Neurosis & Treatment: A Holistic Theory Chapter 1     

Andras Angyal

 

 

1. The Trend toward Autonomy    

 

The existential form of the organism is dynamic; life is a process and must be studied as a dynamic whole.  Every whole is organized according to some leading principle.  Consequently, we must begin by defining the leading principle in the organization of the process of life.  What is the general pattern of the organismic process? An adequate definition of this pattern has far-reaching consequences for the actual study of the organism.  Every organismic part process is a manifestation of the dynamism of the total organism.  The part processes gain their meaning from the general pattern of functional organization and can be correctly understood only in the context of this organization.  In Chapter 1, I shall discuss one aspect of this general pattern.

 

Life as a Process of Self-Expansion

 

Most of the existing definitions of life have one element in common-a theoretical nucleus, which could be called the "immanence theory of life."  This can be roughly stated in the following way: The organism consists of a number of parts, or organs, which have specific functions.  These functions lead beyond the organ itself.  The heart irrigates with blood not only its own tissues but all the tissues of the body.  The function of each organ is to maintain both itself and other organs in working conditions; this organized self-maintenance defines the pattern of the total organismic process, making it a closed circle, comparable to a wheel turning on its own axis without progressing.  The function of each organ is defined by what it accomplishes for the rest of the organism, but the meaning of the whole cannot be derived from these part functions.  From this point of view, a functional definition of the total life process seems impossible, and life as a whole appears as functionally meaningless.  The part processes function to maintain life, and life is the sum of these part processes.  Although this formulation may look like a caricature, the hypothesis of immanence, the "closed-circle" conception of life, is implicit in all theories postulating the maintenance of equilibrium, or self-preservation and survival, as the main trend of life.

 

This hypothesis neglect some highly significant facts.  A little reflection will show that life in all its forms is not a purely circular process.  The circle is open at two points: there is assimilation (intake) on one side, and production on the other.

 

The most primitive form of assimilation, common to every organism, is a material one.  A stream of material (food substances, oxygen, carbon dioxide) flows from the environment into the organism; this stream is maintained and directed by the activity of the organism itself.  The organism reaches out into the surrounding world, draws material from it, and transforms this material into "living matter," i.e., functioning parts of the organismic system.  On the psychological level a similar process takes place.  Experience is acquired, assimilated and preserved in memory.  Assimilation can be defined as the process by which any factor originally external becomes a functional part of the organism.

 

The second break in the circle of organismic process is production.  Each living being creates something that transcends its own limits, be it a new organism or far-reaching changes in the external environment produced through muscular and mental activities.  Theories that define life as two-dimensional process of anabolism and catabolism, or storing and dispersing matter and energy, make the mistake of equating catabolism with dispersion.  The biological function of catabolism is not energy dispersion but energy mobilization.  When anabolism is completed, the next step is the productive utilization of the energy mobilized by catabolism.  The dispersion of matter and energy, their escape from the organismic system, is only an unavoidable by-product of living.  The stored energy is not wasted, and not all of it is turned back to support further assimilation of raw material.  It is used, at least in part, for productive activity; there is a "net profit." Unless one takes into account the inwardly and outwardly directed streams of assimilation and production, the self-transcending character of the functional pattern of living does not become obvious.

 

Assimilation and production can be viewed as expressing a single organismic trend.  By incessantly drawing in foreign material from the outside world and transforming it into its own functional parts, the organism grows and expands at the expense of its surroundings.  It also expands through its creativeness.  Instruments and other devices invented by man extend the capabilities of the organism-its sensory, mental, motor activities-far beyond their original limits.  Such manmade products, become integrated in the total activity of the organism; some of these products are almost like organs added to those we originally possess.  By converting a large range of external objects into devices such as shelters or tools, the organism extends itself into the external world.  Thus, as a first approximation, we may define life as a process of self-expansion.  The dynamism of life does not result in a closed circle but in a process which through its two phases evolves in a definite direction.  This process does not take place within the organism but between the organism and the environment.  The organism cannot expand within itself; it can expand only in a medium originally external to it.  The life process embraces both organism and environment; they are the two indispensable poles of a single process, life.

