"Indeed, science always involves inference, but this can be tested
by and large by seeing if the predictions so generated are
subsequently fulfilled. In cognitive science this is also done by
building working models (i.e., via computational modelling) to see if
the theory generates the same behaviour as a human would display. A
major problem with Freud's theory is that it is rarely as
parsimonious as most cognitive science theories, which makes many of
us suspicious of its current value." (Chris Colbourn: last in
thread)
If we look closer at the concept of neuroses we can see that the
definition contains three sub- groups of behaviour, anxiety states
(panic disorders), phobias and obsessive-compulsive disorders (Gross;
p942), all of which can linked around the same condition:- namely
fear and behaviours that are associated with diminishing or avoiding
the source of fear/phobia/anxiety where obsessive-compulsive disorder
is a way of distracting the person from the source of fear; (in this
case hysterical conditions can be seen when the patient has gone
over the brink in fear).
Gross points out (p973) that although there is acceptance of the
(psychoanalytic) theory that previous experiences create phobias
(perversely enough as we shall see Eysenck and Rachman 1965) , it is
not always the case - some people have no recollection of any
unfortunate incident that may have conditioned this response
(Baddeley 1990). Firstly, the research which shows clear links in
some cases:-
TI: Panic-phobic patients and developmental trauma
AU: David_D,Giron_A, Mellman_TA
NA: 1400 NW 10th Avenue, Miami, FL 33136,
JN:Journal of Clinical Psychiatry 1995 Vol.56 No.3 pp.113-117
DO:Article
AB: Background: Several studies suggest high rates of
developmental trauma among adult anxiety disorder patients. We
attempted to replicate these findings in patients with panic
disorder, agoraphobia, and/or social phobia in comparison with a
nonclinical population and to evaluate possible relationships of
traumas and phobic subtypes. Method: Fifty-one patients with panic
disorder with agoraphobia and/or social phobia were assessed for
lifetime diagnoses using interviews and rating scales and for
developmental trauma by the Life Experience Questionnaire (LEQ).
Fifty-one demographically similar nonclinical subjects completed a
questionnaire that included the LEQ and screening questions for
lifetime psychopathology. Results: Childhood trauma was reported by
63% (N = 32) of the patients (vs. 35% or 18 of comparison subjects
and 24% or 9 of subjects negative for lifetime psychopathology: csi 2
= 7.7, df = 1, p < .01). Sexual and/or physical abuse histories (and
not separation and/or loss) were significantly increased in the
patient group and were most specifically associated with social
phobia. Conclusion: We find a similar, increased rate of childhood
trauma as has been reported in previous studies of anxiety disorder
patients. In our findings, this most specifically represents an
association of social phobia and sexual/physical abuse histories.
However Baddeley (1990) explains the lack of consistency in the
aetiology of phobias in terms of social learning and imitation: that
is to say that we all learn some forms of aversive behaviour whether
or not we have ever come across the stimulus. Seligman's concept of
"preparedness" may be an explanation but social learning is a better
clue. For example someone, say a man, is love (or marriage) -phobic.
He may have had unfortunate experiences in the past but these may
not explain the full extent of his condition. The explanation then
may be that he has learnt from conversations and the media (say James
Bond films, film-stars and pop-singers for eg) that white,
Anglo-Saxon males with a few bob have lots of girlfriends, "sow
their wild oats" (horrible phrase) and generally don't get "tied
down" etc etc. The situation may arise where a charming and
affectionate woman sets her sights on him: he becomes aware of this;
then social learning and imitation kick-in where he becomes aversive
and has all the classic cortisol-type symptoms of dizziness,
palpitations, empty feeling in the chest, butterflies in the stomach,
light sweating, etc.
Interestingly, Ehlers and Breuer (1995; on
bids) have discovered that those with panic disorder or specific
phobias ("panickers") become fixated on the source of their fear,
and this both leads to a shift of attention to the threatening
stimulus and a consequent "fear of fear", which increases the
probability of an attack and most importantly leads to an escalation
of the attack once it starts, it is self-feeding in that sense:
TI: Selective attention to physical threat in subjects with panic
attacks and specific phobias
AU: Ehlers_A, Breuer_P
NA: Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX,
UK
JN: Journal of Anxiety Disorders 1995 Vol.9 No.1 pp.11-31
DO:Article
AB: That patients with panic disorder exhibit an attentional
bias towards physical threat has been inferred from their responses
to such words in modified Stroop paradigms. The present study
investigated selective attention to physical cues directly. Subjects
were given a mild electrical shock to one ring finger followed by a
target stimulus (vibration of one index finger) applied to either the
same or the other hand. An attentional bias index was calculated by
subtracting mean reaction times in trials in which the neutral
target and the electrical stimulus were applied to the same hand from
those trials in which both stimuli were applied to different hands.
