Prologue: The Influence of Neuroscience on Psychoanalysts: A Contemporary Perspective

This issue of Psychoanalytic Inquiry provides psychoanalytic clinicians an opportunity to explicate how neuroscientific ideas have influenced their theory and practice. In identifying the applicability of neuroscience, psychoanalysts should consider the following questions: What relevant information has been theorized, identified and studied in neuroscience and how might these findings affect psychoanalytic theories and approaches? To what degree can these findings be integrated with psychoanalytic ideas? Do these findings favor certain psychoanalytic approaches in contrast to others (e.g., efforts to symbolize unrepresented states vs. interpretation of unconscious conflict)? What modifications of psychoanalytic theories and techniques or adjunctive and alternative treatments do neuroscientific findings suggest and across what clinical situations? What psychoanalytic theories and approaches have been indicated to be incorrect by neuroscience? How might psychoanalysis inform neuroscientific theories and research?

AIthough it will not be a focus of this issue, it is also important to consider objections to these efforts, which at times have been vehement (Blass & Carmeli, 2007). These criticisms have focused on the notion that psychoanalysis involves a subjective realm in which neuroscience has no place. In the view of these authors, such efforts actually represent a danger to psychoanalysis, as they distract from psychoanalytic approaches or emphasize theories and interventions that are separate from it. Indeed, there are significant benefits and potential risks deriving from these endeavors.

One core benefit is that consideration of neuroscientific findings (and information from other neighboring disciplines) reduces psychoanalytic isolation and the potential for reductionistic mentalism or excessive certainty about our views. Arrogance about the correctness of psychoanalytic theories and approaches has done significant damage to the profession. Neuroscience, from Freud onwards, has a history of affecting psychoanalytic thought and will continue to do so, and it is important to understand how these developments influence our thinking. Neuroscientific findings that substantiate certain psychoanalytic ideas may increase the perceived legitimacy of psychoanalytic approaches. Psychoanalytic ideas, clearly explained, can be useful to other disciplines, potentially expanding theories and directing studies. Finally, findings from other disciplines enable an expansion of therapeutic options that can allow psychoanalysis to work more effectively. The use of psychotropic medication, initially viewed as a danger to psychoanalytic treatments, is an example of such an intervention.

Despite these positives, neuroscience can serve as a distractor from or disruptor of psychoanalysis. A focus on biology can steer us away from efforts to understand the mental. Biology and neuroscience have different modes of investigation and different standards for validity and efficacy, which should add caution in identifying the relevance of their findings to psychoanalysis. The development of adjunctive approaches can lead, for better or worse, to a dilution of psychoanalytic techniques in favor of more general therapeutic approaches. An overexcitement or overreach regarding new ideas in the quest for scientific legitimacy can steer analysts in unproductive directions, such as findings being co-opted to promote particular viewpoints within psychoanalysis. For instance, the initial excitement about mirror neurons focused on how their functions supported notions of immediate resonance and implicit knowing, whereas neuroscience and psychoanalytic viewpoints suggest a much greater complexity in this system. Defenses, for example, theoretically could disrupt an effective read of the other by the mirror neuron system.

Keeping these concerns in mind, neuroscience can provide an important source of ideas and theories for psychoanalysts, as demonstrated in this issue, “The Influence of Neuroscience on Psychoanalysts: A Contemporary Perspective.” Each of the authors was asked to provide clinical material identifying how neuroscience affected their clinical work. The first article by Riccardo Lombardi describes how his clinical approaches have been influenced by Antonio Damasio, who has focused on the body as a primary source of information that becomes symbolized. Lombardi considers the importance of getting in touch with the body as essential in treatment, particularly in more severely disordered patients. He believes this task is more essential than addressing intersubjectivity or object representations. His clinical cases demonstrate how he approaches easing the mind body dissociation in his patients.

Jon Sletvold describes the influence of Damasio’s work on his conception of and approaches to obtaining information from the body and its relation the patient’s sense of self. He conceptualizes the self as being embodied and suggests that changes in sense of self include changes in the body, which can be observed by the analyst. He recommends the analyst focus not just on verbal communication but attend to nonverbal communication, including gaze, posture, and facial expression, as well as the analyst’s own bodily feelings. He presents a striking clinical example of an enactment, noting that it is not his usual way of working analytically, which dramatically illustrates bodily changes accompanying a significant change in the patient’s self-conception.

Michele Piccolo revisits the ideas of William James and connects them with the work of Damasio and Bucci in elaborating how somatic states become linked with symbolic content. These concepts are relevant to the treatment of trauma, as noted by Van der Kolk’s observation that the body keeps the score. He uses a model I developed about mentalizing unrepresented and somatic/affective states and how they interact with symbolized intrapsychic conflict. In his cases he demonstrates how attention to symbolizing somatic states served to diminish dissociation and repression related to trauma, as evidenced in part by the patient’s language.

I am the author of the fourth article which describes how neuroscience aids in the understanding of panic disorder and the impact of trauma and can be integrated with psychoanalytic concepts and approaches. Jaak Panksepp’s concept of basic emotions that perform evolutionary adaptive functions, including rage, panic and suffocation, can be used in understanding the development of these disorders. The potential for these systems to interact in producing intrapsychic conflict has been underrecognized by neuroscientists. Case examples demonstrate how the use of psychoeducational interventions, symbolizing somatic/affective states and interpreting intrapsychic conflict combine to relieve panic and posttraumatic symptoms.

A fifth article by Luba and Richard Kessler on linking theory, practice and research looks at how neuroscientific concepts affect our understanding of identification, embodiment, attachment, drive, danger situations, dreams, memory, metaphor, conflict, and defense. In their view neuroscience provides an opportunity to update and revise metapsychological concepts and psychoanalytic terminology. They discuss the implication of findings that dreams are generated in dopamine pathways that overlap with Panksepp’s SEEKING system. REM sleep and memory research suggest mechanisms by which memories can become labile in the transference, allowing for their re-integration in psychoanalytic treatment. Their cases demonstrate how incorporating neuroscientific findings into their clinical experience allows for increased empathy and attunement.

These articles are followed by superlative discussions by Drs. Larry Sandberg and Mark Solms. These discussions demonstrate that there are lively differences in points of view on these topics, and it is the approach of this journal to include these differences.

Fredric N. Busch, M.D.

Issue Editor