After a pleasant lunch in the surprisingly capacious and sunlit dining room on the 9th floor of the Harold Washington Library in Chicago, we reconvened to hear Barbara Fajardo, Ph.D., Institute for Psychoanalysis faculty member and Director of Infant Research at the Department of Pediatrics, Michael Reese Hospital, on "Breaks in Consciousness During the Psychoanalytic Process: A Bridge to Edelman's Work."

Fajardo summarized Edelman's perspective on consciousness as dividing into "primary consciousness," consisting of perceptual organization and memory, and "higher order consciousness," involving awareness of awareness, self-reflective awareness. Dissociation, within this framework, consisted of breaks in consciousness, events in which "conscious knowledge is repudiated."

Fajardo then presented a case of an analysand (the name given to the client or patient in psychoanalysis) who seemed to switch back and forth between two rather well-defined states: "State A," in which she felt a need for fulfillment from Fajardo, her analyst, and "State B," in which her need for fulfillment was directed into relationships with men which quickly became sexualized. In these relationships, the analysand would emotionally distance herself from her work with Fajardo, but they would end after a short time, followed by a return to the state of needing fulfillment from her therapist. Fajardo saw this back-and-forth pattern as something which the analysand had acquired or developed earlier on, and brought into her treatment. Indeed, "repetition of (this) maladaptive state pattern" was seen as "necessary to (her) treatment," in which the "patience and empathy of the therapist facilitates (the) reorganization (of this pattern of alternating states)." Thus, a process of self-reflection, stimulated by the therapist's interpretations and supported by the treatment relationship, was necessary to help the analysand become able to recognize her own pattern and do something about it. This process only became possible when the analysand acted out her self-defeating pattern in relationship to the therapist, the therapist recognized and commented on it, and the analysand was able to reflect on this within the context of her relationship with her therapist.

Fajardo emphasized the need for a "transference narrative," that "integrates past, present and future" as necessary to treatment. Addressing disappointments in transference brings "disappointments in earlier relationships," which may previously have been dissociated, repudiated, into consciousness. Then these automatic repetitious states of perception and emotion can be "reorganized, permitting new values, preferences and possibilities" to evolve.

Thus, Fajardo sees the goal of psychoanalysis as a "reorganization rather than reengagement in (an) incomplete line of development."
Next, Virginia Barry, M.D., faculty member at the Institute for Psychoanalysis in Chicago and a psychoanalyst in private practice, discussed "Reflections on Interactive and Self-Organizing Aspects of Learning in Psychoanalysis." Barry discussed the "mode of organization evolved in transference" as a neurobiological state that was part of clinical treatment. Emphasizing that "what we perceive depends on what we do"--that is, that "knowledge is derived from action"--Barry saw the need to study the "routinized, repeated nonverbal interactions in treatment" as a basis for learning about the analysand. And "action is necessary for new learning."

"The (young child's) ability to read (nonverbal communication) signs emerges out of interactions" with primary caregivers, Barry said. "The way in which the mother (or primary caregiver) responds to the infant's gesture becomes the meaning of the gesture." This leads to the study of "developmental semiotics," which, if I understood it correctly, is the study of the way in which the child learns the meaning of nonverbal signals in her relationship with her caregiver.

The child learns to make meaning out of the "intersubjective engagement" between herself and her mother (primary caregiver). "Trauma blocks the making of meaning." This happens "when dialog breaks down." By "dialog," Barry means nonverbal signaling as well as verbal interchange.

Barry then presented a case in which a woman "decided never to show her feelings since they could be used against her," as they had repeatedly been by her father. This woman developed a positive treatment relationship with Barry, but a turning point came when she perceived Barry as being disinterested in her; perhaps after she had been momentarily inattentive. The analysand accused Barry of being distant and uncaring, in "repetitious patterns (in which) gesture, rhythm, affective exchange, (and) vocal tone became (increasingly) rapid and cohesive." She was treating Barry as if Barry was just like her father.

