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PSYCHOSOMATIC
Feminism and the Neurological Body
By ELIZABETH A. WILSON Duke University Press
Copyright © 2004 Duke University Press
All right reserved. ISBN: 978-0-8223-3365-4
Chapter One
Freud, Prozac, and Melancholic Neurology
One of Peter Kramer's central case histories in his 1993 best-seller Listening to Prozac is the story of a young woman named Lucy. "Her history is dominated by one event. When Lucy was ten and living in a third-world country where her father was stationed, she came home to find her mother dead, shot by a young manservant-a beloved and trusted member of the household-who had become crazed and violent. Lucy showed no immediate reaction to this ghastly occurrence. She remained a productive, well-liked girl" (67).
As an adult, Lucy developed a heightened sensitivity to loss and rejection. She went to see Kramer to deal with this crippling oversensitivity. Her treatment with him involved both psychotherapy and the use of the SSRI (selective serotonin reuptake inhibitor) antidepressants Prozac and Zoloft.
In summarizing her case, Kramer draws attention to Lucy's biology: "Lucy had harbored a kernel of vulnerability that the psychotherapy did not touch. It was as if psychological trauma-the mother's death, and then the years of struggle for Lucy and her father-had produced physiological consequences for which the most direct remedy was aphysiological intervention. But how does psychic trauma become translated into a functionally autonomous, biologically encoded personality trait? How can a mother's death become a change in serotonergic pathways?" (107).
This last question-How can a mother's death become a change in serotonergic pathways?-strikes me as pivotal, not simply to Kramer's project, but also to many contemporary critical and political discussions. In asking this question, Kramer invokes a series of long-familiar debates about the relation of psychology to biology. For many critics, his juxtaposition of a mother's death and serotonergic pathways indicates a dangerous tendency to neurological determinism; many of us suppose that we already know the answer to Kramer's question. Inevitably, we suspect, the complex psychological trauma of a mother's death will be brought under the sway of synapses, neurotransmitters, and cortical pathways, a process that Kramer himself names "the remarkable imperialism of the biological" (105).
In this chapter I show how Kramer's hypotheses concerning the neuro-psychology of depression lead in different directions, both biologically and analytically. I am interested in Kramer's interpretation of depression as a weakened neurological state. By juxtaposing Listening to Prozac with Freud's theories of neurasthenia (nervous weakness), I am able to examine the character of the neurology-psychology interface. Although the relations between neurology and psychology are unanimously declared to be complex, the exact nature of the interrelating components has been less carefully examined. Are they two discrete forces that enter into a complex, yet fundamentally straight relation? Or is their relationality somehow integral to their very nature? What relations of influence operate between such co-implicated domains?
Within the structures of neurological weakness that Kramer and Freud advocate, forces of influence and determination are more mutually entangled than the critics of neurological determinism have hitherto acknowledged. It is this that marks Kramer's and Freud's accounts as both distinctive and instructive. Extending the argument I began in the introduction, I maintain that close attention to neurological detail need not be at the expense of critical innovation or political efficacy. Kramer's and Freud's deployments of neurology are illuminating for a critical assessment of the neurosciences because they restage the now routine claims that neurological theories are always politically dangerous or imperialistic, that biology is a discursive ruse, or that the final word on any psychobiological event must always lie in the domain of social or cultural analysis. Importantly, this restaging is accomplished, not through the recitation of long familiar anti-determinist axioms, but through the iteration of reductive neurological hypotheses.
Nervous Weakness
Neurasthenia means "nervous weakness"; it is a disorder commonly associated with civilized culture at the end of the nineteenth century (Barke, Fribush, and Stearns 2000). Speaking clinically, neurasthenia is a debility of the nerves, causing fatigue, headaches, indigestion, constipation, listlessness, and impoverishment of sexual activity. The American physician George Beard coined the termed in 1869 (Gosling 1987). He wrote extensively about the nature of neurasthenic symptoms, attributing them to the modernization peculiar to American life in the late nineteenth century: "evil habits, excesses, tobacco, alcohol, worry and special excitements, even climate itself-all the familiar excitants being secondary to the one great predisposing cause-civilization" (Beard 1895, 15). Modern life was causing a chronic "feebleness and instability of nerve action," and this in turn produced in the individual an "excessive sensitiveness and irritability" (Beard in Goodall 1996, 65).
