The case for neuropsychoanalysis: Why a dialogue with neuroscience is necessary but not sufficient for psychoanalysis

Abstract

Recent advances in the cognitive, affective and social neurosciences have enabled these fields to study aspects of the mind that are central to psychoanalysis. These developments raise a number of possibilities for psychoanalysis. Can it engage the neurosciences in a productive and mutually enriching dialogue without compromising its own integrity and unique perspective? While many analysts welcome interdisciplinary exchanges with the neurosciences, termed neuropsychoanalysis, some have voiced concerns about their potentially deleterious effects on psychoanalytic theory and practice. In this paper we outline the development and aims of neuropsychoanalysis, and consider its reception in psychoanalysis and in the neurosciences. We then discuss some of the concerns raised within psychoanalysis, with particular emphasis on the epistemological foundations of neuropsychoanalysis. While this paper does not attempt to fully address the clinical applications of neuropsychoanalysis, we offer and discuss a brief case illustration in order to demonstrate that neuroscientific research findings can be used to enrich our models of the mind in ways that, in turn, may influence how analysts work with their patients. We will conclude that neuropsychoanalysis is grounded in the history of psychoanalysis, that it is part of the psychoanalytic worldview, and that it is necessary, albeit not sufficient, for the future viability of psychoanalysis.

Un plaidoyer pour la neuropsychanalyse. pourquoi un dialogue entre neurosciences et psychanalyse est‐il nécessaire mais non suffisant ?

Les avancées récentes dans le champ des neurosciences et ses différents domaines — cognitif, émotionnel et social — ont permis d'étudier des aspects du psychisme qui présentent un intérêt fondamental pour la psychanalyse. Ces développements ouvrent un grand nombre de perspectives dans le champ de la psychanalyse. Notre discipline peut‐elle établir un dialogue productif et mutuellement enrichissant avec les neurosciences sans pour autant compromettre sa propre intégrité et spécificité ? Alors que de nombreux psychanalystes se montrent très favorables à des échanges pluridisciplinaires avec les neurosciences — que l'on désigne du terme de neuropsychanalyse, d'autres ont émis des réserves quant aux effets potentiellement délétères que pourraient exercer ces échanges sur la théorie et la pratique analytiques. L'auteur de cet article expose les grandes lignes du développement et des objectifs de la neuropsychanalyse, tout en examinant l'accueil respectif qui lui est réservé tant du côté de la psychanalyse que de celui des neurosciences. Il discute ensuite des interrogations que cela soulève en psychanalyse, plus particulièrement en ce qui concerne les fondements épistémologiques de la neuropsychanalyse. Bien que dans cet article l'auteur ne traite pas explicitement des applications cliniques de la neuropsychanalyse, il présente brièvement un cas clinique qui illustre son propos, montrant que les découvertes de la recherche en neurosciences peuvent servir à enrichir nos modèles du psychisme, ce qui peut en retour influer sur la façon dont les analystes travaillent avec leurs patients. L'auteur conclut en disant que la neuropsychanalyse fait partie inhérente de l'histoire de la psychanalyse et de sa vision du monde et qu'elle est une condition nécessaire, bien que non suffisante, de la viabilité future de la psychanalyse.

Plädoyer für die neuropsychoanalyse: warum der dialog mit den neurowissenschaften für die psychoanalyse erforderlich ist, aber nicht ausreicht