When Barry felt hurt by such unjustified attack, her analysand felt blamed. When Barry questioned her own conduct from as many points of view as possible to see if there might be any validity in her analysand's accusations, her analysand forgave her. Following each cycle of attack, hurt, blame, questioning and forgiveness, the analysand would move forward in her treatment, feeling stronger and able to be more realistic. Much of this interaction was nonverbal; "The proto-conversation out of which semiotic development could proceed." The analysand's experience of her therapist responding to her emotionally, not just verbally, was necessary to "make intimacy possible."

Arnold Modell, M.D., Clinical Professor of Psychiatry at Harvard Medical School and Training and Supervising Analyst at the Boston Psychoanalytic Institute, spoke next on "The Transformation of Past Experiences."

Modell discussed memory as powerfully influenced by emotional trauma, causing the "compulsion to recreate in current time a major source of neurotic suffering" from the past. Transference "selectively activates aspects of past experiences, so the past is mixed with the present, even if partly in fantasy." The past "can't be changed, but the affective component" of the experience can. (To me, this means that we can't change what happened to us, but we can change what it means to us.)
"Memory, metaphor, and affects are synergistically linked," Modell said. "Repetition compulsion narrows the gap between (the) present and (the) past. There is a kind of time warp in which present is experienced as the same as the past."

Modell discussed metaphor, not just as a form of language, but as a form of mental operation. "Metaphor is not just a figure of speech. Metaphor is a basic and primary element of thought, the process through which meaning is transferred to different domains, and thus transformed. Analogy is the first step, but metaphor is like a template by which we parse familiar experience onto (what is) unfamiliar." Thus, metaphoric thought enables us to move from situations and environments we know into those we don't.

Modell discussed two types of metaphoric function of mind: "frozen" metaphor and "fluid" metaphor. "Frozen metaphor is primitive and unambiguous. Fluid metaphor is ambiguous and involves the self in imaginative ways, leading to new ways of experiencing the world." "Metaphors" may be expressed as images, and are to be distinguished from computations, another function of mind.

Modell discussed the limitations of "frozen metaphors" and their activity in transference. "Intense emotional experiences are templates that act as frozen metaphors, (which are then) involuntarily projected onto the current environment." "Transference repetition" involves situations in which the frozen meaning of a past time is projected onto a current situation. This takes place in psychoanalysis. "The transformation of frozen into fluid metaphors is what treatment is about."

Modell then discussed memory. Memory "is not a process of retrieval from a static memory bank." Semantic memory is impersonal knowledge, experiential memory is personal. "Experiential memory is extracted from past experiences stored as current categories;" it is "retranscripted, an imaginative reconstruction."

Modell discussed "metanomic associations" as associations which substitute a part for the whole, as when one waiter says to another, "The ham sandwich left a small tip." Such associations may often be useful, but they can also "evoke frozen metaphors, which are experienced," as if the present situation were identical to a former one.

Thus, when some part of what someone does reminds us of a former situation in which we were traumatized, it may trigger a "frozen metaphor," causing us to experience the present situation as if it were virtually identical to the past one. Modell discussed Barry's case presentation as an example in which a moment of inattention on the part of a therapist can evoke the frozen metaphor a chronically withdrawn, inattentive parent. The patient then experiences the therapist as like the parent, not just momentarily or occasionally, but completely. "Transference repetition is a focal freezing of metaphor, so that metanomic association leads to freezing" in a current time and situation. This produces a one-dimensional state of consciousness in which "ambiguity is a luxury that can't be admitted." The fluid metaphoric mind, which frees us from the tyranny of past experience, can't help to transform prior traumatic experience when it's not able to operate.

The resolution of a frozen metaphor is accomplished in therapy bit by bit over time, as analysand and analyst share "a complex state of consciousness that accepts the simultaneity of sameness and difference" in situations. Quoting Coleridge, Modell said imagination consists of a coalescence of subject and object, such that "each becomes the other." This is part of the transformative experience.

