"The deficiencies in our description would probably vanish if we were already in a position to replace the psychological terms with physiological or chemical ones...We may expect [physiology and chemistry]
to give the most surprising information and we cannot guess what answers it will return in a few dozen years of questions we have put to it. They may be of a kind that will blow away the whole of our artificial structure of hypothesis.” Sigmund Freud (1920- Beyond the Pleasure Principle)

"Psychoanalysis is based on the biological force to find meaning that is more deeply rooted than an intellectual conviction about the genetic basis of psychological illness." Peter Fonagy

I am currently reading Rachel Blass & Zvi Carmeli’s (2007) article “The case against neuropsychoanalysis: On fallacies underlying psychoanalysis’ latest scientific trend and its negative impact on psychoanalytic discourse” published in the International Journal of Psychoanalysis, 88, 19-40.

I would like to critique this article and some of the many issues it opens up in a series of postings. Hopefully, other ISPS members will join in and engage in a dialogue about this important subject. To begin with, I am not going to speak specifically from the perspective of neuropsychoanalysis. I prefer to think of psychoanalysis as standing on its own and as resilient enough to be able to ‘take in’ influences from multiple disciplines, e.g., neuroscience, developmental psychobiology, epigenetics, infant research, literature, sociology, etc. The problem of psychoanalysis in today’s world in which translational and interdisciplinary research is encouraged, as I see it , is analogous to the problem of the human cell and psyche: how to retain one’s structural identity but not be too rigid as to ward off and reject outside influences which can be potentially nourishing. Neuropsychoanalysis may, in the long run, serve to be more of a corrective influence on psychiatry than psychoanalysis. Leon Eisenberg, a highly regarded social psychiatrist at Harvard, cautioned the field of psychiatry to steer between a brainless psychiatry of the past and a mindless psychiatry of the present. I believe the hegemony of psychiatric radical reductionism and neurobiological reductionism, exemplified in many psychiatric journals, as well as media ads, particularly in the US, is gradually being replaced in academic settings by translational and integrative approaches. The latter is more prevalent in Europe, e.g., the Netherlands, Scandinavia, the UK, Switzerland and Italy.

Blass and Carmeli have done the field a service through their scholarly review of the research and their constructive criticism of neuropsychoanalysis. I do not agree with all of their perceptions of the latter field, e.g., on the issue of non-recollection of non-symbolized memories. Many neuropsuchoanalysts (e.g., Mauro Mancia) emphasize that these experiences encoded in implicit memory (mediated more by the amygdala than the hippocampus) can be discerned in such phenomena as the transference and dreams. In addition, the ‘bilogism’ that Blass & Carmeli seem to be engaged in a polemic with, is reductionistic biology and neuroscience, which does not include as an intimate part of it interactionality with other persons. It seems steeped in Cartesian dualism. Piaget pointed out in his genetic epistemology and conservation experiments, how difficult it is to keep in mind various dimensions of an
object simultaneously, eg. width and height ( or for our purposes, brain and mind). In the field of mental illness I have been making a plea for an in-depth integration of the Rosetta Stone of the three languages of brain, mind and culture. Human beings and their ills are so complex that a single language, whether it be the language of molecular biology (and its cousin, psychopharmacology), sociology, psychoanalysis or cognitive neuroscience, is not adequate to the task of understanding a human being. In short reductionism, as it is in such fields as physics, must give way to emergence (study of complex organizational patterns, whether it is the fractional quantum Hall effect in physics or transference in
psychoanalysis).