 

Autonomy and Heteronomy

 

To define the trend toward self-expansion in a more precise way, we must consider the distinctive feature of living organisms, their autonomy.  The organism is not-as mechanistic philosophy assumes-an inactive point in which various casual chains intersect.  Life is, to a large extent, a self-governing process.  The biological process is not a resultant of external forces but is governed by specifically biological endogenous factors.  To a large extent, the organism itself is the cause of its functions; it is endowed with spontaneity.

 

The organism lives in a world in which things happen according to laws which are heteronomous, i.e. foreign to the organism as such.  It is subjected to the laws of the physical world but it can oppose self-determination to external determination.  An animal dropped from a height falls according to the law of gravitation like any other body, simply as a mass and not as an organism.  Its fall, however, can be modified by influences originating within the organism-a cat, by means of its righting reflexes, manages to land on its feet whatever its position was at the start of the fall.  Clear examples of autonomous self-regulation are the functions that serve to maintain homeostasis; thus heat regulation in the warm-blooded animals enables them to maintain a fairly constant body temperature despite considerable changes in the temperature of the environment.  Phenomena of adaptation- such as the eyes' accommodating for distance and adapting to light and darkness-demonstrate the organism's ability to modify the function of its sense organs according to the demands of the situation.  Selection, choice, self-regulation, regeneration are phenomena which imply an autonomy of the organism.  In fact, not a single life process could be understood without this assumption.  In every stimulus-response sequence the external influence dos not cause, but merely prompts, the response.  The organism responds in its own specific way, i.e., in an essentially autonomous fashion.

 

Because the organism lives in a world independent of itself, its autonomy is only partial and must be asserted against the heteronomous surroundings.  Thus every single organismic process, and also the life process as a whole, is always a resultant of two components, autonomy and heteronomy-self-government and government from outside.  Every organismic process can be characterized by the ratio a : b, where a stands for autonomy, b for heteronomy.  The values of both a and b must be greater than zero, but they vary for different processes.  The ratio varies also from individual to individual and from species to species.  If the environment of a plant becomes poor in food substances, the plan has few possibilities for struggling against this condition; an animal in a similar situation is more autonomous since it can move to other regions to seek food, or in some cases can store it.  Similarly, in many kinds of plants the process of fecundation is dependent on external conditions, such as the action of insects and the wind.  The fate of the seed, its survival and growth, also depends on external circumstances.  In animals, who can deposit the fertilized egg in a protected place, make a deposit of food near it, and care for their young after birth, the reproductive process is less dependent on environmental conditions, although this does not necessarily mean higher efficiency.

 

The organismic process shows a definite trend toward an increase of the relative value of a in the a : b ratio, i.e., a trend toward an increase of autonomy.  This trend has no fixed objective but only a general direction.  At each stage of the biological process the tendency is toward a situation marked by a greater degree of autonomy than the preceding situation, even if this tendency cannot always be carried through.  This trend is equally apparent in the functions concerned with assimilation and with production.  Environmental factors, such as food substances, undergo stages of successive modification which bring them more and more under the control of the organism until they are completely integrated with it.  The process of production-raising crops, building shelters, making tools-result in increased mastery of heteronomous happenings by the organism, which permit it to put them at the service of life.  In both cases there is a shift of the a : b ratio toward a higher relative value of a.

 

In apparent contradiction to this trend, we observe a large group of regressive episodes; in these sequences the successive stages of the organismic total process are marked by a reduction rather than an increase of autonomy.