Aufgrund der in den kognitiven, affektiven und sozialen Neurowissenschaften erzielten Fortschritte konnten diese Disziplinen Aspekte der menschlichen Psyche erforschen, die für die Psychoanalyse von zentralem Belang sind. Diese Entwicklungen erschließen ihr zahlreiche Möglichkeiten. Kann es der Psychoanalyse gelingen, mit den Neurowissenschaften einen wechselseitig befruchtenden Dialog aufzunehmen, ohne ihre eigene Integrität und unverwechselbare Sichtweise zu kompromittieren? Viele Analytiker begrüßen den interdisziplinären Austausch mit den Neurowissenschaften, den wir heute als Neuropsychoanalyse bezeichnen, doch andere haben Bedenken geäußert und befürchten schädliche Einflüsse auf die psychoanalytische Theorie und Praxis. In diesem Beitrag skizzieren wir die Entwicklung und die Ziele der Neuropsychoanalyse und untersuchen ihre Rezeption durch die Psychoanalyse und die Neurowissenschaften. Daran anschließend erläutern wir einige der Bedenken, die aus den Reihen der Psychoanalytiker zu vernehmen sind. Dabei berücksichtigen wir insbesondere die epistemologischen Grundlagen der Neuropsychoanalyse. Dieser Beitrag ist kein Versuch, die klinischen Anwendungen der Neuropsychoanalyse erschöpfend darzustellen; gleichwohl präsentieren und diskutieren wir einen klinischen Fall, um zu zeigen, auf welche Weise die neurowissenschaftliche Forschung unsere Modelle der Psyche bereichern und so wiederum beeinflussen kann, wie Analytiker mit ihren Patienten arbeiten. Wir ziehen den Schluss, dass die Neuropsychoanalyse in der Geschichte der Psychoanalyse wurzelt, dass sie Teil der psychoanalytischen Weltsicht ist und dass sie für die Überlebensfähigkeit der Psychoanalyse notwendig, wenn auch für sich allein nicht hinreichend ist.

Argomento in favore della neuropsicoanalisi. perché il dialogo con le neuroscienze è necessario ma non sufficiente per la psicoanalisi

I recenti progressi delle neuroscienze nel campo cognitivo, affettivo e sociale hanno reso possibile lo studio di aspetti della mente che sono centrali nella teoria psicoanalitica. Questi sviluppi allargano l'orizzonte della psicoanalisi e delle sue possibilità. Ci si chiede se la psicoanalisi sia in grado di raccogliere la sfida e intrattenere con le neuroscienze un dialogo che sia produttivo e fruttuoso per entrambe senza tuttavia compromettere l'integrità e l'unicità della sua prospettiva. Mentre molti analisti accettano di buon grado lo scambio interdisciplinare con le neuroscienze, denominato neuropsicoanalisi, alcuni hanno espresso la preoccupazione che ne possano derivare degli effetti potenzialmente deleteri sulla teoria e sulla pratica psicoanalitica. In questo lavoro tracciamo lo sviluppo e gli obiettivi della neuropsicoanalisi e riflettiamo su come questa disciplina è stata accolta sia nell'ambito psicoanalitico che in quello delle neuroscienze. Passiamo quindi alla discussione di alcuni dei dubbi ai quali si è dato voce in ambito psicoanalitico, sottolineando in particolar modo i fondamenti epistemologici della neuropsicoanalisi. Sebbene questo articolo non intenda affrontare l'aspetto delle applicazioni cliniche della neuropsicoanalisi, ci proponiamo di illustrare, attraverso un breve resoconto clinico, come si possano utilizzare i risultati delle ricerche neuroscientifiche per arricchire i nostri modelli della mente in modi che, a loro volta, possano influenzare il modo in cui l'analista lavora con i pazienti. Ne concludiamo che la neuropsicoanalisi affonda saldamente le radici nella storia della psicoanalisi, che partecipa alla visione del mondo psicoanalitica e che è necessaria, sebbene non sufficiente, alla futura sopravvivenza della psicoanalisi.

Argumentos a favor del neuropsicoanálisis. por qué el diálogo con la neurociencia es necesario pero no suficiente para el psicoanálisis

Los avances recientes en las neurociencias cognitiva, afectiva y social posibilitaron que estos campos estudiaran aspectos de la mente que son fundamentales para el psicoanálisis. Estos desarrollos abren una serie de posibilidades para nuestra disciplina. ¿Puede esta dialogar con las neurociencias de manera productiva y mutuamente enriquecedora sin comprometer su integridad ni su perspectiva singular? Si bien muchos analistas acogen positivamente los intercambios interdisciplinarios con las neurociencias, a los que se denomina neuropsicoanálisis, algunos han expresado cierta inquietud acerca de su posible efecto deletéreo sobre la teoría y la práctica psicoanalíticas. Este trabajo sintetiza el desarrollo y los objetivos del neuropsicoanálisis, y considera su recepción en el ámbito psicoanalítico y en el de las neurociencias. Luego se analizan algunas de las preocupaciones planteadas dentro del campo psicoanalítico, con particular énfasis en las bases epistemológicas del neuropsicoanálisis. Aunque no se pretende abordar íntegramente las aplicaciones clínicas de dicho enfoque, se presenta un breve ejemplo clínico para demostrar que los hallazgos de la investigación neurocientífica pueden utilizarse para enriquecer los modelos psicoanalíticos de la mente de distintas maneras que, a su vez, pueden influir sobre la modalidad de trabajo de los analistas con sus pacientes. Se propone como conclusión que el neuropsicoanálisis tiene su fundamento en la historia del psicoanálisis, que es parte de la visión de mundo psicoanalítica y que es necesario, aunque no suficiente, para la viabilidad futura del psicoanálisis.

