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Thursday, May 5, 2011


Freud [and Charcot also, I assume] noticed something very odd about the symptoms and complaints that psychiatric patients presented to them. The complaints echoed or reflected ordinary non-medical conceptions of the body, rather than the anatomical understanding of neurologists. If a patient had lost the ability to use her right hand, for example, the precise extent and nature of her paralysis did not seem to correspond to the underlying neurological structures that would be familiar to an anatomist. Rather, the patient would not only say, let us suppose, that she could not touch her finger tips with her thumb, so that she could not pick something up. Her loss of motor ability would be exactly what she described, even though that precise impairment might have no natural anatomical or neurological counterpart. Since this is so important that I am going to take some time to make it more precise, with the aid of materials extracted from Wikipedia.

Here is the description, in a Wikipedia article, of the nerves servicing the hand. Take a moment to skim through it so that you will be able to follow what I am saying:

All of the nerves that travel to the hand and fingers begin together at the shoulder: the radial nerve, the median nerve, and the ulnar nerve. These nerves carry signals from the brain to the muscles that move the arm, hand, fingers, and thumb. The nerves also carry signals back to the brain about sensations such as touch, pain, and temperature.

The radial nerve runs along the thumb-side edge of the forearm. It wraps around the end of the radius bone toward the back of the hand. It gives sensation to the back of the hand from the thumb to the third finger. It also supplies the back of the thumb and just beyond the main knuckle of the back surface of the ring and middle fingers.

The median nerve travels through a tunnel within the wrist called the carpal tunnel. This nerve gives sensation to the thumb, index finger, long finger, and half of the ring finger. It also sends a nerve branch to control the thenar muscles of the thumb. The thenar muscles help move the thumb and let you touch the pad of the thumb to the tips each of each finger on the same hand, a motion called opposition.

The ulnar nerve travels through a separate tunnel, called Guyon's canal. This tunnel is formed by two carpal bones, the pisiform and hamate, and the ligament that connects them. After passing through the canal, the ulnar nerve branches out to supply feeling to the little finger and half the ring finger. Branches of this nerve also supply the small muscles in the palm and the muscle that pulls the thumb toward the palm.”

Let us suppose [I am making this example up] that a woman comes into Freud’s consulting room complaining of an inability to pick things up because she cannot make the pad of her thumb touch the tips of her fingers. She cannot grip anything with either hand. As a neurologist, Freud knows that it is the median nerve, descending from the shoulder, that controls this motion, and he also knows that the same nerve gives sensation to the index finger, long finger, and half of the ring finger. So he runs a metal object lightly along those surfaces and asks whether the patient feels anything. “Oh yes,” she says, “that is not the problem. I can feel that well enough, but I cannot make my thumb close around an object and touch the tips of my other fingers.” This puzzles Freud, because if there is an impairment to the median nerve that results in the loss of “opposibility” for the thumb, then that impairment ought also to result in a loss of sensation on the surface of the other fingers served by the same nerve. What is more, the patient has precisely the same problem in both hands, which is simply anatomically incomprehensible.

Under hypnosis [let us suppose], the patient recalls picking up a newspaper in which it was reported that her father, whom she loves devotedly, has been arrested for embezzlement, and that the arrest has taken place in a bordello where he was visiting a prostitute. The woman is horrified by all of this, and blames herself for having picked up the newspaper, thinking [not very clearly] that had she not picked it up, the terrible events would never have occurred. Confronted with this memory after coming out of the hypnotic state, she breaks down, cries inconsolably, and regains the use of her thumbs. [Okay, okay, it is a very hokey example. I am a philosopher, not a novelist or a psychoanalyst. This is the kind of example philosophers come up with all the time. It is why you never want to rely on philosophers for practical advice.]

Now, it is of course perfectly possible that a severe emotional experience can produce dramatic changes in the body, Descartes and the mind-body problem to the contrary notwithstanding. If I receive news that a loved one has died, the blood may drain out of my face and I may feel faint. A sphygmomanometer will reveal a sudden drop in blood pressure, sure enough. If I see a tiger about to attack me, I may experience a flow of adrenaline into my blood stream. What is more, I may well have these physical reactions even though the news is a mistake and the supposed tiger is really a stuffed animal. In other words, the physical change is caused by my idea, not by the reality that the idea purports to represent. Some physical changes caused by ideas, like the drop in blood pressure, may be momentary. Others may be long lasting, or even permanent and irreversible. Nothing puzzling there. We are all quite familiar with such phenomena. They are called psychogenic.

But Freud’s patient, when she came into his consulting room with paralyzed thumbs, had no memory whatsoever of picking up the newspaper, or the news she read there. And if indeed that news produced some sort of psychogenic change in her nervous system, it cannot be found upon examination. Indeed, her actual impairment does not correspond to any neurological deficit that might have been so caused. It is as though the idea of the news about her father continues to be present in her mind, leading her, out of her guilt and horror, to somehow interfere with the operation of her thumbs, even though she cannot call the idea up and report it to Freud when asked. Where can the idea be? Freud formed the extraordinary hypothesis that there is some portion of the mind, some mental region, in which ideas can reside and be efficacious even though we are not conscious of them. He gave to this region the title “the unconscious.”

But for as long as thoughtful people had been speculating about such matters, which is to say for more than two thousand years, it had been an article of faith that the defining characteristic of ideas is consciousness, just as the defining characteristic of bodily things is extension, or perhaps solidity. Unconscious ideas? One might as well talk of bodies that are not extended in space!

To be sure, everyone was familiar with the fact that we have many ideas that are not, at this very moment, present to the mind. My telephone number, for example or the capitol of California, or the names of the actors who starred in Butch Cassidy and the Sun Dance Kid. But though I do not hold before my mind at all times all the ideas that can, in some sense, be said to be “in my mind,” I can access them if I need to [leaving aside senior moments.] We can describe these, with Freud, as residing in the “pre-conscious.” The problem with Freud’s patients was that they seemed possessed of ideas that were having a direct and continuing effect on their bodies, but which ideas they could not access no matter how hard they tried.

In short, Freud had discovered the unconscious. The remainder of Freud’s life and career can be described, as I once heard Bruno Bettleheim put it, as a ceaseless quest for the unconscious..

1 comment:

M said...

Thanks very much, Professor Wolff, for writing and posting this series. I know very little about Freud, and already these are helping me to understand his work and making me want to read his stuff.