 

The phenomena of regression fall into two groups: passive setback and strategic retreat.  A passive setback is analogous to the situation of a man swimming against the current.  His activity aims at progression in a given direction but it is impeded by the force of the stream.  The resulting movement depends on the relative strength of the two components, but even if the man is carried backward we still can say that his tendency is to move upstream.  The tendency of the organism is toward increased autonomy, even if strong heteronomous influences result in a decrease in autonomy.  Similarly, in the case of strategic retreat the goal itself remains "progressive."  Regression may occur when a situation becomes untenable at a complex level, and the person retreats to a more primitive and familiar one to gather his forces for a new advance.  Hypotheses postulating a large-scale regressive trend in the organism itself, such as the hypothesis of the death instinct, are not very convincing.  The fact, which is attributed to the death instinct, such as extreme cases of neurotic self-sabotage, can be explained more plausibly on a different basis.

 

Organism and Environment

 

In the preceding formulations the organism is considered not as a static structure but as a dynamic organization, a process which takes place not within the confines of the body but between the "organism" and the "environment."  This conception, which alone does justice to the nature of the biological process, should replace all attempts to define organism and environment in structural terms.  Their morphological separation is impossible; if attempted it would lead to endless hairsplitting dialectics.  If belongingness to the organism were to be determined merely by an item's spatial position "within the skin," then not only food substance in the oral cavity and air in the lungs would have to be parts of the organism, but even any foreign object, or any substance injected into it.  It would seem more logical to regard, e.g., the contents of the gastrointestinal tract not as a part of the organism but as an insinuation of the environment into the body.  But if one starts making such distinctions endless questions arise.  Do nutritive substances, after being absorbed and passed from the intestines into the current of lymph and blood, become a part of the organism, or would it not be justifiable to call the non-cellular components of the blood "environment"?  One could carry the argument even further and ask whether the metabolically inactive intercellular substances are as much a part of the organism as the metabolically active cells.

 

The conception of organism and environment as entities separable in space is inadequate for the description of biological phenomena.  They become fundamental biological concepts only if we define them as dynamic factors, as opposing directing in the biological total process.  In these terms organism is self-government, and environment is heteronomous influence.  The two presuppose each other, the external world becomes "environment" only when and insofar as it is in interaction with the organism.  Every process which results from this interaction is part of the life process, irrespective of whether it occurs within the body or outside it.

 

Such a definition of organism may seem to contradict common sense since we do experience ourselves as distinct units, with firm boundaries.  Although the boundaries, in fact, are far from being firm and set, the formulation given in the preceding paragraph should be qualified by the statement that not all variations of the a : b ratio are gradual and continuous.  There are sharp gradients between the ratios typical of different groups of functions.  The high degree of control we have over the movements of our body tends to create sharp separation between this unit and the objects and events over which our control is less immediate and certain.  Thus the "organism" and "environment” of common sense are the "structural precipitates" of autonomy and heteronomy.  The factors, which are prevalently under autonomous government, constitute the person, or the subject, while those prevalently under heteronymous government form the objects of the environment.  This is the basic organization of the "biosphere," of the realm in which life takes place, and it is reflected in the basic differentiation o four conscious experience of the world into "I" and "non-I."  Yet within the unit to which we commonly refer as "a person" different groups of processes also have varying degrees of autonomous determination, as demonstrated by the difference between a voluntary act and a knee jerk.  Under pathological conditions the a : b ratio of certain functions may change; what has been previously experienced by us as our own activity may appear as not coming from ourselves.  The line we draw between the person and the environment is not stable; where we draw it is determined by many factors.

 

Some Expressions of the Autonomous Trend

 

In argument that the life process tends toward an increase of autonomy, rather than to a mere preservation of the status quo, I do not mean to postulate an entity, a force hidden behind the scene.  I am merely attempting to give a generalized description of the observable pattern, of the way in which the life process unfolds.  Insofar as this pattern implies only a certain direction in which life processes tend to move, and not any specific goal or end state at which they aim, my point of view is not strictly teleological but merely directional.  A general tendency, of course, cannot appear except in specific manifestations, and some of these manifestations will take the form of pursuit of special fix goals.  But it is the intrinsic pattern of direction that determines (or codetermines) what objects or states can become the organism's goals.  Objects which are, so to say, scattered along this direction may become goals for organismic activity.

