Consilient Psychoanalysis

CONSILIENT PSYCHOANALYSIS

Keith Valone, PhD, PsyD Pasadena, California

The concept of consilience, that is, the fundamental unity of knowledge across disciplines, is applied to the ﬁeld of psychoanalysis. Whereas practitioners in other disciplines, especially the natural sciences, strive for consilience, psychoanalysis as a discipline is found to be frequently lacking in consilience. Impli- cations for paradigm change, metatheory, and evidence-based practice are discussed, and it is suggested that all psychoanalytic theories should be evaluated for their degree of consilience so as to make the discipline as robust and well integrated with knowledge in other disciplines as possible.

The concept of consilience was recently powerfully articulated by distinguished Harvard biologist Edward O. Wilson. Wilson’s (1998a) book Consilience puts forth an eloquent argument for the fundamental unity of knowledge. In the present article, I familiarize the reader with the construct of consilience as deﬁned by Wilson and others and then apply the notion of consilience to psychoanalysis as a discipline.

What Is Consilience?

William Whewell coined the term consilience in 1840 in his book The Philosophy of the Inductive Sciences (Whewell, 1840). Consilience literally means the “jumping together of knowledge” by integrating facts and fact-based theory from different disciplines in order to develop a common language and a comprehensive explanatory framework. By bringing together knowledge from different disciplines and learning in what ways integration can be achieved, reﬁnement and expansion of theory takes place in all disciplines involved. Such integrative efforts can point out weaknesses or inaccuracies in particular aspects of a given theory or discipline. Such efforts also can provide support and validation for theory and can create an exciting synergy in which new ideas and understandings occur

Keith Valone, PhD, PsyD, independent practice, Pasadena, California. I thank Leroy Hood for introducing me to the construct of consilience and for inspiring this article; Joseph Palombo for encouraging me to write and publish it; Joanne Moran, Katherine Schwarzenbach, and Lisa Krueger for their meticulous editorial comments on a draft of this article; and the staff of the Huntington Memorial Hospital Health Sciences Library for their unﬂagging assistance in the acquisition of reference materials. I dedicate this article to the memory of my esteemed friend and colleague, Randall Lehmann Sorenson. Correspondence concerning this article should be addressed to Keith Valone, PhD, PsyD, One West California Boulevard, Suite 321, Pasadena, CA 91105. E-mail: [email protected]

189 190 VALONE as a result of the enrichment coming from the fluent synthesis of knowledge across disciplinary boundaries. A fundamental assumption underlying the notion of consilience is the belief that all knowledge is ultimately unified. Although some have questioned this premise (Rorty, 1998), Wilson and others (Gross, 1998; Wilson, 1998a, 1998b, 1998c) convincingly argue that there is an underlying integration and coherence for all disciplines, ranging from the natural and medical sciences, through the social sciences, to the humanities, and finally to the arts, ethics, and religion. Some of these branches of learning are more consilient than others, and greater efforts have been made to integrate certain branches of learning than others, but Wilson advocates the position that, no matter how difficult or complex the task is, creating consilience among all branches of knowledge and learning is an enormously important and productive endeavor for humanity. Although from an epistemological perspective consilience can be seen as a basic assumption about the fundamental unity of knowledge, it can also be seen as a property that may be found or lacking in any particular theory. Consilience can also be understood as an activity of theory building within any discipline, that is, the vigorous “jumping together” of knowledge from related disciplines with knowledge from within one’s own discipline, the result of which is a synergistic, creative expansion of theory beyond what was understood in any of the previous theories beforehand. In the natural sciences, consilience is seen as an accepted and highly desirable property of theory as well as a highly desirable activity of theory building. Great efforts have been made in physics to create a grand unified theory, with impressive results. Biology and chemistry are other disciplines in which consilience is valued and where attempts are made whenever possible to integrate knowledge across subspecialties so as to create a common body of knowledge and corresponding theory. Moreover, scientists in these fields attempt wherever possible to create consilience among the different disciplines themselves, for example, integrating physics, biology, and chemistry in myriad fascinating and productive ways. Consilience is such an integral part of the natural sciences that it seems self-evident and not worthy of debate or discussion. In the social sciences, however, such great strides toward consilience have yet to be achieved, nor has there been as much effort directed toward consilience. Different disciplines have different languages, different theoretical structures, different analytic methods, and different standards of validity, and often they operate with little awareness or interest in what work is being done in related disciplines. Wilson (1998a) argues that this is true in part because the social sciences are exponentially more complex than the natural sciences. The result of this state of affairs frequently leads to confusion when scholars in these disciplines attempt to communicate with one another, or with scholars in the natural sciences. However, as the natural sciences become more and more consilient, and as complex, hybrid problems that cross boundaries between the natural and social sciences become more a study of focus and speculation, the need for consilience within the social sciences and between the social sciences and the natural sciences becomes imperative. Consilience with the humanities, the arts, religion, philosophy, and ethics is even more challenging, but in Wilson’s opinion, it is ultimately achievable. He outlines a method- ology and conceptual framework for how such grand consilience might be achieved and effectively illustrates the potentially rich interconnections that could be made among such fields as chemistry, biology, medicine, psychology, anthropology, sociology, art, and religion. CONSILIENT PSYCHOANALYSIS 191 Examples of Consilience in Medicine, Psychology, and Related Fields

