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(1948) Described the Emotional Reaction That Follows a Patient S Running Head: ON EFFORTS TO LINK PSYCHOANALYSIS AND NEUROSCIENCE 1 On Aphasia, the Danger Situation, and Contemporary Efforts to Link Psychoanalysis and Neuroscience John M. Watkins Institute of Contemporary Psychoanalysis Author Note John M. Watkins, Institute of Contemporary Psychoanalysis, Los Angeles, CA This manuscript is based on an earlier unpublished version that was awarded the Daphne S. Stolorow Memorial Essay Prize. Correspondence: John M. Watkins, 429 Santa Monica Blvd, Suite 200, Santa Monica, CA 90401. E-Mail: [email protected] ON EFFORTS TO LINK PSYCHOANALYSIS AND NEUROSCIENCE 2 Abstract Recent scientific advances are leading to renewed efforts to integrate psychoanalysis and neuroscience, despite earlier attempts and failures by Freud and others. The collapse of Freud’s attempt to bridge neurology and psychology left a legacy of dualism that remains with psychoanalysis and much of psychology today—a dualism that was absent from his earlier neuropsychological work. Freud’s abandonment of neuropsychological work represented a dramatic shift in his focus of inquiry away from studies of focal cortical lesions and toward a more expansive general theory of mental life and psychopathology. Spanning Freud’s neuropsychological and psychoanalytic theories is a methodology based on the detailed analysis of single or small series case reports; a method that remains at the heart of many critical historical shifts in both psychoanalysis and neuropsychology. Intrinsic to this method is an effort to make sense of individual experience. This paper explores the problems inherent in bridging psychoanalysis and neuroscience by examining a single case report from the perspective of two crucial points in Freud’s career. First, early in his career, Freud presented a neuropsychological theory relating brain structure to language and perception. With this theory, Freud formulated a view of brain-behavior relationships that still has currency today. Much later in his career, with no reference to the brain, Freud reformulated his theory of anxiety in which he described the “danger situation”, thus providing the paradigmatic precursor to modern attachment theories. Keywords: psychoanalytic therapy, neuroscience, intersubjectivity, trauma, psychoanalytic theory ON EFFORTS TO LINK PSYCHOANALYSIS AND NEUROSCIENCE 3 On Aphasia, the Danger Situation, and Contemporary Efforts to Link Psychoanalysis and Neuroscience Soon after writing the Project for a Scientific Psychology in 1896, Freud abandoned attempts to integrate neurology with psychoanalysis, even refraining from publishing the Project. In its place, Freud developed his sweeping metapsychology, together with a more modest method of observation in the psychoanalytic interview. After a one hundred year hiatus, recent scientific advances have encouraged modern neuroscientists and psychoanalysts to revisit the Project and to mount new efforts to join neuroscience and psychoanalysis. These efforts have included influential papers by neuroscientists examining the implications of neuroscience research for the future of psychoanalysis (Kandel, 1998, 1999, 2005), as well as books and papers by psychoanalysts applying neuroscience concepts to the psychotherapeutic process and, more broadly, to the problems of development that concern psychoanalysts (cf. Pally, 1998; Pulver, 2003; Palombo, 2001; Schore, 1994, 2002; Solms & Turnbull, 2002; Stern, 2004). The direction of theoretical influence reflected in these efforts is predominately from neuroscience toward psychoanalysis; that is, the effort has been to add neuroscience to psychoanalysis, rather than visa versa, although the neuroscientist Kandel (1999) ruefully observes that the integrated view developed by Freud “still represents the most coherent and intellectually satisfying view of the mind that we have” (p. 505). The current interest in returning to the neurobiology of the Project is emerging at a time of sharply declining influence of psychoanalysis on clinical practice and on the broader culture (Kandel, 1999). Further, psychoanalytic metapsychology, the all-encompassing general theory of mind and psychopathology first developed by Freud, has been gradually supplanted in many contemporary psychoanalytic approaches by a focus on the processes of the analytic relationship ON EFFORTS TO LINK PSYCHOANALYSIS AND NEUROSCIENCE 4 itself. These newer approaches, often grounded in hermeneutic philosophy, rely on data that emerges directly from the psychoanalytic relationship and emphasize relational concepts, including meaning, mutuality, and intersubjectivity. Recently, there is increased questioning, coming even from within relational, self psychology, and intersubjective approaches, of whether