10 Jaak Panksepp’s Response: Commentary by Clifford Yorke

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Neuropsychoanalysis: An Interdisciplinary Journal

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Jaak Panksepps Response: Commentary by Clifford

YorkeClifford Yorke

a

aFieldings, South Moreton, Nr. Didcot, Oxon, 0X11 9AH, United Kingdom, e-mail:

Published online: 09 Jan 2014.

To cite this article:Clifford Yorke (1999) Jaak Panksepps Response: Commentary by Clifford Yorke,Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 1:2, 251-254, DOI:

10.1080/15294145.1999.10773266

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Ongoing Discussion

Jaak Panksepp s

Response: Commentary

by

Clifford Yorke

251

I appreciate the courteous and considered reply by

Jaak Panksepp to the points I made in discussing his

response to the paper by Solms and Nersessian. Be

fore addressing them, I should like to say, that, to my

mind, the entire exchange shows every sign that the

positions taken by the various participants will lead

to the clarification vital for constructive debate.

In questioning the feasibility of the experimental

use of pharmaceutical agents

in the course

clinic l

psycho n lysis

I was in no way supporting the fenc

ing-in

of

the discipline and arbitrarily precluding

contacts with other forms of knowledge. If that were

so, I would not be taking part in this discussion. I am

entirely in agreement with Panksepp that we

do

need

to probe more deeply into the problem of how the

widely used psychotherapeutic drugs modify

the

emo

tional dynamics of human personality and other di

mensions

of

the human mind

p

178). I firmly

believe that, if psychoanalysis can help

to

craft the

needed tools (p. 178), it has a compelling duty to

do so.

I have looked once more at the relevant part

of

my commentary, to try to see whether it invited misun

derstanding, but concluded that the difficulty was per

haps

of

another kind. One can be familiar, even very

familiar, with the main tenets of psychoanalysis but,

without personal experience of the treatment process

itself, it may be hard to appreciate the nature of the

clinical setting in which psychoanalysts are obliged to

operate. It may be helpful for those participants who

lack that experience if I try to say something about

both the setting and its rationale. It may help to reduce

misunderstanding. If what follows seems a digression,

I believe it to be a necessary one.

Normally, the patient lies

supine

on a couch. This

may afford a helpful degree of

physic l

relaxation, but

it has other, far-reaching, effects. It fosters a measure

of helplessness in the face of professional authority,

however willingly the patient accepts the conditions.

The analyst is out of sight, sitting

behind

the patient,

who has nothing more stimulating to look at than the

ceiling (usually blank). Complete privacy means that

the telephone is inoperative and no interruptions al-

Clifford Yorke, F.R.C. Psych., D.P.M., is a Training and Supervising

Analyst, British Psychoanalytic Society; Honorary Consultant Psychiatrist,

Anna Freud Centre, London.

lowed. External stimuli are further reduced by the lack

of

social interchange: the analyst is, for the most part,

listening: his occasional comments are designed only

to foster the patient s self-understanding or to further

the analytic process. The basic rule requires the

patient

to try

to say everything that comes to mind,

regardless of whether or not it seems appropriate, in

context, or personally or socially acceptable. This

free association, in the context of the analytic set

ting, largely restricts the patient s attention to his own

mental processes, so that the capacity to test reality

is reduced or partially suspended. The restriction of

motility imposed by the patient s physical position

means that mental excitation cannot normally be dis

charged (or gratified) in action, but mainly through

recollection, fantasy, and affect. All these circum

stances facilitate regression-a partial return to earlier

stages of psychological development, a pull toward

childhood-and

give the primitive thought processes

characteristic of the unconscious a greater influence

on current experience. It is that influence that usually

gives every analytic hour an underlying theme.

It may be worth adding that a few patients are

too frightened to lie down or,

if

they do, find the degree

of

regression so deep that it is hard for them to get up

at the end

of

the session and at once resume normal

adult functioning. The technical methods

of

dealing

with these difficulties need not concern us here; I sim

ply want to emphasize the potential power

of

the re

gressive pull. It also has a bearing on some further

points to be made after a brief consideration of the

analyst s role.