In the 5 years since the publication of Wilson’s book, almost 30 articles have appeared in two sister fields of psychoanalysis, namely medicine and psychology, in which consilience has been applied to a number of fascinating integrative efforts, as briefly outlined here. Indeed, in 2000 the New York Academy of Sciences sponsored a conference in honor of Wilson’s book, entitled Unity of Knowledge: The Convergence of Natural and Human Science (Damasio et al., 2001). Within the medical community, Benitez-Bribiesca (1999), citing Wilson, advocates the publication in medical journals of articles specifically focused on the consilient integration of biomedical, clinical, and epidemiological investigations within diverse fields in medicine; so successful have his and others’ efforts been in this regard that Benitez-Bribesca’s article is the lead editorial in a new journal entitled Archives of Medical Research, which is explicitly dedicated to such integrative, consilient contributions to the medical literature. Bloom, Wan, and Koo (2000) have applied the concept of consilience to the field of urology, integrating barometrics with bladders; Djulbegovic, Morris, and Lyman (2000) apply consilience to propose a model of integrating evidence-based medicine with clinical medicine; Raza (2000) has applied a consilient analysis to evolving dysplasias affecting gastric and liver cells to identify common themes and emerging patterns; Chapman (2001) studies immunology from a consilient perspective; and Jacobs (2001) uses consilience to unite nursing theory and knowledge so as to enhance the respect for human dignity in the practice of the nursing profession. In a more purely research vein, Emery (2003) applies consilience to biosystems; Hugall, Moritz, Moussalli, and Stanisic (2002) invoke consilience so as to reconcile paleodistribution models; Smith (2001) addresses archaeology and biology in the consilient study of plant domestication; Lee and Doughty (1997) study evolutionary theory and phylogenetic analysis from a consilient framework; and Menger and Mbadugha (2001) use consilience in an applied biochemistry example involving surfactants. Within the fields of education and developmental psychology, Ferrari, Pinard, and Runions (2001) examine consciousness from a Piagetian perspective, using consilience as an organizing framework; Lederman (2001) attempts to create consilient curricula for K–12 science education; Stanovich (2003) evaluates scientific styles of the psychological processes underlying reading behavior from a consilient perspective; and Starkweather (2002) looks at genetics and environment in the consilient understanding of the epigenesis of stuttering. Only Borland (1999) alone, of all of the authors cited here, questions the utility of consilience in his article on the value of attempting consilience between natural abilities and systematically developed abilities in gifted children. In the clinical psychology, psychiatry, and neurosciences literatures, consilience has been used to better understand and integrate alcoholic behavior and neurobiology (Gold- man, 2002), clinical psychology and neuroscience (Ilardi & Feldman, 2001a, 2001b), and models of language, culture, mind, and brain (Kuhl, Tsao, Liu, Zhang, & De Boer, 2001). Stress and the social environment (McEwen, 2001), development, psychobiology, and culture as applied to child and adolescent psychiatry (Munir & Beardslee, 2001), the epistemology of mental illness (Reznek, 1998), autonomic neuroscience (Robertson, 2001), and sociology and mental illness (Scheff, 1984) all have been approached now from a consilient perspective. Duke (2002) has attempted a “budding effort” toward a consilient integration of theories of personality and theories of art. Of interest, several studies have applied consilient analyses to the specific topic of depression. Rowe (2001) has looked at gene–environment influences in resultant mental states of happiness and depression; Joiner (2001) has attempted a consilient analysis of 192 VALONE interpersonal–psychological theories of depression; and finally, Beach (2001) integrates findings in developmental psychopathology, social psychology, personality psychology, and clinical research and practice on marital and family processes in clinical depression. As can be seen in this brief review of published research in medicine and psychology, in the short time since the publication of Wilson’s (1998a) book, the construct of consilience has generated great interest and creative synthesis in a wide range of exciting and unexpected ways. Judging from the published literature on consilience, with but a single exception colleagues in at least two of our sister disciplines have embraced consilience with gusto and are advancing their fields in a most dramatic and dynamic manner.

