Theoretical and clinical advances in neuropsychoanalysis: reflections on consciousness, dreams, wishing, and the relationship between inner speech, the superego, and the prefrontal cortex

The articles in this issue contribute to a number of lively contemporary theoretical discussions about fundamental aspects of mental life. They illustrate the powerful creativity that arises when psychoanalysis enriches neuroscience, and vice versa.

The pieces in this issue span a wide spectrum of time and space in human life. This is one of the things we value most about neuropsychoanalysis and the people who contribute to it – we take on very big questions, but always attempt to ground these explorations in lived experience. From the longest-range perspective on the human time spectrum, we have an article by Terry Rogers and Ahron Friedberg entitled “A conjecture on the nature and evolution of consciousness.” They present an extremely big-picture view on this fascinating question. Their deep-time perspective on evolution goes all the way back to the emergence of multicellular organisms, arguing that all animals – not just primates, and not just mammals – may have this profound attribute in common. Integrating work by other contributors to the field, including Bernard Baars, Antonio Damasio, Stanislas Dehaene, Rodolfo Llinas, Jaak Panksepp, Mark Solms, and others, Rogers and Friedberg emphasize the unitary nature of conscious experience, its adaptive function in responding to novelty, and its likely critical role in learning. These aspects of their model, and more, have exciting psychoanalytic implications, and will be of interest to readers following the developments in the consciousness literature.

We open the issue at the other end of the spectrum, however – by zooming in on the individual. A very rich Target Article by Christian Salas and Kenneth Yuen, entitled “Revisiting the left convexity hypothesis: Changes in the mental apparatus after left dorso-medial prefrontal damage,” focuses on a single case study of a man with a prefrontal brain injury. Their careful attention to the dynamics experienced during a psychoanalytic therapy with Professor F enriches an emerging depth psychology model of the mind and brain.

We find that Salas and Yuen’s powerful and informative Target Article represents the heart of clinical neuropsychoanalysis. They aim to revisit and continue the pioneering work of Karen Kaplan-Solms and Mark Solms in their by now classic book, Clinical Studies in Neuro-Psychoanalysis (2000). That book was a primer in offering a “depth psychology” of the brain through the examination of neurologically injured patients. It was ground-breaking in its combining the clinical neurological aspects with an extensive psychoanalytic understanding of the psychology and subjective experience of the patient. Salas and Yuen point out that although the book was an essential introduction to this integrating endeavor, it has been followed up by fewer papers than was hoped, as Kaplan-Solms and Solms strongly encouraged others to develop the discipline of clinical neuropsychoanalysis and explore its possibilities.

In their Target Article, Salas and Yuen add substantially to this small but growing literature. They do this by at first introducing Kaplan-Solms and Solms’ methodology of clinical/pathological technique so that we see its importance. They summarize an example used by those authors – a patient with Broca’s aphasia (located in the lateral prefrontal cortex (PFC)). Salas and Yuen then present a patient with brain damage in the dorsomedial PFC, and elaborate on the clinical description of this patient and the resulting changes in his mental function. The picture includes acquired ego deficits and a dysexecutive state, as well as changes in inner speech and superego function. In doing this they are fleshing out the growing model of brain function linked to anatomical brain lesions, adding a chapter to the work of Kaplan-Solms and Solms, as well as other neuroscientific writers such as Oliver Sacks.

The observations that Salas and Yuen make about the case of Professor F, their thoughts on the internal processes in the patient, and the implications for treatment of patients with similar difficulties, are then followed by six very interesting commentaries by clinicians, writers, and thinkers who have already made their own important contributions to this literature. Rudi Coetzer, Fergus Gracey, George Prigatano, Mark Solms, Kobi Tiberg, and Oliver Turnbull bring their expertise to this task by providing a wealth of thoughts that elaborate and extend, and sometimes challenge, the interpretations of the Target Article. The commentators discuss a range of issues, including the technical considerations in working with patients with brain injury, and the human urgency for providing such treatment; important questions about the relationship between language, perspective-taking, and self-regulation; and much more. Readers are strongly encouraged to engage with each of these well-written, humane, and thoughtful commentaries. The authors then respond to these commentaries, including responding to considerations raised by Solms about the medial and lateral prefrontal circuits, which may play different roles in the “primitive” and “mature” aspects of the superego, respectively.

And in the middle of the time-space spectrum of human life, somewhere between the entire species and the individual, we have two articles that explore central mental processes which have both conscious and unconscious aspects, thus resonating with the focus on consciousness, or its impairments, discussed above. One paper, by Calvin Kai-Ching Yu, focuses on typical dream themes, and another, by Georg Schönbächler, Brigitte Boothe, and Dragica Stojkovic, focuses on wishes and wish fulfillment. These pieces suggest that both dreaming and wishing develop along a “blueprint” that most humans presumably manifest in centrally similar ways, but with countless individual differences due to history and experience.

Yu, who has published extensively with both empirical and theoretical contributions to dream research, discusses the evidence for some common themes in dreaming in his article “Typical dream themes and their implications for dream interpretation.” He suggests that typical dream themes may emerge from instinctual neurobiological substrates that most humans likely share in common. He notes that the evidence to date suggests that “typical dream motifs reflect some universal human attributes that are only to some extent modified by environmental factors” (p. 138). He also reviews extensive evidence for the role of dreaming in affect regulation, which would underlie the individual differences between dreams and dreamers, given that individuals will have different experiences driving the dream process. All of this will be of interest to clinicians working with dream material.

In turn, in their article “Mapping a gap: The concepts of the wish and wishing in psychoanalysis and the neurosciences,” Schönbächler, Stojkovic and Boothe engage in a very stimulating exercise in creative synthesis. They bring together data and models from domains which appear to be addressing the same set of functions, but without engaging in much direct dialogue – namely, psychoanalytic theories about wishing and wish fulfillment; neuroscientific work on “wanting” (Berridge, 2009) and SEEKING (Panksepp, 1998); and psychology research on motivational processes. They raise some intriguing suggestions about the dynamic relationship between impulses, drives, longings, and temporary gratification in fantasy, and the activation or suppression of SEEKING and pleasure. For example, they propose that “wanting is always directed towards action in everyday life, whereas wishing is not directly linked with action in everyday life” (p. 167, emphasis in the original). These and other observations are foundation for future explorations that have clinical implications, in relation to compulsive fantasy, addiction, procrastination, and more.

To complement the theoretical, empirical, and clinical work that is integrated in various ways in the Target Article and Original Articles section of this issue, we have wonderful Society Proceedings that illustrate how much our neuropsychoanalytic community continues to develop and thrive around the world. Daniela Flores Mosri has provided our readers with excellent coverage of the keynote talks, symposia, and research sessions at our recent 17th Congress of the International Neuropsychoanalysis Society, held in Chicago July 7–10, 2016. Further details on the symposia and research sessions are found in the Research and Symposia Abstracts. We hope that some of the fascinating work discussed at the Congress in those sessions will appear in fuller form in future issues of the journal.

Finally, Maria Sonia Goergen has curated the 32nd Bulletin of the International Neuropsychoanalysis Society, featuring group reports from three Latin American groups – two vibrant and active groups in Mexico City and Puerto Rico, and a newly formed group in Camboriu, Brazil. We look forward to hearing about more groups in upcoming issues. Regional groups are encouraged to submit updated information on their meetings and membership by visiting the “Society and Groups” section of the website of the Neuropsychoanalysis Association, at https://npsa-association.org/who-we-are/the-international-neuropsychoanalysis-society/.

We encourage readers to explore all the clinical and theoretical richness to be found in this issue, and send us your ideas and information for future issues!