Neuropsychoanalysis can enrich psychoanalytic thinking and learning. While the most important reasons are clinical and theoretical, a neuropsychoanalytic approach can contribute to psychoanalytic education, intellectual life, and psychoanalytic research. We might define neuropsychoanalysis as the interdisciplinary field which embraces neuroscience and psychoanalysis. Within neuroscience, we include neuropsychology, cognitive neuroscience, affective neuroscience, brain imaging research, EEG research, methods of experimental psychology, philosophic considerations relating to mind and brain, and mixed methodologies. The study of neuropsychoanalysis is opposed to any view that attempts to reduce the phenomena of mind to those of brain or vice versa.
In introducing our topic, we will quote liberally from our chapter in our forthcoming book, Textbook of Applied Psychoanalysis: “We view the field of neuropsychoanalysis as both an area of applied psychoanalysis and also a basic science for psychoanalysis.” “As background, it is important to point out a philosophical stance which informs the field. It pertains to the relation between mind and brain. We follow Mark Solms and Oliver Turnbull (2002) in subscribing to the view known as dual aspect monism. According to this view, the mental apparatus (Freud, 1900a) is a single entity, which can be perceived in two different ways—as mind or brain, subjective experience or object viewed from outside.
Related views, sometimes known as anomalous monism, have been endorsed by Marcia Cavell (2003), David Chalmers (1996), Donald Davidson (1970), Thomas Nagel (1974), and Spinoza (1677). Neither view is reducible to the other, in the sense of being more fundamentally causal. Solms provides the example of thunder and lightning (1997)—two distinct manifestations of a single phenomenon. Neither causes the other—both are resultants of an underlying phenomenon. So it is with mind and brain.” Recently, Ronald Britton has endorsed this view in his book, Between Mind and Brain: Models of the Mind and Models in the Mind.
“Within applied psychoanalysis, one branch of neuropsychoanalysis is psychoanalytically informed neuroscience (Solms & Turnbull, 2011), which uses neuroscience and psychological methods, rather than psychoanalytic methods, to explore phenomena in mind and brain. Examples include neuroimaging and other neuroscience methods to study dreaming (Solms, 2000), mourning (Peter Freed, 2008), love (Helen Fisher, 2006), or changes during psychoanalytic treatment (Otto Kernberg, 2012). A second branch may be described as psychoanalytically inspired neuroscience (Aikaterini Fotopoulou, Donald Pfaff, & Martin Conway, 2012; Solms & Turnbull, 2011), which “uses purely neuroscientific methods to test psychoanalytically informed hypotheses.” A third area of applied psychoanalysis is the use of psychoanalytic techniques to study neurological phenomena. Karen Kaplan-Solms and Solms (2002) used analytic methods to study patients with various types of neurological injury. In this work, they made important discoveries which challenged prevailing ideas within neurology.
“As mentioned above, neuropsychoanalysis is not only an area of applied psychoanalysis, but also a basic science for psychoanalysis. This is not to say that neuropsychoanalysis is the only basic science for psychoanalysis. Clearly there are others—linguistics, anthropology, ethnology, evolutionary developmental biology (evodevo), cognitive psychology, and perceptual psychology come to mind. To various degrees, Freud used all of these sciences in his writing. Nor would we say that psychoanalysis is solely based within science. As a clinical discipline, carried out by interacting subjects, within a cultural milieu, and devoted to the relief of suffering, psychoanalysis draws upon many human faculties in addition to science. But science informs and inspires psychoanalysis, while psychoanalysis informs and inspires sciences such as neuroscience.”
In Between Mind and Brain: Models of the Mind and Models in the Mind, Britton writes, “Our task is to become more aware of the unconscious models that inhabit our patients’ minds and at the same time to make ourselves more aware of the models that shape our theorizing.” In other words, our models shape how we work. There are at least two ways in which this is true. The first relates to our explicit and implicit models of the mind. The categories we carry in our minds influence what we are able to see and hear. The second relates to our models of verbal and nonverbal communication between patient and analyst.
