In his interdisciplinary work On Aphasia, although writing on a neuroscientific subject, Freud began to forge a proto-conceptualization of psychoanalysis which respected the mind's capacity to harbor contradictory ideas more or less simultaneously. Thus an early conflict-based psychology arose from the ground structure of how the brain handles language.
In Freud's view, word representations (objektvorstellung) were the key to memory retrieval, via associations laid down in the visual, aural, and tactile/kinesthetic experience of language. Later, when he developed psychoanalysis proper, employing free association and verbal interpretation as a means of understanding hidden thoughts, he drew upon his earlier novel theories of brain localization in the case of aphasic disturbances.
Freud's Project for a Scientific Psychology can be seen as a kind of Rosetta Stone for understanding how his early analytic theorizing extrapolated on his prior work on the brain's information-processing activity. (Michael Basch in 1975 was one of the first to point this out.) He was essentially working alone when he wrote the Project, and the boundary between psychoanalysis and neuroscience was quite permeable, principally because Freud himself was both a psychiatrist and a neuroscientist of the first rank.
One reason Freud eventually abandoned integrating brain science with his psychological theorizing was that the brain science of his day was insufficient for the task. Specifically, he could not solve the problem he set for himself in the Project: explaining how the mind/brain defends itself against unacceptable perceptions. Although Freud hit upon the mechanism of the disavowal of perceptions, he did not hold on to this insight. He further confused himself when he named his perceptual system “pcpt-cs,” for perceptual-conscious, which implied that perception more or less automatically results in consciousness. However, as Basch pointed out in 1983, perception occurs a moment before consciousness and may not result in consciousness. Moreover, Freud was unaware that he was describing a system of information processing. He did not publish the Project during his lifetime and restricted his public utterances to the operations of mind rather than brain. There is reason to believe that privately he never gave up the hope of fulfilling the interdisciplinary goals of the Helmholtz School of Physiology, of which he was an adherent, as were his most influential teachers.
During the period from 1900 to 1938, Freud's first followers significantly expanded psychoanalysis. Most notable among these was Hartmann, who worked on adaptation (bridging psychoanalysis and cognitive psychology), and Anna Freud, who studied the lines of development and the subject of defense (bridging psychoanalysis and infant observation studies). Decades later, cognitive neuroscience developed as a special area encompassing both of these areas of integration. Work such as that of Gedo and Goldberg's developmental-hierarchical model would not have been possible without Hartmann's and Anna Freud's integrative work.
During the period from Freud's death until the mid-1960s, developments in neuroscience were relatively slow in coming. Follow-up research on Poetzel's study of dreams and subliminal perception by Howard Shevrin, Matthew Erdelyi, and others revived the subject, which is now a hot area bridging psychology and psychoanalysis. The pioneering work on dreams and REM sleep by Charles Fisher, William Dement, Alan Rechtschaffen, Edward Wolpert, and others flourished briefly in the 1960s, then died out for decades. Later research on sleep, rest-activity cycles (circadian rhythms), the role(s) of melatonin in seasonal affective disorder, and similar topics has been of only marginal interest to psychoanalysis, with the exception of Max Stern's work. He identified a relationship between nightmares and lack of self cohesion — that is, bad dreams can express an endangered, fragmentable self. Stern's work reproduced part of Heinz Kohut's results, but started from a neurophysiological premise. (Kohut was a neurology resident before he came to psychoanalysis.)
In the 1950s and 1960s there were significant technological advances (for example, early forms of brain scanning were developed), and a small number of pioneering interdisciplinary efforts began, all but forgotten now. David Rapaport, working in the early 1950s, forged psychoanalytic links with cognitive psychology in his fundamental research on cognition and thought pathology, as well as on emotions and memory. Many neuropsychiatrists began to explore the relationship between psychoanalysis and other disciplines. Their work resulted in a correction of analytic theories — for example, Benjamin Rubinstein's debunking of Freud's energy theory in favor of theory based on the distribution of information and Roy Grinker's efforts with Ludwig von Bertalanffy to relate psychoanalytic to biological variables by means of general systems theory.
During the past three decades, there has been what Arnold Cooper called a “quiet revolution,” as academic interest in psychoanalysis has grown and ideas have entered psychoanalysis from an extremely broad range of disciplines.