Key words:

• cognitive neuroscience
• dual‐aspect monism
• Freud
• interdisciplinary dialogue
• meaning
• mind‐body problem
• neuropsychoanalysis
• subjectivity

Acknowledgement

AF's time was supported by an European Research Council (ERC) Starting Investigator Award for the project ?The Bodily Self' N°313755.

Notes

1. When it was first formally introduced (Nersessian and Solms, 1999) the term denoting this interdiscipline was “neuro‐psychoanalysis”. The hyphen was meant to emphasize the fact that psychoanalysis and the neurosciences are separate and cannot be merged. Over the last few years, however, as the phrase became more popular and widely used, the hyphen was dropped. Nevertheless, the reasons for its original usage remain pertinent.

2. It can already be seen that the statements quoted in this paragraph are in opposition to the basic case against neuropsychoanalysis. Who is to determine what the “biological substrate” is, and what the “limits of psychoanalysis” are? It would have to be someone fully conversant with both disciplines, namely a neuropsychoanalyst.

3. Many analysts may be unaware of the fact that within the cognitive neurosciences there has been great scepticism about the very existence of the phenomenon of dynamic repression (Loftus, 1993; McHugh, 1992). One of the reasons for this is that attempts to produce traumatic amnesia in the lab have failed repeatedly. On the other hand, the psychoanalytic literature contains innumerable case studies that support the existence of dynamic repression (Blum, 2003). Blass and Carmeli (2007, p. 23) suggest that an empirical study that might address this apparent contradiction does not belong especially to the field of neuroscience. However, one of the only empirical prospective studies to address it was done by researchers who were familiar with both the psychoanalytic and the neuroscientific aspects of this controversy (Yovell et al., 2003). The study found preliminary evidence for the existence of two different types of amnestic processes following trauma: one that resembles dynamic repression and another that resembles a form that we will consider below, in relation to Ms A's symptoms.

4. There are reasons to believe that in the not‐too‐distant future, advanced imaging techniques might help distinguish between true and false memories even when the patient who experiences them is unable to do so (Cabeza et al., 2001). In our opinion, analysts should not fear, deny or avoid the consequences of this development. It may enhance psychoanalytic technique and help us better understand the subjective experience of remembering something that never took place, a psychoanalytically meaningful mental phenomenon.

5. This conclusion contradicts Pulver's suggestion that the neurosciences, while being relevant to psychoanalytic theory, are irrelevant to psychoanalytic technique. Even if neuroscientific findings only helped him decide which of two pre‐existing psychoanalytic theories to apply in order to understand a particular clinical situation, as he himself described (Pulver, 2003, p. 759), they have thereby influenced his clinical meaning‐making.

6. Those who believe that the neurosciences are irrelevant to psychoanalysis often see no difficulty with a future in which psychoanalysis is irrelevant to the neurosciences, as it has been throughout most of the 20th century. The marginalization of psychoanalysis in the academic world, the loss of its influence and representation in undergraduate and graduate psychology programmes as well as in medical schools and psychiatry residency programmes, and the unwillingness of third‐party health care providers to cover the costs of psychoanalytic treatment, are in our opinion unwelcome consequences of such isolationist attitudes. Likewise, the fact that public and private funding for mental health research heavily favours neuroscience approaches, to the near exclusion of purely clinical ones, is in part another consequence of the absence of psychoanalytic voices in the neuroscientific discourse. In an effort to reverse these trends, all three of us (YY, MS, KF), as well as many other practicing neuropsychoanalysts, have obtained research funding for studies that are based on psychoanalytic theories and that employ psychoanalytic methods. In doing so, the growing neuropsychoanalytic community is strengthening the psychoanalytic voice in the current psychological, psychiatric, and neuroscientific discourse and research activity.

Additional information

Funding

European Research Council (ERC)