Dr. Kavaler-Adler begins her critique by pointing out that I failed to make adequate links between affective neuroscience and the psychoanalytic process, especially the transference and symbolic meaning. This is a fair point. I should have realized that a paper relying so heavily on neuroscientific research would be alien to most psychoanalytic readers. I had wanted to delineate ways in which neuroscience can inform psychoanalysis and I had expected that readers would make the connections for themselves. In light of Kavaler-Adler's remarks, my expectation was naïve. Dr. Kavaler-Adler also points out my failure to mention Melanie Klein when speaking about psychoanalytic innovators. I apologize for this oversight.
My paper elaborated two points, the first of which is that neuroscientific data is scientifically credible, while psychoanalytic data is less credible because it is based on behavior and verbal reports, both of which are open to interpretation and disagreement. Jaak Panksepp, has delineated a taxonomy of seven basic emotional systems found in all mammalian brains. His taxonomy is more reliable and complete than any provided by psychoanalysis. It is more reliable because it is rooted in brain science, identifying specific brain structures and brain chemicals involved in each system. It is more complete because it offers surprises. For example, the urge to PLAY, especially in young animals, is a basic emotional motivating drive.
It is obvious to me that psychoanalysts gain their understanding from a patient's behavior and verbal reports. How else do we learn about them or about anybody? However, Dr. Kavaler-Adler states that I devalue the analytic patient when I speak about verbal reports and behavior. She also writes, “As far as I know, when analytic patients only offer behaviors they are acting out, and when they only offer ‘verbal reports’ they
are defensively contriving their self expression, rather than allowing the spontaneous emergence of unconscious feelings and psychic fantasy imagery.”
I am not sure that I understand her objections. I never meant to devalue patients and I have never encountered any patients who offer only behavior or only verbal reports. It is always an amalgam of both, in my experience. In any case, behavior can sometimes be an instance of acting out, but it is often a spontaneous expression of emotion. For example, a frown might defensively hide a forbidden delight, but it might express genuine irritation or even confusion. The same claim can be made about verbal reports—words too can deceive or reveal.
It is not always easy to discern the true meaning of a person's behavior or to correctly understand the things about which he or she speaks. Brain science, on the other hand, relies on observable physical data and offers greater scientific reliability about the nature of emotion and affect. For example, when Bowlby first wrote about non-sexual attachment as a primary drive, many analysts disagreed, arguing that attachment may seem to be non-sexual, but that it is really a sublimation of the libidinal drive. Although general opinion now favors Bowlby, this does not resolve the controversy scientifically.
Neuroscience does offer resolution. When rat pups are deprived of maternal care, their brains have fewer opiate receptors. Endogenous opiates are comfort chemicals that facilitate positive non-sexual social interactions. Poorly nurtured rats exhibit anxious behavior and the females become inattentive mothers. Chemicals like morphine and heroin, both opiate agonists, do not induce hypersexuality in human beings or in animals. Rather they are powerful anti-depressants. Therefore, neuroscientific evidence indicates that non-sexual attachments are not basically libidinal as Freud thought.
On the basis of this kind of neuroscientific evidence, Panksepp proposed a GRIEF system consisting of brain structures that include cingulated cortex, septal area, bed nucleus of the stria terminalis, the preoptic area, dorsomedial thalamus and periaqueductal gray, all of which are largely fuelled by endogenous opioids. When we are in the company of friends and family opioids are plentiful and we feel good. But when we are
abandoned and lonely, opioids are in short supply and we are miserable. The GRIEF system is Janus-faced but neither face concerns sexuality. This neuroscientific evidence supports Bowlby rather than Freud and it is the kind of physical evidence that is more convincing than are theories based on the things that people say and do.
When elaborating on the seven emotional systems, I wrote about the importance of the SEEKING system, which engenders feelings of euphoric, enthused anticipation along with a sense of agency and a willingness to take risks. I said that while most psychoanalysts accept that attachment (GRIEF) is a basic emotion, the SEEKING system is not fully appreciated. Dr. Kavaler-Adler points out that analysts like Mahler and Klein have highlighted the importance of agency. Dr. Kavaler-Adler herself has written about the role of agency in mourning and development. The SEEKING system, however, encompasses more than agency in the struggle to develop and overcome negative affects of grief and mourning. It is a spontaneous, positive response to life challenges. For example, the SEEKING system is unconditionally aroused when animals are hungry and it spurs them to hunt for food with energy and determination. No doubt Dr. Kavaler-Adler and others appreciate the importance of agency and they may also see the significance of euphoric enthusiasm. However, in my experience, the positive effects of SEEKING arousal remain underappreciated.
The second point of my paper concerned neuroscientific explanations for psychotherapeutic failure. Neuroscience demonstrates that, in general, the cognitive cortex inhibits emotional arousal, while emotional systems arouse the cortex. For example, if you are frightened by a horror-vampire movie, you can regain your composure by telling yourself that vampires do not exist. Conversely, if you are robbed at gunpoint, your FEAR system will be aroused, and you might experience worrying thoughts, bad dreams or even PTSD. Neuroscience demonstrates that more neural connections lead from emotional systems up to the cognitive cortex than in the reverse downward direction. This means that emotions have more power to arouse the cortex than the cortex has to quell emotional arousal.
Psychoanalysis relies on the power of cognitive understanding and the inequality of influence between emotional systems and the cognitive
cortex offers a credible explanation for psychoanalytic failure. This evidence does not undermine the value of psychoanalysis, which is often effective. However, every psychoanalyst knows that treatment has limitations. Nobody has a 100% success rate. We should try to understand when and why psychoanalysis fails.
Dr. Kavaler-Adler, seems to have more confidence in psychoanalysis than do I. She agrees that psychoanalytic gains can be lost during periods of stress, but she believes that analytic insights can redress the balance. Later in her critique she writes about the addictive power of intense emotion, which she distinguishes from pleasure. Most addicts feel better when they take drugs or drink alcohol. They are addicted to the affective pleasure which temporarily replaces and eradicates their misery. If one is addicted to an intense emotion that does not provide pleasure, what motivates such addictions? Such non-pleasurable “addictions” indicate that a person is in the grip of overpowering emotions. I gather that Dr. Kavaler-Adler believes that therapy can address and overcome such unpleasurable addictions. On both points I am not as sanguine. In my experience, even after relatively successful therapy, severe stress, such as bereavement or physical illness, can set in motion a regressive process that is difficult to ameliorate. Similarly, some patients are resistant from the start. Sometimes patients abandon therapy early on, and in other cases, treatment drags on but does not help. The inequality between emotional systems and the cognitive cortex may explain these sad outcomes.
These disagreements notwithstanding, Dr. Kavaler-Adler and I might see eye-to-eye on some issues were we to engage in a conversation rather than in the formal setting of paper-critique-reply. I liked her comments about knots in the stomach reflecting a knotty psychic conflict, and I would like to talk more with her about the mind/body relationship. Likewise, I found her links between parasympathetic arousal and the depressive position persuasive, and, again, I would like to discuss these ideas further. I also thank her for criticizing my failure to make adequate connections between neuroscientific research and the psychoanalytic situation. In contemplating her remarks, I think I might find ways to do better.