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The Scientific Standing of Psychoanalysis Landman P. (2013) Tristesse Business; le Scandale du DSM 5. Editions Naccache L. (2006) Le Nouvel Inconscient. Freud, Christophe Colomb Milo. des Neurosciences. Odile Jacob. Lehembre O. (2004) Qui sommes-nous? Que faisons-nous? Une Roudinesco E. (1982) Histoire de la Psychanalyse en France, vol. 1. enquête du Syndicat des Psychiatres Français et de l’Association Le Seuil (réédition Fayard 1994). Française de Psychiatrie. La Lettre de Psychiatrie Française, 31, 15–19. Roudinesco E. (1986) Histoire de la Psychanalyse en France, vol. 2. Ménéchal J. (2008) Psychanalyse et Politique. ERES. Le Seuil (réédition Fayard 1994). THEMATIC The scientific standing of psychoanalysis PAPER Mark Solms University of Cape Town, South • We need to destroy frustrating objects Africa; This paper summarises the core scientific email [email protected] claims of psychoanalysis and rebuts the (things that get between us and satisfac- prejudice that it is not ‘evidence-based’.I tion of our needs). This is rage. Conflicts of interest. None. • address the following questions. (A) How does We need to attach to caregivers (those who look after us). Separation from © The Author 2018. This is an the emotional mind work, in health and fi Open Access article, distributed disease? (B) Therefore, what does attachment gures is felt not as fear under the terms of the Creative but as panic, and loss of them is felt as Commons Attribution- psychoanalytic treatment aim to achieve? ‘ NonCommercial-NoDerivatives (C) How effective is it? despair. (The whole of attachment the- licence (http://creativecommons. ory’ relates to vicissitudes of this need.) org/licenses/by-nc-nd/4.0/), which • permits non-commercial re-use, We need to care for and nurture others, distribution, and reproduction in especially our offspring. This is the any medium, provided the ori- ‘ ’ ginal work is unaltered and is A. so-called maternal instinct , but it exists properly cited. The written per- (to varying degrees) in both genders. mission of Cambridge University As regards the workings of the emotional mind, • We need to play. This is not as frivolous Press must be obtained for com- our three core claims are the following. mercial re-use or in order to cre- as it appears; play is the medium ate a derivative work. (1) The human infant is not a blank slate; like all through which social hierarchies are other species, we are born with innate needs. formed (‘pecking order’) and in-group These needs (‘demands upon the mind to and out-group boundaries maintained. perform work’, as Freud called them, his The (upper brain-stem and limbic) anat- ‘id’) are felt and expressed as emotions. omy and chemistry of the basic emotions The basic emotions trigger instinctual is well understood (see Panksepp, 1998 behaviours, which are innate action plans for a review). that we perform in order to meet our (2) The main task of mental development is to learn needs (e.g. cry, search, freeze, flee, attack). how to meet our needs in the world. We do not Universal agreement about the number of learn for its own sake; we do so in order to innate needs in the human brain has not establish optimal action plans to meet our been achieved, but mainstream taxonomies needs in a given environment. (This is (e.g. Panksepp, 1998) include the what Freud called ‘ego’ development.) 1 1Here I am focusing on emo- following. This is necessary because innate action pro- tional needs – which are felt as • – grammes have to be reconciled with actual separation distress, rage, etc. – We need to engage with the world not bodily drives – which are felt since all our biological appetites (includ- experiences. Evolution predicts how we as hunger, thirst, etc. – or sen- ing bodily needs) can only be met there. should behave in, say, dangerous situa- sory affects – which are felt as pain, disgust, etc. (See Panksepp, This is a foraging or seeking or ‘wanting’ tions, but it cannot predict all possible dan- 1998.) The way in which I use instinct. It is felt as interest, curiosity gers (e.g. electrical sockets); each the term ‘action plans’ in this article is synonymous with the and the like. (It coincides roughly but individual has to learn what to fear. This use of the term ‘predictions’ in not completely with Freud’s concept of typically happens during critical periods contemporary computational ‘ ’ neuroscience. libido .) in early childhood, when we are not best • We need to find sexual partners. This is equipped to deal with the fact that innate felt as lust. This instinct is sexually action plans often conflict with one another dimorphic (on average) but male and (e.g. attachment v. rage, curiosity v. fear). female inclinations exist in both genders. We therefore need to learn compromises, • We need to escape dangerous situations. and we must find indirect ways of meeting This is fear. our needs. This often involves substitute- BJPSYCH INTERNATIONAL VOLUME 15 NUMBER 1 FEBRUARY 2018 5 Downloaded from https://www.cambridge.org/core. 30 Sep 2021 at 01:41:30, subject to the Cambridge Core terms of use. formation (e.g. kicking the cat). Humans psychoanalytic and