Psychodynamics and Neurobiology: An Integrated Approach

As a discipline, psychiatry has evolved along two major paths that reflect its concern with mind and brain. Unfortunately, this has promoted a Cartesian dualism dividing the psychological from the biological, leading to the conceptualization of behavior in unidimensional terms. There have been a number of reasons for this dichotomization, including differing philosophical orientations, limitations of knowledge, and difficulty integrating biological processes with psychodynamic phenomena. The psychodynamic approach to understanding mental activity focuses on subjective, experiential, nonquantifiable phenomena. The neurobiological approach attempts to explain the same phenomena in objective, measurable, neurochemical, or neuroanatomical terms. For example, an accepted psychodynamic theory of depression explains it as a prolonged disturbance of mood resulting from an anticipated or actual loss or disappointment. On the other hand, the current neurobiological theory holds that it is a dysregulation of noradrenergic and/or serotoninergic neurotransmitter systems. Both explanations may be correct, although from different vantage points. Freud (1895a) in his Project for a Scientific Psychology attempted an integrated neuropsychological explanation of mental events. His lack of adequate neurobiological information forced him to abandon this endeavor, and instead, he developed a metapsychology for personality development, psychopathology, and behavior. Although Freud never suggested neurophysiological or neuroanatomical correlates for different aspects of psychic functioning (e.g., unconscious, ego, id), he nevertheless based his theory on a biological substrate. For example, his dual drive theory depended on biologically determined instincts. Even the term “libido” was defined as a “somatic” sexual excitation (Freud, ). Freud repeatedly acknowledged the role of biological factors in the pathogenesis of mental illness;