Models from neuropsychoanalysis are useful because, surprisingly, such models help us realize that we do not live entirely in our heads. The mind is embodied, nested in the body. After all, taking seriously Freud’s notion (1915) that a drive is “the psychical representative of the demand made upon the mind by virtue of its connection with the body,” neuropsychoanalysis helps us conceptualize how evolutionarily conserved drives are represented in the mental apparatus. This matters each time we decide how to intervene (or not explicitly intervene) in a clinical moment.
For example, in a complex clinical moment, an analyst chose to respond interpretively to a patient’s harsh attack on herself rather than her simultaneous covert attack on the analyst and the analysis. This choice reflected the analyst’s intuitive sense of which theme was the more urgent in the moment. But the clinical decision also reflected a mental model held by the analyst. This model included a taxonomy of fundamental drives or motivations spelled out within affective neuroscience by Jaak Panksepp. In Panksepp’s model, the motivational systems are known as SEEKING, RAGE, FEAR, PANIC/SEPARATION, CARE, PLAY and LUST. The patient’s aggressive attack on herself, in that particular clinical moment, was understood by her analyst as secondary to separation distress. Various clinical details supported this view. For our purposes at the moment, it is not critically important whether the analyst was correct or incorrect in his understanding. What is important for our thesis is that the analyst’s clinical intuition was based in part on a mental model derived from affective neuroscience, i.e. neuropsychoanalysis. The patient’s relieved response could be seen as reflecting activation of a CARE circuit, in Panksepp’s terminology.
These views of drives and circuitry, part of the analyst’s mental model, were not (and most likely would never be) articulated to the patient. What is important for clinical work is that they inform the analyst’s mental model. Even for the analyst, these formulations were all background material. In order to recognize the model that was operating, the analyst needed, after the hour was over, to go through his emotional responses, intuitions and clinical reasoning, and ultimately look to the model of the mind that lay behind his clinical approach at the moment in question. This process of clarifying the analyst’s implicit model could be tested if the analyst were to present this clinical material to a group of analysts in a setting such as a Working Party. In this case, an exposure to neuropsychoanalytic knowledge modified and refined the analyst’s preexisting models of motivation derived from Freud, Klein, and Bion.
Because our work with patients takes place entirely within a subjective realm, every interaction, every insight or formulation, every clinical or scientific theory must be translated into subjective terms in order to be communicated to a patient. We are most often keenly aware of our verbal interventions. But the same may not necessarily be said of our many nonverbal communications—both fleeting ones and longer term impressions. Among the fleeting communications, we include pauses, movements in our chair, verbal intonations and facial expressions if the patient can see us. It is likely that our facial expressions influence patients even if we are out of sight behind a patient on the couch. Our facial expressions are part of a larger emotional gestalt within us that registers somehow in everything the patient can hear, or even sense from us. When we say our emotional gestalts register somehow for our patients, we don’t mean to rest content with the word “somehow.” We would like to learn more about precisely how. And here, we think neuropsychoanalysis may be able to help us, by allowing us to understand more specifically how nonverbal communication occurs.
About 15 years ago, Sydney Pulver wrote “On the Astonishing Clinical Irrelevance of Neuroscience,” which is frequently cited by critics of neuropsychoanalysis. Yet, in the important second half of his article, Pulver writes: “I turn now to the second major point of my paper: the astonishing relevance of neuroscience to psychoanalytic theory.” If psychoanalysis is to be a theory of the mind, as well as a praxis, and if our institutes are to be more than art academies or technical trade schools (Kernberg, 1986), then our theories ought to matter to us. If neuroscience helps us carve nature at its joints, in our theories of the mind, that should matter to us. Of course, our theories of the mind apply to the mind of the analyst as well as the mind of the analysand.
