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What's the point of neuropsychoanalysis?

  • Franck Ramus (a1)
Summary

Neuropsychoanalysis is a new school of thought attempting to bridge neuroscience and psychoanalysis. Yet few neuroscientists and psychiatrists would have heard of it if it had not recently received public support from notable neuroscientists. The present paper discusses whether such support is warranted.

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References
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1 Panksepp, J., Solms, M. What is neuropsychoanalysis? Clinically relevant studies of the minded brain. Trends Cogn Sci 2012; 16: 68.
2 Kandel, ER. A new intellectual framework for psychiatry. Am J Psychiatry 1998; 155: 457–69.
3 Laufer, E. (ed.) The Psychoanalytic Review Special Issue. On the Frontiers of Psychoanalysis and Neuroscience: Essays in Honor of Eric R. Kandel. Guilford Press, 2012.
4 Damasio, AR. Neuroscience and psychoanalysis: A natural alliance. Psychoanal Rev 2012; 99: 591–4.
5 LeDoux, J. Afterword. Psychoanal Rev 2012; 99: 595606.
6 LeDoux, JE. The Emotional Brain: The Mysterious Underpinnings of Emotional Life. Simon & Schuster, 1996.
7 Kandel, E. The Age of Insight: The Quest to Understand the Unconscious in Art, Mind, and Brain, from Vienna 1900 to the Present. Random House, 2012.
8 Carhart-Harris, RL, Friston, KJ. The default-mode, ego-functions and free-energy: a neurobiological account of Freudian ideas. Brain 2010; 133: 1265–83.
9 Janet, P. L'automatisme Psychologique: Essai de Psychologie Expérimentale sur les Formes Inférieures de l'activité Humaine [Psychological automatism: Experimental psychology essay on the lower forms of human activity]. F. Alcan, 1889.
10 Esterson, A. Freud returns? Butterflies & Wheels, 3 May 2004 (http://www.butterfliesandwheels.org/2004/freud-returns/).
11 Marr, D. Vision: A Computational Investigation into the Human Representation and Processing of Visual Information. W.H. Freeman, 1982.
12 Morton, J., Frith, U. Causal modeling: a structural approach to developmental psychopathology. In Developmental Psychopathology Volume 1: Theory and Methods (eds Cicchetti, D., Cohen, DJ): 357–90. Wiley, 1995.
13 Morton, J. Understanding Developmental Disorders: A Causal Modelling Approach. Blackwell, 2004.
14 Misès, R. (ed.) Classification française des Troubles Mentaux de l'enfant et de l'adolescent R-2012: Correspondances et Transcodage – CIM10 (5e édition) [French Classification of Mental Disorders in Children and Adolescents R-2012: Correspondence and Transcoding with ICD-10 (5th edition)]. Presses de I'EHESP, 2012.
15 Amaral, D., Rogers, SJ, Baron-Cohen, S., Bourgeron, T., Caffo, E., Fombonne, E., et al. Against le packing, a consensus statement. J Am Acad Child Adolesc Psychiatry 2011; 50: 191–2.
16 Jolly, D., Novak, S. A French film takes issue with the psychoanalytic approach to autism. The New York Times, 19 Jan 2012 (http://www.nytimes.com/2012/01/20/health/film-about-treatment-of-autism-strongly-criticized-in-france.html?pagewanted=all).
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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What's the point of neuropsychoanalysis?

  • Franck Ramus (a1)
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eLetters

Would neuropsychoanalysis ever be possible?

