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We refuse to posit any contrast in principle between the two sets of aetiological factors; on the contrary, we assume that the two sets regularly act jointly in bringing about the observed result. The amount of aetiological effectiveness to be attributed to each of them can only be arrived at in every individual case separately. These cases may be arranged in a series according to the varying proportion in which the two factors are present, and this series will no doubt have its extreme cases. We shall estimate the share taken by constitution or experience differently in individual cases according to the stage reached by our knowledge; and we shall retain the right to modify our judgement along with changes in our understanding. Incidentally, one might venture to regard constitution itself as a precipitate from the accidental effects produced on the endlessly long chain of our ancestors. The Dynamics Of Transference 2458 Thus it is a perfectly normal and intelligible thing that the libidinal cathexis of someone who is partly unsatisfied, a cathexis which is held ready in anticipation, should be directed as well to the figure of the doctor. But the transference is not tied to this particular prototype: it may also come about on the lines of the mother-imago or brother- imago. The peculiarities of the transference to the doctor, thanks to which it exceeds, both in amount and nature, anything that could be justified on sensible or rational grounds, are made intelligible if we bear in mind that this transference has precisely been set up not only by the conscious anticipatory ideas but also by those that have been held back or are unconscious. There would be nothing more to discuss or worry about in this behaviour of transference, if it were not that two points remain unexplained about it which are of particular interest to psycho-analysis. Firstly, we do not understand why transference is so much more intense with neurotic subjects in analysis than it is with other such people who are not being analysed; and secondly, it remains a puzzle why in analysis transference emerges as the most powerful resistance to the treatment, whereas outside analysis it must be regarded as the vehicle of cure and the condition of success. As soon as this explanation is given, the stoppage is removed, or the situation is changed from one in which the associations fail into one in which they are being kept back. At first sight it appears to be an immense disadvantage in psycho- analysis as a method that what is elsewhere the strongest factor towards success is changed in it into the most powerful medium of resistance. If, however, we examine the situation more closely, we can at least clear away the first of our two problems. It is not a fact that transference emerges with greater intensity and lack of restraint during psycho-analysis than outside it. In institutions in which nerve patients are treated non-analytically, we can observe transference occurring with the greatest intensity and in the most unworthy forms, extending to nothing less than mental bondage, and moreover showing the plainest erotic colouring. Gabriele Reuter, with her sharp powers of observation, described this at a time when there was no such thing as psycho-analysis, in a remarkable book which betrays in every respect the clearest insight into the nature and genesis of neuroses. The Dynamics Of Transference 2459 Our second problem the problem of why transference appears in psycho-analysis as resistance has been left for the moment untouched; and we must now approach it more closely.
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In a distributed representation, words correspond to patterns of activation over units rather than to individual units (see the discussion of the Seidenberg & McClelland, 1989, model in Chapter 7). In practice, it is very difficult, perhaps impossible, to distinguish these possibilities. Given that individual words clearly do not correspond to individual neurons, they must be distributed to some extent. The important issue is the extent to which these distributed representations overlap. Of course, this is not to say that the processes that happen in the boxes in Figure 13. But we can nevertheless identify the general components of the language system and the way that information flows through it. The first is distinguishing between having two separate stores and having one store with two separate input and output pathways. This is a fundamental problem, first raised in Chapter 10 and earlier in this chapter. The second complication is distinguishing between impairments to connections between input and output lexicons and input and output phonological buffers. The role short term memory plays in processes as diverse asspeech perception, word repetition, parsing, comprehension, and learning to speak and read, hasinspired much research on both impaired andunimpaired speakers. Working memory comprises a central executive (which is an attentional system), a visuo-spatial sketch pad (for short-term storage of spatial information), and a phonological loop (see Figure 13. Both the central executive and the phonological loop are important in language processing. The central executive plays an important role in semantic integration and comprehension, while the phonological loop plays a role in phonological processes in language. It is debatable, however, whether any component of general verbal memory plays a role in parsing. We saw in Chapter 11 that reading span predicts performance on a range of reading and comprehension measures (Daneman & Carpenter, 1980). These tasks include forward and backward digit span (how many digits can you remember in sequence) and word span (remembering a number of words and nonwords). In the single-word repetition task, a person has to repeat single words back aloud. In the matching span task, the person just has to say whether two lists are the same or different. No overt repetition is needed in the matching span tasks, but items have to be maintained in the input phonological buffer. One plausible idea is that the passive phonological store of the working memory system is the phonological buffer of the system we described earlier.