 

The life pattern in man has such a great variety of expressions, differing from person to person, that it would be futile to attempt a complete inventory of all the channels through which the trend toward increased autonomy can be expressed.  This is clearly demonstrated by the attempts of different authors to compile lists of human drives, instincts, or wishes; the estimated number has varied from a few to a thousand, depending on the level of specificity at which the survey was made.  An additional difficulty in exemplifying the autonomous tendency with instances of actual behavior is that a single act may have, and usually has, more than one meaning.  Since the trend to increased autonomy is not the only human rend, we can also show, in a given instance of behavior, that some of its features manifest the autonomous tendency.  The following brief discussions merely point to some types of specifically human activity which serve as outlets for autonomous strivings for large groups of people.

 

I shall omit those processes and activities that are determined directly by the structural features of the human body, such as metabolic processes and reflexes, or standard reactions to standard physiological needs-although complex structures of subsidiary activities and meanings developed around some of these needs can subserve the autonomous human strivings in other than purely physiological ways.

 

Perhaps the clearest and most direct expression of the organism's tendency to impress its determination on a wide range of events is the drive to act, to make things happen for the mere joy of action and for the sake of experiencing oneself as the cause of changes.  Such activities may be observed even in the infant.  When the child's physiological needs are satisfied and no distress is present, he will move his limbs, produce noises, and later manipulate and explore objects.  When he begins to acquire language and to exercise his imagination, the child will use them in a similarly playful fashion.  When he learns that with words he can make the adults do what he wants, he exercises this "word magic" untiringly.  As development proceeds, the child will no longer be content with doing things for the sake of mere action.  To be satisfying the activity must lead to some tangible result, have a definite purpose.  In adults, relatively few forms of behavior express a mere drive for action; but although such a drive seldom occurs in "pure culture," it is a component in many activities, including work.  Apart from its practical purpose, one enjoys the achievement aspect of work, the overcoming of obstacles, and the increase in efficiency. One may even deliberately seek difficulties as a challenge for mastery.

 

Curiosity, the eagerness to explore and to know the world, is another manifestation of the trend toward increased autonomy.  That which one knows is to some degree conquered.  Knowing the properties of objects and the laws of various processes facilitates prediction and management.  While knowledge may serve practical purposes, it may also be pursued for the sake of knowing, as an expression of the self-expansive tendency.  Another common expression of the trend toward increased autonomy is the drive to acquire and accumulate property.  Possessing goods, of course, is important for the satisfaction of physiological and other needs, present and future, but it can also express the trend toward mastery more directly.  One's property differs from other objects in that one can do with it, to a large extent, whatever one wants. To own something may mean conquest, a greater possibility of dominance.  The defense of one's inviolacy and integrity against interferences from outside is also an aspect of autonomous strivings.  A person seeking an expression for his self-expansive tendencies through any form of behavior will resent and resist any intrusion into his activities; he will oppose domination by others, assert his right to his property, protect his privacy, and in general resist any encroachment of his sphere of freedom and mastery.

 

When the drive for expansion and mastery is directed not toward impersonal environment but toward one's fellow man, it appears as a tendency to dominate, to compete with, or to gain superiority over others.  These tendencies seldom occur in pure form, although they are a common aspect of interpersonal behavior.  If they manifest themselves in an excessive degree, at the expense of other kids of relationships, they must be viewed as distortions of the trend toward increased autonomy; such distortions may be based on very complex dynamics.