Niels A. Lassen asked “Where do thoughts occur?” Lassen was a developer of brain scanning (radioactive xenon brain scanning for non-invasive visualization of regional cerebral blood flow and metabolic rate), and his profound interest in psychoanalysis contributed to our field. Using PET, MRI, and xenon scans, he described fascinating complex patterns of localized yet distributed activation of functional neuron clusters. Thus he demonstrated the modular architecture of the mind and brain and the importance of frontal lobe functions to our field.
On the one hand, specific neural activity correlates with “thinking” in a psychological sense. On the other hand, some linkages of specialized brain areas into neural networks clearly involve the entire brain in patterns that are modifiable within analysis by a broad range of interpretative efforts. John Gedo, in addition to his developmental-hierarchical model, contributed much to the integration of biological and psychoanalytic perspectives.
Fred M. Levin, M.D., is a training and supervising analyst at the Chicago Institute for Psychoanalysis and on the faculties of Northwestern University Medical School (Psychiatry) and Chicago Medical School (Neurology). In more than 100 papers he has pursued a bridging of analysis and cognitive neuroscience.
Especially important are the vast number of detailed descriptions of clinical cases. Morton Reiser's 1990 integration of brain science and psychoanalysis deserves every practitioner's attention for its detailed analysis of the philosophical and technical pitfalls of reductionism in integrating theory across disciplines. Using his “dual track approach,” Reiser made a compelling argument that REM sleep activity and dream mentation express connections between memories organized into nodal networks of neurons and affectively organized schema of psychic experience within similar networks of ideas (which neurons somehow represent).
Andrew Schwartz and I have been patiently working out details of a psychoanalytic theory of learning, picking up where Rapaport's research was interrupted. Probing the mysteries of transference, employing interdisciplinary perspectives, they tried to give analysts an edge in their clinical efforts to handle difficult transference repetitions and enactments and turn them toward insight and meaningful psychological change. In 1996, Eric Gillett refined Freud's signal anxiety theory, thus incorporating within psychoanalysis the newest versions of Pavlovian conditioning as partial explanations for learning within psychoanalysis.
Gerald Edelman has had a profound effect upon a number of psychoanalytic theoreticians, including Arnold Modell. Edelman's view of mind as an expression of brain has been influential, as are his ideas about reentry and his distinction between primary and self-reflective consciousness. Just this year, Virginia Barry pointed out that a neuroscience model of consciousness supports a psychoanalytic theory based on the hierarchical model of development. Although Modell questioned whether mind is indeed hierarchical and did not see mind as instantiated in brain, he nevertheless saw metaphor as a brain-related learning process involving the transformation of past experience (c.f. Freud's concept of nachträglichkeit).
A recent issue of JAPA, edited by David D. Olds, contains a debate on the nature of consciousness, which has continued on the Internet under JAPAs sponsorship. I cannot summarize the rich and complex debate briefly, except to say that psychoanalysis is alive and well, judging from the fervent discussion by analytic scholars from all over the world. Olds deserves much credit for his interdisciplinary contributions. For example, writing on connectionism in 1994, he noted (echoing Edelman) that “we are, in effect, equating ego with the brain, and making consciousness one of the brain's output vectors. That which is flashed in consciousness then becomes one of the many inputs the brain has to deal with, along with sensory input and input from memory and the visceral system.” He added that “neural net theory could [well] have been invented to explain free association.”
For Olds, every thought is context-related; analysts unpack this information about context, thus revealing how multiple brain events are “signs of percepts and stored memories” loaded into associative networks with a unique patterning that analysts and patients alike can learn to recognize. Olds further mentions Stanley Palombo in this context: “Palombo presents a connectionist model of the condensation of dreaming. He makes use of the ability of a connectionist system to take a partial image and superimpose it on a more complete image, or to bring forth into the dream a conflation of several images which may have common structural elements.” Clearly Palombo, Olds, Reiser, and others are building upon the intuition of Freud and clarifying some of the basic mechanisms of consciousness, thinking, dreaming, and memory.
