First published on Journal of European Psychoanalysis, Number 15 – Fall-Winter 2002
The aim of this paper is to provide some insights on the discussion about the possibility of a joint-venture between psychoanalysis and neuroscience. In our perspective, the relationship between psychoanalysis and neuroscience is dynamic in nature. Indeed, the cultural and technological changes that have occurred in the two domains, mainly related to new concepts of brain-mind system functioning and to the development of neuroimaging techniques, constitute the basic premise for renewed interest in common research. Some important contributions to explain issues of mutual interest can be found in the study of affective regulation and the memory system, particularly of implicit memory processes. For example, the recent observations on the dynamic functioning of the neural system underlying the organization of the emotional experience are very useful for explaining some issues of the object-relation theory. One interesting possibility is that of constructing a research paradigm by combining the richness of the psychoanalytic model with the reliability of the neuropsychological method discussed here through the presentation of some studies.
1. A general view
In Freud’s structural model of drives, the latter are defined in relation to their endogenous origin, to an object and to a goal they are directed toward (Strachey 1966). Greenberg and Mitchell underline that in Freud’s view the concept of drives is on the border between the “psychic” and the “organic” realm, since drives are defined as a source of endogenous stimulation involving the mind in relation to the intrinsic connection between the body and the mind. Since they are the core of the traditional psychoanalytic framework, drives are likely to appear as a critical connecting element between the field of psychoanalysis and the field of biology. Indeed, at the beginning of his psychoanalytic theorization, Freud aimed to construct a psychological research and treatment model in the context of the wide-ranging psycho-biological matrix. Psychoanalysis is the attempt to provide a meaningful explanation of psychic phenomena by making use of research methodology and analysis of the interaction between different components of the mind. Cognitive neuroscience seems to share the same topic of study with psychoanalysis, that is, the human mind, as well as the same objective concerning the possibility of acquiring a deeper understanding of the structure of the mind by singling out functional units related to different components of the psychic apparatus. If we consider all these issues, it is surprising that the topic of the present debate between psychoanalysis and neuroscience regards whether or not collaboration is possible! May a join-venture between psychoanalysis and neuroscience be fruitful? What’s the contribution the two scientific domains can give each-other? On the one hand, these questions indicate the presence of a division between the two disciplines and the difficulty of developing a common research strategy. On the other hand, they reflect new concern for a rapprochement. There are many complex reasons for the alienation of psychoanalysis from neuroscience. Some of the original psychoanalytic formulations were coherent with the possibility of developing a field of research common to psychoanalysis and different biological areas. However, with regard to this discussion, Freud himself stated that the neuroscientific knowledge of that time was not useful for gaining a better understanding of psychoanalytic issues. Moreover, after Freud, psychoanalysts abandoned his original Project  and, instead, supported a reification of metapsychology with little investment in empirical research. Indeed, since Freud began the “adventure in psychoanalysis”, his ideas have undergone substantial revision. The important insights deriving from the object-relation theory, from ego psychology, self psychology and the attachment theory are only examples of the fertility of psychoanalytic research. However, the richness of this conceptual production has not been supported by strong empirical evaluation because of the lack of an experimental methodology other than that adopted in the clinical setting. As outlined by Kandel, many psychoanalytic assumptions have remained abstract without the possibility of an empirical test.
Furthermore, for a long time many neuroscientists disregarded psychoanalytic insights. The stubborn positivism permeating neuroscientific thought resulted in scant interest in topics like emotions and consciousness, with more interest in observable phenomena of the “human experience”. Indeed, cognitive researchers have been mainly attracted by topics such as memory, attention and perception. Moreover, the fact that the psychoanalytic method did not provide empirical verification led neuroscientists to remain aloof from psychoanalytic assumptions. As a result, psychoanalysis was relegated to the periphery of the scientific dialogue. Although on one side psychoanalysts developed theoretical and clinical treatment models, on the other side these models seemed to have inner coherence without external validity. All of these factors led to the creation of broad, structural, communicative barriers between the two domains, particularly psychoanalysts’ progressive mistrust in neuroscientific research, which they considered as the product of a reductionist view of the mind, and neuroscientists’ mistrust in psychoanalysis, a discipline they judged as having low scientific value. The consequence of this historical separation was the creation of two different languages and methodologies that seemed to be irreconcilable.
