Original research Med Humanities: first published as 10.1136/medhum-2019-011645 on 19 June 2019. Downloaded from Corrective biology: psychosomatics in and as neuropsychoanalysis Felicity Callard, 1 Constantina (Stan) Papoulias2 1Department of Psychosocial ABSTRact the ‘puzzling leap from the mental to the physical’.2 Studies, Birkbeck University of This article analyses how and with what consequences That leap for Freud was best exemplified through London, London, UK 2Health Service & Population body–mind relations (the sphere of the psychosomatic) his account of hysterical conversion, and Felix Research, Institute of Psychiatry, are being modelled in the 21st century through Deutsch later took up both the leap and a model Psychology & Neuroscience, considering the interdiscipline of neuropsychoanalysis. of conversion in On the Mysterious Leap from King’s College London, London, The promise of the term psychosomatic lies in its efforts the Mind to the Body.3 Lear challenges a model in UK to rework standard, bifurcated models of mind and which ‘the mental’, as a distinct sphere of action, body: somatic acts are simultaneously psychic acts. But comes to cause something physical, and instead sets Correspondence to Professor Felicity Callard, neuropsychoanalysis, as it brings the neurosciences our sights on the strangeness of vomiting as itself Department of Psychosocial and psychoanalysis together to model an embodied thinking. Such a claim demands an ontological and Studies, 30 Russell Square, ’MindBrain’, ends up evacuating another potent epistemological shift. The ejection of matter carries Birkbeck University of London, characteristic found in much of the psychosomatic meaning; it raises questions of relationality and London WC1B 5DT, UK; intention, of what is wished outside or inside. These f. callard@ bbk. ac. uk tradition—its refusal to adjudicate, a priori, what counts as the adaptive or well-regulated subject. The are well in excess of a straightforward need to rid Accepted 18 February 2019 psychosomatic problem in psychoanalysis profoundly the body of physiologically registered toxins. What Published Online First disturbs everyday models of functionality, adaptation might vomiting be if we choose not to interpret 19 June 2019 and agency, by positing the psyche as an ’other’ of it either as simply an involuntary muscular spasm the physiological within the physiological. By contrast, or the effect of a mental act? In challenging bien neuropsychoanalysis ends up parsing too easily the pensant understandings of bodies and body–mind healthy from the pathological body, such that it is only relations, the invitation to see vomiting as thinking the latter that is subject to forces that work against suggests, instead, that there is an ‘other’ of the self-preservation and self-regulation. In so doing, physiological within the physiological. How would neuropsychoanalysis recasts the radical problematic that one unravel the kind of thinking—ferocious, desta- the psychosomatic installed for psychoanalysis in the bilising or melancholic—that occurs as and through direction of a corrective biology. This corrective biology vomiting? What kind of body, in other words, is the is given form in two ways: (1) through translating the subject who vomits, or shakes or faints? Freudian drive—that unruly and foundational concept The desire to disrupt standard, bifurcated models which addresses the difficult articulation of soma of mind and body can be found in many strands of http://mh.bmj.com/ and psyche—into a series of Basic Emotion Systems research and practice that are in some way indebted modelled by the affective neuroscientist Jaak Panksepp to psychoanalysis. This article focuses on the strand and (2) through resituating and quarantining the which calls itself neuropsychoanalysis. As its name troubling, non-adaptive aspects of the Freudian psyche testifies, neuropsychoanalysis is an attempt to map within the domain of addiction. That easy separation psychoanalysis through a certain kind of neurosci- between the healthy and the pathological is all too ence, grounding the Freudian unconscious through often found in current descriptions of healthcare and neurobiological correlates, thereby opening up a on September 29, 2021 by guest. Protected copyright. patient encounters. The article refuses it and calls for location for the psyche–soma (the psychosomatic) the revivification of other ways of thinking about how which would revitalise both partners. We use the human subjects—psychosomatic organisms—find ways term psychosomatic throughout this article in a to