Academic journal article International Journal of Psychoanalysis

Psychic Reality and the Nature of Consciousness

Academic journal article International Journal of Psychoanalysis

Psychic Reality and the Nature of Consciousness

Article excerpt

Introduction

Classically, psychoanalysis has not paid the phenomenon of consciousness the attention it deserves. Freud took the view that mental activity was unconscious in itself, and saw consciousness as merely a reflection or perception of this unconscious activity (Freud, 1915). Since his time, the unconscious has been considered the appropriate object of psychoanalytic investigation, and understanding and interpretation of the unconscious a sine qua non of therapeutic change. To the extent that other therapeutic approaches (such as cognitive behaviour therapy) have concerned themselves with the patient's conscious experience, they have been regarded by psychoanalysis as barely scratching the surface, leaving the 'deeper structures' untouched and therefore failing to effect lasting change (e.g. Milton, 2001).

Cognitive behaviour therapy and other therapeutic approaches that concern themselves with conscious experience have been criticized for taking a view of the mind that is too mechanistic, and for targeting the rational (adult) part of the patient too exclusively. Attention to the experiential, emotive dimension is felt to be missing, resulting in a therapeutic encounter that lacks depth. Within psychoanalysis, comparable criticisms have been directed toward approaches, including our own, that are felt to be losing sight of the dynamic unconscious and focusing too exclusively on conscious experience, and/or paying too much attention to the mechanisms or functions underpinning subjectivity without proper consideration of the patient's subjective experience or psychic reality (e.g. Holmes, 2006; Weinberg, 2006). Attempts to bring psychoanalysis into dialogue with empirical research and neuroscience have been criticized for similar reasons. Ron Britton (2010) has suggested that the tendency to talk in terms of mechanisms, functions, etc. reveals something about the position of the speaker vis-´-vis the mind: 'In talking of mechanism and mentalism he is outside looking in, in talking of organism and symbolism he is inside looking out.' Throughout the history of psychoanalysis, there has been concern that paying too much attention to consciousness and the mechanisms of mind will result in an impoverished picture of the individual's psychic reality.

This paper describes the case of Mr K, a patient who forced his analyst (PF) to confront the potential for reductionism that is arguably inherent in mentalization theory with its focus on the developmental processes that result in the constitution of subjectivity and its concern with the patient's ability to think about thinking. In working with Mr K, attempting to enhance his capacity for mentalization by applying the principle that change is brought about through the patient's recognition of his own mind in the analyst's mind failed miserably. The patient got worse, not better. As with any analysis in difficulty, the first step in addressing this clinical impasse was to consider what it might be like to be inside the patient's mind, looking out. However, we suggest that in order to take this position and gain a full appreciation of Mr K's psychic reality, a consideration of the nature of his consciousness could not be bypassed. This leads us to some more general reflections on the nature of consciousness and its relations with the unconscious. The clinical implications of these reflections are discussed and their impact on the work with Mr K are described.

Introducing Mr K

As a child Mr K was severely neglected. His parents were devout followers of a now fortunately almost forgotten cult-like group that incorporated a fundamentalist Christian ethic with profound deliberate self-deprivation, regarding emotion itself as an unacceptable deviation from a 'righteous path'. He had no friends and his parents ignored him. It is unclear whether this neglect was part of their own profound pathology or an understandable reaction to Mr K's rejection of them.

Mr K. …

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