The scientific standing of psychoanalysis
精神分析的科学立场
作者:Mark Solms
翻译:妃子笑
2018年2月
This paper summarises the core scientific claims of psychoanalysis and rebuts the prejudice that it is not ‘evidence-based’. I address the following questions. (A) How does the emotional mind work, in health and disease? (B) Therefore, what does psychoanalytic treatment aim to achieve? (C) How effective is it?
本文总结了精神分析的一些核心科学主张,驳斥了所谓的精神分析并非“循证”的偏见,作者主要阐述了如下的问题:A情感心智在健康和疾病领域是如何工作的?B精神分析的治疗目标是如何达成的呢?C精神分析有多么有效?
A. As regards the workings of the emotional mind, our three core claims are the following.
一、关于情感心智是如何工作的,主要有以下3个方面来论述:
(1) The human infant is not a blank slate;
1.1 人类婴儿并不是一块白板。
like all other species, we are born with innate needs. These needs (‘demands upon the mind to perform work’, as Freud called them, his ‘id’) are felt and expressed as emotions. The basic emotions trigger instinctual behaviours, which are innate action plans that we perform in order to meet our needs (e.g. cry, search, freeze, flee, attack). Universal agreement about the number of innate needs in the human brain has not been achieved, but mainstream taxonomies (e.g. Panksepp, 1998) include the following.【1】
【1】Here I am focusing on emotional needs – which are felt as separation distress, rage, etc. – not bodily drives – which are felt as hunger, thirst, etc. – or sensory affects – which are felt as pain, disgust, etc. (See Panksepp, 1998.) The way in which I use the term ‘action plans’ in this article is synonymous with the use of the term ‘predictions’ in contemporary computational neuroscience.
这里主要聚焦在情感需求—比如分离痛苦、愤怒等等,而不是身体的需求—比如饥饿、口渴等,也不是感官的影响—比如疼痛、恶心等(见Panksepp,1998)我使用“行动方案”这个术语的方式和当代的计算机神经科学使用“预期”这个术语的方式是如出一辙的。
弗洛伊德叫做本我的部分)。这些基本的情感激发了本能的一些行为,这些行为就是内在行动方案,我们依靠这些内在行为方案来满足我们的需要(比如说哭泣、寻找、僵直、逃跑、攻击)。现在关于人类大脑到底有多少内在需要并没有达成广泛的一致,但是主流的分类方法还是有的,(比如 Panksepp,1999),具体如下 1:
就像其他物种一样,我们生来是携带一些内在需求的。这些需求由情感来感知的,也是靠情感来表达的,(依靠头脑工作来满足需求,- We need to engage with the world – since all our biological appetites (including bodily needs) can only be met there. This is a foraging or seeking or ‘wanting’ instinct. It is felt as interest, curiosity and the like. (It coincides roughly but not completely with Freud’s concept of ‘libido’.)
我们需要和这个世界打交道的,因为我们所有的那些生物性渴望(包括躯体的需要)都要在这个世界上得到满足。这种就叫做觅食、寻求或者想要的那种本能。这种需求在情感上就是感兴趣、好奇和喜欢。(这方面和弗洛伊德的力比多的概念有所重合,但并不是完全一样)。 - We need to find sexual partners. This is felt as lust. This instinct is sexually dimorphic (on average) but male and female inclinations exist in both genders.
我们需要找到我们的性伴侣。这种本能的情感就是性欲。这种本能是二元性别的(在统计意义上的二元性别),但是任何性别中都存在男性或者女性的潜在可能。 - We need to escape dangerous situations. This is fear.
我们需要逃离危险的环境,这种情感叫做害怕。 - We need to destroy frustrating objects (things that get between us and satisfaction of our needs). This is rage.
我们需要摧毁那些让我们挫败的东西(就是阻止我们满足我们需要的事物)。这种情感叫做愤怒。 - We need to attach to caregivers (those who look after us). Separation from attachment figures is felt not as fear but as panic, and loss of them is felt as despair. (The whole of ‘attachment theory’ relates to vicissitudes of this need.)
