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Neuropsychoanalysis: An Interdisciplinary Journal

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Commentary by John C. Marshall (Oxford)

a

John C. Marshall
a

Neuropsychology Unit, University Department of Clinical Neurology, The Radcliffe

Infirmary, Woodstock Road, Oxford OX2 6HE, UK, e-mail:
Published online: 09 Jan 2014.

To cite this article: John C. Marshall (2001) Commentary by John C. Marshall (Oxford), Neuropsychoanalysis: An
Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 3:1, 27-28, DOI: 10.1080/15294145.2001.10773331
To link to this article: http://dx.doi.org/10.1080/15294145.2001.10773331

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27

Psychoanalysis and Cognitive Neuropsychology

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Freud, S. (1895), Project for a scientific psychology. Standard Edition, 23:281-391. London: Hogarth Press, 1966.
Gardner, H. (1985), The Mind's New Science. New York:
Basic Books.
Kinsbourne, M. (2000a), New models for old: Taking the
neural network seriously. Brain & Cognit., 42:13-16.
- - - (2000b), The mechanism of confabulation. This
Journal, 2(2): 158-166.
Plaut, D. C. (1995), Double dissociation without modularity: Evidence from connectionistic neuropsychology. J.
Clin. Exper. Neuropsychol., 17:291-321.

Schapiro, D. (1965), Neurotic Styles. New York: Basic

Books.
Semenza, C. (1983), A framework for cognitive neuropsychology: An open quest. Address to the First Workshop
on Cognitive Neuropsychology, Bressanone, Italy.
Sherrington, C. S. (1906), The Integrative Action of the
Nervous System. London: Scribner.
New School University
66 West 12th Street
New York, NY 10011-8693
e-mail: kinsbourne@aol.com

Commentary by John C. Marshall (Oxford)

Clearly there are two Freuds: the neurological Freud

and the analytic Freud. Clearly, the two are intimately
related. And equally clearly, as Carlo Semenza reiterates, Freud overtly ditched his neurological self in the
closing years of the 19th century and thereafter preserved only his psychology. Semenza argues, correctly
I believe, that Freud always retained his conviction
that cognition was biologically grounded but could see
no way in which this fact could help explain the phenomena that interested him. He accordingly chose, in
Semenza's words, "to behave as if only psychological
facts were available."
Although, as I said, Semenza's account seems to
fit the available record, there is nevertheless something
odd, uncanny even, about the timing of Freud's choice.
By 1900 (the publication date of The Interpretation of
Dreams), the foundation had already been laid for a
behavioral neurology in which the patterns of preserved and impaired cognition after relatively focal
brain injury began to assunle a comprehensible form.
Preliminary decompositions of the language faculty,
of object recognition, of memory, of reading and writing, and of skilled praxis had already been published
by the major figures in clinical neurology in England,
France, Germany, and Scotland. What better time,
then, to join an emerging field that promised even
greater discoveries to come? In a sense, Freud started
out in precisely this direction: The monograph on
aphasia (1891) and the unpublished manuscript that
we know as "A Project for a Scientific Psychology"
(1895) were indeed critical of some aspects of the
John C. Marshall, Ph.D. is Professor of Neuropsychology in the Department of Clinical Neurology at the University of Oxford.

diagram-makers' work, but these writings could nonetheless be plausibly regarded as a continuation and
deepening of the new paradigm (Marshall, 1974). As
a matter of fact, Freud's profound concept of "levels
of representation" led him to psychoanalysis, but
could it not equally well have kept him within an extended, theoretically augmented cognitive neurology?
Why instead did Freud so enthusiastically embrace
hermeneutics? How could an avowed materialist, a
disciple of Ernst Brlicke, Emil Du Bois-Reymond, and
Hermann Helmholtz write a book on the "interpretation" of dreams while keeping a straight face?
It is my conviction that Freud's studies of hysteria, first with Jean-Martin Charcot and then with Josef
Breuer, drove him initially into hermeneutics, and then
into analysis. It can hardly have surprised Freud (or
anyone else) that sights, sounds, smells, and emotions
can cause bodily changes without mechanical intervention: Studies on Hysteria (Breuer and Freud,
1893-1895) contains an amusing digression on erections provoked by friction versus the sight or even the
thought of a pretty girl. No, what must have terrified
Freud was the discovery that the form of hysterical
paralysis, somatosensory loss, visual field constriction, and so on did not obey the known constraints
of neuroanatomy. As Freud (1893) writes, "hysteria
behaves as though anatomy did not exist or as though
it had no knowledge of it" (p. 40).
How could a man with Freud's training accept
that the shape of a patient's loss of tactile sensation
corresponded not with the distribution of the nerves
that represented the hand but rather with the "idea"
of the hand, with that part of the body to which the
word hand refers? How likewise could hysteria para-

