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From Cincinnati WG U.S. the University of Cincinnati station presents the fifth in the series of Franco wild Institute lectures by Dr. Murray's Levine professor and director of the Department of Psychiatry at the University of Cincinnati College of Medicine. Dr. Levine is the author of psychotherapy in medical practice a book which has gone through 18 editions and has been translated into three foreign languages. He was also president of the American delegation to the First International Congress of psychiatry in Paris. These wild Institute lectures were given at the Hebrew Union College Jewish Institute of Religion in Cincinnati under the title psychiatry and ethics. The topic of this lecture is creative ethics. Here now is Dr. Levine. When I began to work on this fifth Leichter I get a quick review of the material of the previous four sessions I found there were two major emphases one can be summed up by saying that
man is really up against it in this his life. Man is confronted by many powerful forces both outside and inside himself and these forces often seem impersonal and overwhelming. The other emphasis can be summed up by saying that man has done an amazing job has responded in many ways with strength and flexibility. He has tried to hard to cope with and to master the forces which threaten him. He succeeds in some ways in Pharaoh's and in others. Now I want to be sure that you're following me and this contrast of the interplay between the forces acting on man and man whose active response it is. So I want to put it in the setting of a similar interplay in the lives of all animals and discuss the forces acting on them and their response.
It starts with a D and a mass age. The genetic message in the chromosomes from one generation to the next. There is a specific set of messages for each species which is a powerful factor indeed in the course of the life of the individual animal. But also there are many individual variations in heredity and the genetic endowment. These variations are mutations appear constantly and in any animal population in what George Wald the biologist cause the mistakes in the messages in the genetic code. Therefore the beginning of the life of the individual animal is a passive process. Since the animal to be born plays no part in the chromosome stability of the species or in the chromosome variations in the individual animal. Then after it is born in the life of an animal is deeply influenced by the conditions of its environment and by the impact of other animals.
The interplay of genetic endowment and environmental circumstances are the forces which in good part shape its life. But the animal itself is an active participant in the process. It plays a role in individual survival by its responses to the environment within the range permitted by its genetic endowment. And each species plays a role in its own destiny. It adapts and adjusts and changes it must do so to survive. Therefore the struggle for survival both the in competition and in cooperation is an active process of interaction of change and of growth alertness to danger speed of response coping with the environment patterns of adaptation and adjustment to other animals and to external conditions.
All of these are active processes which differentiate living organisms from non-living objects from the past seventy of a grain of sand. Not to this degree of police delay for him for human animals is not only a passive submission to the forces of the environment to the availability of food and water to the animate Darr in animal dangers. Each species of animal has specific patterns of coping active play with or of mastering the problems of life or of trying to do so. Then when we turn to the human animal we see that in man there is a comparable struggle between powerful external forces and it. It's man's own powerful attempts to cope and to master and man must cope with most of the forces confronting other animals. In addition man in contrast to most of the other better animals must face the danger of being killed by others of his own species.
Perhaps because of his development of conceptual thinking of language of fantasy or projection so that men may regard man in a nearby valley as if they were members of another species. And so Kara and ARC yard finally and most important man must cope with a large variety of forces within himself which are often or are in conflict. At times such forces when they were studied in individual patients give the impression that they are so powerful like the forces in the world outside that they can determine the course of our lives. It is for this reason that Freud began to use the impersonal pronoun the air Ideally the act as the word for the forces in the human being are the drives toward behavior of one sort or another the temptations in general the forces by which we seem to be live.