Consilience and Psychoanalysis

Let us now turn to our own field. How consilient is psychoanalysis as a discipline? Unfortunately, psychoanalysis has a long and distinguished history of eschewing consilience. Freud’s initial efforts at theory building were remarkably consilient for their time, in the sense that he actively attempted to integrate knowledge from other disciplines and to embed psychoanalysis within science, the humanities, and the arts and to intermix ideas and theoretical constructs across disciplinary boundaries (Kitcher, 1992). However, revisions of classical psychoanalytic theory by Freud and others have often attempted to reify classical psychoanalytic constructs and “freeze them in time” rather than to modify the theory in the face of increasing conflicts and incompatibilities with new discoveries, advancements, and theoretical revisions in other disciplines (Bornstein, 2001). Indeed, it is popular among some psychoanalysts to take the position that psychoanalysis is a self-contained field, with no need to be concerned about developments and discoveries in the natural or social sciences, the humanities, or the arts. Much of this thinking is consistent with a postmodern epistemology, in which all theories are seen as equally valid and equally plausible, where the very idea of comparing theories with one another for their degree of consilience would seem senseless (Mitchell, 1993). It is a central thesis of this article that these trends in contemporary psychoanalysis are a grave error, and that in the coming century psychoanalysis must embrace the notion of consilience or become obsolete, replaced by other disciplines that are themselves consilient (Bornstein, 2001). Knowledge of the world around us is exploding in other disciplines. In biology, neurology, and neuropsychology in particular, our understanding of the human brain and mind is evolving rapidly. Parallel developments are taking place in psychophysiology, psychopharmacology, genetics, medicine, and psychiatry. Clinical, cognitive, and developmental psychologists are making extremely important contributions to the understanding of normal and disordered human development and the workings and structure of the mind. Psychoanalytic theories that ignore these developments, or flaunt their indifference to such developments, lose credibility in the eyes of colleagues in other disciplines and, increasingly, even among many therapists, both analysts and otherwise. Worst, our patients suffer when the theories we use to understand and help them do not incorporate useful knowledge from related disciplines. Why should we not draw upon as much knowledge and information as possible when attempting to engage in the remarkably complex process of psychoanalysis? We should insist that our theories are rigorously evaluated to ensure not just that they are consistent with accepted knowledge in other disciplines, as the analyst Carlos Strenger proposes in his brilliant monologue on external coherence (Strenger, 1991), but moreover that they are consilient, that they actively CONSILIENT PSYCHOANALYSIS 193 integrate and incorporate accepted knowledge and facts from our sister sciences. It would seem that only good will come for us as therapists and our patients, who rely on us to be as informed and expert as possible in understanding their problems and in helping them to find and live better, more satisfying lives. Consilience is omnidirectional: Psychoanalysis can influence and change theories in many if not most other disciplines as well as be influenced by them. Psychoanalysis most effectively and powerfully makes these contributions to other disciplines by itself embracing the notion of consilience, resulting in a reciprocal infusion of integrated knowledge. Contemporary psychoanalysis has much to offer to all of the various branches of psychology, to psychiatry, to the neurosciences, to the social sciences, and to the arts and the humanities. By embracing these disciplines, exchanging ideas, synthesizing discoveries, and cross-fertilizing facts and concepts, psychoanalysis will remain a vibrant and essential area of study and knowledge in the coming years. If one accepts the central importance of consilience to psychoanalysis, it becomes apparent that any psychoanalytic theory can be evaluated with respect to its degree of consilience, as consilience can be thought of as a property of any theory. Within each psychoanalytic theory, some propositions may be more consilient than others as well, and so a careful evaluation and analysis of every contemporary psychoanalytic theory would be a very worthwhile task. Certain theoretical proposals, such as Freud’s drive theory, are woefully lacking in consilience, as there is absolutely no evidence in neurology and biology for any psychophysiological or neurochemical system that corresponds to classical drive theory (Holt, 1965; Lichtenberg & Hadley, 1989; Panksepp, 1999b). Other psychoanalytic theories, such as Bowlby’s attachment theory (Bowlby, 1969, 1973, 1979, 1980, 1988; Fonagy, 2001), Lichtenberg, Beebe, and Lachmann’s motivational theory and application of infant research to psychoanalysis (Beebe & Lachmann, 2002; Lachmann, 2000; Lichtenberg & Hadley, 1989; Lichtenberg, Lachmann, & Fosshage, 1992), Weiss and Sampson’s control mastery theory (Weiss, 1993; Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986), Slavin and Kriegman’s work integrating psychoanalysis and evolutionary theory (Slavin & Kriegman, 1992), Schore’s integration of neurobiology and emotional development (Schore, 1994), the Shanes and Gales developmental systems self psychology (Shane, Shane, & Gales, 1997), and Sorenson’s innova- tive efforts to synthesize spirituality and religion with contemporary psychoanalytic theories (Sorenson, 2004), to name but seven examples, are much more consilient in their propositions and assertions, being supported by research and knowledge generated within these theories as well as by active corroboration from other disciplines. Much could be learned about the theories that we use in our practices if we consider them in the context of their degree of consilience. As we embrace the notion of consilience, our theories will evolve and expand in surprising and exciting ways, becoming richer and more useful to us as well as to those in other disciplines.