我们需要依附依恋于我们的照料者(就是那些照顾我们的人)。和依恋对象分离的话,我们就不仅会害怕还有更深的恐慌,如果丧失了依恋对象我们就会绝望。(整个依恋理论跟我们依附需求的变迁是有关系的) - We need to care for and nurture others, especially our offspring. This is the so-called ‘maternal instinct’, but it exists (to varying degrees) in both genders.
我们需要照顾和养育其他个体,特别是养育我们的后代。这就是所谓的“母性本能”,这种本能在两种性别中都存在,只不过程度不同。 - We need to play. This is not as frivolous as it appears; play is the medium through which social hierarchies are formed (‘pecking order’) and in-group and out-group boundaries maintained
我们需要玩耍。玩耍这个需求可不像看上去那样无聊。玩耍可以作为一个媒介,通过这个媒介社会阶层形成了,(也就是团体中的位序形成了),而且团体内部和外部的这些界限得以维持。
The (upper brain-stem and limbic) anatomy and chemistry of the basic emotions is well understood (see Panksepp, 1998 for a review).
关于上脑干和边缘系统的解剖学和主要情感化学物质的这些科学研究都已经很好的被解释了。(详见panksepp,1998年的研究)
The main task of mental development is to learn how to meet our needs in the world.
1.2 精神心智发展的主要任务就是学会如何在这个世界上满足我们的需求。
We do not learn for its own sake; we do so in order to establish optimal action plans to meet our needs in a given environment. (This is what Freud called ‘ego’ development.) This is necessary because innate action programmes have to be reconciled with actual experiences. Evolution predicts how we should behave in, say, dangerous situations, but it cannot predict all possible dangers (e.g. electrical sockets); each individual has to learn what to fear. This typically happens during critical periods in early childhood, when we are not best equipped to deal with the fact that innate action plans often conflict with one another (e.g. attachment v. rage, curiosity v. fear). We therefore need to learn compromises, and we must find indirect ways of meeting our needs. This often involves substituteformation (e.g. kicking the cat). Humans also have a large (cortico-thalamic) capacity for satisfying their needs in imaginary and symbolic ways. It is crucial to recognise that successful action programmes entail successful emotion regulation, and vice versa. This is because our needs are felt as emotions; thus, successful avoidance of attack reduces fear, successful reunion after separation reduces panic, etc., whereas unsuccessful attempts result in persistence of fear and panic, etc.
我们不仅仅为自身需要的原因去学习,我们这么做就可以建立起来最优化的行为方案来满足我们在给定环境中的需要(这就是弗洛伊德说的“自我”的发展)。这种发展是很有必要的,因为内在的行为模式一定要和实际经验相协调。进化能够预期我们应该如何行为,比如在危险的环境中如何行为,但是进化不能预料所有可能的危险(比如说电插座的危险),每一个个体必须学会害怕哪些东西。这种情况经常发生在童年早期的关键时期,在早期关键期我们还没有配备足够的能力来处理一个事实,就是有些内在的行动方案是和其他方案相矛盾冲突的,(比如说依恋和愤怒,好奇和害怕)。因此我们需要学会妥协,我们必须找到能够满足需要的那种间接的方式,这就经常涉及到替代形成(比如说踢猫理论)。人类也拥有一个巨大的能力(皮质丘脑的能力)用想象的和象征的方式来满足自己的需要。这种能力对于认识到成功的行为模式需要成功的情感调节至关重要,反之亦然。这是因为我们的需要都是以情感的方式来被感知的;因此成功避免被袭击的话就可以减少害怕,和依恋对象分离后重新团聚就可以减少恐慌等等。反之如果这些行为企图没能成功的话,就会导致害怕和恐惧持续下去。
Most of our action plans (i.e. ways of meeting our needs) are executed unconsciously.