These include the insistent and presumed basic drives at times called instincts including the sexual aggressive self-aggrandizing competitive destructive and hostile dry. From the point of view of the development of an ethics which is sound a biologically and psychodynamic place sound it is imperative to emphasize the existence of these forces which we call the Erda and of the strength of these internal forces as well as the external forces in man's life may actually be irresistible in good part of times or may seem to be to some degree they are not under man's own control. Some of them are unconscious are not even known to man even as they exert their great pressure. From the point of view of ethics two points must be made about the ID forces. One is that often in their unchanged or primitive form
forces of the air there are unacceptable to the individual himself and to others. Second and emphasis on the demanding persistence surging forces of the ared can help us debunk the unworkable notion that a human being can simply be given a set of rules and be expected to behave for me in accordance with those rules or that he is free to do so. Free of forces which fight strongly against accepting the rule is now the first group then of psychoanalytic studies by Freud and others focused primarily on the erred on the deep end hidden forces the drives which by the way at first were merely described as part of the unconscious but later work called The ED. Then came the second period in the 1920s and 1930s in which the studies focused more directly on the forces the super ego. This includes the conscience
which is the conscious part of the internal standard setting forces. Plus the unconscious portion of the super ego the more deeply embedded standard setting forces. Modest day with the suit was the super ego force and exhibitionism the ID force in the conflict which I discussed in a previous lecture. Now one of the extraordinary discoveries during the second period when the focus was on the super ego was that it is a serious mistake to conceptualize the conscience the super ego as exerting its influence by a single voice of conscience which would give the right answer which represents the voice of morality or of reason the conscience has several voices and even more important a good part of the super ego cannot speak has no audible voice is unconscious is unknown to the individual but nevertheless is acting with great
force and impact. In fact the unconscious portion of the conscience which often is archaic or outmoded is one of the strongest forces in human life. For example many a woman wants to have a good sexual relation with her husband but is unable to do so because a hidden deeply forgotten part of her personality had accepted totally and for ever. The doctrine that sex is dirty and forbidden and many a man not can recognize in terms of his contemporary conscience that Mary just is an equal equal relation but behaves at times as if there is a part of his conscience which says Thou shalt never permit a woman to be the equal or thy partner in his childhood he may have seen that principle used by some grown ups who had a strong influence in his life and so he came to think that this was the way life should
be. Or perhaps the principle represents his own to start had versions of our last extreme pattern in which he had seen it in his childhood. Now comes the third day in the historic called period sequences of psychoanalytic study is in which the primary emphasis shifted from the forces of the air down the forces of the super ego to the third group by the internal forces those of the ego. The work of the Anna Freud in a large number of psychoanalysts and other workers has given a firm basis for the understanding of the forces of the ego for an ego psychotic. Now the ego comprises the set of forces which can be defined as having the basic job of doing something about the various forces in the conflict within the human being. The ego must be a kind of mediator a
conciliation service one which says hey there boys stop fighting and we'll find a way to deal with all of that. Yes. Now these three the it had the super ego and the ego are not three little man inside the scar fighting for control and domination. Although at times the anthropomorphic use of three these three words guys make it sound that way. But these three terms are merely shorthand words for three overlapping and interacting groups of forces at a number of levels. The ego now is the set of forces which tries to cope with internal conflicts. It is the executive coordinating adaptive problem solving integrating controlling compromising set of forces in the personality. Also it works toward the resolution of conflicts between the individual and the extremal world. Hard to a large degree the ego is
realistic and pluralist state. It has many of the attributes which we described in a previous session as comprising the third kind of thinking. Now then this description of the human animal in three sets of internal forces one is the profoundly strong rather impersonal forces of the air. The second is the super ego the third is the group of forces the ego which attempts to use reason and reality adaptation integration and resolution as its principles. And such a tripartite description leads inevitably to the question of whether this picture of man throws light on the age old problems of freedom of the will and of psychic determinism involved in such considerations also as several very practical questions. One is the issue of man's responsibility for his own behavior related to
this is the question of whether human beings can control all their primary drives or their disturbed feelings or thinking or behavior. If only they would tried to do so or whether On the contrary. These are irresistible. To try to find the pressure some partial answer is I turn to our old reliable to clinical experience. I start with a simple procedure about which all of you know the use of a thermometer to take one's temperature. Usually taking the temperature by mouth is accurate enough but there are times when mouth temperature taking is impossible or inaccurate. Armpit temperature usually is unreliable. So then if an accurate knowledge of the body temperature is a sunk shore to see what direction an illness is taking or what the response to medicine has been wrecked don't tempt or taking