Consilience, Paradigm Change, and Psychoanalysis

Since its inception, psychoanalysis has been characterized by a strong correspondence between the theories proposed and the authors of those theories. Beginning with Freud and continuing ever since, developments in psychoanalytic theory have typically been directly associated with powerful, eloquent theoreticians who propose their own particular brand of psychoanalysis, whether Jungian, Kleinian, Winnicottian, Fairbairnian, or Kohutian, to name a few examples (Masling, 2003). This state of affairs continues to the present time 194 VALONE essentially unaltered. Theoretical debates, even in contemporary psychoanalytic conferences and journals, often devolve into contests wherein the forcefulness and personal conviction of the various defenders of particular theoretical positions take center stage in attempts to resolve conflicts among theories, rather than invoking more impartial and impersonal criteria to compare and contrast competing theories (Bornstein, 2001; Spence, 1982). Moreover, ad hominem attacks on proponents of competing theories continue to be tolerated by the psychoanalytic community to an unacceptable degree (Lachmann, 2000). For two recent and distressing examples, see Waiess’s (2002) ad hominem attack on Bornstein (Bornstein, 2001, 2002) and the heated exchange between Stolorow and Orange versus Strozier (Orange, 2003; Stolorow, 2003a, 2003b; Strozier, 2003a, 2003b). If we are to replace argument by authority and ad hominem attacks on competing theories and theoreticians with more refined methods of determining how psychoanalytic theory should advance, what criteria do we use? How do we move beyond theories that are so directly associated with their authors’ personalities and idiosyncratic worldviews to more universal, generalizable theories of psychoanalysis? The time has come for psychoanalysts to use new criteria for evaluating the validity and utility of their theories. The postmodern notion that all theories are equally useful and equally valid, such that no comparison among theories is necessary, is an outdated concept that needs to be retired in this new millennium (Mitchell, 1993; Wilson, 1998a). Some psychoanalytic theories are better than others, some parts of any given psychoanalytic theory are better than other parts, and some psychoanalytic theories are just plain wrong and should be thrown out. The natural sciences have largely replaced ad hominem attacks and argument by authority with more sophisticated methods and criteria in order to compare competing theories. Moreover, contemporary theoretical advances in the natural sciences are seldom directly associated with the authors of those advancements. In such disciplines, theory evolves and changes in response to convergent evidence and methodical investigation of the phenomena under consideration—in short, consilience. Thomas Kuhn (1970) described in elegant detail this sociological process of change in the sciences and the many influences that result in dramatic paradigm change even in the hard sciences.

Consilience, Empiricism, and Psychoanalysis

Whereas empirical investigation plays a central role in the natural sciences and many social sciences, psychoanalysis is notorious for rejecting the principle of empirical investigation (Bornstein, 2001, 2002; Karon, 2002; Lothane, 2002; Mills, 2002; Schachter & Luborsky, 1998; Waiess, 2002). I have noted in my own personal interactions with many respected analytic colleagues a dishearteningly common assertion that psychoanalysis is simply too complex and ephemeral, and the interactions between a particular patient and a particular analyst simply too unique, to ever allow for scientific investigation of what we do. Skolnikoff underscores my observation by noting a stance by many psychoanalysts of “closemindedness, dogmatism, and the need to deny and discourage the validity of competing ideas and theories and even the usefulness of psychoanalytic research” (Skolnikoff, 2004, p. 100). A general attitude by many psychoanalysts of devaluing empirical research in psychoanalysis was graphically empirically validated in a recent experiment conducted by Schachter and Luborsky (1998). In this study it was found that 60% of the analysts who participated in the survey expressed a high degree of conviction that the clinical tech- CONSILIENT PSYCHOANALYSIS 195 niques and rationales that they used in their practice were effective and sound; yet these same analysts were significantly less likely to report reading empirical research articles (as opposed to clinical research articles) than were the smaller group of analysts who reported lower levels of conviction in their own clinical techniques and rationales. Thus, the more certainty analysts have in their theories and techniques, the less open they are to reading empirical research that might alter, challenge, or expand the very theories and techniques that they so confidently employ. Of course, the assumption that the psychoanalytic process is beyond experimental investigation is simply untrue. What about the pioneering research of Luborsky and the Penn Psychotherapy Research Project (Luborsky et al., 1980; Luborsky, Crits-Christoph, Mintz, & Auerbach, 1988; Mintz, Luborsky, & Christoph, 1979)? Or the lifetime of work by Hans Strupp on psychodynamic psychotherapy at Vanderbilt University (Strupp, 1980; Strupp & Bergin, 1969; Strupp & Binder, 1984; Strupp, Butler, & Rosser, 1988; Strupp & Hadley, 1979)? Yet a third of the many examples of impressive empirical research on the psychoanalytic process is that conducted by Weiss and Sampson and the Mount Zion Research Group (Weiss, 1993; Weiss et al., 1986) in San Francisco on control mastery theory. This body of data is a testimony to what can be achieved in contemporary empirical research of psychoanalytic topics when a group of highly dedicated and motivated analysts donates considerable time to conduct such research investigations. Finally, the work of Beebe and her colleagues on the co-construction of face-to-face mother–infant interactions and the application of this sophisticated research to adult psychoanalytic treatment is nothing short of revolutionary (Beebe, 2004a, 2004b; Beebe & Lachmann, 2002). Other summaries of empirical research in psychoanalysis may be found in Fisher and Greenberg (1985, 1996), in the Empirical Studies of Psychoanalytic Theories series (Bornstein & Masling, 1998a, 1998b, 2002; Masling, 1990; Masling & Bornstein, 1993, 1994, 1996), and in a recent excellent review by Doidge (1997). It is thus clear that it is possible and, in the opinion of at least some psychoanalytically oriented researchers, desirable, to conduct research into the psychoanalytic process. It is also painfully evident that in a relative sense, very little empirical research has been done in the field of psychoanalysis, particularly in recent decades. Bornstein (2001) recently comprehensively addressed this issue, pointing out that psychoanalysis has become essentially irrelevant to the community of scientific psychology. He noted that in a recent study by Robins, Gosling, and Craik (1999), “less than 2% of articles published in psychology’s flagship journals contain keywords related to psychoanalysis” (p. 5). Born- stein goes on to outline “the Seven Deadly Sins of Psychoanalysis.” Each is discussed in more detail below, as they relate directly and powerfully to the issue of consilience. The first, insularity, consists of the tendency of psychoanalysts to interact primarily with one another in writings and professional conferences. Bornstein (2001) points out that psychoanalysts “deprive themselves of exposure to competing viewpoints and alter- native perspectives that might enrich the psychoanalytic model” (p. 7). Although I think that Bornstein exaggerates the insularity of contemporary psychoanalysts to relevant information in other fields, his point is nonetheless well taken and a valid criticism of psychoanalysis as a discipline, one that could be in part corrected by an adherence to consilience. The second, inaccuracy, involves the continued acceptance of psychoanalytic concepts and constructs that have been contradicted or invalidated by empirical studies. Bornstein (2001) states, “Within the psychoanalytic canon, concepts contradicted by empirical findings are intermingled with those that have been supported, and no systematic 196 VALONE effort has been made to distinguish between the two” (p. 8). I could not agree more with this statement, and in fact Bornstein is unwittingly putting forward a powerful argument in favor of consilience. The third, indifference, refers to the tendency of psychoanalysts to simply ignore developments in related fields. Contemporary psychoanalytic writing tends to be divided into tightly knit subgroups that ascribe to a particular theoretical position. As Bornstein (2001) points out,