Alan Schore described the formation of self and correlated brain development — as seen, for example, in the migration of dopadrenergic midbrain cells upward into the frontal cortex, thus contributing to self regulation (now synonymous with neural control). Michael Posner created a detailed original map of the executive control system of the brain (especially elucidating the role of the anterior cingulate cortex), giving us a basis for understanding consciousness (as attentional control) in terms of brain functioning and concomitant mental mechanisms. Howard Shevrin brilliantly investigated conscious versus unconscious activity using a powerful research methodology that distinguishes one from the other on the EEC. Barry Opatow further connected conscious and unconscious modes of wishing and thinking, in ways that on the one hand remind us “how the object world is first and foremost generated in the experience of Desire,” as Opatow put it, and on the other tie together transference, cognition, and development as in a tightly constructed T. S. Eliot poem.
David Forrest persuasively described the continuum that exists between normal and neurotic psychological defense mechanisms, which merge imperceptibly with neuropsychiatric adaptations influenced by neurological state. In a similar vein, Michael Sacks suggested that certain diagnostic conditions — for example, schizophrenia—which some believe are unlikely to benefit from psychoanalytic approaches, actually require the use of psychoanalytic notions for an understanding of the bizarre symptoms and communications of psychotics, for developing models for humane treatment, and for help in providing useful hypotheses for defining the neuropsychological impairment/Steven Roose offered the idea that modern analytic affect theory has a more complex view of affects, including their role as motivators. Martin Harrow developed exciting hypotheses bridging neurological and psychological frameworks that explain the negative and positive symptoms of such schizophrenic patients.
Kathleen Biziere's research on cytokines showed that the central nervous system contributes to the modulation of immune responses. Conversely, the immune system can effect the central nervous system via cytokines, secreted by immune cells that cross the blood-brain-barrier. Thus the possibility exists that disorders of one system affect the other. June Hadley brilliantly summarized the neuropsychopharmacology of motivational systems for the psychoanalytic literature in Joseph Lichtenberg's Psychoanalysis and Motivation. Finally, Oliver Sacks, in fascinating papers and books (and as portrayed in the movie Awakenings) brought sophisticated philosophy, cognitive neuroscience, and psychopharmacology to the attention of both specialists and the lay public. The interrelatedness of introspective/empathic and scientific/observational approaches is embodied in all such research efforts.
As a consequence of the modern interdisciplinary work noted above, we have advanced considerably in our approaches to patients with various disorders. Patients with obsessive compulsive disorder show a clear improvement when treated psychoanalytically, but they often require the simultaneous use of selective serotonin re-uptake inhibitors, such as Paxil, Prozac, Zoloft, and the like. Similarly, treatment of bipolar patients calls for eclectic approaches that combine the prophylactic use of Depakote or lithium carbonate along with psychoanalysis or intensive psychotherapy. Biological and dynamic psychiatrists and psychoanalysts are beginning to recognize that the progress of many patients is limited if their therapists do not take a dual approach: intensive analytically oriented treatments to capitalize fully on the learning “window” created by the use of appropriate medication. In other words, interdisciplinary research greatly supports combining treatment modalities in creative ways and without prejudice.
By presenting a history of some research bridging cognitive neuroscience and psychoanalysis, I am not implying that analysts should give up what they are doing and become neuroscientists, learning a new area of specialization to the exclusion of other interests. Rather, I am suggesting that there is a need to integrate psychoanalysis and neuroscience, to help us understand how mental activities are instantiated in brain. I also believe that psychoanalysts gain the respect of psychiatrists, and of scientists in general, when they respect and understand something about the proper use of psychotropic medication.
Two metaphors come to mind. In the first, all of the practicing psychoanalysts in the world are like a giant multicellular organism, where useful information is exchanged between its various cells. The second relates to the Jewish mystical tradition of “Tikun Olam.” In this tradition, each individual, in doing what is right for him- or herself, finds his or her personal fragment of the mythical perfect sphere that existed “in the beginning of time” and helps to restore the original perfection, thus doing good for all. When each of us pursues our special talents and interests, the analytic world is better off precisely because we communicate our insights to each other across disciplinary boundaries. In this way we increase knowledge for all of us.
Parts of previous reviews of the literature are incorporated here. Those interested in more details on specific areas should consult Regina Pally's articles in the International Journal of Psycho-Analysis. A number of areas that might have been included have not been — for example, chaos theory—because they are not central to the subject. Request a full bibliography by e-mailing .