may become an urgent necessity. But many a patient objects to a rectal thermometer a small number object very strongly. A few object most strenuously strong objections directo temperature taking occurred chiefly under two conditions. In one the emotional forces within the individual are very strong indeed. Such a patient often has enormous anxiety about the apertures of the body with the exception usually of the mouth. If something is to go into an aperture it may be regarded as very dangerous as getting past the defenses into the body. Occasional a rectal temperature taking may be visualized by a woman as symbolizing a rape or as a dangerous rectal intercourse or by a man as a dangerous homosexual experience in a very rare circumstance the prospect of work don't tempt or taking may
evoke so much anxiety that it no longer should be called anxiety but rather a panic state in which the patient may be out of control. Such a panic usually lasts for a few hours or a few days. The other strong objection to rectal temperature taking is based on a different sequence. This is one which can be carved the hysteric dramatization of the anxiety over what is were guarded as a very unpleasant experience not as an overwhelming danger. Such a patient feels a moderate degree of anxiety and strong resentment often and then unconsciously uses the technique of dramatizing the anxiety and the danger so that it begins to feel unbearable. The anxiety amount steadily but in such an instance the actual experience of recto temperature taking is disturbing only to a moderate or minor degree. And when
those around are not controlled by the dramatic response the temperature taking usually proceed fairly easily and the patient is relieved that it is over. Now this contrasting pair of responses symbolizes a large mass of experience which helps to give a working answer not an ultimate answer to questions of freedom of the where and of determinism. One more correctly phrase such contrasts provide part of the answer to the question of whether the internal forces in human life are irresistible or resistable either by the individual himself or by those around him. In the first type of response described as a possible homosexual panic or panic about the penetration of an operator of the body the forces involved in some cases are not controllable by the individual's ego. In the second example of the dramatization of an unpleasant experience the forces almost always are controllable by the ego.
Now I could tell I could give another contrasting pair of reactions. This one would have to do with horses but I'll condense it only to say that in the first of the pair a man who enjoys horseback riding and is thrown from the horse can be persuaded by his friends to get back again on the same horse or on another horse. And that is able to control the forces which had been stirred up by the experience of being thrown from the horse. In contrast an individual who has had a phobia of horses all of his life has as if he were to try to get up onto a horse or be forced to get upon the horse has unleashed in him self a series of forces which basically they are uncontrollable by the ego and which will result in a kind of panic. So this contrast leads to the same point as did the other contrast of the two patterns underlying
strong objections direct or thermometer. In each pair one set of forces is usually not controllable by the ego but the other set of forces is usually controllable by the ego and this must be phrased now in more quantitative terms. For this we can say that the strength of the ego varies along a continuum from weak to strong. Also the ego may be strong in some ways but less strong are weak in other way. Similarly of the voices may vary in strength in intensity and in duration. The ID forces as a group can be very generalized as being on a continuum from we just wrong. But also each of the individual drives comprising the ared varies along its own continuum from weak just wrong. So that the outcome at any time depends on the interaction between the ego in its different degrees and kinds of strength with the relevant active surging
erupting forces in their differing degrees in kinds of strength. Now this formulation permits us to say that the ego of the executive integrating forces of the human being at times can cope with Kim Masters some of the drives the surging untamed forces the personality but at times it cannot cope with our masters some of the force of this formulation would seem to get something of a working answer to the basic questions that have to do with responsibility irresistibility on the light and essentially the overall answer is that the outcome very is as it might have been expected to do depending on the forces involved in the struggle. But then if we want to use this formulation in a broader sense as to whether it contributes to our understanding of the issues of freedom of the world and of determinism there is another point
to consider. The ego itself may be the end product of past experiences past developmental forces which could be said to determine the way in which the ego will respond with weakness or strength or the way in which the ego might respond to specific confrontation. The ego in part is influenced by the inheritance of specific genes but that influence being modified extensively by the impact of the environment. There is evidence that ego development has depended on past experience but at each step in the past the ego responds actively to the environment to the experience which is shaping it. And finally one can say that the current functioning of the ego is in part determined by a very complex series of causal interactions in the past and that this determines in part the current capacity of the ego to cope with the forces of the it in the super ego. But the even these findings and this sequence of logic