For the analyst, too, is restricted in what he can

say or do. He must say nothing that can interfere with

the patient s focus on his own mental processes. For

that reason, he cannot talk about himself or his real

life; to do so would inhibit or interfere with the pa

tient s fantasies about him. Questions are distracting,

and are rarely asked (analytic patience will generally

supply the answer in due course). Neither (within the

limits

of

common sense) will the patient s questions

be answered: the reason

why

the question is asked is

by no means always conscious, and is generally more

important for the analysis than any formal answer.

The analyst makes only interventions that further the

analytic work-in particular, comments that tend to

bring unconscious material into consciousness. As far


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s

possible, he tries to avoid suggestion, above all,

listening in a very special way. The analyst listens

withfree floating attention

trying not to attach greater

importance to

anyone

of the patient s utterances than

he does to another, and makes no conscious effort to

remember.

This method of listening means that, time

and time again, relevant information from earlier ses

sions sometimes weeks or months before--comes to

mind unbidden, and acts as a pointer to the less con

scious implications of what the patient is saying. The

analyst is, of course, listening with an analyzed mind

that facilitates an understanding

of

the underlying

meaning of what the patient has said.

It should not be thought that free association

(which is not in

fact

free but motivated) will itself

convey, directly, unconscious material. The patient is

nothing

if

not

conflicted.

Mental content that the pa

tient was unable to tolerate in everyday life will face

opposition from psychological defenses, and normally

these defenses are themselves unconscious. For that

reason, a defense will generally need to be addressed

before the drive representative behind it can be

brought into awareness. As for affects, these can only

be conscious. They do not, however, always present

themselves when they might be expected to do so To

take a rather vivid example from an actual analysis: a

patient told his analyst that he would like to break

every bone in his (the analyst s) body, but spoke with

no evidence of anger, let alone rage. The analyst said

that the patient would perhaps feel very frightened

if

he were able to feel that he really wanted to do him

so much damage. He would not have told the patient

that he did feel something when the patient knew very

well that he didn t. Dealing with the inhibition of the

processes by which affects reach awareness often calls

for slow and patient work. There are other defenses

against affective awareness: these are different in kind

from defenses against the mental content of drive rep

resentatives.

Mental content unaccompanied by affective ex

perience has its counterpart in affect seemingly di

vorced from mental content. One can feel furious, for

example, without recognizing the object

of

that fury.

In that case, the technique

of

interpretation is aimed

at the uncovering of the unconscious mental represen

tations.

The pull back to childhood plays a major part in

the development

of

that vital agent in analytic work,

tr nsference the reexperience, in the present, of feel

ings, thoughts, and attitudes toward the analyst more

appropriate to parental and other important figures

from the past. It may be useful to say a few words

Clifford Yorke

about this remarkable phenomenon. Perhaps the first

thing to say is that spontaneous transference occurs in

everyday life. Some people approach any figure of

authority with attitudes that may, however remotely,

derive from a childhood attitude to a father. A bank

manager may be approached

s

a benign paternal fig-

ure who can be relied upon to look after his client s

best interests, or

s

a somewhat daunting character

only too likely to turn down a request for a loan. Or

someone may, almost instantly, dislike a woman who

is too reminiscent of unacceptable maternal traits or,

conversely, instantly like her for opposite reasons. The

person concerned may not know why certain people

bring out strong likes or dislikes even when there has

been

no

time

to

get to know them. But spontaneous

transference can be

of

any degree

of

intensity.

In analysis, spontaneous transference is there

from the beginning. It is affected by the patient s

hopes, expectations, and conscious and unconscious

fantasies about the analyst to whom he is entrusting so

much. The illness and the wish to get better contribute

strongly

to

its nature and quality, but the affective

component is usually substantial. Furthermore,

if

a

patient s need for love is unmet in reality or not fully

satisfied, the analyst or, for that matter, any new per

son in the patient s life, will be met by what Freud

(1912) called libidinal anticipatory ideas. There is

a readiness for transference. But, as the analysis gets

under way, the transference becomes more complex

and increasingly centered around the person

of

the

analyst. A full explanation of this phenomenon is be

yond brief summary: but the two most important fac

tors are regression (discussed above) and the

repetition compulsion (Freud, 1914, 1920, 1925). The

compulsion

to

repeat earlier modes of attachment and

behavior reflects a conservative trend in the organism:

