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Psychoanalysis as Biological ScienceReview - Psychoanalysis as Biological Science
A Comprehensive Theory
by John E. Gedo
Johns Hopkins University Press, 2005
Review by Andrea Bellelli, MD
Mar 14th 2006 (Volume 10, Issue 11)

In this book the psychoanalyst John E. Gedo takes a position in the quarrel between two reciprocally incompatible views on psychoanalysis, i.e. the biological and the hermeneutical. This quarrel has been plagued by many instances of a lack of comprehension on both sides that have confused the issue to the point that the views of independent critics like Adolf Grunbaum and Malcolm Macmillan have been clearer than those of the psychoanalysts themselves. Since I personally favor the hermeneutical interpretation of psychoanalysis, it is important that I warn my readers in advance: my views may be biased.

The hermeneutical school of psychoanalysis, developed by philosophers like Paul Ricoeur and Jurgen Habermas, and by psychoanalysts like George Klein, Merton Gill and Roy Schafer, maintains that psychoanalysis is a human science, akin to the interpretation of texts (notably, but not exclusively, sacred texts), and its only scope is to help the patient to modify his opinions on himself, his own history and his problems. Hermeneutic psychoanalysts imply that such a change of opinion may be helpful in curing the disease or at least in reducing its symptoms. Obviously such a view undermines any pretence to understand the causes of psychiatric disorders, and their biochemical and anatomo-physiological basis, e.g. the relationship with one's parent is not any more viewed as an event of the infancy but as the present memory of it, with all its uncertainties. Even neurological symptoms such as hallucinations enter the picture only through the description of the subjective feeling of the patient, and the psychoanalysts who adhere to the hermeneutic view try to concentrate on the "now and here" of the patient, rather than to his personal history. Hermeneutic psychoanalysis has been reluctant to fully develop its premises, since this would result in a dramatic "amputation" (the word is Grunbaum's) of most widely held psychoanalytic folklore. Gedo criticizes the hermeneutical version of psychoanalysis exactly on these grounds, i.e. it still pretends to explain causal relationships, but it lacks explanatory power for symptoms that have an obvious neurological basis (p.16-22). This criticism is not unfounded but it refers to the incomplete development of the hermeneutic premises, and the correct objection should be that this school has been incapable of renouncing completely to any reference to the neurological aspects of mental disease, leaving them to biological psychiatry.

Biological psychoanalysis is the opposite of its hermeneutical counterpart, in that it pretends to discover and describe psychological events in relation to their anatomo-physiological basis. This was Freud's very initial approach, that culminated in the unpublished manuscript Project of a scientific psychology (1895). In the Interpretation of dreams (1900), Freud partially renounced to the pretence of anchoring his theory to the anatomy and physiology of the brain, and laid the foundation of an intermediate level of explanation, that he called "metapsychological". Freud's metapsychology deals with such concepts as psychic energy (probably the heir of previous century's vital force), the structures of mind (conscious, preconscious and unconscious, later to be replaced or upgraded to Id, Ego and SuperEgo), the censorships and the defenses and so on. Most of Freud's metapsychology was obsolete in the very moment in which it was formulated, and Gedo recognizes that it is now untenable: hence (according to Gedo) the necessity of a new biological theory, capable of integrating psychoanalysis and neurology:

"We must therefore face the disturbing fact that psychoanalytic theories cannot be scientifically validated from within psychoanalysis alone; competing analytic hypotheses will also have to be judged on the basis of their congruence with data from cognate fields, such as semiotics, cognitive psychology, and brain science." (p.29)

This phrase is revealing of the two major defects of Gedo's work: firstly, it at the same time recognizes the scientific inadequacy of psychoanalytic clinical "data" and yet fails to take the appropriate conclusion of discarding them. Gedo actually neglects to inform his readers that psychoanalytic data are strongly criticized by the psychoanalysts themselves, by psychologists (e.g. Dawes, The house of cards; Macmillan, Freud evaluated), physicians and philosophers of the science (e.g. Popper, Conjectures and Confutations; E. Nagel, Methodological problems of the theory of psychoanalysis). It is important to stress that the hermeneutic interpretation of psychoanalysis was proposed forty years ago exactly to overcome these difficulties, and maintains that psychoanalysis is capable of subjective persuasiveness, if not of objective validity, and that persuasiveness is clinically important. In this respect it is also noteworthy the incongruence of Gedo's formal tribute to the father of psychoanalysis:

"... Freud most lasting and valuable contribution was not conceptual ... [it] was the development of a novel observational method through which it became possible for the first time to gain reliable data about the inner life of human beings." (p.5).