Neverthless, currently some conditions that prevented interaction between psychoanalysis and neuroscience have changed. In neuroscience, some constructs traditionally the object of psychoanalysis have now acquired critical scientific interest. Presently, in order to create a unitary view of how the brain-mind works the development of a coherent theory to explain affective regulation and the processes of consciousness seems necessary; and efforts have already been made to investigate these processes. Several authors have studied the different roles of the cerebral hemispheres in emotional behavior and the brain pathways underlying some of the aspects of affective functioning. In particular, several clinical and neuroimaging studies have outlined the role of the amygdala in unconscious emotional perception and learningand the critical function of the orbito-frontal cortex for the adaptive conscious regulation of emotional state and response. Davidson et al, sustained that emotional self-regulation is underlined by a neural pathway that involves various pre-frontal areas (PFC) such as the orbitofrontal PFC, the dorsolateral PFC and the anterior cingulate cortex, and subcortical limbic structures such as the amygdala and the hypothalamus.
The relevance for psychoanalysis of experimental evidence of different brain circuitry sustaining the conscious and unconscious elaboration of emotional stimuli and behaviour is obvious. Still more interesting is to clarify how the two systems interact to form the complex subjective affective experience. Research in basic neuroscience has also led to better comprehension of the effects of psychological stressors on the declarative memory system. Indeed, some authors have pointed out the adverse effects of prolonged glucocorticoid exposure – as a consequence of the infant’s separation from his mother (stress condition) – on the hippocampal neurones. In fact, prolonged exposure to high glucocorticoid levels can result in reversible or permanent hippocampal damage (atrophy), thus causing memory deficits (storage and recall of mnemonic trace). The finding of an alteration of the long-term potentiation process demonstrates that these effects are also observable at the molecular level. These findings are very important for the interest of psychoanalysis in the mechanism of repression of mnemonic traces following a traumatic experience (psychic trauma). The neural plasticity is of great importance. This concept refers to the brain’s ability to modify its structural and functional organization as a consequence of different (e.g. physical, psychological) events. The idea of a separation between “organic” and “psychic” appears to be definitively surpassed by the necessary consideration that brain and mind are involved in a circular relationship in which psychic and physical processes interact and give rise to the unitary brain-mind system. The insights on the dynamic mechanism regulating the functioning of the brain together with the development of advanced functional neuroimaging techniques such as PET and FRMI, enabling a fine and deeper representation of cerebral structures and of neuronal activity, constitute the theoretical and technical base for a renewed interest in research by psychoanalytic science. For example, the possibility of analyzing cerebral modifications following psychotherapy is very attractive. This possibility now has realistic prospects.
Research concerning integration of the knowledge acquired by the two disciplines has been the topic of various papers in the psychoanalytic field; it is now possible to develop a research model by combining the richness of the analytical, clinical examination with the reliability of the neuropsychological method.
In this new context, the rapprochement between neuroscience and psychoanalysis and, indeed, the chance to develop an integrated view of the brain-mind complex, seem possible.
2. Aspects of convergence between neuroscience and psychoanalysis
Eric Kandel’s work is an important contribution to the analysis of the interaction between neuroscience and psychoanalysis. In this paper, the author proposes an integrated model in which psychoanalysis has the guiding role for exploration of the psychic realm and neuroscience constitutes the natural empirical testing context. Kandel points out in detail the correspondence between the concept of implicit memory in cognitive psychology and some aspects of the unconscious as defined by psychoanalysis. Memory is a multi-componential system primarily consisting of two sub-systems: declarative (explicit) memory and implicit (procedural) memory. Declarative memory refers to processes activated to allow the conscious recollection of facts and events. Implicit memory indicates those memory processes (e.g. priming, learning and formation of new motor and perceptual skills and habits and emotional learning) that take place without conscious, intentional information recall. There is general agreement with the assumption that declarative and implicit memory are subserved by different cerebral pathways. Indeed, the cerebral structures underlying declarative memory lie in the hippocampus and in the related structures of the medial temporal lobe and diencephalon, whereas procedural memory is the result of the activity of cerebral areas outside the medial temporal lobe and of distributed sub-cortical regions.