 

It is not by chance that the purest and strongest manifestations of the autonomous trend appear during the period of development, particularly in early childhood.  The child's speedy growth is paralleled by his intense drive to utilize and master his developing functions and to expand into the world.  The infant's exercise of autonomy is limited to his organic functions and to the expressive behavior which serves as a signal for the adult to try and guess its needs; the satisfaction of these needs is the function of others.  The child's need for food, warmth, etc., may be adequately met; yet before long he will want to "do it myself," even when he is not ready for it, and will protest against being helped.  If not discouraged by those around him, he will enjoy a variety of spontaneous activities, not limited to the gratification of physiological needs, and will practice his new functions in a persistent deliberate fashion.  Starting life in a state of dependency, he steadily grows toward independence and self-government and thus achieves greater fulfillment in one crucial aspect of living.  A person whose autonomous strivings have been abundant and successful in a variety of areas becomes resourceful and competent.  These qualities have an instrumental value in relation to his specific goals, but they are also values in themselves; as expressions of fullness of life they are unquestioned and unquestionable.  Developing competence and self-reliance is a part of the normal growth of personality and an important aspect of our ideal of maturity.

 

Disturbances of Autonomy

 

Neurotic living has for its constant concomitant an impairment of autonomy in some form and degree, though the specific dynamics that bring it about are different in different cases.  This aspect of neurosis has been pointed out by various authors.  Impairment of autonomy is one aspect of the "weak ego" concept of psychoanalysis.  It is central in Adler's conception of the inferiority complex, and it plays a part in the formulations of those authors who, like Fromm, emphasize the reduction of personal freedom in neurosis.

 

Phenomenologically, the manifestations of impairment or of distortion of the autonomous trend may appear as either a lack or an excess of autonomous striving, although the roots of the two groups of conditions may be similar.  When the lack of autonomy is a generalized one, the person's course seems to be determined by external happenings; he becomes a straw in the wind, a piece of driftwood carried by currents, a creature of circumstances.  This state of affairs is created by the person himself.  A self-image strongly colored by feelings of importance, whatever its origins, will affect the person's behavior and way of living and may eventually bring about an actual reduction of self-determination.

 

Other people, and the social and cultural situations created by them, are the most vital aspects of human environment.  Consequently, the impairment of autonomy has conspicuous and far-reaching results when it manifests itself in interaction with others.  Lack of self-government in interpersonal relations can take many shapes: excessive conformism, an ability to disagree with anybody, or dependence on the help of others far in excess of the objective necessity are examples familiar to everyone.  In most cases the genesis of these forms of behavior cannot be understood without taking into account the role played by tendencies other than the autonomous.  Thus the equation a child may have made between being loved and having things done for him may be at the root of his persistent clinging to dependence; it explains the often observed recurrence of helplessness after the arrival of a siblings.  Perhaps one of the most paradoxical manifestations of impaired autonomy is the behavior of a person who not only fails to assert himself but effectively invites exploitation.  By giving another the power to use him, this person exchanges his status of living organism for that of a mere tool.

 

The distortions which take the form of excessive autonomy are often compensations for real or felt lacks, reactions to threat.  Extreme resentment and rejection of any influence exercised by others is typical of the development phases marked by struggles for emancipation; in some neurotic forms rebelliousness and intolerance of any interference remain fixed patterns in adulthood.  The counterpart of clinging to dependence is the wish to be completely independent of others and to accept no help; this is sometimes a reaction against being babied, a protection against being destroyed as a self-determining individual.  Another variant of behavior which appears as an over strong drive for autonomy is the repetitive testing or "proving" of oneself by acts reasserting one's competence and mastery.

 

Disturbances of autonomous strivings form an important aspect of work inhibition, an ubiquitous condition in neuroses.  This impairment may reflect a fear of failure based on feelings of incompetence and helplessness-a reluctance to try in earnest, lest the outcome of a valid test should confirm one's worst fears-or it may express opposition to requirements felt to be imposed from outside.  In both cases the presence of autonomous strivings in a distorted form is quite obvious, and these are only two examples of many possible kinds of distortion.