does not require do not require the conclusion the determinism in the usual sense is the only tenable answer because determinism or since determinism must be redefined. The ego Shorty is deeply influenced by past experience and other determinants but gradually the ego has come to include patterns of flexibility plasticity variabilities strategy just sation making and choice. The ego now is capable of struggling in a flexible many sided way with the other forces of the personality. When activity is needed it is a definition of causation or determinism. Which is far more complex than some bomb is more multiple than single or is multi dimensional rather than linear is more dynamic than static. In a parallel way really in a simpler way but still an exact
parallel. Perhaps in a parallel way the one one can say that the integrated activity of the cortex of the brain requires explanations different from the explanations of simple reflex brain activity includes some variety of voluntary action. Similarly the understanding of the functions of the ego must include the fact that it is the result of past events and causes. But in that process it has developed a range of voluntary choices and decisions and methods of integration. No occasionally This is described as an illusion but it is much more than that. I would rephrase it or I would phrase it this way that in the ego of the human animal past experience in part determines its activity but also that the human animal or for the sake of survival or has evolved the processes and
functions of the ego which must be must be called choice and decision. Central direction and integration aiptasia coordination and the inhibition of one pattern combined with the accentuation of another pattern. At the very least such an approach permits a tentative operational working answer which seems to be the best available at the moment. Just some of the crucial issues raised in this section of the discussion. The best phrased to symbolise this approach is to speak of a pressure on the ego control or a flexible ego control. Now using this punk Sapt we can say that there are situations in which the forces opposing the ego are too great to be controlled by the ego. An example is a panic aroused by a great impulse a great increase in the EMP pulse to herd another person. Also are there other situations in which the forces
opposed to the ego have not increased in strength to upset the brim. But in which the strength of the ego itself has been diminished. An example is the weakening of the ego when the cortex of the brain is saturated with enough alcohol to lower its capacity to function. In both instances the ego may lose control and the other forces will dominate. Now quoting its clinical experience again one can have little doubt that a patient who acts on the basis of delusions and hallucinations might find it be impossible to correct his host nations or delusions are to avoid acting in accordance with them. And one can have little doubt that an individual who has a severe eye hand-washing compulsion might become panic and even briefly psychotic if someone by force prevented him from washing his hands. Over a period of
time in both cases the anti ego forces predominate over ego forces. But many of us have known individuals who apparently were unable to control some of their behavior who insist that certain patterns were irresistable. But then you are surprised to find they are able to do so under certain circumstances. For example during war time or in a civil crisis many men and women are able to force themselves to work more effectively and productively than they believed they could. Also a man who is sure that he cannot resist some of these patterns for example of being overly sympathetic and over permissive with children may be able to resist to control these patterns. When someone he regards as honest and reliable and as dedicated to his own interests whom he would regard as dedicated to his own interest strongly urges that
he resist the temptation. Now the above discussion of ego forces and the use of as much ego control as possible when it is needed can be given dramatic emphasis by a true star a. What happened when a group of disturbed psychotic patients in a hospital in Switzerland some forty or fifty years ago when a by mistake given access and sent him to the forest to chop down trees which the hospital needed for its fireplaces in the prawn the previous day the hospital had prepared two lists of names of patients. One was a list of those who had volunteered to work in the woods. These were patients who had made a good or an approximate recovery and were about to be discharged from the hospital. The second list was a patients who were to be given name and improved variety of medication which might lessen or ameliorate their seriously disturbed thinking and
behavior. These patients were typical of those who in the days before the advent of present day treatment were overactive at times violent breaking furniture or defending themselves against attacks by the enemies in their delusional system. These are the two lists of patients were reversed by some mistake and the disturbed patients who were supposed to be given the new medicine instead were taken into the forest under the supervision of one attending. They went to have found it peacefully with only an occasional noisy outburst carrying the kind of axes they had used earlier in their lives before they became sick. They did a fairly good job of chopping down an adequate number of trees and of cutting the wood into usable lengths with only a minor response to individual hallucinations. Then they brought the wood back to the hospital or put it in good order and I shag
went back to their part of the hospital and again became extraordinarily disturbed it.
Frank Weil lectures
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#5 (Reel 1)
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University of Maryland (College Park, Maryland)
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