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I have elsewhere tried to express this in the formula: hysterical symptoms are overdetermined. It is true that earlier I put the relation between recent and infantile aetiology aside as a separate theme. Nevertheless, I cannot leave the subject without overstepping this resolution at least with one remark. You will agree with me that there is one fact above all which leads us astray in the psychological understanding of hysterical phenomena, and which seems to warn us against measuring psychical acts in hysterics and in normal people with the same yardstick. That fact is the discrepancy between psychically exciting stimuli and psychical reactions which we come upon in hysterical subjects. We try to account for it by assuming the presence in them of a general abnormal sensitivity to stimuli, and we often endeavour to explain it on a physiological basis, as if in such patients certain organs of the brain which serve to transmit stimuli were in a peculiar chemical state (like the spinal centres of a frog, perhaps, which has been injected with strychnine) or as if these cerebral organs had withdrawn from the influence of higher inhibiting centres (as in animals being experimented on under vivisection). Occasionally one or other of these concepts may be perfectly valid as an explanation of hysterical phenomena; I do not dispute this. But the main part of the phenomenon of the abnormal, exaggerated, hysterical reaction to psychical stimuli admits of another explanation, an explanation which is supported by countless examples from the analyses of patients. And this is as follows: the reaction of hysterics is only apparently exaggerated; it is bound to appear exaggerated to us because we only know a small part of the motives from which it arises. The Aetiology Of Hysteria 430 In reality, this reaction is proportionate to the exciting stimulus; thus it is normal and psychologically understandable. We see this at once when the analysis has added to the manifest motives, of which the patient is conscious, those other motives, which have been operative without his knowing about them, so that he could not tell us of them. I could spend hours demonstrating the validity of this important assertion for the whole range of psychical activity in hysteria, but I must confine myself here to a few examples. What would you think, now, if you were to observe this high degree of readiness to feel hurt on the slightest occasion, if you came across it between two normal people, a husband and wife, perhapsfi You would certainly infer that the conjugal scene you had witnessed was not solely the result of this latest trifling occasion, but that inflammable material had been piling up for a long time and that the whole heap of it bad been set alight by the final provocation. It is not the latest slight which, in itself, is minimal that produces the fit of crying, the outburst of despair or the attempt at suicide, in disregard of the axiom that an effect must be proportionate to its cause; the small slight of the present moment has aroused and set working the memories of very many, more intense, earlier slights, behind all of which there lies in addition the memory of a serious slight in childhood which has never been overcome. Or again, let us take the instance of a young girl who blames herself most frightfully for having allowed a boy to stroke her hand in secret, and who from that time on has been overtaken by a neurosis. You can, of course, answer the puzzle by pronouncing her an abnormal, eccentrically disposed and over-sensitive person; but you will think differently when analysis shows you that the touching of her hand reminded her of another, similar touching, which had happened very early in her childhood and which formed part of a less innocent whole, so that her self-reproaches were actually reproaches about that old occasion. If you touch a particular spot, you do something you did not intend: you awaken a memory which may start off a convulsive attack, and since you know nothing of this psychical intermediate link you refer the attack directly to the operation of your touch. The patients are in the same state of ignorance and therefore fall into similar errors. If, however, the physician has been able to bring together the conscious and unconscious motives for the purpose of explaining a hysterical reaction, he is almost always obliged to recognize that the seemingly exaggerated reaction is appropriate and is abnormal only in its form. The Aetiology Of Hysteria 431 You may, however, rightly object to this justification of the hysterical reaction to psychical stimuli and say that nevertheless the reaction is not a normal one.