Sixty-one patients with panic disorder, 45 subjects with infrequent
spontaneous panic attacks, 24 patients with specific phobias, and 40
normal controls participated in the study. Consistent with our
hypothesis, subjects with spontaneous panic attacks, but not normal
controls, shifted their attention toward the threatening stimulus.
There was no difference between panic disorder patients and
infrequent panickers. Selective attention to physical threat could
increase the probability that anxiety is triggered or that it
escalates during panic attacks. Patients with simple phobias showed
the same response pattern as panickers. Lack of specificity in our
paradigm may be related to the importance of 'fear of fear' for all
anxiety disorders or to the relevance of tactile stimuli for the
fear structures of animal phobics.
Rutter (1993; p163) suggests thatagoraphobia is in itself a
rationalisation (explanation) of thepanic-state itself. 60% of all phobics
suffer from this"generalised" anxiety (Gross; p942), which is shown to be associated
with separation (Mitchell 1982) and alcoholism (Merikangas et al
1995: on bids). Thus, in terms of agoraphobia, when someone sees
themselves as being in the position of being left alone they panic
and then the panic feeds itself; being outside just heightens the
experience:, and alcohol (and benzodiazepines) make things worse
(alcohol doesn't reduce cortisol; cigarettes do; on bids).
Similarly with our hapless marriage-phobic he fixates on the female
by whom he feels threatened, cortisol levels rise, he self-induces a
panic attack and avoids her/flees etc.
Hence we can see twoexplanations of neurotic behaviour: firstly
childhood experiencesand trauma (including separation-anxiety and sexual abuse) and
secondly imitation and social learning (including preparedness). On
top of this, once the phobia is learnt, the tendency is for the
sufferer to work themselves into a phobic state as a result of their
latent fear - ie they see their fear round every corner whether or
not it is there in fact. This can then insinuate itself into their
working-life which then makes it a real problem in terms of their
progress, as well as impaired function and economic loss coupled with
the impact on public-health costs:
TI: The social costs of anxiety disorders
AU: Leon_AC, Portera_L, Weissman_MM NA: Department of Psychiatry, Box 147,
Cornell UniversityMedical College, 525 East 68th Street, New York, NY 10021,
JN: BritishJournal of Psychiatry 1995 Vol.166 APR. Suppl.27 pp.19-22
DO: Article
AB: Background. The social costs of anxiety disorders, which afflict
a substantial proportion of the general population in the United
States, are considered. Method. Data from the National Institute of
Mental Health (NIMH) Epidemiological Catchment Area Program were
analysed. Results. Over 6% of men and 13% of women in the sample of
18571 had suffered from a DSM-III anxiety disorder in the past six
months. Nearly 30% of those with panic disorder had used the general
medical system for emotional, alcohol or drug-related problems in
the six months prior to the interview. Those with anxiety disorders
were also more likely to seek help from emergency rooms and from the
specialised mental health system. Men with panic disorder, phobias
or obsessive-compulsive disorder in the previous six months are more
likely to be chronically unemployed and to receive disability or
welfare. Discussion. Once correctly diagnosed there are safe and
effective psychopharmacologic and behavioural treatments for the
anxiety disorders. Nevertheless the burden of anxiety disorders
extends beyond the direct costs of treatment to the indirect costs
of impaired social functioning.
Hence we can infer from the evidence that at least 50-60% of
neurotics have had a trauma in the past, thatthat trauma can lead to
behavioural disorders ie phobia, anxiety and panic, that the major
problem is a desire to hide the problem (Gross p942), that the
problem leads to social impairment and alcohol and other substance
abuse, which in turn is likely to lead to impaired economic function
and related social health costs. Where does this leave
psychoanalytic theory in relation to cognitive psychology?:
"Indeed, science always involves inference, but this can be tested
by and large by seeing if the predictions so generated are
subsequently fulfilled. In cognitive science this is also done by
building working models (i.e., via computational modelling) to see if
the theory generates the same behaviour as a human would display. A
major problem with Freud's theory is that it is rarely as
parsimonious as most cognitive science theories, which makes many of
us suspicious of its current value."
Parsimonious is one word for it: confused is another:
"one of the problems with cognitive psychology is that there has
been a proliferation of theories, but it is often not clear how these
relate to each other. In other words, theories in cognitive
psychology do not coalesce to form a unified theory of human
cognition" (Eysenck and Keane, p31).
This perhaps is the problem for cognitive psychologists and H.J.