"The environment must be perceived as relatively safe" for consciousness to become more fluid than frozen. The original environment is the relationship of the child with its mother. Her touch, physical holding, heartbeat, voice, and gaze all convey signals to the infant. At times, the infant can't differentiate between its feelings and those of its mother. Thus, the content of the mother's mind "regulates the infant's state." A complex consciousness of sameness and difference will develop if the infant experiences its relationship with its mother as safe. The child develops the ability to experience "the paradox of oneness and two-ness."

"Loss of metaphoric capacity" in a parent who has been traumatized "may be transferred to the child." For example, children of Holocaust survivors may develop a total identification with their parents as victims; experientially becoming their parents, hiding from the Nazis, when confronted with frightening, but far less serious, challenges. Such "loss of metaphoric capacity" prevents the emergence of the perception of simultaneous sameness and difference.

The continuing plasticity of the mind-brain into adulthood makes it possible for therapy to "shape the architecture of the adult's brain," even as it was initially shaped by the relationship with the child's primary caretaker.

The first day of the conference concluded with a lively panel discussion including all the presenters. Since he had to leave Saturday evening, this was Edelman's only opportunity during the conference to respond to the analysts' comments on his work and its relevance to theirs.

He was "not so sure one way or another" about Barry's concept of pre-verbal processing. He compared the concept of ambiguity and simultaneity to diatonic music, in which "you get a hint of resolution, but not complete." He said "an analyst has to use a tremendous amount of imagination to make the non-linearity of interpretation meaningful," which "makes it more like an art than a science."

"What are emotions for?" Edelman asked. "How much is feeling, how much cognitive, and if it's a ratio, how do you make it a metaphor?" As an example of a complex affective/cognitive process, he discussed envy as "surrealistic interpretations you put on others to maintain your self-esteem."

Discussing development, Balaban said that it contains "sudden, unpredictable changes." "We don't have a theory about how development works," he said, because "we can't predict how an organism will look in a completely new environment." Fajardo commented that someone entering treatment might be engaged in "a search for an environment which will facilitate a change (that) one is looking for." I found this a very appealing image.

Tononi commented that "individuality (and) the value of history (provide) an area of conceptual connection between neuroscience and psychoanalysis, but (that it was important to) avoid facile assumptions."

Fajardo commented that "affect (is) tied to salience (or the) value (of perceptions or events), and said that "sadness and fear are both negative but different in texture."
Edelman commented that "selectional systems" (including the evolution of systems within the brain, species, etc.) follow three principals:

1. A "generator of diversity" (initials, g.o.d.)
   
2. "Encounters of some sort to poll the environment."
   
3. The development of "a form of differential amplification of phenomena based on that poll."

"There's always a trade-off between specificity and range" in adaptation, he continued. For example, a species may mutate too much, in which case it will not achieve a good adaptation to its environment; or too little, in which case it will be "perfectly adapted for five minutes," then become extinct.
"Category comes under the constraint of value in an epigenetic system that brings (evolutionary) encounters you couldn't foresee," he said. "You absolutely need some sort of external constraint that constrains the system so that it won't dither. Evolution imposes (such) constraint."

Edelman saw primary consciousness, perceptual and non-verbal, as conferring an "advantage in learning," to rapidly identify certain "configurations or confluence of cues" in order to decide how to react to a situation very quickly. Such a form of consciousness "might determine the next step without necessarily having anything to do with the current one." Such a "next step" might not be logical, or extrapolated from what one was just doing, although it would make sense in retrospect. (Here, the thought occurs to me that psychotherapy often involves a collaboration in which neither therapist nor patient can forsee or specifically predict the "next step" in adaptation which their work is searching for, and which, if successful, it will help to bring about.)

Commenting on awareness, Tononi said that "stimuli can be involving a large part of the brain when we are not aware of it." We may be aware of something else, as in experiments on perception in which different stimuli are provided to each eye, with the result that the person sees a series of switching images while each visual field is fully occupied with one image all the time.

On Sunday morning, the panel of presenters (except Edelman) took more written questions from the audience, moderated by Arnold M. Cooper, M.D., North American Editor of the International Journal of Psychoanalysis, Professor Emeritus of Consultation and Liaison Psychiatry at Cornell University, and Training and Supervising Analyst at Columbia University Center for Psychoanalytic Training and Research. Cooper commented that "We (psychoanalysts) have never understood the material from our cases without the help of other disciplines," citing the Oedipus myth as an example.

