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“If the clinical hypothesis is not completely confirmed, the clinician must be willing to reassess the situation and change the treatment. The relentless self-examination that is necessary to achieve this goal is difficult to maintain in an era in which we are increasingly taught to trust only the data obtained by others.” This quote from Dubovsky (2007) refers to industrial influence on psychopharmacological treatment practices. “If the clinical problem itself is poorly defined and obfuscated by marketing strategies, the focus of neurobiological research is set for random effort and misunderstanding” (Fava, 2009).
In an increasingly “evidence-based” environment, what is the clinician to do with the neuroscience data that is increasingly derived using multiple assumptions, frequently questionable, by “experts” in neuroimaging, statistics, and other fields that may be far removed from the clinical encounter? The psychoanalytic component of neuropsychoanalysis potentially provides a counterbalance to possible harm from zealous overapplication.
In a series of lectures to a diverse audience addressing concerns about harmful misapplication of neuroscience, Dr. Jim Deutsch reviewed among other topics those of empathy and the limbic overwhelming of frontal mechanisms in “fight-flight-freeze” situations. A question arose concerning how humans could possibly have “evolved” the capacity to be concerned for the welfare and suffering of those who live on the other side of the globe, even overriding immediate concerns for their own well-being, in these perilous times. A neuroimaging study offers a basis consistent with a developmental progression from representations of manipulable objects to love objects (Zaki, Weber, Bolger, & Ochsner, 2009). The argument might be that, while neural structures might indeed