Eysenck himself who consigned Freud (and Jung) to the rubbish-bin of
life (on T.V with Jeremy Isaacs on "Face-to- Face") when the
evidence points in a particularly parsimonious way to the
facts of the matter.
I have to say at this point that I think Stevan Harnad is right when
he says that cognitive psychology is the catch-all science; I think
the real problem is for cognitive scientists (as opposed to
cognitive psychologists) who keep forgetting (or repressing!) that
humans came first and humans are not computers and will not fit a
computer model (Eysenck and Keane; p509). Humans are neurotic and
complex as Freud and Jung realised and traumas in development lead to
behavioural inconsistencies that are amenable to both behavioural as
well as psycho - analytical and -therapeutic methods. It is a
hopeless task to try and create a computer model that is going to
have to endure the pain, humiliation, not to mention the rank
criminality (statutory rape) of child sexual abuse and then see "if
the theory generates the same behaviour as human would display".
Such things are unethical, not to say unthinkable. Freud himself, as
disordered as he was in his own way, came up with a method to unravel
human personal distress. The evidence clearly infers that he was
right and cognitive psychologists/scientists, who are known for
quietly dropping the affective element from the issue (ibid, p465)
have got to come up with something better than idle dismissal of a
great person's work, although it seems to me that if they wish to
dispute Freud they are left with no choice but that, given the lack
of evidence to sustain their own position.
The uncomfortable truth is that between 5 and 20 % of all children
are likely to be exposed to sexual abuse and girls are two to three
times more likely to experience it. In the case of this university
that means up to 2000 people have been exposed to this abuse and that
between 66 to 75% of them (1400 to 1500) are women (on our course,
because the sample is skewed and there are disproportionately more
women than men 12-14 women and 1 or two men). These people are then
likely to suffer neurotic disorders:
TI: Sexual abuse and sexual health in children: New dilemmas for the
pediatrician
LA: French
AU: Finkelhor_D
NA: Family Research Laboratory,University of New Hampshire, 126 Horten, Durham, NH 03824,
N: Schweizerische Medizinische Wochenschrift 1994 Vol.124 No.51-52
pp.2320-2330
DO: Conference
AB: Epidemiologic research in nearly two dozen countries shows that
sexual abuse is a real danger for 5-20% of all children, girls being
2-3 times more at risk than boys. Sexual abuse has proved an
important risk factor in many behavioral or even somatic disorders,
including posttraumatic symptoms such as nightmares, phobias,
nutritional problems, aggressivity and school problems. Unfortunately
the problem is surrounded by shame, denials and numerous misleading
prejudices which make it hard to diagnose.
This leaves us with a picture of 6% of men and 13% of women
presenting neurotic disorders:- ie between 5 and 20% of the sample
with a ratio of women to men of between 2-3 to 1. This to my mind
at least leaves me with a strong reason to believe Freud's theory.
Present cognitive psychological theory would help these people
through behaviour therapy/modification, psychoanalysis will help them
to understand the psychic processes which are involved (good therapy
is a learning process, to me at least.
Dohrenwend and Link (1985; in the handbook of medical sociology)
showed that those with a college (ie university) education are less
likely to suffer from mental disorders: this is probably because more
educated people are able to discuss and explore their feelings and
reveal their fears more than the less-educated: to talk, cope and
accept. On that basis I have discussed Freud's ideas here and I hope
with the sensitivity that the subject demands.
However to leave the discussion in the realm of existential romance
(with acknowledgements to Jean-Paul Sartre):- I wonder what would
happen if the marriagephobe "X" met a woman "Y" who had experienced
childhood abuse:- they get to know each other and start to be
attracted to each other. As soon as that happens "X" gets phobic and
aversive and Y" gets phobic and aversive (attraction makes her
sexphobic); they both see the other as being a threat to each other
and then spend the rest of the time hiding from each other - going
round in ever-decreasing circles! However the man is aware of his
phobia and then decides that he will use behavioural methods
(exposure) to overcome his aversion (because he happens to really
like the woman: a case of approach-avoidance conflict where approach
is winning; there's a real struggle going on here!). However he
doesn't know at that point that she is aversive, he's been too busy
avoiding her to notice: so then he ends up trying to gain exposure
while she is still avoidant! She gets more and more avoidant (pace
Ehlers and Breuer) and he more frustrated! Eventually he asks her why
she's so avoidant. She, being brave and honest as well as beautiful,
tells him the truth (which is a considerable act of intimacy in
itself) and adds that he appears too interested! (now there's irony
for you!) Then he's doubly involved and even more confused which
adds to her confusion! Cognitive scientist, where are your computers
now?
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