Neuropsychoanalytic Explorations: Linking Practice, Theory, and Research

ABSTRACT

Clinical vignettes along with applicable neuroscientific research findings are considered for the purpose of examining the utility of neuropsychoanalysis to psychoanalytic thought and practice. Several fundamental psychoanalytic concepts are revisited along both lines. Among them are: identification, embodiment, attachment, drive, danger situations, dreams, memory, metaphor, conflict, defense. In the process, the metapsychology of the “mental apparatus” gains renewed attention. The article uses instances of three different clinical situations as moments open to neuro-psychoanalytic explorations of several basic psychoanalytic propositions: on the couch; on the phone; in the chair.

Acknowledgments

This article is dedicated to the memory of Martin H. Blum, M.D. (1932–2013) for his surpassing learning and inspiring teachings.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

¹ To be sure, his hierarchy of the danger situations is actually couched in the terms of his theory as fears of loss of object, loss of love of object, castration, and superego (Freud, 1926). However, on a less stringently theory-adherent view, castration expresses concerns about body intactness, while social acceptability is ushered in by post-oedipal superego as the basis of the contract of entering into shared social space and observing its laws.

² As such this demonstrates how psychoanalytic treatment represents a deftly performed dance between idiographic (private, unique) and nomothetic (shared, lawful) perspectives.

³ Panksepp’s work lies at the center of burgeoning and converging neuroscience research on “intrinsic motivation” which suggests that “intrinsically motivated exploratory and mastery behaviors are phylogenetically ancient tendencies that are subserved by the dopamine systems” (Di Domenico & Ryan, 2017, p. 1). Although his work is being slowly and progressively validated (Watt, 2017), remaining controversies revolve around the role of cognition in human emotional experience and to a lesser extent the acceptance of animal consciousness. Regarding the former, an article by Panksepp, Lane, Solms, and Smith (2015) attempts to reconcile cognitive and affective neuroscience, a task bedeviled by definitional, methodological and philosophical differences.

⁴ In The Problem of Anxiety (1936) and in An Outline of Psychoanalysis (1938) Freud continues to see instinctual drives as organizing the environment and as being organized by it so that inner and outer worlds are inextricably interrelated. (Loewald, 1960). Such an understanding should have served to mitigate the fervent anti-metapsychology movement of the next two decades.

⁵ Dreams occur in other stages of sleep whenever arousal produces a hallucinatory experience in the relative absence of modulating external stimuli and executive functioning. However, during REM there are special physiological conditions as will be described..

⁶ Interaction of dopaminergic with other neuromodulatory systems would also need to be taken into account for a complete picture of the neurobiology of dreaming (Perogamyrosa, Dang-Vu, Desseilles, & Schwartz, 2013).

⁷ It must be acknowledged however that he still maintains that Freud’s dream theory is 100% wrong..

⁸ Given that at 6 months infants are sleeping 15 h per day and spending 30% of that time in REM, this correlation with cortical growth implicates REM sleep as a functionally significant factor in the child’s rapid and prodigious mental and emotional development.

⁹ Documentation of waking human hippocampal theta has been quite difficult since for many years it could only be accomplished through intracranial recordings in epileptic patients.

¹⁰ Although the theta sleep memory consolidation hypothesis is the dominant theory there exists some contradictory data which seem to implicate interaction with NREM memory processes. (Vertes, 2011). A most thorough review of these complex matters can be found in Perogamvros et al., 2013.

¹¹ During this period differences in EEG theta activity between social and nonsocial stimuli become more pronounced.

¹² It is worthwhile to consider whether the muscle atonia of REM sleep occurring at a time of intense internal activation may serve as the most basic model of defense for it succeeds in containing all activity in the mental sphere. Unfortunately, at this point there is much controversy even simply about the mechanisms of this inhibition of motor activity during REM (Brooks & Peever, 2008). However, the phenomena of REM sleep behavior disorders, in which this muscle paralysis fails and dreams are acted out, often with injurious consequences (Schenck & Mahowald, 2002) does suggest this possibility..

¹³ Inhibition of stereotyped instinctual response allowing for fresh thinking and “experimental action” is central to the psychoanalytic theory of thinking discussed in Chapter 7, elaborated at a panel at an American Psychoanalytic Association annual meeting (Arlow, 1958) and reiterated by Solms (2015).

¹⁴ The psychoanalytic centrality of the wish in dreaming gains support from neuropsychoanalytic exploration. For if we employ Freud’s definition of the wish as the psychical impulse to re-establish the situation of previous satisfaction we have invoked the two central generators of the dreaming process, desire, and memory. In this regard a paper entitled Mapping a Gap: the concepts of wish and wishing in psychoanalysis and neuroscience (Schonbachler, Stojkovic, & Boothe, 2016) explicitly address the connections between the wish and the SEEKING system.

¹⁵ This is therefore a waking version of the failure of mental containment seen in REM sleep behavior disorders.

Additional information

Notes on contributors

Luba Kessler

Luba Kessler, M.D., is a psychiatrist/psychoanalyst in private practice in Roslyn, New York.

Richard J. Kessler

Richard J. Kessler, D.O., is Faculty, New York Psychoanalytic Institute.