As John Dall’Aglio wrote, “Dynamic localization [an important method of neuropsychology] demonstrates one way in which psychoanalytically investigated mental phenomena arise between networks of neural structures (Kaplan-Solms & Solms 2000).” In fact, this method was specifically espoused by Freud in his critique in On Aphasia of the more static localizationist brain theories of his time. Dall’Aglio (2017) continues: “Objective study of these neural structures—along with careful psychological observation of their mental and behavioral correlates—can identify a more specific relationship between the mental phenomena that intersect in these dynamic neural networks. As a result, neuroscientific study of these networks can contribute theories concerning particular relationships between subjective experiences.”
Neuropsychoanalysis is a tool for studying psychoanalytic theories of the mind and of therapeutic action. It can help us spell out the implications of our theories for another discipline, allowing us to seek consilience. And neuropsychoanalysis can generate hypotheses for psychoanalysis, which can then be investigated within psychoanalytic work.
Therefore, neuroscience can and should influence psychoanalytic theory. But we would go farther than Pulver. Neuropsychoanalysis can help us study how our theories are used in our work. Our theories are part of the backdrop of our work. When we are conscious of theory during clinical hours, it usually means we are distancing ourselves from the patient, due to problematic countertransference. Theories are generalizations or abstractions, rather than particulars. Concepts such as the depressive position, the Oedipus complex, psychic retreats and projective identification are quite abstract. None of our theories are applied in the clinical situation without mediation. We interact with our patients one-to-one, speaking to an individual from some place in ourselves. Sometimes we hear voices. Henry Smith (2001) wrote about hearing the multiple voices of supervisors and colleagues past when he was with a patient. In one theory of mind, we might say that at such moments our own unformulated experiences and intuitions about the patient recruit the words of our supervisors to give voice to our own intuitions. This is analogous to the ways we recruit day residues in dreams. Our premise is about conscious and unconscious mental life, about how emotional experiences and deeply embedded assumptions about the world are engaged in the production of sentences, verbal narratives and interpretations. What we believe, we are likely to see. And so, we would like to be as precise as possible in what we believe—especially about the mind. In valuing unformulated knowledge, we want to learn as much as possible about the mind (and brain) methods by which such knowledge is created, maintained, sequestered, revised or symbolized.
Critics of neuropsychoanalysis might ask whether we could do all this if neuropsychoanalysis had never been invented. We’ll never know that, since we live in the era following the work of Freud, the first neuropsychoanalyst. He has already shaped our views about the nature of the mind, even if we reject some of the things he said. At the American Psychoanalytic Association meeting in New York in January 2017, Robert Paul stated that Freud’s Project for a Scientific Psychology, one of his most neurological works, is a skeleton key to understanding what is most obscure in Beyond the Pleasure Principle, because the structure of mind in Beyond the Pleasure Principle was set out in The Project.
There is an increasing body of psychoanalytic research that involves outcome measures observable in brain functioning. For example, consider the LAC Depression Study, conducted at the Sigmund Freud Institute in Frankfurt. The study used clinical and extra-clinical measures to investigate process and outcome of long-term psychoanalytic treatment of major depression. The associated fMRI/EEG Depression Study (FRED) looked at the effects of interventions, yielding data about both process and outcome of treatment. A rich paradigm, using neuropsychoanalytic techniques in combination with other extra-clinical measures, such as the Operationalized Psychodynamic Diagnosis (OPD) Manual, added depth to the study. Such uses of neuropsychoanalytic methods are becoming more frequent in psychoanalytic research, and have much to offer in the future.
Interdisciplinary work is a two-way street. Psychoanalysis can and should enrich its neighboring disciplines and be enriched by them as well. A glance at the program of the American Psychoanalytic Association in its National and Annual Meetings reveals the great extent to which this is already in place. The vitality of our discipline and its place within the academic and larger intellectual world require vigorous pursuit of these mutually enriching connections. Neuropsychoanalysis is a key element in this facet of intellectual life.