1.3 我们大多数的行为方案(也就是满足我们需要的那些方式)都是无意识的执行的。
Consciousness (‘working memory’) is an extremely limited resource, so there is enormous pressure to consolidate and automatise learned solutions to life’s problems (for a review see Bargh & Chartrand, 1999, who conclude that only 5% of our goal-directed actions are conscious). Innate action programmes are effected automatically from the outset, as are the programmes acquired in the first years of life, before the cortical (‘declarative’) memory systems mature. Multiple unconscious (‘non-declarative’) memory systems exist, such as ‘procedural’ and ‘emotional’ memory (which are mainly encoded at the level of the basal ganglia). These operate according to different rules. Not only successful action plans are automatised. With this simple observation, we can do away with the unfortunate distinction between the ‘cognitive’ and ‘dynamic’ unconscious. Sometimes a child has to make the best of a bad job in order to focus on the problems which it can solve. Such illegitimately or prematurely automatised action programmes are called ‘the repressed’. In order for automatised programmes to be revised and updated, they need to be ‘reconsolidated’ (Tronson & Taylor, 2007); that is, they need to enter consciousness again, in order for the long-term traces to become labile once more. This is difficult to achieve, not least because most procedural memories are ‘hard to learn and hard to forget’ and some emotional memories – which can be acquired through just a single exposure – appear to be indelible, but also because the essential mechanism of repression entails resistance to reconsolidation of automatised solutions to our insoluble problems. The theory of reconsolidation is very important for understanding the mechanism of psychoanalysis.
记忆”)是一个非常有限的资源,要巩固和自动化学习应对生活问题的方案是面临巨大压力的。(Bargh和Chartand两位科学家1999年得出一个结论,我们人类以目标为导向的行为只有5%是意识层面的)。内在行为模式从一开始就是自动有效的,这是在生命的早年就获得的那些模式,在皮质记忆(“陈述性记忆”)系统成熟之前就有了。多种的无意识记忆(“非陈述性记忆”)系统是存在的,比如说“程序的”和“情感的”记忆(这些记忆主要是在基底神经的水平上来编码的)。这些记忆的运作取决于不同的规则。不仅仅是成功的行为方案是自动化的。我们简单观察一下,就可以弄清楚, “认知的”无意识和“动力学的”无意识之间是不同的。有时,一个孩子需要从不好的工作任务中获取最佳利益,就要聚焦在那些能被解决的问题上面,这种不合逻辑的或者说早熟的自动化的行为模式称为“压抑”。为了让自动化模式重新修订和更新,就需要一个重新整合的过程(Tronson和taylor,2007年),也就是说这些行为模式需要再一次进入意识层面,为了让那些长期记忆的痕迹变得更加松动。这一目标并不容易达到,不仅仅因为程序记忆“很难记住也很难忘记”,一些情绪记忆只需要简单的暴露体验就可以呈现出来,看上去非常持久,而且也因为压抑的根本机制导致了阻抗,这些阻抗不利于重新整合和自动化那些难题的行动模式。重新整合对于理解精神分析的机制非常重要。
意识(“叫工作The clinical methods that psychoanalysts use flow from the above claims
二、精神分析师使用的临床办法起因于如下几个方面:
Psychological patients suffer mainly from feelings. The essential difference between psychoanalytic and psychopharmacological methods of treatment is that we believe feelings mean something. Specifically, feelings represent unsatisfied needs. (Thus, a patient suffering from panic is afraid of losing something, a patient suffering from rage is frustrated by something, etc.) This truism applies regardless of aetiological factors; even if one person is constitutionally more fearful, say, than the next, their fear is still meaningful. To be clear: emotional disorders entail unsuccessful attempts to satisfy needs.
