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7/25/2019 9 the Neuropsychology That Would Have Interested Freud Most: Commentary by Oliver Turnbull (Bangor, UK)
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The Neuropsychology That Would Have InterestedFreud Most: Commentary by Oliver Turnbull (Bangor,UK)Oliver Turnbull
a
aCentre for Cognitive Neuroscience, School of Psychology, University of Wales, Bangor,
383670, Gwynedd, Wales, LL57 2DG, U.K. e-mail:
Published online: 09 Jan 2014.
To cite this article:Oliver Turnbull (2001) The Neuropsychology That Would Have Interested Freud Most: Commentary byOliver Turnbull (Bangor, UK), Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences,
3:1, 33-38, DOI: 10.1080/15294145.2001.10773334
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Psychoanalysis and Cognitive Neuroscience
(Kosslyn, 1999). Language activation studies show
discrete regional responses in classical language areas
when the brain is
sliced
axially or coronally. My
colleagues at the Brain Imaging Research Institute in
Melbourne, Graeme Jackson and David Abbott, have,
for analytic purposes, viewed the brain
as
a series of
decreasing concentric volumes. Voxel counts are pro
jected onto the surface of each volume. This approach
yields a rather different view. What appear
to
be dis
crete regions in conventional cuts through the brain,
can now be appreciated
as
continuous transcortical
ribbons of activation. This finding has something in
common with Freud's aphasiological model, and is
interesting from that point
of
view. The difficulty that
remains, however, is that cognitive activation para
digms do not contain within them the broad mental
reach
of
psychoanalytic concepts. The most we can
hope for at this stage is a cerebral map
of
fragments
of the Freudian view of mind. Working memory is
a favorite topic amongst the neuroimaging fraternity;
perhaps the mystic sketchpad would allow one to
claim working memory as a fundamentally Freudian
concept
Along similar lines, the notion
of
verbal memory
is crucial in censor-ego function (Gilmore and Nerses
sian, 1999). There is a growing body
of
literature on
the functional neuroanatomy
of
verbal memory. It is
becoming clear that this function is underpinned by
a widely distributed cortical system that includes the
highest levels
of
neocortical association cortex (Dolan
and Fletcher, 1997), and pathways to the hippocampus
via perirhinal and entorhinal cortices (Saling and
Weintrob, 1999). This system clearly has one foot in
the external world, and the other in the inner world.
But does this finding lead us to the seat
of
ego?
While I find it difficult to accept the idea
of
a
special and natural nexus between cognitive neuropsy
chology and psychoanalysis, I applaud Semenza 's
contribution to the search for a link between the two
cultures of psychology, for its desire
to
bring to an end
the century of misunderstanding (Whittle, 1999).
References
Dolan,
R
J., & Fletcher, P. C. (1997), Dissociating prefron
tal and hippocampal function in episodic memory encod
ing. Nature, 388:582-585.
Freud, S (1891),
On Aphasia.
New York: International
Universities Press, 1953.
Gilmore, M.,
Nersessian, E. (1999), Freud's model of the
mind in sleep and dreaming.
This Journal, 1 2 :225-232.
Kosslyn, S M. (1999), If neuroimaging is the answer, what
is the question? Philosoph. Trans. Roy. Soc. Lond., B.,
354: 1283-1294.
Saling, M. M., Weintrob, D. (1999), The functional neu
roanatomy of verbal memory in focal epilepsy. In
ternat. Neuropsycholog. Soc., 5:274.
Whittle, P. (1999), Experimental psychology and psycho
analysis: What we can learn from a century
of
misunder
standing.
This Journal, 1 2 :233-245.