Beginning in the 1880s, Freud was also interested in neurasthenia, although he defined it much more narrowly than did Beard. Freud claimed that neurasthenia is not due to excess of effort, overwork, or modernization. For Freud, neurasthenia is always and only a sexual neurosis. Overwork and the stresses of modernization may trigger neurasthenia, but only where there is a preexisting nervous weakening caused by sexual dysfunction: "Sexual exhaustion can by itself alone provoke neurasthenia. If it fails to achieve this by itself, it has such an effect on the disposition of the nervous system that physical illness, depressive affects and overwork (toxic influences) can no longer be tolerated without [leading to] neurasthenia. Without sexual exhaustion, however, all these factors are incapable of generating neurasthenia. They bring about normal fatigue, normal sorrow, normal physical weakness, but they only continue to give evidence of how much 'of these detrimental influences a normal person can tolerate'" (Freud 1893, 180).
Freud placed neurasthenia (along with hypochondria and anxiety neurosis) in the category of the actual neuroses-what might be called, these days, psychosomatic illness. The actual neuroses were distinguished in terms of their etiology from the psychoneuroses (hysteria, obsessional neurosis, melancholia, etc.). Freud argued that the causes of the actual neuroses were quite straightforward: they were to be found in the absence or the inadequacy of sexual satisfaction. His classification of neurasthenia with the actual neuroses allows us to note two things about its etiology:
1. Neurasthenia has its origin in the particularities of the patient's life as it is configured in the present, not in past infantile events or in repressed conflict. Thus, the "actual" of the phrase "actual neurosis" refers to actuality in the temporal sense of the here and now (Laplanche and Pontalis 1988). Specifically, it is immoderation in masturbation or the prolonged practice of coitus interruptus that Freud isolates as the behavioral determinants of neurasthenia. Or at least this is the case for men. In women, neurasthenia is rarely caused directly by masturbation, but more usually through inadequate sexual relations with a neurasthenic husband: "Normally, girls are sound and not neurasthenic; and this is true as well of young married women, in spite of all the sexual traumas of this period of life. In comparatively rare cases neurasthenia appears in married women and in older unmarried ones in its pure form; it is then to be regarded as having risen spontaneously and in the same manner [? as in men]. Far more often neurasthenia in a married woman is derived from neurasthenia in a man or is produced simultaneously" (Freud 1893, 181). The transmission of neurasthenia from man to woman is not primarily psychological or cultural, but somatic. One sexually inadequate body generates another.
2. Neurasthenic symptoms are somatic or bodily rather than psychic in origin, and are not amenable to psychoanalytic intervention: "The essence of the theories about the 'actual neuroses' which I have put forward in the past and am defending to-day lies in my assertion, based on experiment, that their symptoms, unlike psychoneurotic ones, cannot be analyzed. That is to say, the constipation, headaches and fatigue of the so-called neurasthenic do not admit of being traced back historically or symbolically to operative experiences and cannot be understood as substitutes for sexual satisfaction or as compromises between opposing instinctual impulses, as is the case with psychoneurotic symptoms (even though the latter may perhaps have the same appearance)" (Freud 1912, 249). The mechanisms of symptom formation in neurasthenia are directly somatic; they are not psychic compromise formations but rather the "direct somatic consequences of sexual disturbances" (Freud 1916, 388). In this sense, "actual" refers to the unmediated nature of the symptom. There is no meaning to be uncovered and interpreted in either neurasthenia or anxiety neurosis; Freud believed that the actual neuroses were properly the concern of the biomedical sciences.
Freud (1895b) offers an account of symptom formation in anxiety neurosis (one of the actual neuroses) in which these etiological notions are clearly articulated. In the sexually mature male, Freud suggests, somatic sexual excitation is produced almost constantly and eventually accumulates to a level where it impinges on the psyche. Specifically, it is "pressure on the walls of the seminal vesicles, which are lined with nerve endings," that eventually breaks through the resistance to the cerebral cortex and "express[es] itself as a psychical stimulus" (108). This cathects, or libidinizes, a series of sexual ideas in the psyche, producing a libidinal tension that demands to be discharged. The adequate discharge of this libidinal tension is possible only through "a complicated spinal reflex act which brings about the unloading of the nerve-endings, and in all the psychical preparations which have to be made in order to set o that reflex" (108). Freud calls this a specific or adequate action. That is, adequate discharge requires the synchronous release of somatic and psychic tension. Anything less than this will mean that accumulated somatic excitation will continue to breach the sub-cortical resistances and intrude into the psyche. A similar process is also attributed to women: "In women too we must postulate a somatic sexual excitation and a state in which this excitation becomes a psychical stimulus-libido-and provokes the urge to the specific action to which voluptuous feeling is attached" (109). Anxiety neurosis occurs, in both men and women, when somatic excitation cannot be worked over psychically. Neurasthenia occurs whenever adequate discharge of excitation ("normal coition, carried out in the most favorable conditions," 109) is replaced by a less somatically adequate one (e.g., masturbation). In the case of masturbation, the nerve endings are not properly unloaded, and the somatic tension will continue unabated, producing the symptoms of neurasthenia.