According to the structural model in psychoanalysis, unconscious is dynamic and includes both the content of the id and the psychic conflicts and defenses of the ego. The unconscious content is kept void of awareness by the action of a strong defense mechanism such as repression. In his article, Kandel argued that the concept of procedural memory has no correspondence with this formulation of the unconscious. Indeed, according to the author some linkages can be traced to the component of the unconscious related to that portion of the ego that in psychoanalytic view, even if not repressed, remains unconscious and includes habits and perceptual and motor skills. Kandel defines this unconscious as the “procedural unconscious”. Both procedural memory and procedural unconscious can be considered forms of learning without awareness, whose functioning is somehow independent from the activity of particular inhibitory processes. Indeed, skills and habits, the former referring to procedures to operate in the environment and the latter to dispositions and tendencies specific to a set of stimuli that play a role in guiding behavior, are viewed as the result of a progressive learning process related to repetition and practice. Pavlov’s classical conditioning paradigm shows the process underlying procedural learning by the repeated association of two stimuli: the conditioned stimulus and the unconditioned stimulus. In this experimental procedure, subjects learn not only that the conditioned stimulus precedes the unconditioned one, but that the presentation of the conditioned stimulus predicts the occurrence of the unconditioned one in relation to the psychobiological value of the unconditioned stimulus. In this perspective, procedural memory and procedural unconscious could be conceptualized as a form of primary dynamically implicit regulation of responses to inner and environmental demands exerting a continuous action on the psychic functions.
These insights are very relevant if we consider on one hand the early affective experience in the growth of the individual, in a period in which the declarative memory system is not yet developed, and, on the other hand those changes occurring during psychoanalytic therapy that are not directly related to interpretation or to any conscious process.
As regards the first issue, according to the object-relation theories a child progressively forms structured internal representations of objects and of the relationship between the self and others that constitutes the critical requirement for the differentiation of the psychic apparatus and the constitution of a differentiated identity. Moreover, the interior object representations determine the formation of modules that regulate individual perceptions, expectations and interpersonal behavior. In his attachment paradigm, Bowlby proposed that the earliest interactions between mother and infant are regulated by a circular relationship. In this relationship, the child activates emotive and behavioral patterns directed to the pursuit of communication and contact with his mother. Her responses have the aim of feeding the positive emotional state of the child. The repeated activation of this interactive system determines the constitution of the child’s emotional disposition. The quality of the earliest experiences is of great importance for development of emotional stability in the individual. Somehow, both the internal representation of objects and the emotional disposition of the child can be considered consequences of implicit learning. In this view, one can assume that the primitive, meaningful matrix and the operative schemata to give a coherent and continuous “sense” to the experience of one’s own self lies in the procedural unconscious.
As regards the second issue, concerning the processes of psychotherapy, some authors highlight that progress in psychotherapy is not only related to conscious insight processes but also to the acquiring of new implicit memories that broaden the range of the patients’ procedural strategies. According to the authors, these implicit memories are connected to the “moments of meaning” that occur between the analyst and the patient. We can assume that the characteristics of the analytical setting, together with the repetition of moments of meaning in the interaction between the analyst and the patient, contribute to the formation of a sort of “procedural field” which, on an implicit level, gives specific sense to that particular relationship leading to the development of the transference phenomena. In this view, the comprehension and analysis of such unconscious movements, which are not directly dynamically unconscious related, seem to have primary importance for understanding the implications of implicit learning for experience and behavior.