School of Behavioural Science
Department
of
Psychology
The University ofMelbourne
Victoria
3
Australia
e-mail: [email protected]
The Neuropsychology
That
Would Have Interested
Freud
Most:
ommentary
by Oliver Turnbull (Bangor, UK)
Carlo Semenza has offered a thought-provoking dis
cussion on the relationship between the theoretical
foundations of psychoanalysis, and those of modern
cognitive neuropsychology. In doing so, he reviews
the core features
of
the cognitive approach, and sug
gests that psychoanalysis shares much in common
Oliver Turnbull, Ph.D., is Senior Lecturer in Cognitive Neuroscience
at the University
of
Wales, Bangor, and Consultant Neuropsychologist at
The Anna Freud Centre, London.
with modern cognitivism. It is a radical, and rather
interesting, argument. The idea is interesting because
there are unquestionably
some
similarities between the
two fields, which is (to some extent, see below) cap
tured by Semenza's use
of
Howard Gardner 's list
(1985). For example, there is much merit in the argu
ment that both fields are investigating the mental appa
ratus, and that they do so using the language of
representation. Semenza's idea that Freud can be
regarded
as
a diagram maker has some appeal. In addi-
7/25/2019 9 the Neuropsychology That Would Have Interested Freud Most: Commentary by Oliver Turnbull (Bangor, UK)
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tion, Freud was clearly of the opinion that the mental
apparatus consists
of
a number
of
component parts,
each
of
which is relatively independent, and that such
systems can be (at least to some extent) independently
modified (though the process is one of over- or under
activation, rather than by lesion). These arguments
make Semenza s suggestion rather interesting.
The Modern Opinion of Semenza s Position
However, Semenza s argument is radical because
one can already hear the howls
of
objection from both
sides. I can think of very few cognitive neuropsycholo
gists who would blithely accept that their discipline
shares its core assumptions with psychoanalysis. Cer
tainly, such scientists would be wondering why the
core assumptions and methods
of
the two disciplines
appear to be so different (for a review
of
these con
cepts see the introductory chapters of Ellis and Young
[ 9 8 8 ] ~ McCarthy and Warrington [ 9 9 ] ~ Parkin
[1996]). For example, where are the concepts of mod
ularity and dissociation in psychoanalysis? Where are
the painstaking experimental attempts to localize a
deficit to a single component
of
a model
of
mental
apparatus? There are no doubt ways in which such
questions can be countered by Semenza, but only with
difficulty. However, I feel that the most important ob
jection relating to a link between psychoanalysis and
cognitive neuropsychology relates to the type
of
pa
tient that is studied. Where in psychoanalysis would
you find the investigation of
neurological patients with
focal brain lesions? It is true that there has been some
work
of
this sort, especially recently (e.g., Kaplan
Solms and Solms, 2000). However, it has been almost
entirely absent from the earlier history
of
psychoanaly
sis. I will return to this point later in this discussion.
The objections against an analogy between psy
choanalysis and cognitive neuropsychology would
also be strongly heard from the psychoanalytic side.
Where, analysts would doubtless ask, are the great
questions
of
motivation, emotion, and personality to
be found in cognitivism? This is, I feel, the weakest
aspect of Semenza s argument. He claims, from Gard
ner s list, that the two fields share a common founda
tion in the (momentary) deemphasis of affect and so
on Such an argument is difficult to defend. It seems
that psychoanalysis is, in many respects, directly con
cerned with context, culture, and history. Indeed, it is
beyond dispute that affect is
of central
concern to
psychoanalysis, and it almost certainly
is
not a viable
enterprise if the role of emotion is deemphasized. The
Oliver Turnbull
obverse side
of
the coin is also true: The absence of a
consideration
of
affect lies at the core of the cognitive
approach. For this reason, in particular, I doubt that
many analysts would agree with Semenza.
Freud s Opinion of Semenza s Position
Semenza s argument is all the more interesting be
cause
of
the matter of historical precedent. As he
points out, modern cognitive neuropsychology has ex
plicitly looked to the behavioral neurologists
of
the
late 19th century as intellectual forebears (Shallice,
1988). Of course, we also know that psychoanalysis
was predated by Freud s substantial academic career
as a neurologist during the same period. Thus, we are
in the interesting position
of
having a clear set
of
his
torical documents in which Freud gives
his
opinion
of
the acknowledged forebears
of
modern cognitive
neuropsychology. In one sense, then this allows us to
ascertain Freud s position
on
Semenza s claim.