Mind and brain are two different approaches to a single underlying object—the mental apparatus. Our day-to-day work as psychoanalysts is within the realm of mind. But in preparing to undertake that work, it is important for us to be educated in central principles derived from the realm of the brain. This is important background knowledge for mature psychoanalytic thinking about theories and techniques.
We believe it is also important for psychoanalysts to confront the philosophic issues presented by the “hard problem” of the relationship between mind and brain. This has particular importance at a time when brain science (and brain-based approaches to treatment) are presented frequently to patients, and also to clinicians. Psychotropic medications, brain stimulation technologies and brain imaging are well-known modalities in the discourse of the brain. Psychoanalysts should be able to think clearly about how these modalities relate to our work as psychoanalysts and to the relationship between mind and brain.
Because of these considerations, neuropsychoanalysis and its sub-disciplines, must be part of psychoanalytic education for those in training, and for psychoanalysts who have completed their training.
As co-chairs of APsaA’s Study Group for Psychoanalysis and Neuroscience, we feel one of our ongoing missions is to disseminate the rapidly expanding knowledge base of neuropsychoanalysis to the membership and to encourage and enhance teaching at institutes.
In keeping with this sentiment, we conducted a survey in 2009 of all the 31 APsaA institutes to ascertain whether they offered courses in neuroscience and if they did what were the contents of their curricula.
At that time, 17 institutes offered either a course in their standard educational sequence, an elective, or an item of postgraduate study. A core curriculum was constructed from the reading lists of the institutes. The results of this survey were presented to the Committee on Psychoanalytic Education (COPE) in 2011 and the core curriculum posted on the APsaA website.
However, the field has evolved at a dizzying pace. Plans are now underway to conduct another survey and make available to the institutes an updated list of suggested readings.
Our study group is responsible for a discussion group and a symposium at the meetings, and regularly collaborates with the Science Department to help organize research presentations. The possibility of establishing a study group for teaching neuropsychoanalysis is being entertained.
What follows is a sample from a course titled Neuropsychoanalytic Conversations one of us is teaching at NYPSI. Exchanges with biology and specifically neuroscience may be complicated and treacherously reductionistic, but also potentially enriching and generative. One way of avoiding some of the pitfalls is to explicitly conceptualize the teaching of neuroscience as a way to teach psychoanalysis. As noted before, neuropsychoanalysis is a tool for studying psychoanalytic theories of the mind. The following brief summaries of some classes will serve to illustrate this point:
The purpose of the course is to revive, refine and enrich the interdisciplinary dialogue that took place in the mind of Sigmund Freud 120 years ago and capture the exciting sense of discovery of that time. This conversation presumably played out most intensely during the last decade of the 19th century and culminated in the founding document of psychoanalysis, The Interpretation of Dreams, the first neuropsychoanalytic text.
Page 8Neuropsychoanalytic? Yes. After all, from the intimate details of people’s lives and dreams a vision of the “mental apparatus” emerges in Chapter 7 from ideas first articulated in On Aphasia (1891), where we see Freud describe dual aspect monism. His “speech apparatus” is the first of his important “borderland,” i.e., mind/brain concepts; the “mental apparatus” concept emerging in Chapter 7 additionally implicates the body and its instincts. In this richly fertile borderland, he first germinates the original terms of projection, cathexis, representation, overdetermination, regression (retrogression), the precursors to thing and word presentations as well as primary and secondary process.
Neuropsychoanalytic Conversations begins with a discussion of the “specimen disorder of neuropsychoanalysis,” anosognosia for left hemiplegia, a paralysis disorder typically caused by a lesion to the right parietal lobe or a diffuse lesion to the right frontal-temporal-parietal area. Such patients deny their paralysis while often showing implicit knowledge of the dysfunction, exaggerating the strength of the affected limbs, rationalizing their not following commands to move their limbs (“I’m tired”) and even delusionally misidentifying the limb (“it’s my mother’s arm.”) An understanding of this fascinating syndrome is only possible if one considers how the mind develops along the lines of the establishment of self and object boundaries, narcissism, defense mechanisms and the management of hallucinatory wish fulfillment. Exploration of this syndrome is an exercise in the methodology of neuropsychoanalysis in which neuroanatomical and neuropsychological considerations interlace with the considerations of mental development and psychodynamics.