psychoanalysts’ indifference to others’ ideas and ﬁndings is propagated by the large number of highly specialized psychoanalytic journals that are edited and read almost exclusively by adherents to the prevailing theoretical views. An isolated “psychoanalytic universe of ideas” has inadvertently been created by those within the discipline, and for the most part this universe is detached from empirical data and the inﬂuence of competing theoretical concepts. (p. 9)

Bornstein (2001) correctly exposes the tendency of psychoanalytic training and exposition to segregate into internally homogeneous “camps” that tend to ignore and devalue developments in competing psychoanalytic theories and in the intellectual world outside of psychoanalysis. Replacing such attitudes with a consilient perspective would certainly combat the indifference that Bornstein identifies in this “Sin.” The fourth, irrelevance, concerns the fact that psychoanalysis has largely faded in relevance in contemporary graduate training in mainstream psychology and psychiatry. Because most psychoanalytic writers have not aggressively integrated psychoanalytic ideas with those of other disciplines, related disciplines are increasingly ignorant of important and exciting developments in psychoanalysis, some of which are in fact highly consilient with those disciplines. The fifth, inefficiency, highlights the excessive, convoluted theoretical assumptions and constructs that pervade many if not most psychoanalytic theories. Psychoanalytic theories that are obtuse, are difficult to understand, and have internal contradictions and inconsistencies do not easily lend themselves to generating testable hypotheses that can be either supported or rejected by empirical investigation. Moreover, theories that lack parsimony and clarity cannot be subjected to consilient analysis by attempting to integrate theoretical assertions and propositions with the accumulated knowledge in related disciplines. The sixth, indeterminancy, illuminates the lack of clarity and precision regarding the definition of key psychoanalytic constructs (see also Gru¨nbaum, 1984). When a psychoanalytic theory does not precisely define its terms, these terms cannot be used to operationally define constructs so as to investigate these constructs empirically. In a similar fashion, imprecise and poorly defined terms make a consilient analysis of a psychoanalytic construct difficult, if not impossible: If a construct is itself unclear, how can it be compared with constructs in related disciplines? The seventh, insolence, underscores the tendency of psychoanalysts to display an attitude of arrogance and superiority toward competing psychoanalytic theories and to outside knowledge. As Bornstein (2001) aptly states, “the insolence of the psychoanalytic community has caused psychoanalysis to become more religion than science, alienating those who might otherwise have taken the theory seriously” (p. 11). In contrast, a consilient approach to psychoanalysis embraces an attitude in which every theoretical proposition, assumption, and assertion is open to question, open to revision, and open to CONSILIENT PSYCHOANALYSIS 197 rejection—the antithesis of a dogmatic, arrogant stance toward advancing psychoanalytic theory and technique. Bornstein’s (2001) Seven Deadly Sins are a wake-up call to psychoanalysis to integrate with the broader intellectual community, psychological and otherwise. Although Bornstein’s focus is primarily on the lack of synthesis between the scientific community and psychoanalysis, his arguments are equally persuasive in supporting the profound need for psychoanalysis to embrace consilience as one important method of theory building, expansion, and revision. Moreover, with the recent move by Division 39 (the Division of Psychoanalysis) of the American Psychological Association (APA) to establish a Committee on Evidence-Based Practice, psychoanalysts are acknowledging that we as a profession cannot ignore the standard of care of evidence-based practice set by the broader mental health and health care community to integrate research evidence with clinical expertise and patient values so as to provide optimal patient care. Jaine Darwin, current president of Division 39, states that the APA is working toward “adopting and advocating for a definition [of evidence- based practice for the Division of Psychoanalysis] that reflects our respect for psychodynamic and psychoanalytic psychotherapy as a science that relies on the qualitative as well as quantitative data” (Darwin, 2004, p. 1). Clearly those psychoanalytic theories that are more consilient are more likely to spawn evidence-based treatments, and those that are less consilient are less likely to. As we cannot currently rely on empirical investigation as a routine approach to testing and comparing psychoanalytic theories, what other criteria should we use? Wilson suggests four such criteria, which I will outline here. First, he proposes parsimony. All other factors being equal, the theory that is simplest and requires the least units and processes to explain the phenomena under investigation is the best. Second, he proposes generality. The greater the range of phenomena described by a theory, the more likely it is to be true. Third, he proposes consilience. To quote Wilson, “the units and processes of a discipline that conform with solidly verified knowledge in other disciplines have proven consistently superior in theory and practice to units and processes that do not conform” (Wilson, 1998a, p. 198). Fourth, he proposes predictiveness. Again to quote Wilson, “those theories endure that are precise in the predictions they make across many phenomena and whose predictions are easiest to test by observation and experiment” (Wilson, 1998a, p. 198). Any psychoanalytic theory can be evaluated using any of these criteria to determine its overall validity. I hope that in the future we observe a general trend in psychoanalysis in which it becomes standard practice to subject our favorite theories to these basic tests, and to compare and contrast competing psychoanalytic theories using these criteria. In my opinion, weaknesses and flaws in any theory can be identified using these criteria, and revisions of theory can be guided by these criteria as well.