older methods of adaptation are preferred at the ex

pense of the new. It is most readily observed in chil

dren s play and in their insistence that the same story,

when repeated, must be told in the same way. A dis

tressing form of the repetition compulsion is seen in

traumatic neurosis. The traumatizing incident is lived

(or dreamed) over and over again: each time, the over

whelming excitation aroused by that event is fraction

ally discharged. It is usually a minute step toward

recovery. But, in general, the conservative trend in the

repetition compulsion is rarely absolute:

if

it were

there would be no such thing

s

progressive develop

ment and certainly no capacity for adventure. There

are people who are terrified of anything new, but they

may

find

psychoanalysis rather too novel for their

tastes. But the repetition compulsion is real enough: I


4/5

Ongoing Discussion

was particularly impressed when I met a patient who

had twice married tuberculous husbands and nursed

each through to his death.

The level

of

regression varies in different disor

ders. But, generally, drive organization (the mental

organization structured around the drive representa

tives and derivatives at any given phase of develop

ment) reverts to a point at which, from the standpoint

of personal history, there was a particularly strong

drive attachment to an infantile object. That has im

portant consequences for the nature

of

what can prop

erly be called the transference neurosis. Similarly, the

nature and quality of ego regression and superego re

gression varies, too, even at different phases of the

same analysis. The analyst may, for example, be seen

s an external source of proscription (or support), like

the parental figure of a 3-year-old-well before the

superego has been fully internalized. All this will be

variously reflected in the transference.

I have not discussed here what has been called

countertr nsference Classically this referred to the

analyst s unconscious responses to the patient stem

ming from his own past, to be dealt with by self-scru

tiny and, when called for, some self-analysis. Today,

its meaning is more controversial, and I omit it from

this brief account.

Some years ago, I tried to examine these pro

cesses from the standpoint

of

metapsychology (Yorke,

1965): that attempt needs updating, and I hope to re

turn to the subject elsewhere. It is a crucial matter for

psychoanalysts, since there can be

no

sound theory of

technique without a clarification

of

these important

issues. We need to know, for example, why and how

interpretation works, or fails to work, and what adap

tations of technique are called for in widely differing

types of disorder. (The remarks made above

o

not,

for example, apply to children and

to

those on the

border

of

psychosis.) On this occasion I have tried to

do no more than give a bare outline of how an analysis

is conducted, in the hope that it will further discus

sions between our disciplines. It has, I believe, a legiti

mate claim to mutual interest. The metapsychology

of

the treatment process, of the method by which, after

all, psychoanalysis has made most of its discoveries,

is something we all need to understand better from our

two perspectives.

I return to Jaak Panksepp s comments. Pharma

ceutical agents cannot be administered in the course

of psychoanalytic treatment without interfering with

the necessary conditions without which the treatment

cannot operate. In my original commentary I said that

if drugs were used which divorced thought from af-

5

fect, associations would lose their power to convey

information without which the analyst would not be

able to operate. I believe that statement to be gener

ally true, but it is not meant to set aside considerations

of

common sense. Patients do, occasionally, turn up

under the influence (say)

of

alcohol, for reasons that

have nothing to do with experiment, and we can ob

serve the effects. The analysis will effectively be sabo

taged, and the reasons for the behavior (e.g., a negative

transference reaction and/or self-destructiveness) can

not be analyzed either. I once tried to treat a heroin

addict who attempted a old turkey recovery, but

s soon as she ran into painful experiences she re

turned to the needle and analysis was impossible. On

the other hand, a patient referred by a psychiatrist who

was seriously anergic and unable to talk until treated

by antidepressants would,

if

she wanted self-under

standing, become treatable if her background mood

had returned to something like its norm.

These examples are meant to do no more than

point to the fact that drugs can make treatment possi

ble or quite impossible. The experimental use of phar

maceutical agents is a very different matter. It is a

safe general rule that the analyst should never himself

prescribe. To do so would require him to step outside

his analytical role, with unpredictable consequences.

The transference relationship would be seriously inter

fered with; the analyst, however well intentioned, is,

one way or another, directly acting on the patient s

body. That may be fine if

the patient is consulting a

doctor for a physical disability, but that is not the view

he will take of

his analyst s responsibilities. The pa

tient may resent that interference, at least uncon

sciously, even if he has given formal consent. The

unconscious being what it is, he may see the drug s

an elixir of life, as a poison, or indeed anything else.

