Saturday, 17.08.2019

Julio Moizeszowicz: Psychodynamic Psychopharmacology
Julio Moizeszowicz and Mirta Moizeszowicz: Psychopharmacology and Freudian Theory
A Collated Document

Hector Warnes’ final comment

Regarding the relationship between Psychoanalysis and Science, it cannot be denied that Psychoanalysis does not belong to the Exact or hard Sciences like chemistry, physics, biology, astronomy and mathematics (Naturwissenschaften). Psychoanalysis has been relegated to the field of the human Sciences (Geisteswissenschaften und Kulturwissenschaften) along with history, sociology, philology, anthropology, literature, jurisprudence, psychology, etc. Over the years, however, attempts to build bridges between these two areas of enquiry (this split was not unlike Descartes’s dicotomy between res extensa and res cogitans) has been partially successful and the monumental painstaking review of Professor Moizeszowicz pointed to that direction. In short, in Science we have to be able to adopt rigorous methods of testing hypothesis and predictions of outcome, conducting controlled experiments and obtaini a high level of consensus.

Psychoanalysis is closer to a Hermeneutic than to a Scientific view of man. What complicates matter is the fact that there is not a unified theory of the Unconscious and Freud himself, during his life time, kept on updating, changing and improving on his earliest discoveries. Freud started off with the Reflec Arc model, then he put emphasis on Hermann von Helmholtz’s thermodynamics which led to the Drive and the Libido theories followed by the Topographic model (the Conscious, the Preconscious and the Unconscious Mind). Thereafter, he found support in his clinical experience to defend the Structural or Tripartite Model (the Id, the Ego and the Superego with its own intrapsychic conflicts) and finally the Object relations model.

His disciples, particularly Otto Rank, Alfred Adler, Carl Gustav Jung, Wilhem Reich, Melanie Klein, Karen Horney, Donald Winnicott, Sandor Ferenczi, Fritz Pearls and others, in open conflict with Freud, each developed a different model either bioenergetic, cultural, interpersonal, cognitive or social. Psychoanalysis over the years has grown to become an unyielding Corpus of knowlege and clinical experience back up and sustained by many field and laboratory experiments: the study of maternal deprivation in animals and humans, the long term effect of early traumatic experiences in the child, Lorenz studies of imprinting, dream experiments, the use of hallucinogenic drugs in producing experimental psychosis, the sensory isolation experiments, the earliest testing of psychotropic drugs in modifying animal behaviour, Hans Selye outstanding work on Stress, the experimental rise of psychophysiology and psychosomatics which grew into psychoneuroimmunoendocrinology, and so on.

Further, the psychoanalytic Societies were Split between the Kleinian and the Freudian, the Ego Psychologist and the Self-psychologist (following Heinz Kohut far-reaching studies on Narcissism) and the Freudians and the Lacanians. In each of these blosoming fields of enquiry there are countless variables and it would be unfair to compare each school with the more limited and accurate effect of neuropsychotropic medication on discreet brain centers and neurochemical targets. Though Freud was a pioneer in the taxonomy of a hierarchical psychopathology (inspired by H. Jackson and Wernicke) and the sorting out of specific defences against Angst and or an unbearable Reality, he always kept an open mind regarding the future of psychoanalysis as Prof. Moizeszowicz’s quotations of Freud’s scientific orientation and his epigenetic model later on completed by Eric Erickson stages of development show. Freud himself realized early enough that the psychotic was not analyzable (contrary to Melanie Klein’s attempts to analyse Manic-Depressives patients) and had doubts about the analyzability of the perverse and psychopathic characters. The identification of a specific defence used by the psychotic: denial, projection and Verwerfen (rejection, dismissal or Ablehnung) was crucial in the understand of the psychopathology of psychosis versus neurosis (Verdrängung or Repression). The Ego deals with reality anxiety; the Id deals with neurotic anxiety; and the Superego deals with moral anxiety. One of Freud’s outstanding papers, Mourning and Melancholia, became the basis for the study of the impact of normal and pathological grieving processes (Trauerarbeit) later observed and tested in animal and humans with its accompanying multiple somatizations.

The difference in the psychodynamic evaluation of the cases put forward by Professor Moizeszowicz is the fact that a group of psychoanalysts of the same psychoanalytic Institute and the same theoretical orientation would not come to a consensus on the matter. Interrater reliability of this group would be very low indeed as compared with Interrater reliability of experienced psychopathologists rating a patient’s mental status.

If I was able to elicit or kindle the same neuronal circuit and or the same cortical state, we would notice that it would be associated with a psychic event we would call memory. We have learned that love, rejection, anger, attachment and grief have all neuroanatomical and neurochemical underpinnings. The bridge built in order to surmount the gap between the biological and the mental that Professor Moizeszowicz put forward has been confirmed by the Nobel Prize winning psychiatrist, psychoanalyst and researcher Eric Kandel in his book Psychiatry, Psychoanalysis and the new Biology of the Mind, American Psychiatric Publishing, 2005 and by G. Northoff, Neuropsychoanalysis in Practice: Brain, Self and Objects. Oxford University Press, 2011.

To close my comments, I would like to cite a letter that Anna Freud wrote to Morris Lipton (which was brought to my attention by Professor T. Ban): “In all of these cases the therapeutic use of drugs did not in anyway interfere with the progression of analysis, quite on the contrary it helped the analysis to maintain itself during phases when otherwise the patient might have had to be hospitalized…" On the other hand, ”an excessive drug prescription might caused the patient to cease to be himself.”

May 18, 2017