Consilience and Metatheory

In the later part of the 20th century, the paradigm shift from classical psychoanalysis to a variety of relational, two-person, intersubjective models of psychoanalysis was accom- panied by a corresponding shift in metatheory. In part reacting to the rigid inflexibility of classical analysts to question or revise their theory in the light of new understandings within and outside of psychoanalysis, most contemporary psychoanalysts rejected the goal of a grand unified theory, instead embracing a pluralistic approach in which many 198 VALONE different psychoanalytic theories were encouraged to thrive side by side in a “live and let live” climate of mutual tolerance, if not collaboration. This relativistic approach appeared to safeguard the contemporary psychoanalytic community from recreating the significant damage caused when classical psychoanalysts wielded autocratic, dogmatic control over training, publication, teaching, and practice in a quasi-religious fashion. In recent years, suggestions that contemporary psychoanalytic theories should be compared and contrasted to determine which is the more helpful, is the more effective, or better explains clinical or empirical data have been resisted as attempts to reimpose a hegemony of any one theory over other theories. The result is a broad, rich array of interesting, stimulating, and creative psychoanalytic theories, often significantly overlapping one another while using different languages, constructs, and assumptions about human development, psychopathology, and approaches to ameliorative change. Stephen Mitchell (1993), in his superbly written review of what he called a “revolution in metatheory” (p. 40), discussed these issues and the implications for theory of shifting from the classical psychoanalytic assertion of having found the one Truth to a perspectival approach in which various subjectively constructed truths emerge as a more useful model of the essential nature of the psychoanalytic endeavor. As Mitchell notes, with this shift to pluralism has come a crisis in metatheory. If all theories are equally useful and valid, and if every analyst’s perspective is uniquely effective and valid as well, then what is the need for any theory, and how can the analyst justify him- or herself as an authority, offering something to patients above and beyond what they could get from interactions with any other human being? Mitchell (1993) identifies three strategies that contemporary psychoanalysts have invoked to address this crisis. The first response is what Mitchell terms “an appeal to empiricism” (p. 48), in which it is argued that empirical research designed to test and compare psychoanalytic theories will ultimately resolve differences among them. Al- though it is unfortunate that Mitchell himself did not embrace empiricism as a primary method of theory construction and development in his own brand of psychoanalysis (Masling, 2003), he nonetheless correctly points out that empiricism is one plausible strategy in responding to this postmodern metatheoretical crisis. The second response is to use a phenomenological approach in which the need for theory is diminished and the goal of psychoanalysis is to as fully as possible articulate the patient’s phenomenology, independent of what the analyst knows or believes. The third response is the hermeneutic, constructivist approach, in which the analyst and patient cocreate an experience together, unique to each patient–analyst dyad, where the analyst’s authority and knowledge about the patient come from within herself or himself; his or her analytic training provides one well-informed, if not Authoritative, perspective with which to help the patient deal with the problems for which treatment was sought. Although Mitchell (1993) points out limitations and flaws of each of these three responses, he feels that they can add to the advancement of psychoanalysis and continue “the development of an orderly, disciplined form of rational theorizing that takes into account the analyst’s participation” (p. 66). To Mitchell’s three responses I will add a fourth: consilience. I believe that if we subject our psychoanalytic theories to the principle of consilience, much more theoretical integration can and will take place. Moreover, weak and nonconsilient notions can be retired from psychoanalysis, eventually resulting in a convergence upon a common model for psychoanalysis that will, itself, constantly be revised, reworked, and replaced through the process of consilience. CONSILIENT PSYCHOANALYSIS 199 Toward a Consilient Psychoanalysis