His emotional response will vary accordingly. What

ever else, he will feel, correctly, that the analyst has

stepped out

of

his proper role. Analysis, at best, is a

delicate undertaking and, as I hope my brief resume

of the method has suggested, calls for the reduction

of

external stimuli and interference to the lowest possible

level. I will not repeat here the objections I voiced in

previously published material.

This difference of opinion with Panksepp only

applies, however, to the use of drugs during formal

psychoanalysis itself, and it is likely that psychoana

lytically informed methods

of

investigation could be

devised. Solms and Nersessian, in their concluding

remarks (p. 224), make suggestions which I would

endorse. If, as I believe, Panksepp is in accord with


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5

these suggestions, there is no good reason why there

should be any significant disagreement on this score.

On the question

o

drives, and their link with

affects, I find little to add to what has already been

said. The differences between Panksepp and myself

have been diminished, I believe, but there is room for

further discussion. Although Freud included hunger

and thirst among the self-preservative instincts in

his earlier formulations, appetitive strivings ought not

to be

equated

with drives in the psychoanalytic sense.

The somatic oral erotogenic zone is not in itself the

source

o a biological need. There is much to debate

in matters o this kind. In respect o the drives, I find

the comments o Solms and Nersessian very much to

the point. On this and the question o affects there are

a number

o

psychoanalytic tools that can be used to

examine the effects

o

drugs prescribed for validmedi

cal reasons. The concept o developmental lines (A.

Freud, 1963) is one o them. But it is worth remember

ing that we can reach a very useful provisional psy

choanalytic diagnostic assessment o patients with all

kinds o disabilities, including serious physical defects

that affect psychological functioning, by the use o

Anna Freud's profile schema A Freud, 1962). It can

be applied to children, adults, psychotic patients (Free

man, 1973), and to drug-induced conditions. A pilot

study

o

ten severe heroin addicts was made many

years ago (Wiseberg, Yorke, and Radford, 1973). The

status

o

the profile in relation to the concept

o

devel

opmental lines has been discussed elsewhere (Yorke,

1980).

Studies

o this kind still fall within the ideo

graphic rather than the nomothetic approaches to sci

ence. I was interested in Panksepp's responses to my

comments on this distinction, and from the nomothetic

standpoint neuropsychology can be expected to offer

us valuable information. The clinico-anatomical

method has, however, already given us invaluable

work without recourse to mensuration. As for aca-

Clifford Yorke

demic psychology, I am less enthusiastic than Pank

sepp about the value o rating scales. In all this I

would, however, echo the reminder, by our editors,

that a psychological model only becomes accessible

to

physical investigation once the neural correlates of

the components o the model have been identified

p 213). Success may only be partial in the foresee

able future, but I cannot think we are aiming at impos

sible goals.

References

Freeman, T. (1973), The metapsychological profile schema.

In: The Psychoanalytic Study

of

the Psychoses. New

York: International Universities Press.

Freud,

A

(1962), Assessment

o

childhood disturbances.

The Psychoanalytic Study

of

the Child 17:149-158. New


(1963), The concept o developmental lines. The

Psychoanalytic Study

of

the Child 18:245-265. New


Freud, S (1914), Remembering, repeating and working

through (Further recommendations on the technique o

psycho-analysis, II). Standard Edition

12:

145-156.

London: Hogarth Press, 1958.

(1920), Beyond the Pleasure Principle. Standard

Edition 18:1-64. London: Hogarth Press, 1955.

(1925), An Autobiographical Study. Standard Edi-

tion 20:1-74. London: Hogarth Press, 1959.

Wiseberg, S., Yorke, C., Radford, P (1973), Aspects o

self-cathexis in mainline heroin addiction. In: Studies

in

Child Psychoanalysis Pure and Applied

Mongr. 5.

New Haven, CT: Yale University Press.

Yorke,

C

(1965), Some metapsychological aspects

o

inter

pretation. Brit.

Med. Psycho

,

38:127-142.

Clifford Yorke

Fieldings

South Moreton

r Didcot Oxon

OX]]

H

United Kingdom

e mail: [email protected]

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10 Jaak Panksepp’s Response: Commentary by Clifford Yorke