Mourning and melancholia revisited: Correspondences between principles of Freudian metapsychology and empirical findings in neuropsychiatry Robin L. Carhart-Harris, University of Bristol Helen Mayberg, Emory University Andrea L. Malizia, University of Bristol David Nutt, University of Bristol Journal Title: Annals of General Psychiatry Volume: Volume 7, Number 1 Publisher: BioMed Central | 2008-07-24, Pages 9-9 Type of Work: Article | Final Publisher PDF Publisher DOI: 10.1186/1744-859X-7-9 Permanent URL: https://pid.emory.edu/ark:/25593/rx8jn Final published version: http://dx.doi.org/10.1186/1744-859X-7-9 Copyright information: © 2008 Carhart-Harris et al; licensee BioMed Central Ltd. This is an Open Access work distributed under the terms of the Creative Commons Attribution 2.0 Generic License (http://creativecommons.org/licenses/by/2.0/). Accessed September 26, 2021 8:33 PM EDT Annals of General Psychiatry BioMed Central Review Open Access Mourning and melancholia revisited: correspondences between principles of Freudian metapsychology and empirical findings in neuropsychiatry Robin L Carhart-Harris*1, Helen S Mayberg2, Andrea L Malizia1 and David Nutt1 Address: 1Psychopharmacology Unit, University of Bristol, Bristol, UK and 2Emory University School of Medicine, Atlanta, GA 30322, USA Email: Robin L Carhart-Harris* - [email protected]; Helen S Mayberg - [email protected]; Andrea L Malizia - [email protected]; David Nutt - [email protected] * Corresponding author Published: 24 July 2008 Received: 2 February 2008 Accepted: 24 July 2008 Annals of General Psychiatry 2008, 7:9 doi:10.1186/1744-859X-7-9 This article is available from: http://www.annals-general-psychiatry.com/content/7/1/9 © 2008 Carhart-Harris et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Freud began his career as a neurologist studying the anatomy and physiology of the nervous system, but it was his later work in psychology that would secure his place in history. This paper draws attention to consistencies between physiological processes identified by modern clinical research and psychological processes described by Freud, with a special emphasis on his famous paper on depression entitled 'Mourning and melancholia'. Inspired by neuroimaging findings in depression and deep brain stimulation for treatment resistant depression, some preliminary physiological correlates are proposed for a number of key psychoanalytic processes. Specifically, activation of the subgenual cingulate is discussed in relation to repression and the default mode network is discussed in relation to the ego. If these correlates are found to be reliable, this may have implications for the manner in which psychoanalysis is viewed by the wider psychological and psychiatric communities. Background ory to the illness of depression. It is the task of this paper 'When some new idea comes up in science, which is to parallel the psychological processes described by Freud hailed at first as a discovery and is also as a rule dis- with the physiological processes identified by modern puted as such, objective research soon afterwards clinical research in order to furnish a more comprehensive reveals that after all it was in fact no novelty' [1]. understanding of the whole phenomenon. The intention of this paper is to draw attention to consist- Under the tutelage of Meynert, Freud began his career as encies between Freudian metapsychology and recent find- neurologist studying the anatomy and physiology of the ings in neuropsychiatry, especially those relating to medulla. Inspired by a Helmholtzian tradition (1821– depression. A case will be made that findings in neuroim- 1894) and a 'psycho-physical parallelism' made fashiona- aging and neurophysiology can provide a fresh context for ble by the likes of Hering (1838–1918), Sherrington some of the most fundamental theories of psychoanalysis. (1857–1952) and Hughlings-Jackson (1835–1911), In his famous paper 'Mourning and melancholia', Freud Freud began to consider more seriously how a science of carried out an elegant application of psychoanalytic the- movements of energy in the brain might account for psy- Page 1 of 23 (page number not for citation purposes) Annals of General Psychiatry 2008, 7:9 http://www.annals-general-psychiatry.com/content/7/1/9 chological phenomena [2]. It has been argued that Freud 'It is probable that the chain of physiological events in never truly abandoned his physiological roots [3,4] and the nervous system does not stand in a causal connec- that his early flirtations with psycho-physical parallelism tion with the psychical events. The physiological continued