hermaneutic and other alternatives to psychoanalytic metapsychology have, in a sense, gone too far in excluding neuroscience. One view holds that in rejecting Freud’s metapsychology the new relational approaches have thereby lost the ability to provide a coherent view of the human condition and as a consequence lost influence in the larger society (Kandel, 1999; Strenger, 2006). Another critique points to new data emerging from attachment theory and neuroscience research that supports a “need to refashion a psychoanalytic metatheory that is consistent both with the new research base and with a more fluid, mutual, and constructivist view of relational change in adulthood” (Lyons- Ruth, 1999: 577). A third view cites psychoanalytic case reports that are not easily accounted for without including a neuroscience perspective, including case reports of patients with focal brain injuries and learning disorders (Kaplan-Solms & Solms, 2000; Miller, 1991; Palombo, 2001). Even in a mainstream textbook on psychoanalytic case formulation, McWilliams (1999) presents a brief, but fascinating example of the interplay between human relationships and brain injury (pp. 54-55). Historical Obstacles. Any attempt to bring neuroscience into psychoanalytic theory runs counter to three powerful historical trends. First, Freud’s grand attempt to formulate a psychoanalytic theory based on the contemporary neurology of his time failed dramatically and, some would say, decisively directed psychoanalysis away from brain-based explanation. Freud abandoned the Project early in his career, and never returned to any of his efforts to incorporate ON EFFORTS TO LINK PSYCHOANALYSIS AND NEUROSCIENCE 5 neurological variables into the data base of his theory (e.g., On Aphasia). Instead, Freud came to favor explanation that was composed of mental constructs grounded in observations that emerge from the psychoanalytic situation, including his self analysis (Breger, 2000). Although ideas initially developed in the Project appeared in Freud’s later writing (Basch, 1975; Holt, 1989: 215), there was no necessary mapping of Freud’s later constructs onto specific underlying neural processes. Moreover, his theory did not reference any specific methodological or epistemological constraints that depended on fundamental biological principles (e.g., natural selection), although the implication of a biological grounding may have been assumed (Holt, 1965; Kandel, 1999; Solms & Salig, 1986; Sulloway, 1979), particularly in that portion of Freud’s work referred to as the metapsychology (Gill, 1976). Second, Kohut, like Freud originally a neurologist, rejected psychobiology at the same time he abandoned drive theory, setting in place a pattern that has been followed by subsequent relationally-based theories, including self-psychology, relational psychology, and intersubjectivity. For Kohut, biological influences in psychoanalysis, represented by drive theory, were eschewed because they produced, “severe distortions in our perception of man’s psychological essence without yet achieving a true integration of analysis with biology and medicine” (1982, p. 405). For Kohut, exploration of the domains of meaning and of the physical world does not require the use of different methodologies and languages. This position led Kohut to insist that he was employing a scientific method when he described his cases, thus defining a boundary between his theory and hermeneutics. Third, the influence of hermeneutic philosophy on psychoanalysis leaves little room for neuroscience-based theorizing, because hermeneutics sharply delimits psychoanalytic inquiry to include primarily material intrinsic to the analytic relationship. The emergence of hermeneutic ON EFFORTS TO LINK PSYCHOANALYSIS AND NEUROSCIENCE 6 philosophy as an organizing framework for the psychoanalytic process coincided with increasing calls by non-hermeneutic thinkers within psychoanalysis, including George Klein, to shed the mechanistic explanations of Freudian metapsychology and move to a more circumscribed theory of personal meaning and action in the psychoanalytic situation (Guntrip, 1967; Klein, 1976). The term metapsychology can be found scattered through various parts in Freud’s scholarly writings and letters, especially in Chapter 7 of The Interpretation of Dreams (Freud, 1900) and in a series of papers published between 1915 and 1917 (Freud 1915 a, b, c; 1917), in which Freud famously outlined the dynamic, economic, and structural aspects of his theory. But despite the seeming centrality of metapsychology to psychoanalysis, Holt (1989) in an exhaustive review of Freud’s writings on metapsychology, points out that, “Freud used the word ‘metapsychology’ (or any variant of it) less than once a year, on average, and in only nine works” (p. 26). Consistent
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