Balaban said that "the connections between the major parts (of the brain) are mostly there at birth, the major exception being connections within the cerebral cortex and between the cortex and other parts of the brain." These are the connections which evolve, uniquely for each individual, during his or her development.

Responding to a question about a "critical period for learning," Balaban said that this notion had emerged from early work with animals. "We now know that that's wrong," he said. Some animals, for example, deprived of early experience, are "much more ready to learn" when the corrective environmental stimulation is supplied. Fajardo added that "Developmental theory in psychoanalysis is really muddy (and) impressionistic." She pointed out that it was "useful to try to think about cases in different ways."

Barry discussed her concept of "the coherence value of truth," meaning that there may be no absolute truth but we come closer to it as we see how things relate to one another.

Several questions concerned the difference between the world views of neurobiology and psychoanalysis. Modell said that "the unconscious that cognitive science and neurobiologists talk about is not the same as the one that psychoanalysts talk about, because repression is a key concept in the Freudian unconscious." He added, "Neurobiology may need to help us here." Tononi commented that Freud's information about neurophysiology was limited to what was available in his time, and that much of that was wrong. For example, there was no concept of inhibition in the brain when Freud studied neurophysiology. (This is significant because neural inhibitory processes of some sort would obviously be implicated in repression.)

Responding to a question about why psychoanalysts should care about work in neurobiology, Modell replied that psychoanalysis had always been receptive to, and benefited from, work outside it's own field. "If we close our minds to things in other fields (e.g., neurobiology), and only read our own papers, we become a cult."

Tononi contrasted the unconscious of cognitive science, which is seen as "not (very) smart at all," with that of psychoanalysis, which "is smart." He added that there is a lot of knowledge based on experience in the brain even without awareness, for example, when anesthetized. But, as of now, we cannot locate or measure it. "There is no neurophysiological indication of a dynamic unconscious," Tononi said, although he accepts that a dynamic unconscious exists.

Continuing with the theme of the difference between neurobiology and psychoanalysis, Balaban said that there is a "culture of measurement" in biology "that is often not appreciated by interpersonally trained experts (Balaban himself was an "interpersonally trained expert" in linguistics before becoming an experimental neurobiologist). For example, brain measurements are often indirect, such as amount of blood flow to a part of the brain while the subject is doing a certain task. Generalizations can be misleading; perhaps it's not just the amount of neural firing but the relationships among groups of cells that are important for certain functions. "In biology, you try to keep your interpretations within the limits of your measurement."

Balaban, editor of a forthcoming book, "The Differences Between the Sexes," said that development can be seen as both discontinuous and continuous, depending on the time scale. For example, "puberty is discontinuous within the larger developmental scale, (but) continuous within a period of time once it begins."

A panelist (I didn't note whom) commented that the emerging model of mental function "discards the drive/object dichotomy" in prior psychoanalytic theory.
Although I had to leave before the final open discussion, I was able to hear Fred M. Levin, M.D., Faculty Member at the Chicago Medical School and Northwestern University Medical School, and Training and Supervising Analyst at the Chicago Institute for Psychoanalysis, consider "The Relevance of Neuroscience for Psychoanalysis." He touched on important ideas presented by each speaker, and considered other ideas connecting psychoanalysis and neurobiology. In his book, "Mapping the Mind," Levin speculated that "repression (forgetting, especially of a highly personal experience) and disavowal (downplaying the emotional significance of experience)" might be "left to right and right to left blocks, respectively, of the flow of information between the cerebral hemispheres," an idea which he presented today. His comment on Fajardo's presentation deftly brought together much that had been said: "We don't get back on track, we do something unique that compensates."

Many years before, I'd heard Rene Dubos present a similar idea; that "cure" (in medicine) is not usually a return to homeostasis but rather the achievement of a new adaptation. Attending this conference helped me to "consolidate" what I'd heard in that much earlier one.