Eric Kandel (2005-”Psychiatry, Psychoanalysis, and the New Biology of Mind”) made a plea that psychoanalysis create closer links with biology and cognitive neuroscience. I would add to this the fields of social and affective neuroscience. Kandel is quite aware, however, that at present we have no satisfactory biological understanding of complex mental processes.  He outlined many areas in which psychoanalysis and neuroscience could potentially enrich each other (many of these were focused on in the Blass & Carmeli article): the nature of unconscious mental processes; the nature of psychological causality; psychological causality and psychopathology; early experience and predisposition to mental illness; psychotherapy and structural changes in the brain; psychopharmacology as an adjunct to psychoanalysis, etc. Mancia (2006) also made a list of potentially fruitful areas in which neuroscience and psychoanalysis can collaborate: the study of emotions and their development within relational contexts (I would add also the sociocultural piece-the ‘big history’ of the family and individual, sometimes involving social catastrophes and upheavals); memory systems and unconscious processing of experience (I think of what Winnicott was reaching for in his gem of a paper “Fear of Breakdown”);
dreams, REM and non-REM sleep; ultrasound studies of the fetus (the kind of research Alessandra Piontelli and Johannes Lehtonen are doing)-I would add the effects of prenatal stress on the developing fetal neuroaxis; early-infant mother communication; neurobiological maturation (I would add its effects on affect regulation); the study of empathy, embodied simulation, sharing of emotional pain, mirror neuron systems, etc. 

Many authors in the field have cautioned us to include the psychological level in our analysis of neuroscience research. Bolton and Hill (1996) noted that intentionality (beliefs, goal-directed plans,
fears, etc.) and experience pervade biological systems to the molecular level. This is borne out in neuroscience research in which psychogenic stress was genotoxic in various body cells. Fishman and colleagues (1996) reporting in the International Journal of Neuroscience demonstrated in
rats that behavioral, psychogenic stress can result in DNA damage and chromosome aberrations. They noted:”behavioral stress can induce genotoxic damage on at least two levels, chromosomal and molecular, and in at least two cell types, bone marrow and leukocytes” (p. 224). Bolton and Hill assumed that mental states characterized by intentionality could not be reduced to physico-chemical or neural processes without valuable information and meaning being lost in the process. They criticized what is
known as “biological psychiatry” for reducing biological processes to physics and chemistry and departing from an intentional-causal analysis which is essential in both psychology and biology.

Neuroscience and psychoanalysis are two distinct disciplines which have much to offer each other. It is not a matter that the way forward for psychoanalysis is to ‘submit’ to an imposition onto it of neuroscience, rather, the sharing of new information which can help to clarify mind-body
interactions which seem to require more than one approach to arrive at a fuller understanding.

I do not believe that it is necessary for analysts to have a deep knowledge of the CNS in order to assist their patients in living fuller, less constricted lives. Personally, I have found the study of the brain
helps me to understand more deeply such phenomena as anxiety (e.g., why anxiety contains within it the sense of being out of control), rage, shame, transference/countertransference interactions, addictions, etc.   The complexity of the brain (I am including some information on this below), as well as its neuroplasticity, including such processes as neurogenesis, epigenetics and the regulation of gene expression, e.g., demethylation of DNA, speaks to me of the importance of relationships and subjectivity in the development of the human person. It may well be that Martin Buber’s statement “All real living is meeting” may well be true at all levels of the human being (including the relation between the CNS and
immune systems). I am including some key references for those persons interested in pursuing this subject further. I have ommitted many fine volumes which may be more widely known to our ISPS community.

Bilder, R.M. & LeFever, F.F. (Eds.) (1998). Neuroscience of the Mind on
the Centennial of Freud’s Project for a Scientific Psychology. New York:
Annals of the New York Academy of Sciences, Volume 843.

Bolton, D. & Hill, J. (1996). Mind, Meaning, and Mental Disorder: The
Nature of Causal Explanation in Psychology and Psychiatry. NY: Oxford
University Press.

Corrigal, J. & Wilkinson, H. (Eds.) (2003). Revolutionary Connections:
Psychotherapy and Neuroscience. NY: Karnac.

Cozolino, L. (2002). The Neuroscience of Psychotherapy: Building and
Rebuilding the Human Brain. NY: W.W. Norton & Company.

Cozolino, L. (2006). The Neuroscience of Human Relationships: Attachment
and the Developing Social Brain. New York: W.W. Norton & Company.