Freud had a variety of opinions about the state
of
behavioral neurology in the late 19th century. On
the one hand, he was sufficiently interested in the topic
to have followed the literature, investigated a number
of
patients, and published
on
the
topic the
best ex
ample being Freud (1891). This sort of behavioral neu
rology was the forerunner of neuropsychology in
general (rather than cognitive neuropsychology in par
ticular), and it clearly held great interest for Freud in
the period before psychoanalysis.
However, it is
also well known that Freud s admi
ration for the neuropsychology of his time was far
from total. From one perspective, Freud was unhappy
with some specific aspects
of
the data collected in the
field (see the early chapters
of
Freud [1891]). More
importantly, in the present context, he disagreed with
his cognitive colleagues
on
some core theoretical
points. For example, he seems particularly uncomfort
able with the narrow localizationist view, which
is (arguably) the forerunner of modularity, and hence
cognitive neuropsychology. Thus, in the famous chap
ter 6
of Aphasia
he describes the thought-pro
voking model that offers a reinterpretat ion
of
the
classic aphasiological data. In its place he suggests a
nonmodular account of the dissociation evidence,
which stands up well to modern scrutiny (cf. Pribram,
9 6 2 ~
Shallice, 1988, pp. 245-257). However, it is a
position that
is
more-or-Iess incompatible with modu
larity. Given that modularity is central to modern cog
nitive neuropsychology (Ellis and Young, 9 8 8 ~
McCarthy and Warrington, Parkin, 1996) this
7/25/2019 9 the Neuropsychology That Would Have Interested Freud Most: Commentary by Oliver Turnbull (Bangor, UK)
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Psychoanalysis and Cognitive Neuroscience
makes it difficult to regard Freud
as
a founder of the
discipline.
However, while Freud was clearly
interested
in
the neuropsychology of his time, the interest was not
sustained through his career-he described problems
of this sort as a silly game
of
permutations (Solms,
2000, p. 83).
Of
course, the clearest evidence of his
waning interest in neuropsychology
is
his growing in
terest in what was to become psychoanalysis. This
intellectual shift was (arguably) a result of the fact
that many patients (notably those with hysteria) had
no demonstrable brain lesion at autopsy, and could not
adequately be explained in terms
of
the box-and-arrow
diagrams offered by the neuropsychology of Freud's
time. One of the reasons for this may have been that
such models focused on cognition at the expense of
emotion and motivation. Indeed, by dealing with this
omission, affective neuroscience and modern neuro
psychiatry are making great strides in establishing the
biological basis of disorders which were previously
classed as functional rather than organic. The
absence of knowledge of this sort in the neuroscience
of
Freud's time is likely to have been one
of
the rea
sons for his shift of emphasis to psychoanalysis, where
Freud developed a theory that
was
capable
of
ex
plaining the deficits of his patients. We can observe
the period of transition in the fact that the 1895 Proj
ect for a Scientific Psychology is an attempt to de
velop a neurological model which incorporates affect
and motivation. It was,
of
course, famously aban
doned-and marks the turning point in Freud's inter
est in the neurobiology
of
the mental apparatus.
What Sor t of
Neuropsychology Would Have
Interested
Freud?
This presents us with an interesting question. Freud
would have had no real desire to investigate the neuro
biology of, say, language and vision, when his inter
ests had moved on to those of emotion and motivation,
which lie at the core
of
psychoanalysis. However,
as
the years passed, Freud had access to an increasingly
well-developed model of the mental apparatus, which
could potentially be tested using the method which
was familiar to him from his earlier career. If he had
pursued this line
of
enquiry, then he
would
have been
able to establish the biological basis
of
psychoanaly
sis-the problem which he had failed to deal with in
the Project. This begs the question of why Freud
did
not
investigate the biological basis of the psycho
logical topics that
were
of interest to him. Had he done
35
so, then the discipline that we have recently named
neuropsychoanalysis
would have emerged decades
earlier than it now has. Why did he not begin to inves
tigate the neuropsychology that would have been of
greatest interest to him? One way to view this issue
is in the context of the standard detective novel, where
one evaluates evidence using three criteria: means,
motive, and opportunity. We should briefly examine
each.