Claudio Gentili, Assistant Professor in Clinical Psychology
13 October 2013

The idea of merging neuroscience and psychoanalysis is intriguing and supported by both leading neuroscientists and psychoanalysts (1). However, in addition to the criticisms raised by Ramus (2), we believe one additional fundamental aspect must be overcome before science may celebrate the birth of a new discipline. From an epistemological point of view, in line with Karl Popper, psychoanalysis cannot be considered science, but rather "metaphysics". Unlike neuroscience, psychoanalysis does not follow the "scientific method", it is not falsifiable, and hence neuropsychoanalysts do not test their theories in an empirical way. Consequently, the great majority, if not all, of the neuropsychoanalysis papers are theoretical reviews loosely based on results from neurobiological research rather than original studies designed to verify specific hypotheses. Indeed, neuropsychoanalytic statements appear to be based merely on surface analogies. For instance, some authors claim that the Default Mode Network (DMN) may represent the neurobiological substrate for the Freudian Ego (3), simply because the DMN areas are more active during self-directed mental activities as compared to externally directed ones, increase their internal coherence from childhood to adult life, are dysfunctional in several psychiatric disorders and are partially involved in autobiographic memory. Although the above characteristics belong to Ego as well, other intrinsic DMN properties are in sharp contrast with the properties that define Ego: DMN is present also in non-human primates, its activity changes just slightly during REM and N-REM sleep, and it does not fade completely during coma or anesthesia. On the same line, the finding that empathy may be rooted in the mirror neuron system (MNS) does not have any direct implication for fundamental psychoanalytic concepts like emotional contagion, countertransference or projective identification (4). Empathy and emotional contagion are not synonymous, and no study has yet shown in an unambiguous way that MNS is involved in emotional contagion. More importantly, countertransferance and projective identification of the therapist are emotional processes that may even end up being of an opposite sign as compared to the patient's emotional state. Therefore, MNS would not merely generate a "mirror" emotion, but rather a more complex, multiple-step emotional reaction (a sort of "deforming mirror"). No scientific study has yet proven MNS to do so. In sum, the cases above are just two of the multiple examples that indicate how the asserted relationship between neuroscience and psychoanalysis to date has relied on surface analogies, which stem out of representativeness heuristics and cherry-picking processes. Therefore, these claims do not survive a deeper analysis. Neuroscience has been proving itself to be a powerful tool to dissect old fundamental issues in psychology, philosophy and ethics and it will likely bridge a gap in psychoanalysis as well (5). From this perspective, a dialogue between neuroscience and psychoanalysis is highly desirable. For it to happen, though, psychoanalysis will have to move from the Authority Principle and begin to obey to the laws of scientific methodology - e.g., reproducibility, falsification, verifiability, measurability. Would this ever be possible?1) Panksepp, J., & Solms, M. What is neuropsychoanalysis? Clinically relevant studies of the minded brain. Trends in Cognitive Sciences, 2012; 16: 6-8. 2) Ramus F. What's the point of neuropsychoanalysis? Br J Psychiatry. 2013; 203: 170-1. 3) Carhart-Harris, R. L., Mayberg, H. S., Malizia, A. L., & Nutt, D. Mourning and melancholia revisited: correspondences between principles of Freudian metapsychology and empirical findings in neuropsychiatry. Annals of General Psychiatry 2008; 7, 9-42.4) Gallese, V., Eagle, M. N., & Migone, P. Intentional attunement: mirror neurons and the neural underpinnings of interpersonal relations. Journal of the American Psychoanalytic Association 2007; 55: 131-176.5) Pietrini P. Toward a biochemistry of mind? Am J Psychiatry 2003; 160: 1907-8. ... More

Conflict of interest: None declared

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pinpointing the point

jeremy a holmes, Visiting Professor
09 September 2013

In Ramus' (1) enthusiasm to rid himself of franco-freudian bathwater and champion what he rather blandly calls 'psychology', he has jettisoneda 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-to-adult, therapists and their patients. Relational neuroscience brings together insights from psychoanalysis and neuroscience, clarifying and deepening understanding inboth fields. Here are three brief examples. Strathearn et al (2) show howinsecurely 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 (3) fMRIstudy 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 (4) finding ofactivation of Cg25 region of the cyngulate gyrus in profound depression isconsistent with the idea of an interpersonally isolated and punitive superego desperately trying to prevent overwhelming Pankseppian modalitiesimpulses of PANIC and RAGE from reaching consciousness (5). 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 isa 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. Today's psychoanalysts' task 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 andconceptual innovation, reveals the mechanisms by which evolutionary changecomes about. Similarly, contemporary neuroscience helps unravel the brainpatterns 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 HPA axis and its embodiment in the nervous and endocrine systems; 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-heldgood object. Both viewpoints no doubt have fascinating, if as yet undiscovered, brain correlates.