Grawe, K. (2007). Neuropsychotherapy: How the Neurosciences Inform
Psychotherapy. London: Lawrence Erlbaum Associates.

Green, V. (Ed.) (2003). Emotional Development in Psychoanalysis,
Attachment Theory and Neuroscience: Creating Connections.
NY:Brunner-Routledge.

Kandel, E.R. (2005). Psychiatry, Psychoanalysis, and the New Biology of
Mind. washington, DC: American Psychiatry Publishing, Inc.

Kandel, E.R. (2006). In Search of Memory: The Emergence of a New Science
of Mind. New York: W.W. Norton & Company.

Kaplan-Solms, K. & Solms, M. (2000). Clinical Studies in
Neuro-Psychoanalysis: Introduction to a Depth Neuropsychology. New York:
Karnac Books.

LeDoux, J. (2002). Synaptic Self: How Our Brains Become Who We Are. NY:
Penguin

Levin, F. (1991). Mapping the Mind: The Intersection of Psychoanalysis and
Neuroscience. Hillsdale, NJ: The Analytic Press.

Levin, F. (2003). Psyche and Brain: The Biology of Talking Cures. Madison,
CT: International Universities Press.

Mancia, M. (Ed.) (2006). Psychoanalysis and Neuroscience. New York:
Springer.

Modell, A. H. (2003). Imagination and the Meaningful Brain. Cambridge, MA:
The MIT Press.

Moskowitz, M., Monk, C., Kaye,C. & Ellman, S. (Eds.) (1997). The
Neurobiological and Developmental Basis for Psychotherapeutic
Intervention. Northvale, NJ: Jason Aronson Inc.

Panksepp, J. (1998).Affective Neuroscience. Oxford University Press

Pliszka, S.R. (2003). Neuroscience for the Mental Health Clinician. New
York: The Guilford Press.

Rose, S. (2005). The Future of the Brain: The Promise and Perils of
Tomorrow’s Neuroscience. New York: Oxford University Press.

Sanguineti, V. (2007). The Rosetta Stone of the Human Mind: Three
Languages to Integrate Neurobiology and Psychology. New York: Springer.

Solms, M. & Turnbull, O. (2002). The Brain and the Inner World: An
Introduction to the Neuroscience of Subjective Experience. NY: Other Press.

(A fuller bibliography is available upon request from the author)

The human brain: Complexities involved

To begin with, it is important to keep in mind that the human brain is the most complex organ that we know of. Gerald Edelman (Edelman & Tononi, 2000), Nobel Prize Laureate in Medicine and director of The Neuroscience Institute of Scripps, pointed out that of the 100 billion or so neurons, the cerebral cortex contains about 30 billion and 1 million billion synapses-the possible number of neural circuits is a factor of 10 followed by at least a million zeros.  If we counted one synapse per second, we would not finish counting for 32 million years. Sanguineti (2007) noted that there are on average  10,000 to 100,000 synapses per neuron. Our brains form a million new connections for every second of our lives
concludes Colin Blakemore, a neuroscientist at the University of Oxford and chief executive of the UK Medical Research Council (26 November 2005 NewScientist.com news service). The number of possible neural circuits, or mental states, i.e., individual minds, which could potentially be constructed from all of the possible dynamic patterns among cell assemblies is at least as large as 101017. This hyperimmense number is staggering when you compare it to the atomic mass of the universe, i.e., the number of protons in the universe, which is 1080. The age of the universe (about 20 billion years) in units of picoseconds (the basic time unit of chemical dynamics) is about 1030. Because of this complexity,
Sanguineti (2007) concluded:

“Therefore the complexity of the structural organization that forms the foundation to mind can be described as hyperimmense and justifies the opinion of many scientists that the brain is the most
complicated known physical structure in the entire universe and that its connectivity, dynamics, and ways it relates to the body and to the world are like nothing else science has ever encountered” (p.16).

Brian Koehler