psychopharmacological also have a large (cortico-thalamic) capacity methods of treatment is that we believe feel- for satisfying their needs in imaginary and ings mean something. Specifically, feelings symbolic ways. It is crucial to recognise that represent unsatisfied needs. (Thus, a patient suf- successful action programmes entail successful fering from panic is afraid of losing some- emotion regulation, and vice versa. This is thing, a patient suffering from rage is because our needs are felt as emotions; frustrated by something, etc.) This truism thus, successful avoidance of attack reduces applies regardless of aetiological factors; fear, successful reunion after separation even if one person is constitutionally more reduces panic, etc., whereas unsuccessful fearful, say, than the next, their fear is still attempts result in persistence of fear and meaningful. To be clear: emotional disorders panic, etc. entail unsuccessful attempts to satisfy needs. (3) Most of our action plans (i.e. ways of meeting (2) The main purpose of psychological treat- our needs) are executed unconsciously. ment, then, is to help patients learn better Consciousness (‘working memory’)isan (more effective) ways of meeting their needs. extremely limited resource, so there is This, in turn, leads to better emotion regulation. enormous pressure to consolidate and The psychopharmacological approach, by automatise learned solutions to life’s pro- contrast, suppresses unwanted feelings. We blems (for a review see Bargh & do not believe that drugs which suppress Chartrand, 1999, who conclude that only feelings can cure emotional disorders. 5% of our goal-directed actions are con- Drugs are symptomatic treatments. To scious). Innate action programmes are cure an emotional disorder, the patient’s effected automatically from the outset, as failure to meet their underlying need(s) are the programmes acquired in the first must be addressed, since this is what is years of life, before the cortical (‘declara- causing their symptoms. However, tive’) memory systems mature. Multiple symptom relief is sometimes necessary unconscious (‘non-declarative’) memory before patients become amenable to psy- systems exist, such as ‘procedural’ and chological treatment, since most forms of ‘emotional’ memory (which are mainly psychotherapy require collaborative work encoded at the level of the basal ganglia). between patient and therapist. It is also These operate according to different true that some types of psychopathology rules. Not only successful action plans are auto- never become accessible to collaborative matised. With this simple observation, we psychotherapy. can do away with the unfortunate distinc- (3) Psychoanalytical therapy differs from other tion between the ‘cognitive’ and ‘dynamic’ forms of psychotherapy in that it aims to unconscious. Sometimes a child has to change deeply automatised action plans. This make the best of a bad job in order to is necessary for the reasons outlined focus on the problems which it can solve. above. Psychoanalytic technique therefore Such illegitimately or prematurely automa- focuses on the following. tised action programmes are called ‘the • Identifying the dominant emotions (which repressed’. In order for automatised pro- are consciously felt but not necessarily grammes to be revised and updated, they recognised as belonging to the self, etc.). need to be ‘reconsolidated’ (Tronson & • These emotions reveal the meaning of Taylor, 2007); that is, they need to enter con- the symptom. That is, they lead the sciousness again, in order for the long-term way to the (ineffective) automatised pro- traces to become labile once more. This is grammes that gave rise to the feelings. difficult to achieve, not least because most • The pathogenic action programmes procedural memories are ‘hard to learn cannot be remembered directly for the very and hard to forget’ and some emotional reason that they are automatised (i.e. memories – which can be acquired through unconscious). Therefore, the analyst just a single exposure – appear to be indel- identifies them indirectly, by bringing to ible, but also because the essential mechanism awareness the repetitive patterns of behav- of repression entails resistance to reconsolidation iour derived from them. of automatised solutions to our insoluble pro- • Reconsolidation is thus achieved through blems. The theory of reconsolidation is reactivation of mainly subcortical long- very important for understanding the term traces via their derivatives in the pre- mechanism of psychoanalysis. sent situation (this is called ‘transference’ interpretation). Only cortical memories B. can be ‘declared’. • Such reconsolidation is nevertheless dif- The clinical methods that psychoanalysts use flow ficult to achieve, mainly owing to the ways from the above claims. in which non-declarative memory sys- (1) Psychological patients suffer mainly from tems work, but also because repression feelings. The essential difference between entails resistance to the reactivation of 6 BJPSYCH INTERNATIONAL VOLUME 15 NUMBER 1 FEBRUARY 2018 Downloaded from https://www.cambridge.org/core.
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