The Clinical Infant and The Reliability Of Memory

“Developmental psychology can inquire about the infant only as the infant is observed. To relate observed behaviour to subjective experience one must make inferential leaps. Clearly, the inferences will be more accurate if the data base from which one is leaping is extensive and well established. The study of intrapsychic experience must be informed by direct observation, as the source of most new information about infants continues to be naturalistic and experimental observations…In contrast to the infant as observed by developmental psychology a different “infant” has been reconstructed by psychoanalytic theories in the course of clinical practice (primarily with adults). This infant is the joint creation of two people, the adult who grew up to become a psychiatric patient and the therapist, who has a theory about infant experience. This recreated infant made up of memories, present re-enactments in the transference, and theoretically guided by interpretations. I call this creation the clinical infant, to be distinguished from the observed infant, whose behaviour is examined at the very time of its occurrence.” ( The Intersubjective World of the Infant p. 15)

Stern’s division of the two infants is extremely interesting and theoretically valuable. The developmental infant is well studied and understood with more and more sophisticated experimental techniques, better cross cultural studies, better recording equipment and availability of neuroscientific tools we learn more and more about the typical developmental milestones of children each day. The clinical infant is a different beast. It is as Stern notes the creation of two people the analysand and the analyst. When a person enters therapy and starts telling their story they are narrating how things seem to them in the present moment. As the therapy proceeds and the analysand sometimes reflects on his childhood a larger picture of who the analysand is and how he became the person he is will emerge.

But of course the analysis isn’t centred entirely on constructing a narrative about the analysand. The analysand will a lot of the time have come to analysis because of some particular issue; neurosis, depression, anxiety etc. Sometimes talk will circle around certain topics week after week, the analysand will have one view about what is bothering him, and the analyst may have another. The analysand may have concerns about what the analyst is thinking, he may gear his talk towards what he thinks the analyst wants to hear etc. Nonetheless it is true, that over time in therapy, that in some cases; cases that could go on for years, a picture of the self does emerge.

This self doesn’t just emerge from the analysand telling his story and the analyst faithfully recording it. The analyst will offer interpretations of behaviour that the analysand talks about. He will interpret slips of the tongue, dreams, the tone of voice that the analysand talks about different people in, he will note logical discrepancies in the way analysand treats different people for equivalent behaviour etc. Sometimes the analysand will agree with the analyst and sometimes not, but with the analyst in the position of the person who knows; the master interpreter of the unconscious etc his views will have more weight for the analyst than most people’s views do. Eventually a picture of the psychoanalytic infant and adult will be constructed and a narrative of how the infant became the adult that arrived in analysis will be constructed.

Now whatever the therapeutic efficacy of this technique, one wonders to what degree it is an accurate biography of the analysand. These are not mere academic questions when Freud (circa the 1890’s) was told by his analysand’s of their early childhood experience of sexual abuse; he took them at their word. He believed that the children were recounting factual material. And he used this “factual” material as evidence for his seduction theory of hysteria. Later he abandoned the seduction theory arguing that so many people were claiming to have been seduced that it was very improbable to have actually happened. This is when he moved towards his theory of childhood sexuality and argued that the reports adults were giving in therapy were reports of unconscious childhood phantasies of seduction. A big problem with the childhood sexuality explanation is that there is a danger that Freud could be told about a real case of sexual abuse, and ignore it because of his theory.

Another major problem is the problem of suggestibility. There have been cases documented where analysts have convinced patients that x or y occurred when there is virtually no evidence that this is the case. The analyst who convinces the patient of this occurring and the patient’s relation with their family is never the same. A tragic version of this story occurred with a patient Carol Myers who through therapy was convinced she had been ritually abused by her family who were allegedly members of a satanic cult. Myers ended up committing suicide and subsequent research indicates that some of the claims Myers made to her analyst Dr Fisher turned out to be wildly false. And there are suspicions that Myers was lead into believing falsehood through suggestions of her therapist. There is ample evidence that false memories can be implanted in a person, for example, the psychologist Elizabeth Loftus managed to implant false memories into her patients see her (1997) Paper ‘Creating False Memories’. Whatever the truth of the Myers case is it does give pause for thought. If analysts are capable of inadvertently placing false memories into their patients this raises serious difficulties with any notion of a psychoanalytic infant being anything other than a made up fiction (albeit a fiction that has some theoretical utility).