Means, Motive, and Opportunity
First, it would seem that Freud had the
means
to study
the psychoanalytic aspects of the changes seen after
brain injury. This is the question of
whether he had
the knowledge and skills necessary to carry out the
task. The evidence here seems, at first sight, fairly
clear. For example, Freud had all the clinical tools
required to make an assessment of an appropriate pa
tient. He was, after all, not only a neurologist and
neuropathologist, but also an experienced psychoana
lyst. His years of experience in various domains of
neurological science leave us in no doubt that he had
sufficient knowledge of neuroanatomy and neuropa
thology to carry out such a study. In fact, clinicoana
tomicallocalization
of
function was a subject
of
very
special interest to
him
(Solms, 2000,
p
80). Finally,
he was extraordinarily familiar with the detail
of
psy
choanalytic theory, having developed the theory him
self. Thus, it seems self-evident that Freud had the
necessary knowledge and skills.
Second, Freud clearly had a
motive
We have es
tablished above that Freud had little taste for the neu
ropsychological investigation
of cognitive
abilities in
his later
career-they
no longer held any great interest
for him. However, he would have had
very
good rea
son to investigate the biological basis of psychological
functions of psychoanalytic interest. Some evidence
of this comes from the fact that he lived to see the early
emergence of the science of psychopharmacology, and
appears to have followed the progress of
the discipline
with some interest. More importantly, he frequently
made statements to the effect that our understanding
of
various depth psychological functions would be all
the easier
if
we knew their biological basis. Finally, he
made frequent reference to the fact that the separation
between psychoanalytic theory and neuroscience was
'The deficiencies in our description would probably vanish if we
were already in a position to replace the psychological terms by physiolog
ical or chemical
ones
(Freud, 1920, p 60).
7/25/2019 9 the Neuropsychology That Would Have Interested Freud Most: Commentary by Oliver Turnbull (Bangor, UK)
5/7
only temporary, and that the disciplines would one
day be reunited.
2
Thus, Freud would have been de
lighted to see the present-day moves toward interdisci
plinarity. One surely cannot claim that he would have
been anything but highly motivated to investigate the
neurobiological basis of psychoanalysis.
This leaves the final
question-of
whether Freud
had the opportunity Would he have been able to carry
out such investigations, even if he had both the skills
and the motivation to complete the task? One should
recall that Freud was seeing patients more or less
all
day, every day
of
the working week, for the duration
of his analytic career (Jones, 1956). Thus, we may
assume that he would not have had the time to visit
hospitals and to investigate the appropriate patients.
Indeed, he would certainly not have considered a brief
interchange with a patient at the bedside to be suffi
cient to draw any sort
of
reliable psychoanalytic infer
ence about them. It would be necessary to meet
regularly with the patient, in a setting like that
of
his
analytic consultation room. Without this, he would not
be investigating the depth psychological issues that
were
of
real interest to him.
However, the lack of time to visit hospitals need
not be such a major objection to the claim of lack
of
opportunity. Freud was spending a great deal
of
time
seeing patients, and he could have perhaps taken on
someone as an analytic patient who had suffered a
neurological injury. In such a case, Freud would not
have to travel to the hospital to see the patient, and he
need not be hurried in making a premature diagnosis
at the bedside. Instead, he would be able to take his
time in assessing the mental apparatus in all its com
plexity. If the proposal that Freud could have seen
neurological patients in his consulting room is valid,
then Freud would have had the opportunity (as well
as the motive and means) to investigate the biological
basis
of
psychoanalysis. To the best
of
my knowledge,
he did not do so. Why did he not choose this strategy?
There are a range of possible reasons for Freud s
reluctance to take
on
neurological patients. Perhaps
(1) no one would refer neurological patients to him.
This seems unlikely, given that psychiatry and neurol
ogy were closely allied disciplines, that Freud was
well connected in the medical community in Vienna,
and that he received a huge number of international
referrals (Jones, 1956). Another option is (2) that
Freud may have been of the opinion that such patients
would not
benefit
from analytic treatment, and hence
2 We must recollect that all of our provisional ideas will presumably
one day be based on an organic substructure (Freud, 1914, p 78).