If "psychoanalytic theories cannot be scientifically validated from within psychoanalysis alone", then probably its "reliable data" are not so reliable after all and Freud's most valuable contribution vanishes.

The second defect of Gedo's comprehensive theory is that the cognate fields have rarely, if ever, confirmed the hypotheses of psychoanalysis. This argument brings us to the logical center of the book, namely Gedo's biological theory. Based on the collection of scattered information from psychoanalysis on the one hand, and neuroanatomy and related sciences on the other, Gedo proposes a five step model of neurological and psychological development of the infant, in which step I is dominated by lower (subcortical) centers, step II by the right hemisphere, step III by the left hemisphere, step IV by the integration of the hemispheres and step V by the prefrontal cortex (p.55). The time progression between the steps of the model is linked to the development of the corresponding neurological structures, e.g. myelinization of the corpus callosum (the most important inter-hemispheric connection) would favor or determine the passage from step III to step IV. Since Gedo is not concerned with the identification of the different steps and their progression, neither shall I, but is is hard to avoid questioning the meaning of right or left hemisphere dominance and its manifestations, since the anatomo-physiological evolution of the brain in the newborn is harmonic and continuous rather than localized and stepwise. Even is we skip this problematic part of the theory, and stick to its psychoanalytical implications, which Gedo discusses at length, problems and inconsistencies abound, and the final theory is more obsolete today than Freud's original was in 1900. To demonstrate this point, we can compare the neurological development with the evolution of psychical defenses, a cornerstone of psychoanalysis. Thus we learn that withdrawal is characteristic of step I, projective identification of step II, disavowal of step III, repression of step IV and, finally, renunciation of step V (p.88). Gedo mantains that adult patients may present any of these defensive mechanisms in relation to their fixation to the corresponding phase of their infancy, in the best Freudian tradition; however, a grave inconsistency of the theory follows immediately, for how is it possible that an adult, with a fully myelinized corpus callosum can regress to the function of an infant whose corpus callosum is immature? In Gedo's theory regression and fixation are impossible because of their very link to anatomical conditions of the newborn or the infant child; nevertheless, they are constantly invoked as an explanation of nevrotic symptoms. Moreover, the theory suggests that regression is induced by those pathological conditions in which the corpus callosum is damaged, e.g. the Wernicke-Korsakoff syndrome, or surgically cleaved, e.g. to prevent the diffusion of recurrent untreatable epileptic crisis. Regression does not occur in these instances, or at least no psychoanalyst ever described it, but an even greater problem it is that Gedo fails to address the point.

It is unnecessary to multiply the examples of the inconsistencies between the different parts of the theory, but it may be worth noting that Freud had been wise enough to introduce metapsychology as a flexible joint between neuroanatomy and psychology, exactly to allow room for a florid, overgrown theory that could not be nailed to the limitations of an unyielding science like neuroanatomy. If metapsychology is untenable and needs be abandoned, either one switches to the hermeneutic side, cutting on the pretences of scientific objectivity, or one trims the theory to a level compatible with neurology, psychiatry and psychology. Gedo does neither and pretends to root psychoanalysis directly on neurology, e.g.:

"... better reality testing and greater affect and frustration tolerance ... are changes in basic biological functions. These can only take place through the gradual establishment of new arrangements within the central nervous system ..." (p.42)

He leaves to the "cognate sciences" the burden of the proof, and neglecting that these sciences have already demonstrated that psychiatric diseases are not associated to characteristic lesions of the brain. Overall, the book is representative of a current of psychoanalytical theorizing that we may define oblivious: he writes as if no criticism had ever been raised against the theory, and is only concerned with the disagreements internal to the community of psychoanalysts.


© 2006 Andrea Bellelli


Andrea Bellelli has an MD and a degree in psychology, and teaches biochemistry in theMedical School of the University of Rome, Italy.


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