 

Perhaps the most general structural feature of work inhibition is the disruption of integration in the dimension of progression, i.e., segregation of one part from the whole in the means-end sequence of behavior (See Chapter 4.)  For a healthy person the activity itself (though promoting some practical purposes, some other manifestations of autonomous coping with the world) retains its self-expressive value.  The activity is enjoyed for its own sake, not merely as a means to an end.  In fact, in cases of good integration the "end” is the totality of the work process of which the means are as much a part as the outcome.  In doing the parts one is doing the whole.  One does not merely want to "get there" but enjoys the total process of getting there, both the stretches of smooth functioning and the challenges presented by problems and obstacles.  Disturbances and inhibitions arise when, for whatever reason, the end result becomes dissociated from the activity as such.

 

The following is a patient's testimony: AI love fixing engines, and I love driving the go-cart in the race, but the thought of hooking the engine onto the go-cart and getting the cart to the track drives me crazy; at the thought of it I can't lift a screw driver." This patient enjoyed his sessions but missed many hours because he could not bear the thought of driving to them.  It was the same each morning; he liked the thought of being up but could not bear to go through the process of getting up.

 

Such situations often develop if the outcome of an activity-seen, e.g., in terms of earnings or prestige-becomes all-important.  The "means" activities then are no longer a source of pleasure but merely an annoying obstacle, or at best a peripheral devitalized process.  Thus work deteriorates into a chore.  Since in our culture work forms the bulk of adult activities, this transformation does not merely diminish one's effectiveness, it also greatly reduces the joy of living potentially available to the person.

 

The integrated functioning of any general trend presupposes a harmonious balance between the trend itself and its specific content, the process which embody the trend and give it concrete existence.  Some of the expressions of the trend toward increased autonomy-such as those insuring the intake of food-are prescribed by physiological necessity; some are made inaccessible for the person by his state of physical or mental development, by cultural prohibitions, or by the external circumstances.  Yet normally the person still has a wide range of autonomy-increasing activities available to him from among which he can choose, and shift, according to his preferences.  Thus communication between "surface” and "depth" is maintained.  The underlying trend, the dynamic Gestalt, retains its transposability, and a variety of specific activities can acquire vital meaning as embodiments of the trend.  Each activity is valued as an expression of the basic trend and is also enjoyed in its specificity, in the particular patterning it contributes.

 

If for some reason this coherence between the pattern and its potential material gets disrupted, the general pattern becomes schematic and empty, and the concrete activities become either meaningless or too important in their specifics.  In some cases autonomous strivings can be expressed only in very special limited ways-a situation analogous to that of a person who must limit his diet to one kind of food.  Should this food not be easily available, most of his efforts must be spent on obtaining it.  Or a person may focus all his strivings on one particular goal only to find that when reached it fails to bring satisfaction.  The overvalued goal has become segregated from its roots and lost its function of expressing the basic trend.  A different case of disturbed balance between the trend and its expressions is that of a person who finds no concrete ways to embody his autonomous strivings, which are consequently fated to remain shadowy and unreal; witness the feeling of some patients and of many normal adolescents that they cannot focus on anything because they are attracted by everything, or wish to actualize all their potentialities.  A striking expression of an "empty" unembodied autonomous drive is the passionate assertion made by an adolescent who feels that he is fighting for his freedom and integrity, but cannot define his goals in any positive terms: "I want to do what I myself want to do, but I don't know what it is."  To anticipate the topic of the next chapter, we find a similar disturbance in the functioning of the other major trend in those adolescents who are "in love with love," the concrete objects of this love being highly changeable or remaining elusive.  All disturbances of this type may be viewed as instances of disruption of integration in the vertical or depth dimension, i.e., of segregation of an underlying trend from its concrete expressions.  This disruption may also result in disturbances of the transverse structure of behavior, i.e., in a lack of coordination between various personal pursuits.  (See Chapter 4.)