Some psychoanalysts have bitten the bullet and claimed that “reality” plays no real role in the psychoanalytic process. In her book ‘Becoming a Subject’ Marcia Cavell gathered together some quotations which reveal this attitude towards reality by some therapists:

Reality”, as we use the term, refers to something subjective, something felt or sensed, rather than to an external realm of being existing independently of the human subject’ (Atwood 1992: 26-27)

The idea of analytic ‘objectivity’ is an intellectual remnant of the one-person psychology paradigm. … Might reducing the object of analysis to the “interaction” between the patient and analyst not mislead us, if it predisposes us to imagine that there is an objective reality “out there” between analyst and patient, that one can be “objective” about. (Fogel et al. 1996: 885)

The psychoanalytic task is not trying to discover something that was already there, in the patients mind, but trying to devise a view of [his] life present and past, that works, i.e. that helps him feel better’ (Renik: 1998: 492)

(The above quotes taken from Marcia Cavell ‘Becoming a Subject 2006 p.72)

This cavalier attitude towards reality may seem harmless, and it could be used to solve the problem raised by Stern of how do we merge the developmental infant with the clinical infant? With this loose attitude towards reality one could simply argue the clinical infant is a theoretical construct which is useful in therapy but it has no reality outside of it. This approach would be fine except analysand’s leave therapy believing in what has been uncovered about his childhood in the therapy. This will have consequences for the child’s relationship with family members and friends afterwards, so it is only ethical that analysts at least try using every tool at their disposal to render accurate accounts of childhood experiences. This is what people like Solms, Stern and Cavell are trying to do as they try to ground psychoanalytic theories in facts of neuroscience, and developmental psychology. It might be worth discussing what they have discovered and see how it relates to Sterns problem of merging the clinical and the developmental child.

Some Neuroscientific and Developmental Facts About Memory:

In his ‘The Interpersonal World of the Infant’ Stern presents some interesting evidence which he thinks demonstrates that we are capable of forming reliable memories from early on in life:

“Is the infant capable of remembering the three different kinds of experience that make up the other main core self-variants-agency, coherence, and affect…It is now clear that there are recall memory “systems” that are not language based and that operate very early (see Olson and Strauss 1984) Motor Memory is one of them. The point is that cued recall for motor experiences can be experimentally demonstrated, as well as inferred from natural behaviour, and that these motor memories assure self-continuity in time. The thus constitute another set of self-invariants, part of the “motor self”…It is well established that infants by five to seven months have extraordinary long-term recognition memory for visual perceptions…for some events, recognition memory appears to operated across the birth gap…Clearly, the infant has the memorial capacities to register, recognize, and recall affective experience so that continuity of the affective self is assured. (Stern: ‘The Interpersonal World of The Infant pp 90-94)

Now while the data that Stern as brought together is impressive sceptics will probably note that it flies in the face of the empirical fact that people typically don’t remember the early years of their childhood. I think that this objection if voiced relies on a crude understanding of the nature of memory. When Stern talks about affective memories, motor memories, and perceptual memories he is not talking about memory as it is ordinarily used (the closest neurological analogue to what we typically mean by memory is Episodic Memory). We typically wouldn’t attribute episodic memory to young children below the age of 12months. But there is plenty of evidence for other types of memory at play as the child learns about his world. It is worth looking at some of this evidence for different types of memory and how they relate to the findings of psychoanalysis.

