Arnold Goldberg - The Brain, the Mind and the Self: A psychoanalytic road map

Psychoanalysis enjoyed an enormous popularity at one time, but has recently fallen out of favor as new psychiatric medications have dominated the treatment of mental illness and a new interest in the brain and neuroscience begins to dominate the theory as to the cause and cure of mental illness.

How do we distinguish between the brain, the mind and the self? In his new book, Arnold Goldberg approaches this question from a psychoanalytic perspective, and examines how recent research findings can shed light on it. He repositions psychoanalysis as an interpretive science that is a different activity to most other sciences that are considered empirical.

Giving clear coverage of the various psychoanalytic models of the mind and the self, Goldberg examines how these theories fare against neuroscientific evidence, and what implications these have for psychoanalytic clinical practice. The Brain, the Mind and the Self: A psychoanalytic road map sets up evidence-based, robust psychoanalytic theory and practice that will give psychoanalysts, social workers and practicing psychologists a valuable insight into the future of psychoanalysis.

Arnold Goldberg, M.D. was born and raised in Chicago and trained at the University of Illinois, Michael Reese Hospital and the Institute for Psychoanalysis in Chicago. He is recently retired from the Cynthia Oudejans Harris MD chair, and Professor of Psychiatry at Rush Medical Center.

First published 2015

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2015 Arnold Goldberg

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British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Cataloging-in-Publication Data

Goldberg, Arnold, 1929 , author.

The brain, the mind and the self : a psychoanalytic road map /

Arnold Goldberg.

p. ; cm.

I. Title.

[DNLM: 1. Psychoanalysis. 2. Psychoanalytic Theory. 3. Mental

Processes. 4. Neurosciences. WM 460.2]

RC504

616.8917dc23

2014042825

ISBN: 978-1-138-78832-9 (hbk)

ISBN: 978-1-138-78833-6 (pbk)

ISBN: 978-1-315-76561-7 (ebk)

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The essence of something is not at all to be discovered simply like a fact; on the contrary, it must be brought forth, since it is not directly present in the sphere of immediate representing and intending. To bring forth is a kind of making, and so there resides in all grasping and positing of the essence: something creative.

Martin Heidegger

Inasmuch as I have lived through the heyday of psychoanalysis and am now experiencing what seems to be its ultimate decline, an autobiographical account seems both permissible and warranted. Those of us who decided to pursue psychiatric training after medical school were united in the view that becoming a psychoanalyst was our ultimate goal. Our training during psychiatric residency was primarily based on treating patients with psychoanalytic concepts of treatment. The few somatic treatments, such as electroshock therapy or insulin comas that were available were reserved for the inpatients who were usually psychotic and beyond talk therapy. There were no drugs, save the barbiturates, until Thorazine came upon the scene soon to be followed by legions of medications. Psychiatrists who eschewed psychoanalysis seemed primarily to care for these very sick inpatients and resorted mainly to these few somatic therapies. Some psychoanalysts, however, did choose to apply psychoanalytic ideas to psychoses, and long hospitalizations of over a year were commonplace. Although the change was slow, it was dramatic, albeit mightily ignored by many psychiatrists; drug therapy, changed everything. Beginning with the anti-psychotics and followed by the anti-anxiety drugs and antidepressants, a new breed of psychiatrist evolved, and with this rather noteworthy historical movement, psychoanalysis as practiced in the training of psychiatrists began its decline. No doubt many psychoanalysts maintained a stalwart faith in what they did and how they did it, but overall this became a vanishing breed.

The medical student who chose to become a psychiatrist was once the primary candidate or student to enter a psychoanalytic institute in order to become a psychoanalyst, but now fewer physicians make this choice, and alongside the new institutes that trained non-medical students, the older institutes began accepting social workers and psychologists for training. Concurrent with the decline in the usual form of psychoanalytic treatment, there arose a somewhat watered-down form of therapy initially termed psychodynamic therapy. This was distinguished from what was called classical psychoanalysis by being less frequent and less lengthy, as well as less costly. It may have started from the efforts to treat patients with psychoanalytic ideas by those who were not yet full-fledged psychoanalysts, but ultimately it became an alternative to psychoanalysis proper and soon dominated all talk therapy.

The status of psychoanalysis changed markedly as alternative treatments came upon the scene. Whereas once the chairman of the department of psychiatry at a medical school was almost required to be a psychoanalyst, the office paradigm transformed to his or her needing to be an expert in psychotropic medications, with analytic training either being unnecessary or even a hindrance. Fewer and fewer people, either medical or non-medical, applied to psychoanalytic institutes for training, and a host of other forms of treatment ranging from cognitive behavioral therapy to mindfulness came to be popular both because of time and cost, as well as effectiveness for a variety of patients. Psychoanalysis began to appear almost quaint.

The decline of psychoanalysis and the upsurge in drug therapy for mental illness shifted the basic theoretical study from that of the workings of the mind to the functions of the brain, and slowly the theory of the mind became that of the brain. A recent book by an eminent computer expert is entitled How to Create a Mind: The Secret of Human Thought Revealed (Kurzweil, 2012), even though it is entirely about the brain. It is quite representative of present-day thinking, which assumes that the organ inside the skull is where the mind is and so assumes that the mind is just another word for the brain.

Psychoanalysis reacted to this new focus on the brain (now called neuroscience) with a combination of responses. Some analysts ignored it, some embraced it, and some worked to incorporate it into a collaborative effort. However, over the years psychoanalysis has itself changed, primarily by dividing into a number of groups usually heralding a single person who concentrates on one or another variant of psychoanalysis. There are thus a series of forms of psychoanalysis ranging from Melanie Klein and followers of Kleinian thought to those championing Jacques Lacan, Heinz Kohut, Wilfred Bion and on and on to many groups hardly known outside of their particular geographic location. Such splintering or divisiveness is often applauded as a sign of pluralism, and this pluralism can lead to specialized vocabularies and a lack of agreement as to what psychoanalysis is. This erosion of a core definition of psychoanalysis seems to parallel its claim as to its being a proper study of the mind.