In Ramus's Reference Ramus1 enthusiasm to rid himself of Franco-Freudian bath-water and champion what he rather blandly calls ‘psychology’, he has jettisoned a lusty baby. It is precisely the superficiality of much of academic psychology that draws neuroscientists to psychoanalysis, in their search for models of the mind compatible with brain science. The central focus of psychoanalysis is the development and vicissitudes of intimate relationships: parent-child, adult-adult, therapist-patient. Relational neuroscience brings together insights from psychoanalysis and neuroscience, clarifying and deepening understanding in both fields. Here are three brief examples. Strathearn et al Reference Strathearn, Fonagy, Amico and Montague2 show how insecurely attached mothers respond to images of their crying babies with activation of brain areas associated with disgust rather than care, compared with their securely attached counterparts. Coan et al's Reference Coan, Schaeffer and Davidson3 functional magnetic resonance imaging study of married couples illustrates how holding a loved-one's hand mitigates the impact of anticipated threat, with reduced need for self-oriented defensiveness as manifest by less activation of the anterior insula and superior frontal gyrus. Carhart-Harris et al's Reference Carhart-Harris, Mayberg, Malizia and Nutt4 finding of activation of Cg25 region of the cingulate gyrus in profound depression is consistent with the idea of an interpersonally isolated and punitive superego desperately trying to prevent overwhelming Pankseppian modalities impulses of panic and rage from reaching consciousness. Reference Holmes5 All three examples suggest the profoundly interpersonal aspect of affect regulation, implicit in psychoanalytic theories, and that the capacity to experience, tolerate and integrate negative emotions with the help of a loved other is a mark of psychological health, as well as being a goal for psychotherapeutic treatment of depression and anxiety.
In Whitehead's aphorism, ‘a science which hesitates to forget its founders is lost’. We need to be able to kill the fathers; but it is equally important to honour them. The task of today's psychoanalysts is to sift the gold from the dross in Freud and his successors' ideas. Paradigm shift instigators like Freud may be argued with, superseded at times, but never forgotten. We are still ‘Darwinians’, despite the fact that Darwin had no model of DNA to help him explain how acquired characteristics were transmitted across the generations. Modern genetics, through technical and conceptual innovation, reveals the mechanisms by which evolutionary change comes about. Similarly, contemporary neuroscience helps unravel the brain patterns which underlie some of Freud's pioneering insights. These include: the fragility of the ego compared with the pulsive power of midbrain and limbic structures; the drawbacks - in terms of energetic overload and sequestration from learned experience - of self-oriented rather than interpersonal defences, preventing impulses from the limbic system from reaching the prefrontal cortex; how top-down regulation (mentalising), fostered by therapy, can mitigate self-destructive impulses ‘from below’; the impact of trauma on the hypothalamic-pituitary-adrenal axis and its embodiment in the nervous and endocrine systems; and how, given adverse developmental and interpersonal circumstances, this complex mind-body system can founder, producing the phenomena of mental illness.
Ramus is no doubt right to suggest that intensive psychoanalysis is an inappropriate first-line treatment for autism, but to base his widespread condemnation on this aberration is to mistake the part for the whole. From a psychoanalytic perspective the latter error might be a manifestation of ‘paranoid schizoid’, rather than ‘depressive position’ thinking, of pre-mentalising rather than mentalising mode. Admittedly, this letter could equally be seen as a last-ditch defense of a dearly held good object. Both viewpoints no doubt have fascinating, if as yet undiscovered, brain correlates.