Other points of convergence between psychoanalysis and neuroscience derive from research on the mechanisms underlying the regulation of affective behavior. With regard to Freud’s structural model, drives are endogenous sources of stimulation that involve the psychic apparatus. Endogenous and environmental stimulation cause an increase in excitation (energy) in the organism, and the feeling of satisfaction is mediated by a process of motor discharge of the stored excitation. This mechanism determines the affective experience; its quality is strongly connected with the quickness of resolution of the state of tension and defines the properties of the objects and of the internal objects’ representation. Therefore, in the presence of stimuli, whether external objects or internal representations, the organism responds by producing signals (excitation) that guide behavior. In a neural model of affective functioning, the orbitofrontal cortex is considered to be highly involved in the regulation of emotional processes and particularly of goal-directed emotional behavior. Several studies in primates and in humans have reported that lesions in the ventro-medial frontal cortex impair learning of the association between a stimulus and a reward, and the capacity to organize behavioral strategies in relation to a change in reinforcement conditions. This process has a critical role in the mediation of learned emotional responses. Moreover, according to Bechara et al, a lesion of the ventromedial frontal cortex is associated with impairment in the analysis of somatic or emotional signals and in decision-making ability. As the authors reported, in the perspective of the somatic marker hypothesis emotional evaluation plays an important role in the decision-making process. The orbitofrontal cortex activity allows for modification of behavioral strategies in relation to variation in the emotional value of the stimuli . Furthermore, orbitofrontal damage produces important personality changes such as lack of interest in one’s condition and future, elation, loss of initiative, disinhibition and difficulty in understanding others’ feelings. Indeed, Stone et al found that patients with bilateral orbitofrontal damage have a deficit in the ability to make inferences about others’ mental states, an ability known as “theory of mind”. In detail, this function refers to the capacity to represent other people’s knowledge, intentions, beliefs and desires and, thus, it subserves the comprehension and prediction of the others’ behavior. These patients do not present cognitive limitations in understanding the others’ mental states but, rather, a deficit in connecting their theory of mind inferences with comprehension of emotions. In the authors’ interpretation, the orbitofrontal cortex, as part of a larger neural system, is particularly involved in theory of mind tasks that require emotional processing. Moreover, the distributed anatomical connections of the orbitofrontal cortex to the sensory cortical areas, with the hippocampus, the amygdala and the hypothalamus provide the cerebral substrate for the integration of internal and environmental information acting as a “convergence zone”. Therefore, the orbitofrontal cortex appears to be involved in the analysis of both emotional (e.g. somatic modifications) and motivational states, and in the modification of behavioral strategies with respect to internal and external contingencies and in the subjective affective experience in the social relationship. Furthermore, orbitofrontal structures appear to be concerned with the experiences of pleasure and pain, with the encoding of vocal and facial emotional expressionand with the production of images of faces. Thus, the orbitofrontal cortex seems to have all the features to give rise to internal representations of objects rich with affective motions. In an integrated model, this cerebral region, as part of a larger neural circuitry subserving emotional self-regulation, could act as an organizer of affective experience by regulating the process that leads to the satisfaction of drives, particularly with respect to environmental demands, and by the definition of the objects of drives (i.e., the ones that allow reducing inner excitation) and of stable internal object representations related to the experience of pleasure and frustration.
2.1 Some common research perspectives.
In this section, we are going to examine two contributions. The first one refers to Kaplan-Solms and Solms’ work in neuro-psychoanalysis, a new field at the border between psychoanalysis and neuroscience. These authors suggested applying the psychoanalytical technique, with some changes from the classical method (i.e, frequency of sessions, length of entire treatment), to neurological patients with focal brain damage in order to identify the cerebral organisation of deeper psychic functioning. Of particular interest is the observation of four patients with ventromesial frontal damage in a psychoanalytical setting. The authors argued that the psychic functioning of these patients resembled that of the system unconscious. Indeed, the patients showed features such as “exemption from mutual contradiction, primary process thinking (e.g. concrete thought, object properties fluctuation in relation to own needs), timelessness and replacement of external by psychical reality”. The authors accurately described these processes by analysing free associations, transference phenomena and the patients’ adaptation to the clinical setting. Interestingly, in some cases the patients showed a transient capacity to use the analyst as an internal holding object, thus experiencing better psychological integration that was not preserved after the session. Based on these observations, the authors assumed that the ventromedial frontal area is of crucial importance for the realization of the secondary process through the inhibition of the primary process of the mind. Thus, in the authors’ perspective, the function of the ventromesial cortex subserves the integration between the external and the internal realm and the differentiation of the components of the psychic apparatus. These considerations are coherent with evidence in neuroscience upholding the inhibitory function of the prefrontal cortex and the critical adaptive role of the orbitofrontal cortex in emotional regulation and in the social realm.