to haunt 'the whole series of [his] theoretical events do not cease as soon as the psychical ones works to the very end' [4]. begin; on the contrary, the physiological chain contin- ues. What happens in simply that, after a certain point This paper will begin with an overview of some key con- in time, each (or some) of its links has a psychical phe- cepts of Freudian metapsychology (libido, cathexis, object nomena corresponding to it. Accordingly, the psychi- cathexis, the ego, the super ego, the id, the unconscious, cal is a process parallel to the physiological – "a the primary and secondary psychical process and repres- dependent concomitant"' [9]. sion) and an attempt will be made to hypothesise their physiological correlates. This will be followed by a sum- Integrating psychoanalysis with modern neuroscience is a mary of 'Mourning and melancholia' and an extensive difficult and controversial endeavour. It should be made look at relevant findings in neuropsychiatry. Of special clear from the outset what we believe it is possible for this interest are neuroimaging findings in depression and approach to achieve. Psychoanalysis can be viewed on induced depressed mood, deep brain stimulation (DBS) two levels: a hermeneutic, interpretative or meaning based of the subgenual cingulate (Brodmann area 25/Cg25) for level; and a metapsychological, mental process based level. the treatment of intractable depression, electrical stimula- The hermeneutic level is inherently subjective. The ques- tion of medial temporal regions, and regional atrophy tion has often been raised whether it is possible to identify and glial loss in the brains of patients suffering from spatiotemporal coordinates of subjective meaning. This major depression. view was shared by Paul McLean in his seminal book 'The triune brain in evolution' [10]: Before beginning, it is important to make a few brief com- ments on the principle of psycho-physical parallelism. 'Since the subjective brain is solely reliant on the deri- Drawing connections between psychological and biologi- vation of immaterial information, it can never estab- cal phenomena was an approach that Freud was both crit- lish an immutable yardstick of its own...Information is ical of: information, not matter or energy' [10]. 'I shall carefully avoid the temptation to determine It would be incorrect to align this position with dualism. psychical locality in any anatomical fashion' [5]. Psychophysical parallelism is a materialist approach that acknowledges that meaning arises through time between 'Every attempt to discover a localisation of mental networks of communicative systems. It must be stated processes...has miscarried completely. The same fate that the evidence cited in this paper cannot logically vali- would await any theory that attempted to recognise date psychoanalysis on the hermeneutic level and neither the anatomical position of the system [consciousness] does it provide evidence for the efficacy of psychoanalysis – as being in the cortex, and to localise the uncon- as a treatment modality (see [11] for a review). What we scious processes in the subcortical parts of the brain. believe it can do, however, is bring together converging There is a hiatus here which at present cannot be filled, lines of enquiry in support of the Freudian topography of nor is it one of the tasks of psychology to fill it. Our the mind. The findings cited below describe changes in psychical topography has for the present nothing to do physiological processes paralleling changes in psycholog- with anatomy' [6]. ical processes; however, the objective measures do not shed any light on the specific content or meaning held And receptive to: within these processes. Aside from interpretation, much of Freud's work was spent theorising about dynamic psy- 'All our provisional ideas in psychology will presuma- chical processes; energies flowing into and out of mental bly some day be based on an organic substructure' [7]. provinces, energy invested, dammed up and discharged throughout the mind. It is this metapsychological level of The ambiguity in Freud's position can be explained by his psychoanalysis that we believe is most accessible to inte- criticism of the modular or 'segregationist' [8] approach gration with modern neuroscience. and preference for a more dynamic model [9]. Essentially, Freud was opposed to 'flag polling' the anatomical causes An introduction to some key terms of Freudian of psychological phenomena but not the drawing of par- metapsychology allels between psychological and physiological processes: Libido 'Libido means in psycho-analysis in the