Downloaded by [Adelphi University] at 00:14 23 August 2014

28
lyze a "conceptual" body part in blatant opposition
to the' 'true" distribution of anatomical innervation?
Freud (1893) made a valiant attempt to incorporate
these patterns within "standard" neuroanatomy: He
distinguishes between a "projection" paralysis and a
"representation" paralysis. In a projection paralysis,
the extent and locus of impairment are, as the textbooks say, determined by a point by point mapping
between neuropathology of the gray matter of the spinal cord and the motor loss. But the mapping between
periphery and cortex, is, Freud argues, one-to-many
and many-to-one. Hence in a representation paralysis
after cortical damage there need be no direct relationship between the impaired parts of the body and the
structure of peripheral innervation. This is a very
clever notion (and may well have some truth to it),
but Freud was too experienced a neurologist not to
know that the nature of "organic" impairments after
cortical lesion was dramatically different from those
of "conversion" symptoms in hysteria.
From this moment on, the concept of representation in Freud was deployed with respect to psychic not
neurological functions. He had been forced to acknowledge that the patient's "ideas" could determine the
very shape of the body's pathology. This observation is
orders of magnitude more difficult to explain (and more
disturbing) than the fact that shame can cause blushing
or terror lead to involuntary freezing. No available philosophy of mind (reductionism, identity theory, parallelism, dual aspect theory, or emergence) seems capable
of encompassing hysterical simulations of neurological
disease. No wonder that Freud retreated (advanced?) to
psychoanalysis not neuroanalysis.
Semenza argues that cognitive theory, rather than
"hard" neuroscience, will lead us to solutions that
Freud could not imagine. I am not entirely convinced.
Cognitive neuropsychology has proved hugely more
successful in explaining the operation of modular functions than central systems. So far, computational psychology has managed to deal moderately well with
syntax and logic but not with fixation of belief (Fodor,
2000) and the' 'frame problem" (Pylyshyn, 1987). But
fixation of belief and unfixation of belief are precisely
the currencies in which analysis deals. Patients tell tales
to themselves (and to analysts); analysts tell tales to patients (and to themselves). Do these tales determine belief, or do beliefs determine tales (or both)? Reliable
evidence about the "truth" (or helpfulness) ofparticular narratives is hard to find. Detailed evidence about
the neurological instantiation of the narrative faculty is
perhaps even harder to uncover (although Freud whim-

John C. Marshall
sically noted that the ego wears its cap on the left, in
close proximity to the language modules).
Where next? Neuropsychoanalysis could perhaps
do worse than look again at the anosagnosias (Anton,
1899) and the somatoparaphrenias (Halligan, Marshall, and Wade, 1995). In these syndromes, the relationships between the locus of brain damage, the
"primary" symptoms thereof, and the patient's narrative about the situation as a whole might provide a
way of thinking about how to integrate brain stories
and psychic stories. Finally, just as the study of hysteria provoked the break between the neurological Freud
and the analytic Freud, so perhaps hysteria, in conjunction with modern functional neuroimaging, might
start to bridge the gap (Marshall et aI., 1997).

References
Anton, G. (1899), Ueber die Selbstwahrnehmung der Herderkrankungen des Gehirns durch den Kranken bei Rindenblindheit and Rindentaubheit. Archiv fur Psychiatrie,
32:86-127.
Breuer, J., & Freud, S. (1893-1895), Studies on Hysteria.
Standard Edition, 2. London: Hogarth Press, 1988.
Fodor, J. (2000), The Mind Doesn't Work that Way. Cambridge, MA: MIT Press.
Freud, S. (1891), On Aphasia. New York: International
Universities Press, 1983.
- - (1893), Quelques considerations pour une etude
comparatif des paralysies motrices organiques et hysteriques. Arch. de Neurologie, 26:29-43.
- - (1895), Project for a scientific psychology. Standard Edition, 1:281-391. London: Hogarth Press, 1966.
- - (1900), The Interpretation of Dreams. Standard
Edition, 4&5. London: Hogarth Press, 1953.
Halligan, P. W., Marshall, J. C., & Wade, D. T. (1995),
Unilateral somatoparaphrenia after right hemisphere
stroke: A case description. Cortex, 31: 173-182.
Marshall, J. C. (1974), Freud's psychology of language. In:
Freud: A Collection of Critical Essays, ed. R. Wollheim.
Garden City, NY: Doubleday, pp. 349-365.
- - Halligan, P. W., Fink, G. R., Wade, D. T., & Frackowiak, R. S. J. (1997), The functional anatomy of a
hysterical paralysis. Cognition, 64:B I-B8.
Pylyshyn, Z., Ed. (1987), The Robot's Dilemma: The Frame
Problem in Artificial Intelligence. Norwood, NJ: Ablex.

Neuropsychology Unit
University Department of Clinical Neurology
The Radcliffe Infirmary
Woodstock Road
Oxford OX2 6HE

UK
e-mail: john.marshall@clneuro.ox.ac.uk