Ensuing classes involve neuropsychoanalytic “discussions” between psychoanalysts and neuroscientists. For example, given the foundational importance of the dream in psychoanalysis the decades long debate between Mark Solms and Allan Hobson about the validity of Freudian dream theory is discussed. Solms’s seminal discovery of the role of the meso-limbic meso-cortical dopamine (SEEKING) system in the instigation of dreams gives fresh impetus to the theory. Scientific disciplines other than neuroscience are also recruited to provide additional illuminations. For example, the oft neglected but highly relevant evolutionary biology of REM sleep is offered to provide a more robust picture of dreams. From such a discussion emerges an enriched appreciation of the central importance of dreaming and hallucinatory wish fulfillment to psychoanalytic theory and to more complex and dynamic understandings of perception, consciousness, memory and reality testing. A remarkable consonance of fundamental psychoanalytic propositions and modern neuroscientific exploration is discovered. It is hard to imagine a candidate in today’s “age of the brain” not being impressed by recent neuroscientific “discoveries” of the hallucinatory basis of perception and the continuum between dreaming and waking consciousness. One can imagine the sense of affirmed psychoanalytic conviction that might develop about psychoanalytic theory as a result, perhaps akin to that which occurs about the power of the unconscious revealed in one’s own analysis.
Neuropsychoanalytic Conversations can shed new light on old controversies. A favorite article of the class by Yoram Yovell (2008, “Is There a Drive to Love?”) is the basis of a dialogue with Jaak Panksepp, the father of affective neuroscience. Initially, Yovell outlines and analyzes the history of the psychoanalytic conception of instinct (drive), places it in a neuroanatomical context and then articulates it with Panksepp’s basic emotional systems SEEKING, LUST, RAGE, PANIC/SEPARATION, CARE, PLAY. What emerges initially is the correspondence of libido to the SEEKING system (implicated in dreaming too). He then explores whether the existence of the PANIC/SEPARATION system supports John Bowlby’s conceptions of attachment over libido as the motivational basis of the initial mother-child bond. Interestingly, in this context he quotes Freud as stating that attachment is the older of these two systems. Inevitably, class discussion veers into an enlightening trip into the history of psychoanalysis and its politics. These discussions are then at hand when fMRI studies of infatuation and loss are reviewed as well as transcultural surveys of definitions of romantic love. The layered neuropsychoanalytic conversation about a psychoanalytic concept such as drive allows for a richer and more panoramic view of an essential psychoanalytic subject.
The aim of such teaching discussions is to promote healthy curiosity, and provide a cautionary warning and antidote to facile extrapolations from biology to psychology. Their purpose is to contribute to a strong foundational template for life-long psychoanalytic learning.
From the Issues in Psychoanalytic Education Editor
The article on neuropsychoanalysis by Charles Fisher and Richard Kessler is the first in the series of interdisciplinary forays planned for this column. The intent is to probe adjacent fields both for their suitability for psychoanalytic application to them as well as their capacity to illuminate and sharpen psychoanalytic propositions proper. This article additionally makes the particular case that among them neuropsychoanalysis reconnects contemporary psychoanalysis to Freud’s foundational discoveries and insights.
In keeping with the vision of psychoanalysis as located at the crossroads with biology and culture, interdisciplinary inroads in both directions are welcome. For submission inquiry please contact me at .
—Luba Kessler
Editor’s Note:
For more information about the core curriculum presented in 2011 and other references in this article, you may contact the authors at or .