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But the amounts of excitation coming in from these parts of the body do not all undergo the same vicissitudes, nor is the fate of all of them the same at every period of life. They are actually formed at the expense of the excitations proceeding from the erotogenic zones, and they rise like dams to oppose the later activity of the sexual instincts. Now anal erotism is one of the components of the instinct which, in the course of development and in accordance with the education demanded by our present civilization, have become unserviceable for sexual aims. It is therefore plausible to suppose that these character-traits of orderliness, parsimony and obstinacy, which are so often prominent in people who were formerly anal erotics, are to be regarded as the first and most constant results of the sublimation of anal erotism. He entirely agreed with it, but there was one passage, which though of course he accepted and understood its meaning like that of the rest struck him as so grotesque and comic that he sat down and laughed over it for a quarter of an hour. This passage ran: "One of the clearest signs of subsequent eccentricity or nervousness is to be seen when a baby obstinately refuses to empty his bowels when he is put on the pot that is, when his nurse wants him to and holds back that function till he himself chooses to exercise it. He is naturally not concerned with dirtying the bed, he is only anxious not to miss the subsidiary pleasure attached to defaecating. About twenty minutes afterwards, as we were having some cocoa, he suddenly remarked without any preliminary: "I say, seeing the cocoa in front of me has suddenly made me think of an idea that I always had when I was a child. I used always to pretend to myself that I was the cocoa-manufacturer Van Houten" (he pronounced the name Van "Hauten") "and that I possessed a great secret for the manufacture of this cocoa. Everybody was trying to get hold of this secret that was a boon to humanity but I kept it carefully to myself. I was interested to see how, only a quarter of an hour after my friend had fended the phantasy off (though, it is true, in the comparatively mild form of raising an objection on formal grounds) he was, quite involuntarily, presented with the most convincing evidence by his own unconscious. Cleanliness, orderliness and trustworthiness give exactly the impression of a reaction-formation against an interest in what is unclean and disturbing and should not be part of the body. An invitation to a caress of the anal zone is still used to-day, as it was in ancient times, to express defiance or defiant scorn, and thus in reality signifies an act of tenderness that has been overtaken by repression. The connections between the complexes of interest in money and of defaecation, which seem so dissimilar, appear to be the most extensive of all. Every doctor who has practised psycho-analysis knows that the most refractory and long-standing cases of what is described as habitual constipation in neurotics can be cured by that form of treatment. This is less surprising if we remember that that function has shown itself similarly amenable to hypnotic suggestion.
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The involvement of the lateral with the elements of attention proposed by Mirsky, and prefrontal cortex in the executive attention system relates an additional element that was labeled encode. Subse- to its role in holding mental representations of specific in- quently, the battery was extended to healthy children with formation in temporary memory. Once erations is consistent with the definition of working mem- again, four factors were identified, each similar to the ele- ory. The Stroop test (1935) illustrates the roles of the ments of attention identified in the adult studies. The four elements of attention, and their hypothesized the attention systems and structures presented here supportive neural substrates, are presented in Table 9. Focus-execute attention involves selective attention studies of auditory spatial attention, similar to visuospa- and rapid perceptual-motor output. There is agreement that, at a corti- change attentional focus in a fiexible and adaptive cal level, the right hemisphere, particularly the parietal manner. Recently, a fifth component of attention, stable, was identified, and represents the consistency of attentional effort. The five elements of attention are believed to be Executive Functioning supported by relatively distinct neuroanatomic regions (see Table 9. The distribution of the attention system throughout frontal lobes are unique in organization and function. Accordingly, the attention system more than a century, controversy, confusion, and specula- is quite vulnerable to disruption when brain injury is sus- tion have existed over the function(s) of the frontal lobes. Chapter 11 discusses the application of emotional regulation, and moral judgment). Be- of rudimentary executive functions and the later develop- cause of the significant afferent and efferent connectivity ment of more complex functions, such as abstract reason- of the frontal lobes with other brain regions, disruption to ing and judgment, parallel the lengthy development of any one these connecting systems can produce pathologic the prefrontal cortex. Interestingly, the emergence of rudi- behaviors similar to those caused by direct frontal damage. However, ganglia can result in pathologic behaviors similar to those more complex functions continue to evolve long after seen with dorsolateral prefrontal damage. Although the maximum synaptic density is reached, and refiect a term executive functioning does not denote a specific host of other developmental advances such as synaptic anatomic basis for behavior, it does implicate the frontal pruning and sculpting, axonal myelination, and neuro- cortex and its interconnective neural circuitry. Goldman-Rakic has studied the relation of planning, fiexible problem solving, working memory, at- prefrontal development to the emergence of the cognitive tentional allocation, inhibition, and at the highest levels, operation of object permanence, that is, the capacity to the self-monitoring and self-assessment of behavior.
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