In his ‘The Brain and The Inner World’ Solms and Turnbull note that there are two areas of storage in the brain for memories:

  1. Long Term Storage: Both recent and remote memory are parts of long term memory (LTM)
  2. Short Term Storage: Refers to information that is in your consciousness right now (derived from events that occurred a few seconds ago) is your short term memory STM. (Sometimes called working memory)

Solms argues that it is quiet likely that the cells that survive the great pruning are deeply consolidated and serve as templates to later experiences.            If Solms is correct about this, and a lot of evidence indicates that he is, then may indicate that early experiences do influence our later lives and that our brains and bodies maybe good at storing these experiences accurately. He goes on to correctly argue, that the distinction between conscious and unconscious memory is very well established in neuroscience (implicit and explicit memories are synonymous with unconscious and conscious memory).

Explicit memory (remembering the day you got your dog, what you were doing etc),

Implicit memory: Not conscious, first person or verbal. It also includes memories of skills, habits and experiences we acquire through experience. This type of implicit memory is called procedural and involves ‘knowing how’ as opposed to knowing that.

PROCEDURAL MEMORY: Is a kind of bodily memory; e.g. knowledge of how to walk, how to cycle a bike, of how to type etc. Procedural memory and abstract memory can be dissociated it is common for patients to lose abilities but to retain the abstract knowledge about the skill they have lost. Procedural memory functions implicitly (unconsciously). Solms notes that as soon as procedural memory becomes explicit it becomes something different either episodic memory or semantic memory. Typically procedural memories are associated with both semantic and episodic memory. This fact is important for thinking about the clinical self. While procedural memory may accurately capture some childhood fact the act of turning it into episodic or semantic memory actively transforms its nature. So to some degree psychoanalytic reconstruction involves a falsification.

Another type of implicit memory is associative memory which Cavell argues is the way in which memories are organised along pathways that are associative and idiosyncratic (Cavell p. 13). She argues that all memory, thought and perception may move along associative networks (she cites Bracknel and Westen both of whom are psychoanalysts not psychologists).

Episodic Memory: Which concerns the specific context of an experienced event including time and place of the event.

Semantic Memory: Is acquired during an event but is stored separately from the memory of the event itself. Cavell notes that semantic memory is a network of associations and concepts that underlies our basic knowledge of the world (word meanings, facts, categories, propositions etc.) Solms and Turnbull et al note that studies of amnesia shows that episodic memories can be destroyed and semantic memories can remain intact (Solms and Turnbull p. 170). It is stored in the form of third person information. Semantic memory is divided into various subcomponents that can be damaged in isolation.

Emotional Memory:

“With a few other writers, LeDoux distinguishes emotional processes from feeling. His view is that ‘a subjective emotional experience, like the feeling of being afraid, results when we become consciously aware that an emotion system of the brain, like a defence system, is active’ The emotional meaning of a stimulus can begin to be appraised by the brain before it has made its way into conscious perception; that is, the brain may evaluate something as threatening – ‘bad’ before the person herself knows exactly what the stimulus is and what is threatening about it” (Cavell p.16)

LeDoux notes that emotional memory has two routes to affect our behaviour; there is the direct route that causes instant behaviour say, for example, a dog was burned by fire in the past and therefore he automatically flinches when around fire. There is also the emotional memory that is processed by the hippocampus provides the amygdala with information around the content of the emotional experience, allowing data from multiple memory systems to be unified into what may become, for a creature who can tell one, a coherent story (ibid p.17). Pre-verbal children register affective experiences before they can use symbols, and this pre-verbal, affectively coloured experiences continue to exert an influence throughout life, (ibid p17). However it is worth noting that while LeDoux acknowledges some similarity with his discoveries and Freud’s there are clear differences. LeDoux argues that there is no evidence that emotional memories are repressed rather they are unconscious in their nature because of the architecture of the brain On the other hand Anderson et al. (2004) show that we can willingly suppress an unwanted memory and that the longer it is suppressed the more thorough the job is (Cavell p. 20).