The other contribution regards Anderson and Green’s study on the processes underlying the suppression of unwanted memory. In order to study this mechanism, the authors applied a form of the go/no go paradigm. The experiment had three phases: a training phase in which the subjects had to learn 40 unrelated word pairs; a second study phase in which a cue from one of the word pairs was shown to the subjects on a computer screen and they were requested either to respond by recalling and saying the associated word, or not to think of the response (word) in relation to the specific cue presented (executive control in active inhibitory process). In the following test phase, cues were presented to the subjects and they had to respond by recalling the correct associated word with the instruction to give a response to each cue. The results showed an impairment in suppressed word pairs recall. In the authors’ view, these outputs showed that intentional inhibitory cognitive processes (executive control) can produce an impairment in memory recall, and the possibility arises that the process of repression proceeds from an explicit to an implicit level. On the whole, these insights confirm the presence of a repression mechanism directed toward inhibiting undesirable memories, as Freud suggested [see 1], and can lead toward better understanding of the functioning of psychological defense mechanisms.
These contributions show how knowledge and methods of cognitive neuroscience and psychoanalysis can be applied in common research. It would be very interesting to use the psychoanalytical technique to study and treat patients suffering from organic amnesia. In this syndrome, there is a dissociation between an impaired declarative memory and a substantially spared implicit memory as a consequence of a lesion involving the temporo-mesial or diencephalic structures. Indeed, the observation of these patients in a psychoanalytical setting could lead us to a better understanding of the influence of implicit learning both in transference phenomena and in more general therapeutic factors, and could clarify the function of the underlying cerebral structures in determining the feeling of continuity of the self and the stability of internal objects representation.
The aim of this paper to provide some insights about the ongoing discussion over the possibility of a joint-venture between the two sciences. Our considerations can be summed up in three issues:
1) the presence of cultural and technological transformations that constitute the basic premises for a rapprochement;
2) the statement of fact that convergence exists over some aspects of brain-mind functioning;
3) the potential advantages of a common research strategy.
We can conceptualize the field of neuro-psychoanalysis as an emergency, that is, a dynamic movement emerging from the interactions between two complex systems whose properties cannot be reduced to individual components; that is, a new form of thinking and operating whose richness derives solely from the combination of the stimuli arising from the two disciplines. In this perspective, it is important to implement the study of neurobiology and cognitive psychology in the educational background of psychotherapists and psychoanalysts, so that new researchers will have integrated training that is more functional for constructing a reliable model of research in neuro-psychoanalysis.
The observations reported here indicate the essential contribution a critical analysis of the progress in neuroscience and psychoanalysis can give to the explanation of questions of mutual interest (e.g. affective regulation, implicit learning).
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Carlo Caltagirone, neuropsychiatrist, professor of Neurological Rehabilitation at the Medicine Faculty of “Tor Vergata” University in Rome and Scientific Director of the “Fondazione Santa Lucia”, Scientific Institute for Research and Health Care. He has published over 140 papers on international scientific journals, dealing with issues regarding clinical neurology, clinical and behavioral neuropsychology and neuro-rehabilitation [email@example.com].
Alberto Costa, Ph.D. student in neuropsychology at the Università Cattolica del Sacro Cuore in Rome, specialized in “individual and group analytic psychotherapy”. He was professor of Clinical Psychology at a first level degree course for orthopedic technicians at the Medicine faculty of the “Tor Vergata” University in Rome. His current research focuses on the study of cognitive and affective processes in neurological diseases and psycho-affective syndromes. He is author or co-author of several papers [firstname.lastname@example.org].