and life instincts contribute to the construction of the ‘”ego” that provides for self-preservation by defending the organism from unconscious forces. In support of their interpretation on page 45 the authors quote from Freud that ”the transmission of energy has an aim…it is to unload the excitation that has entered via the stimuli” and suggest that in accordance with the ‘inertia principle’ “the organism seeks to unburden itself from an excess of quantity of stimulus”.
The authors present an update on advances in the neurosciences and suggest that the origin of some current contributions to the neurosciences are in Freud’s work and hypotheses. They also present an extensive review of the relevant literature by E. R. Kandel; K.H. Pribram and M M Gill; M. Bear, B. Connors and M. Paradiso; P. Marty; S M. Stahl; Sami-Ali; O. Kernberg and many others.
The authors maintain that the beginning of life is crucial in the structuring of the Self. According to them ”If the mother has not fulfilled its humanizing function the child takes the place of the absent mother or of her overwhelming presence that would perpetuate the toxic circuit between the two of them” (p. 98). Based on this notion the authors put forward a contemporary formulation of Freud’s conceptual framework relevant to neuropsychopharmacology in which genetic factors combined with childhood experiences activate the so called ‘toxic nucleus’ and neurotransmitter imbalance (the original actual neurosis). According to them certain personality types could filter better stressing life-events and these personality types mitigate the genetic code, whereas some other personality types speed up or increase the potential for life events triggering certain genes and the chances of becoming ill (p.101).
On page 107 the authors present Freud’s psychodynamically-based diagnoses and DSM IV diagnoses. Freud’s diagnoses include: Actual neurosis or neurasthenia; Acute anxiety neurosis (Angst); Chronic anxiety neurosis; psychoneurosis or transference neurosis: Conversion hysteria; Anxiety-hysteria; Narcissistic psychoneurosis; Psychosis, schizophrenia and severe depression or Manic depressive disorder. The DSM IV diagnoses include: Anxiety disorders: Panic attacks, agoraphobia; Specific phobias; social phobias; Posttraumatic stress disorders; Generalized anxiety disorder; Anxiety induced by drugs or medical illnesses, etc.; Somatization disorders or Briquet syndrome; Conversión disorder; Somatoform disorder; Hypochondria; Dysmorphophobia; Chronic pain syndromes, etc.; Affective illnesses, dysthymia, bipolar disorders, unipolar disorders; Schizophrenic and psychotic disorders.
The authors suggest the use of a multiaxial diagnostic scheme to underline the multifactorial aspect of patient’s psychopathology. On page 108 they spell out the variables on which diagnostic formulations should be based. They are:
1. Clinical manifestations
2. Libidinal fixations: somatic discharge, oral, anal and phallic orientations.
3. Ego fixations--Object-relations: inside-outside, autoerotism and narcissism, capacity for mourning loss love.
4. “Toxic nucleus” as related to psychoneurobiology and early response types.
5. Defences: Areas of conflict between ego and drives, between ego and external reality and between ego and superego. Defence mechanisms: repression, denial, negation, projection, introjection, isolation, reaction formation, undoing, rationalization, regression, identification, acting-out, sublimation.
On page 120 the authors present a diagram with a list of symptoms that was presented as syndrome by Freud that today would be diagnosed as Panic disorder.
Reviewer’s Comments: This is an exceptionally well written book that brings together nosology, clinical psychopathology, neurosciences and psychodynamic formulations. The latter are too condensed to allow an evaluation of the patient’s strength and weaknesses, typology, defence mechanisms, object-relationships, and current focal conflicts in the light of precipitating factors. The authors put forward Freud’s original hypothesis that there is a “toxic nucleus” lurking in the background of our psyche (the chemical factor) and whether it becomes manifest in one or another form of mental illness depends on individual vulnerabilities and on brain and environment interaction. They suggest that we are all at risk of becoming ill as a result of “affective flooding” and at times we go too far to avoid “affective flooding” which is equally harmful.
November 19, 2015