Beard located the source of neurasthenic sensitivity and irritability in the cultural conditions pressing on the minds and bodies of individuals. In Freud, a different kind of neurasthenic mechanism is being hypothesized. It is the flesh itself that carries the etiological burden of neurasthenia. While the toxic influences of physical illness, depressive affects, and overwork may contribute to a general fatigue, it is only when the nervous system is unable to discharge accumulated somatic tension through a sexually adequate action that the symptoms of neurasthenia are produced. It is not a crude biology that Freud nominates here; more provocatively, it is a sexualized nervous system that cultivates neurasthenic symptomology. It is the nerve endings in the seminal vesicles that play a pivotal role in the adequate circulation and discharge of somatic and psychic excitation, and therefore in the management of a certain degree of bodily and mental well-being.
Rather than sounding a critical warning against a theory that endeavors to place a penis-brain reflex arc at the explanatory center of a psychological model, I would like to look a little more closely at what is entailed ontologically in this hypothesis. That is, I wish to put to one side the alarm, mockery, or incredulity that the juxtaposition nerves-penis-cortex-psyche would normally elicit in certain critical and political circles, and listen for what kinds of useful critical and political tenets such a juxtaposition may be laying before us. Is Freud's circuit of nerves-penis-cortex-psyche an assemblage of self-contained elements arranged in determinable relations of cause and effect? Or is it a psychosomatic economy within which the identity of each element (nerve, penis, cortex, psyche) is constituted as an effect of that economic structuration? If it is the latter (which I argue it is), then the identity of penis and cortex cannot be known in advance of, or outside of, their excited, circuitous relations. Moreover, the difference between biology (penis and cortex) on the one hand and the psyche on the other cannot be determined such that we can know with absolute certainty that the juxtaposition of seminal vesicles and psyche means that the first term prescribes and subdues the second term. If the psyche is already of the circuitry that encompasses cortex, nerves, and penis, then we have a system of mutual constitution from which no particular element emerges as the originary, predetermining term. In such a network the psyche is indeed cortical, nervous, seminal, but so too are the seminal vesicles constituted at their core as psychic, so too is the cortex irreducibly sexualized. Charges of neurological determinism inadequately grasp the ontological and relational complexity that this Freudian model entails.
A theoretical caveat concerning relationality is necessary here. The structure I am elucidating in Freud could be called a relational or distributed network only when certain ontological conditions have been met. It seems to me that the logic of distribution is critically valuable only as it approximates a Derridean notion of dissemination or différance-that is, a distribution or relationality that it constitutive of its component elements (E. A. Wilson 1998). The distribution of already intact entities (penis, cortex, psyche) into part or subentities is not what is entailed in my reading of Freud. In this second, problematic sense of distribution, the difficulty of a singular, localized presence (penis, cortex, psyche) is not addressed by distributing that presence secondarily into fragments, networks, or mobile assemblages. Distribution has to be originary and constitutive. Freud was cognizant of the need to think about neurological distribution carefully. He made his concerns explicit in his little-read but highly regarded monograph on aphasia (Freud 1891), where he argues strongly against Wernicke's theory that aphasia is a disruption to speech centers. Freud maintains that such a theory doesn't sufficiently revise the localizationist tendencies of phrenology: "Considering the tendency of earlier medical periods to localize whole mental faculties ... in certain areas of the brain, it was bound to appear as a great advance when Wernicke declared that only the simplest psychic elements, i.e., the various sensory perceptions, could be localized in the cortex ... But does one not in principle make the same mistake, irrespective of whether one tries to localize a complicated concept, a whole mental faculty or a psychic element?" (54-55). Freud's subsequent, unpublished musings on neurasthenia try out this hypothesis about neurological circuits, association, and influence in less orthodox territory.
(Continues...)
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