Oliver
Turnbull
seeing such cases would have been unethical. This ar
gument has a slightly stronger basis, given that the
talking cure was designed for the treatment
of
neu
rosis, and that Freud was always skeptical
of
those
who attempted its use for other disorders (such s
schizophrenia). Finally, for those who favor conspir
acy theories, there is the unlikely possibility (3) that
Freud did see such patients, but chose not to report
them.
The Claim of Lack of Means
To the best of my knowledge, there has only been one
attempt to explain why Freud did not embark
on
an
analytic investigation of neurological patients. Solms
(2000) claims that Freud did not attempt to investigate
the problem because t he clinico-anatomical meth
od
was incapable
of
providing the correlations he
sought (p. 81). Thus, he suggests that Freud did not
have the means (the theoretical and methodological
tools) necessary to undertake this line of enquiry, be
cause
of
the limitations of the currently available
method. Now, we should recall that the clinicoanatom
ical method has been a central feature
of
neuropsy
chology for some 150 years, and was the technique
by which so many of the great discoveries of the disci
pline were made (aphasia and the language areas of the
left hemisphere; recent memory and the hippocampus,
etc.). It is not a method that lacks reliability; it is also
the tool that is
currently
being recommended as an
excellent candidate method for pursuing modern neu
ropsychoanalysis (Solms, 1998a,b, 1999,2000; Kaplan
Solms and Solms, 2000). Thus, it is of some impor
tance that we clarify why Freud may have rejected this
approach, and also how it is that Solms et al. now
come to recommend it.
Solms s claim is that Freud rejected the clinicoa
natomical method, as it existed during his lifetime
because it was incapable of accommodating (1) the
functional nature of neurotic pathology and (2) the
dynamic nature of normal mental processes (p. 81).
This situation, Solms argues, has now changed; he
dates this change to the work of Aleksandr Romano
vich Luria (1902-1977). The claim is that Luria s in
troduction of the concept of a functional system
adapted the clinico-anatomical method to accommo
date the essentially dynamic nature of the mental pro
cess (Solms, 2000,
p
98). This method was not
available during Freud s lifetime, because it was de
veloped by Luria after the Second World War (see
Luria s [1979] autobiography for an account
of
the
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Psychoanalysis and Cognitive Neuroscience
chronology). This argument suggests, then, that Freud
did not feel able to undertake the task
of
developing
a depth neuropsychology because of the inadequacy
(real or merely perceived)
of
the available methods in
neuropsychology. He lacked the means
to
do so. It
may well be that there are problems with Solms's
claim; for example, why did Freud not have another
attempt at developing a dynamic neuropsychology, as
he did in the 1895 Project ? He might well have
had greater success in the 1930s, in the context of
developments in psychopharmacology. However, the
one merit
of
Solms's argument is the best one: that it
explains the evidence that Freud does not seem to
have tried to develop neuropsychoanalysis.
Semenza's Argument Reconsidered
What does this mean for the argument suggested by
Semenza: that Freud came close to developing by
himself the central tenets of cognitive neuroscience ?
I think there are two points that can be made. First,
Freud clearly
did
involve himself in the neuropsychol
ogy
of
his time. Had he continued to work
in
neuro
psychology proper (instead
of
moving to
psychoanalysis) he would have continued
to
make a
contribution perhaps
even a more substantial one
than he is currently credited with (cf. Pribram, 1962).
However, I doubt that he would have made the sub
stantial contribution to
cognitive
neuropsychology that
is suggested by Semenza; for example, because
of
the
great importance
of
cognition to Freud's interests,
and because of his attitude to modularity. Thus, Se
menza's claim is interesting, but probably overstated
on this point.
Second, one might rephrase Semenza's position
to consider Freud as the founder
of another
sort
of
neuropsychology, which investigated the neurobiol
ogy
of
the psychological functions that
were
of interest
to him. This discipline, now called neuropsychoana
lysis, is the neuropsychology that would have inter
ested Freud most, and the field that he would have
liked to have founded. It seems that he did not make
the attempt. The one argument in his favor
on
this
point is that his repeated suggestions that such a disci
pline would be inevitable, given that neuroscience
would grow across the decades, has laid the ground
work for the new field. It will be
of
some interest to
see what happens to psychoanalysis in the process, for
Biology is truly a land
of
unlimited possibilities. We
may expect it to give us the most surprising informa
tion, and we cannot guess what answers it will return
7
in a few dozen years to the questions we have put to
it (Freud, 1920, p 60).
