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Professional News
Analytic Theory, Not Practice Influenced by Neuroscience
Psychiatric News
Volume 37 Number 3 page 13-13
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Sydney Pulver, M.D: "We are in the midst of a great neuroscience bubble, a time of irrational exuberance."

Sydney Pulver, M.D., a clinical professor of psychiatry at the University of Pennsylvania and a training and supervising analyst at the Psychoanalytic Center of Philadelphia, is a man who likes sticking his neck out, ruffling things up.

For instance, he has grappled over the years with such contentious subjects as medical hypnosis, exorcism and demonic possession, and the dismay at finding oneself naked in dreams. Yes, indeed!

Thus, it should probably come as no surprise that he decided to deliver a plenary talk at the December meeting of the American Psychoanalytic Association in New York City that would roil his psychoanalyst colleagues. The title of his talk? "On the Astonishing Clinical Irrelevance of Neuroscience."

"The mind is my profession—of course I’m interested in the brain!," said Pulver as he warmed up his audience of several hundred analysts. They had gathered in the Grand Ballroom of the Waldorf Astoria Hotel, where the meeting was being held, to hear his address. But right now, Pulver declared, "we are in the midst of a great neuroscience bubble, a time of irrational exuberance (forgive me, Alan Greenspan)!"

Audience laughter followed.

"I want to leaven some of the overexpectation that tends to be stirred up by many of the papers about neuroscience that are appearing these days in the analytic literature. These papers often imply that neuroscience will in some way change our daily psychoanalytic technique, an implication that I feel strongly is unwarranted. [By technique I mean] the way we are with patients . . .our way of listening, our timing, our psychoanalytic attitude."

Pulver cited some of the papers that have attempted to document how neuroscience has changed analytic technique but in his view do not really make the case. He also provided an example from his own analytic experience to support his contention that neuroscience has not altered analytic technique.

"Many, if not most, of our patients have suffered traumatic episodes that play an important part in their psychopathology," he related. "For many years, I had approached such patients with the conception that the memory of these episodes had been repressed. One of my therapeutic goals was to help my patients recover those traumatic memories. It will be no surprise that some of those patients did recover those memories, and some didn’t. My patients always realized, of course, what I was looking for. Those who did not clearly recover memories felt, as did I, that although in many ways the analysis was helpful, in this one aspect it had failed.

"[Then], in the past few decades, cognitive and neuroscientific description of. . . memory systems led me to realize that memory organization is much more complex than our topographical model implied. Many of the traumatic memories I was searching for were not coded explicitly and were unrecoverable as memories per se. As I appreciated this, I began conveying to patients that, while they might be able to remember these traumatic episodes, they might also gain access to them only through their less-direct appearance in dreams, bodily sensations, and fantasies. . . .

"My change in attitude changed the tone of some of my analyses, sometimes subtly but occasionally dramatically. Soon, however, I realized that this same ambivalence about traumatic memories was present within psychoanalysis itself, almost from the beginning, and certainly far earlier than any neuroscientific findings."

In short, Pulver stressed, neuroscience has not brought about any significant changes in analytic technique to date, and "I want to dampen any wild hope you may have had that neuroscience will revolutionize your way of working with patients."

Nonetheless, after arguing that neuroscience has not transformed analytic technique and will probably not do so in the future, Pulver cocked a provocative eyebrow and declared: "I turn now to the second major point of my paper: the astonishing ‘relevance’ of neuroscience to psychoanalytic theory." And to bolster this position—that neuroscience is changing analytic theory—he referred to neuroscience’s influence on the theory of motivation.

Analysts’ initial assumption about motivation, he explained, was that it arose from the id and was in some way either sexual or aggressive. This assumption was based upon Freud’s drive theory. However, neuroscience has since shown that there are motivational systems in the brain for not just sexuality and aggression but some other drives as well, such as hunger, thirst, safety, maternal devotion, and social attachment. As a result, analysts are starting to integrate these findings into their own hypotheses, and a "few brave souls have even advanced comprehensive motivational theories based on these systems," Pulver said. "These attempts have not yet caught on, but we are moving in the right direction."

Still another way that neuroscience is impacting analytical theory, Pulver pointed out, is via its influence on concepts of the ego. Analysts used to view the ego as a rather abstract "hodge-podge of functions and processes," he said. But those functions and processes are now becoming much clearer, thanks to neuroscience research taking place in areas such as perception, planning, reasoning, learning, memory, self-awareness, and empathy. In fact, in 50 years or so, the term "ego" will be usurped by the term "executive system," Pulver suggested.

"Our topographic description of the mind, which we now crudely designate as ‘conscious, preconscious, and unconscious,’ " Pulver predicted, "will be refined to be congruent with the many different ways in which mental functioning relates to varieties of consciousness, an area now just beginning to be investigated by neuroscience."

Neuroscience, he said, is likewise hard at work in other areas pertinent to analytical theory. These include sleeping, dreaming, nonverbal communication, and mechanisms of therapeutic action. Advances in these areas, he anticipates, will also recast analytical theory.

What is crucial, he emphasized, is that analytical theories be kept congruent with neuroscience advances. "And we ought to be educating our psychoanalytic candidates about neuroscience," he added. "In fact, we are doing it at our institute in Philadelphia. Some sessions are being taught by analysts and neuroscientists simultaneously."

"So, while neuroscience is not going to help us with technique, it sure is going to tell us a lot about theory," Pulver concluded. To which his audience rose from their seats and gave him appreciative applause.

But had he converted them to his views on neuroscience and analysis? Some very possibly, but others not all. For one could be overheard saying as the applause receded in the spacious ballroom: "I disagree with Pulver’s premise. If neuroscience influences our theory, it also has to influence our technique since our theory informs our technique." ▪

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Sydney Pulver, M.D: "We are in the midst of a great neuroscience bubble, a time of irrational exuberance."

Sydney Pulver, M.D., a clinical professor of psychiatry at the University of Pennsylvania and a training and supervising analyst at the Psychoanalytic Center of Philadelphia, is a man who likes sticking his neck out, ruffling things up.

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