2.1 心理病人主要是因为情感上遭受痛苦。精神分析疗法和精神药理学疗法之间的主要区别就是我们相信情感、感受意味着一些事情。特别是,情感代表着未能满足的需要。(因而,一个恐慌的病人是害怕失去某种东西,一个愤怒的病人被什么挫败了,等等)。不管病因学如何解释,这个常理是显而易见的,即使一个人本质上更加害怕了,那么也要说这种害怕是仍然是有意义的。澄清一下:情感障碍使得我们满足需要的那些企图没能成功。
The main purpose of psychological treatment, then, is to help patients learn better (more effective) ways of meeting their needs. This, in turn, leads to better emotion regulation. The psychopharmacological approach, by contrast, suppresses unwanted feelings. We do not believe that drugs which suppress feelings can cure emotional disorders. Drugs are symptomatic treatments. To cure an emotional disorder, the patient’s failure to meet their underlying need(s) must be addressed, since this is what is causing their symptoms. However, symptom relief is sometimes necessary before patients become amenable to psychological treatment, since most forms of psychotherapy require collaborative work between patient and therapist. It is also true that some types of psychopathology never become accessible to collaborative psychotherapy.
精神病理学的方法正好相反,是要压抑那些不想要的感受。我们不认为压抑感受的那些药物能够治愈情感障碍。药物是针对症状的一种治疗方式。要治愈一种情感障碍,病人潜在的需要没有被满足这种情况是必须要言说的,因为这样才导致了他们的症状。当然有的时候在病人能够配合心理治疗之前,症状的缓解是很有必要的,因为大多数心理治疗的形式都需要病人和治疗师合作进行。也有可能某些类型精神机能障碍永远也不能进行合作的心理治疗。
2.2精神分析治疗的主要目标是帮助病人们学习满足需要的更好的(更有效的)方式。从而,这就导致了更好的情绪调节。Psychoanalytical therapy differs from other forms of psychotherapy in that it aims to change deeply automatised action plans. This is necessary for the reasons outlined above. Psychoanalytic technique therefore focuses on the following.
2.3 精神分析疗法和其他心理治疗的方法有所不同。精神分析疗法的目标是致力于深入的改变自动化的行为方案,上文已经大体阐述了必须这么做的主要原因。因此,精神分析技术主要聚焦在以下几个方面:
- Psychoanalytical therapy differs from other forms of psychotherapy in that it aims to change deeply automatised action plans. This is necessary for the reasons outlined above. Psychoanalytic technique therefore focuses on the following.
识别出占主要地位的那些情感(意识层面已经感觉到了但是个体自己不一定能意识到是属于他自己的,等等) - These emotions reveal the meaning of the symptom. That is, they lead the way to the (ineffective) automatised programmes that gave rise to the feelings.
这些情感揭示出症状的意义。那就是这些情感导致了(无效的)自动化行为模式,这种行为模式又引起了一些感受。 - The pathogenic action programmes cannot be remembered directly for the very reason that they are automatised (i.e. unconscious). Therefore, the analyst identifies them indirectly, by bringing to awareness the repetitive patterns of behaviour derived from them.
引起疾病的这些行为模式不能被直接回忆起来,因为这些模式都是自动化的(比如说无意识层面的)。因此精神分析师们通过把重复性行为模式带入到意识层面的方法来间接的识别出这些模式。 - Reconsolidation is thus achieved through reactivation of mainly subcortical longterm traces via their derivatives in the present situation (this is called ‘transference’ interpretation). Only cortical memories can be ‘declared’.
重新整合的过程是通过主要是皮质下长期记忆的痕迹的重新激活来实现的,这种重新激活是在当下情景中通过皮下衍生物产生的(这就是对所谓的“移情”的解释)。只有皮层的记忆可以“呈现”。(妃子笑个人理解皮质下的记忆直接呈现不了,要通过当下情景刺激下的衍生物来激化。) - Such reconsolidation is nevertheless difficult to achieve, mainly owing to the ways in which non-declarative memory systems work, but also because repression entails resistance to the reactivation of insoluble problems. For these reasons, psychoanalytic treatment takes time – i. e. numerous and frequent sessions – to facilitate ‘working through’.
然而,重新整合的过程是很难实现的,主要是因为非陈述性记忆系统的工作方式,也因为压抑机制产生了对重新激活那些难解问题的阻抗,正因为如此,精神分析治疗需要的时间比较长,比如说长时间多频次的咨询次数,来促进“修通”。
Mental healthcare funders need to learn how learning works. For a more detailed account of the mechanism of psychoanalytic therapy, see Solms (2017).