Some in psychoanalysis have already grasped the wisdom of Wilson’s call for consilience and embraced the amalgamation of psychoanalysis with knowledge from other disciplines in their writings. In 1999 a new journal was inaugurated, Neuro-Psychoanalysis, the lead issue of which was dedicated to the consilient integration of Freud’s theory of affect with modern neuroscience. As outlined in an introductory article by Solms and Nersessian (1999b), the articles in the issue were dedicated to addressing the question “What are the possible neuroanatomical, physiological, and chemical correlates of Freud’s functional theory of affect?” (p. 13). A powerful, in-depth article by Panksepp (1999b) exploring the consilient synthesis of emotions viewed from psychoanalysis and neuroscience was followed by commentaries and discussion from senior neurologists and psychoanalysts (Damasio, 1999; Green, 1999; Panksepp, 1999a; Schore, 1999; Shevrin, 1999; Solms & Nersessian, 1999a; Yorke, 1999). A detailed review of the rich interrelations between neuroscience and affect theory outlined in the contributions to this issue, even as restricted only to classical Freudian theory, is beyond the scope of this article, yet it is well worth reading as a brilliant example of the power and vigor that results from applying the concept of consilience to the field of psychoanalysis. Forrest (1999), a psychoanalyst and psychiatrist, demonstrates a deep and broad grasp of consilience as applied to psychoanalysis in his article, in which he reviews Wilson’s (1998a) book and considers likely domains for consilient exploration within psychoanalysis. Forrest offers his own clinical interests for possible consilient study: movement disorders, associative memory, language acquisition, character, body image and plasticity, identification and misidentification, dreams and creativity, society, and child development (p. 379). Again space limitations preclude a more extensive discussion of these topics in the present article. Forrest makes a strong, clear argument for the value of consilience as applied to the field of psychoanalysis with several useful clinical examples. I am myself a clinical psychologist–psychoanalyst in full-time independent practice in office and hospital settings, as well as a senior training and supervising analyst teaching and participating in a psychoanalytic institute in Los Angeles. As such, my personal interests in consilience go very much to the practical, clinical applications of a consilient synthesis of knowledge in closely related disciplines with contemporary psychoanalytic theories, particularly as related to psychoanalytic work with patients who are not frequently approached in treatment from a psychoanalytic perspective. Four current examples of great interest to me at the moment are (a) a consilient synthesis of the current knowledge in psychiatry and clinical psychology on the etiology, course of illness, and treatment of so-called dual diagnosis patients (i.e., patients with a comorbid psychiatric diagnosis such as a mood disorder, an anxiety disorder, a psychotic disorder, a personality disorder, or the like, with a coexisting substance use disorder) with contemporary psychoanalytic theories of psychopathology and addiction; (b) a consilient integration of the D disorganized–disoriented infant attachment literature from developmental psychology (Hesse & Main, 2000) with the psychoanalytic literature on dissociation, disavowal, splitting, multiple self-states, multiple personality disorder, and sequestering of affect states (Valone, 2003); (c) a consilient synthesis of the literature in psychiatry, clinical psychology, and neurology on body dysmorphic disorder with psychoanalytic theories of early formation of self-image, affect regulation, shame, disordered attachment, visual representation of self, and procedural memory and knowledge; and (d) a consilient integration of the psychological, sociological, and anthropological literatures on the development and expression of emotional and psychological problems in men with 200 VALONE psychoanalytic theories of masculine self-delineation, gender identity, patterns of attachment, and affect regulation in men as viewed from contemporary psychoanalytic perspectives. I already synthesize these knowledge bases about dual diagnosis, the D disorganized–disoriented attachment literature, body dysmorphic disorder, and the unique aspects of working with male patients into my own psychoanalytic work with these populations, and I find that my theoretical understanding of my patients is much enriched and my clinical interventions are substantially broadened and more flexible and powerful as a result. There is a vast opportunity to integrate knowledge from other disciplines with psychoanalysis in creative and highly productive ways, limited only by the imagination and knowledge bases of those psychoanalysts attempting such integration. I have no doubt that many other psychoanalysts conduct the same intuitive consilient integration in their own practices with their own multiple areas of expertise. It is my hope that this article will encourage such practitioners to begin to put pen to paper, or fingertips to keyboard, as the case may be, so as to share their enriched consilient expansions of psychoanalytic theory and practice with the broader psychoanalytic community as I am doing here. Are there pitfalls to applying consilience to psychoanalysis? Do we risk becoming dedifferentiated as a discipline by incorporating knowledge from other disciplines by actively, creatively infusing external ideas and sources of information with those that are exclusively generated from within the psychoanalytic tradition? Is the unique profession and discipline of psychoanalysis somehow threatened by becoming suffused with ideas from chemistry, physics, medicine, biology, and psychology? To me such a worry is absurd. If this were the case, psychoanalysis would have been stillborn. Freud made valiant efforts in his initial theory building to make early psychoanalysis as consilient as possible, and clearly, such attempts resulted in an explosion of unmatched, creative ideas that became unquestionably psychoanalytic, not a watering down of psychoanalysis into a soup of undifferentiated chemistry/biology/physics/neurology. The more we become excited with knowledge from other disciplines, the more stimulated we become in ever deeper, richer ways of expressing and theorizing about our own uniquely psychoanalytic understandings of the human mind, human development, disordered development, and the alleviation of suffering and unlocking of human potential and expansive creativity that are the sine qua non of why we have become psychoanalysts in the first place.