Jeremy holmesSchool of Psychology, University of Exeter, EX4 4QG, UKj.a.holmes@btinternet.com

1)Ramus F. (2013) What's the point of neuropsychoanalysis? British Journal of Psychiatry 203 170-1712)Strathearn, L., Fonagy, P., Amico, J., & Montague, P. R. (2009). Adult attachment predicts maternal brain and oxytocin response to infant cues. Neuropsychopharmacology, 34, 2655-2666.3)Coan J., Schaeffer, H. & Davidson, R. (2006) Lending a Hand: social regulation of the neuronal response to threat. Psychological Science 17 1032-10394)Carhart-Harris, R., Mayberg, H., Malizia, A. & Nutt, D. (200-8) mourning and melancholia revisited: correspondences between principles of Freudian metapsychology and empirical findings of neuropsychiatry. Annals of General Psychiatry, 7, 9-42.5) Holmes, J. (2013) An attachment model of depression: integrating findings from the mood disorder laboratory. Psychiatry 76 68 -86

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Conflict of interest: None declared

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The latest manoeuvre in the Freud Wars

Felicity Callard, Senior Lecturer in Social Science for Medical Humanities
09 September 2013

It is hard to know with whom Ramus is most angry. Is it the esteemed neuroscientists, (Damasio, Friston, Kandel, LeDoux), whom he considers to have lent credence to psychoanalysis? Or is it the neuropsychoanalysts (largely engaged via only one position paper by Panksepp and Solms and an article co-authored by Carhart-Harris), who represent to him another attempt to 'rehabilitate' Freud? Or is it the French psychoanalysts, whom,he argues, harm patients and hold back 'evidence-based psychiatry'? Or is it Freud himself, whose ideas Ramus regards as both unoriginal - Plato andPierre Janet said it all before - and malignant?

The historian of psychoanalysis John Forrester would not be surprisedby Ramus's mode of critique. Forrester noted in the late twentieth centurythat the 'classic maneuver' by those opposing Freud is to argue that 'if what he says is right, he stole it from somewhere else ... On the other hand, if what he says is wrong, it belongs entirely to him and it is we who are the fools if we believe it.'1 Ramus's scattergun attack on neuropsychoanalysis should, indeed, be seen as the latest skirmish in the interminable Freud Wars.

But what Ramus's attack on neuropsychoanalysis obscures - by interpreting neuropsychoanalysis as, ultimately, an attempt simply to 'rehabilitate' Freud - is what is arguably most interesting about it (at least from my perspective as a historian of science and psychiatry). For while neuropsychoanalysis situates itself in proximity to Freudian psychoanalysis, it is a distinct project.2 It differs in several of its scientific methods, terminologies and objects; the canon on which it draws; and some of its modes of clinical treatment.3 And consider Solms and Panksepp, whom Ramus, like many, takes to be the central architects ofneuropsychoanalysis. There is something both fascinating and unexpected about a neuropsychologist and psychoanalyst (Solms) joining forces with anaffective neuroscientist (Panksepp) whose research career has been built on electrical stimulation studies involving non-human animals (which vocalize, but do not talk; cf. psychoanalysis as 'the talking cure'). Their partnership is built on their separate and conjoined challenge to dominant models of the emotions in cognitive and affective neuroscience4 5- and affect, indeed, forms one of the main lines of neuropsychoanalytic research. Both would virulently disagree with Ramus's claim that the ideasthey attribute to neuropsychoanalysis 'are already mainstream within cognitive, social, and affective psychology and neuroscience'.

To understand the specificities of 'neuropsychoanalysis' - in relation to as well as in contradistinction from psychoanalysis - requires, at the very least, reading the peer-reviewed journal Neuropsychoanalysis (not referenced by Ramus), which is the central locus for scientific and clinical data, disputation and model-building amongst neuropsychoanalytic researchers and clinicians, as well as their interlocutors. For Ramus, such efforts would be unnecessary. His consummate lack of doubt as regards what (the heterogeneous practices of) psychoanalysis and neuropsychoanalysis are and do, as well as '[w]hat is needed' for any proper 'rehabilitation' of psychoanalysis, ensure that forhim any further enquiry would be otiose. His scientific and moral certainty is both remarkable and dismaying.

1. Forrester J. Dispatches from the Freud Wars: Psychoanalysis and its passions. Cambridge, MA: Harvard University Press, 1997.2. Papoulias C, Callard F. The rehabilitation of the drive in neuropsychoanalysis: from sexuality to self-preservation. In: Kirchhoff C,Scharbert G, editors. Freuds Referenzen. Berlin: Kulturverlag Kadmos, 2012:189-215.3. Fotopoulou A, Pfaff D, Conway MA, editors. From the Couch to the Lab: Trends in Psychodynamic Neuroscience. Oxford: Oxford University Press, 2012.4. Panksepp J. Affective Neuroscience: The Foundations of Human and AnimalEmotions. New York: Oxford University Press, 1998.5. Solms M, Nersessian E. Freud's theory of affect: questions for neuroscience. Neuropsychoanalysis 1999;1(1):5-14.

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