Overall the neuroscientific data, indicates that emotional, and motor memory are formed very early prior to learning language do serve as a structural template for future life; however a lot more work on the topic needs to be done. Nonetheless Solms and Turnbull claim in “The Brain and The Inner World” that the most vulnerable memories are the most recent ones while the most our earliest are the hardest to destroy because of the process of consolidation may indicate that there is something to the clinical infant that is worth researching into further.

The problem is that these unconscious memories are not unconscious in the sense of beingrepressed they are unconscious because of the structure of the brain. When we translate them into episodic memory we can never be one hundred percent sure of how accurate translation of the memories is. And there is always a risk of the therapist inadvertently implanting false memories into us.

A lot of people come to therapy because their ways of thinking and being have become mal-adaptive. Therapy helps them to rationally reconstruct how their behaviour became mal-adaptive and how they can become happier and healthier people. But we cannot say for certain that the narrative self constructed in therapy reflects reality accurately. We do know that this practice has practical utility John Thor Cornelius https://www.youtube.com/watch?v=IQBx5TONHac has brought together the biggest meta analyses that have been done and shown psychoanalysis performs as good as Cognitive Behavioural Therapy in the short term, and better in the long term. So the clinical infant is justified pragmatically even it its epistemic status is somewhat sketchy. To improve the epistemic situation we need further studies into implanted memories and the neuroscience of memory and these facts need to be integrated into neuroscience.

Whatever the fate of the ‘clinical infant’ interms of its epistemic status, an important sense of who we are, is our narrative selves. Our narrative self, is the self we construct in interaction with our social group as soon as we become language users. From the moment people are born they are immersed in a readymade drama. Their name is prepared for them, their room is prepared for them, and they have a place within a family unit who already have a collective narrative (with some individual differences) created by the family about its nature and its relation to the wider word. From about 12months when the child starts triangulate on shared objects of experience with his parents and mouth words the child begins to make his faltering steps into the socio-linguistic world of his family. If the child has brothers, and sisters they will have their own phantasies of who the child is and what his relation is to the rest of the family. Likewise the parents will have similar phantasies about the child and its relation to the socio-linguistic world. A lot of the time the child will have behaviours labelled as good or bad; they will be told that they are good or bad boys by parents, sisters and peers and here will begin a process of judging and describing oneself interms of a relation to the competencies and normative judgements of others.

When people grasp a language with concepts which they share with others and can combine using rules to create a potentially infinite amount of utterances they have the capacity to think about themselves in whatever way they want. But they live in a particular society and their self conception will be constantly in interaction with the norms and idiosyncratic beliefs of the significant others lives that the person lives in. Thus say the person thinks they are generous, or a good singer, an excellent athlete their views on their selves will be judged by public criterion. If, for example, a person who thinks they are an excellent athlete finishes last in every competition they enter their self conception will be wildly at odds with public criterion. If the person has normal abilities to learn from others, and facts in the world his self conception will modify. So the narrative self is sometimes forced into line with public criterion. Though people don’t always test their beliefs about themselves, they don’t always utter them publically, and when they do sometimes people are too polite to correct them. Thus a person who considers himself funny, may elicit polite laughter from his peers, (who really don’t find him funny), he may not see their rolling eyes etc. So a big part of his narrative self is that of being funny. The narrative self is a constantly unfolding self sometimes, shaped by public criterion, and sometimes oblivious to it.

When a person enters into therapy say after a marriage break up they will tell a story about the marriage break up. This will involve descriptions of the spouse’s role in the break up, of his own role and the role of other involved parties. The therapist has no way of verifying the reality of the narrative self, except within the narrow confines of the therapy. Yet the narrative self is a vital part of pretty much all therapies. If we give up ‘the clinical infant’ are we forced to give up the ‘narrative self’? And is this giving up too much e.g. pretty much all therapies? I would argue that we cannot give up the ‘the clinical infant’ but must try to improve our ability to construct one by learning more about neuroscience, and through listening to analysands in as open and honest a manner as possible.

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