Consilience and Uniﬁcation

It is my position that psychoanalysis will benefit from adopting the notion of consilience and applying consilience to all of our psychoanalytic theories. Does this mean that we should strive for a grand unified theory in psychoanalysis? In my opinion such a goal is imperative and essential. Such a goal is already embraced in physics, the ultimate of which is the so-called grand unified theory, or Theory of Everything. The other natural sciences similarly strive for unification within their own disciplinary boundaries and between boundaries with other so-called hard sciences in such a profound way that “for the material world at least, the momentum is overwhelmingly toward conceptual unity” (Wilson, 1998a, p. 10). Taking an example closer to home, Sternberg and Grigorenko (2001) have recently put forth a powerful argument in the field of psychology for a grand unification within that sister discipline. They propose a “multiparadigmatic, multidisciplinary, and integrated study of psychological phenomena through converging operations” (p. 1069). I am in CONSILIENT PSYCHOANALYSIS 201 complete agreement with Sternberg and Grigorenko on the immense value of striving for unification within psychology, and I would urge psychoanalysts to heed this call for unification within psychology and apply it to our own discipline as well. One major caveat is in order, however, as follows. Sternberg and Grigorenko (2001) are calling for unification of a discipline, psychology, that is already vastly more consilient than psychoanalysis. Psychology embraces empiricism; psychology openly strives to incorporate knowledge from other fields such as anthropology, chemistry, physics, medicine, art, religion, ethics, biology, mathematics, and even psychoanalysis (to wit, this journal); and psychology attempts to define and articulate theoretical postulates in a manner such that they are testable and refutable, something sadly lacking in much of psychoanalytic theorizing. In short, psychology as a discipline is already “consilient friendly.” Lest psychoanalysts leap to the conclusion that it is possible to follow psychology’s suit and attempt to become unified without first embracing consilience, be forewarned. Yes, it is perfectly possible for a discipline to be completely unified in its theoretical principles and yet be entirely nonconsilient. For a simple example, let us take phrenology. Phrenology is the now defunct discipline of reading psychological characteristics from the protuberances of the skull. In the heyday of phrenology in the 1820s through the 1840s, phrenological readings were in great demand to provide character evaluations so as to assist employers in the selection of employees, to determine aptitudes for career planning, to assist in mate selection, and in a variety of other applications (van Whye, 2004). As it turns out, phrenology was a highly unified discipline, its theoretical underpinnings and propositions being held in close agreement by the founders and masters of the field (van Whye, personal communication, December 27, 2003). However, in at least some of its major propositions, namely that psychological traits and characteristics could be accu- rately and validly gleaned from reading bumps and irregularities on the surface of the skull, phrenology was entirely lacking in consilience, receiving no support from devel- oping fields of psychology, neurology, and medicine. This lack of consilience resulted in phrenology’s fall into disrepute and eventual ridicule. It is noteworthy that phrenologists vehemently opposed subjecting their theoretical claims to scientific scrutiny and empirical investigation (van Whye, 2004). Thus, we can see that unification of a discipline is no guarantee of consilience, yet without consilience, unification is ultimately of little or no value if the propositions of such a unified discipline have never been integrated with the accepted knowledge accumulated by the rest of humanity. Turning to psychoanalysis, for those who would like to first unify within our own borders and only later take on the task of integrating a unified psychoanalytic knowledge with that in other disciplines, I ask this: How are we to be assured that the very theoretical propositions that may be thrown out in order to achieve unification within psychoanalysis are not exactly those that are the most consilient? Consider the abandonment of Freud’s seduction theory early on in the history of psychoanalysis as one example (Masson, 1985; Olafson, Corwin, & Summit, 1993; Powell & Boer, 1995). And who will make the decisions as to which propositions to keep and which to eliminate to achieve unification? By attempting unification in the absence of consilience, we risk returning psychoanalysis to the stifling, suffocating past, where the Truth was held by a small cadre of “enlightened” analysts who controlled developments in theory, practice, and training by selecting one “correct” psychoanalysis over all others. Instead, by continuously submitting all of our psychoanalytic theories to consilient analysis, and by refining and revising theory as a result, a grand unified theory of psychoanalysis is the inevitable outcome. Moreover, in such a case, even a grand unified 202 VALONE consilient theory of psychoanalysis itself will always be incomplete, never fully articulated, and forever open to revision, change, or rejection via adherence to the principle of consilience. The mechanisms for such revision would come not from any one person, psychoanalytic institute or organization, or special “priesthood” of experts (Kirsner, 2001; Skolnikoff, 2004). Such revision would come from throughout the discipline of psychoanalysis as all theoreticians, practitioners, and educators relentlessly apply the criterion of consilience to any theoretical proposition, constantly asking, “Is there a better way to understand what we do, one that is more fully integrated with the rest of the knowledge in the world?” Such a fundamental commitment to consilience should be a cornerstone of the future of contemporary psychoanalysis.

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