In summary, Semenza contends that Freud
founded a discipline that I believe he would not have
wanted to found (cognitive neuropsychology). In addi
tion, it is clear that Freud did not found a discipline
that I believe he would have wanted to found (neuro
psychoanalysis). To make a set
of
claims other than
this would, I think, not do justice to Freud's attitude
to the neuropsychology
of
his day and its relationship
to psychoanalysis. Freud made substantial contribu
tions to both psychoanalysis and neuropsychology, but
it seems that we have identified some areas in which
he did
not
make a radical contribution. We should
remind ourselves
of
the enormous contribution that
Freud made (in several domains), but also recall that
excellence in one domain does not imply omniscience.
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A
W. (1988), Human Cognitive
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(1914), On narcissism: An introduction. Standard
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(1920), Beyond the Pleasure Principle.
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A
R (1979),
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of
psychoanalysis.
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Centre rCognitive Neuroscience
School
Psychology
University
Wales, Bangor, 383670
Gwynedd, Wales
LL57 2DG, U
e-mail: [email protected]
Carlo Semenza
Response to Commentaries by
Carlo
Semenza (Trieste)
General
While waiting for relevant case studies, neuropsychoa
nalysis, as I think this journal is trying to promote,
can only be an intellectual exercise. This exercise of
exploring the fields of psychoanalysis and neurosci
ence primarily consists
of
the search for concepts that,
while developed in one
of
the two disciplines, may
turn out to be useful if somehow incorporated into
the other.
The shared belief is obviously that psychoanaly
sis and neuroscience, while differing in aims and
methods, are ultimately about the same
thing-the
hu
man mind. We know that the two disciplines have
been separated almost from the very beginning, and
that adepts of one field have generally gone their own
way without knowing too much about the other field.
In many respects this separation was desirable,
and dictated by theoretical necessity and lack of em
pirical findings bridging the two fields. In the past
decade, however, the opinion emerged that there was
no longer a reason for this state of affairs. It was intu
ited that the advanced knowledge in neuroscience
could now allow useful interaction with psychoanaly
sis. I am also convinced that the reverse is true: Psy
choanalysis can indeed inspire interesting
interpretations
of
findings in neuroscience.
Within this framework I felt I could offer a few
suggestions. These were by no means prescriptions, as
some of my commentators, notably Green, understood
them to be. My aim was only to provide some food
for thought. In short, my main suggestions were the
following:
Carlo Semenza, M.D., is Professor of Neuropsychology at the Univer
sity of Trieste, Italy.
If psychoanalysis is to benefit from neuroscience,
this could better and more naturally happen with
the mediation
of
cognitive psychology.
2 Cognitivism is not a psychology entirely extrane
ous to Freud s thought. If Freud s scientific back
ground and his
work on
aphasia in particular are
closely considered, his familiarity with ideas and
methods that would later be the basis of cognitive
psychology is revealed.
3 Cognitive neuropsychology and psychoanalysis
have methodological affinities. The supremacy of
single case methodology, valid in both disciplines,
stems from what cognitive neuropsychologists
have called the principle of transparency: Pathol
ogy, provoking an imbalance among working struc
tures and processes, may highlight, in specific
cases, functions that are obscured by the harmoni
ous flow of a relatively undisturbed mind.
4 Connectionist models should be adopted with the
utmost caution. Shallow analogies will not work
and would make any theorization more prone to
criticisms of Popper s type (while I believe that,
properly defended by the same sort of arguments
that cognitive neuropsychologists use, psychoanal
ysis could instead be virtually immune to such dev
astating objections).
5 Somehow, against immediate intuition, the modu
larity theory may be useful, especially in a less rigid
form than Fodor s. There are indeed theoretical
distinctions within memory functions that are neu
rologically implemented. These distinctions may be
useful when considered within psychoanalysis. A
key concept in Fodor s theory, that of informa
tional encapsulation, may perhaps be specula-