live, and to die. capacious way—as a difficult term with numerous histories and one which signals attempts to account for how the psyche and the body are intimately How is the mind to recognise itself in, say, an act of bound up with one another. We consider the vomiting? The real mystery is not ‘the mysterious leap neuropsychoanalytic project in light of the concern from mind to body’: how something mental, an idea, that this special issue (on biopolitics and psycho- can cause something physical, like vomiting, to occur. somatics) has with how the assumed divisions The real mystery is how it is possible for there to have between mind and matter, and the mental and the been no leap. How could vomiting itself be ‘thinking’? somatic, have been both a provocation and a lure How could we recognise the mental in something so © Author(s) (or their physical?1 for analysis and for therapeutics. In this context, we employer(s)) 2019. Re-use are interested in understanding how neuropsychoa- permitted under CC BY. nalysis arranges mind and matter, nature and value Published by BMJ. through an explicit commitment to install subjective 4 To cite: Callard F, Jonathan Lear, in his philosophical explication of intentionality within rather than alongside biology. Papoulias C(Stan). psychoanalysis as the attempt to imagine what a While medical humanities as a field has so far Med Humanit science of subjectivity might be, uses the example engaged relatively little with neuropsychoana- 2019;45:152–161. of vomiting to revisit Freud’s famous description of lytic texts, this work has received some analytical 152 Callard F, Papoulias C(Stan). Med Humanit 2019;45:152–161. doi:10.1136/medhum-2019-011645 Original research Med Humanities: first published as 10.1136/medhum-2019-011645 on 19 June 2019. Downloaded from attention within the humanities more broadly.5 And some writers in the opposite direction. That is, the drive is a ‘concept on the have shown interest in the emerging interdiscipline as a space to frontier between the mental and the somatic’—it designates advance the medical humanities. For example, the philosopher a turnpike at which the psyche emerges from and acts on the Catherine Malabou, in The New Wounded: From Neurosis to body.9 In the final part of the article, we briefly consider how Brain Damage, argues that neuropsychoanalysis ‘recognises the neuropsychoanalysis presses its reworked drives—now hooked essential and reciprocal link between the life of the brain and into Panksepp’s Basic Emotion Systems—into the complex subjective experience’.6 In particular, Malabou is interested in question of addiction. This elaboration of addiction is an exem- how neuropsychoanalysis ties psyche, affects, body and brain plary instance in which neuropsychoanalytic accounts install the together—by placing the regime of sexuality and that of cere- embodied brain by cleaving apart appropriately and inappro- brality on the same plane. Equally, the writer Siri Hustvedt priately (pathologically) activated subjects—subjects motivated discusses the influence of a neuropsychoanalytic group on her by life-affirming pleasures from those whose drive has been development of a psychosomatic account of the ‘mysteries of hijacked by something other than self-preservation. We ask what [her] own nervous system’ consequent on a shaking fit she expe- it might mean to refuse that easy separation, one which is all rienced while giving a public talk about her father (who had too often found in current descriptions of healthcare and patient died 2 years previously).7 We see, here, how neuropsychoanal- encounters, so as to revivify other means of thinking about how ysis is being put to work with reference to the question of the human subjects—psychosomatic organisms—find ways to live psychosomatic: it appears to promise a way of overcoming the and to die. sequestration of brain (matter) from mind, of affect from cogni- tive intentionality, of sexual logics from cerebral logics, of the corporeal from the mental. NEUROPSYCHoanaLYSIS AND THE EMBODIED BRAIN We maintain that the neuropsychoanalytic commitment to an Neuropsychoanalysis is a diverse, interdisciplinary field that embodied subjective intentionality is actualised via recourse to comprises the efforts of researchers and clinicians within several a neuroevolutionary backdrop that plays a determining role in branches of psychoanalysis, the neurosciences and psychiatry to both the interpretation of experimental findings and the solidi- construct a shared space of inquiry in which ‘to consider how fication of overarching concepts. While neuropsychoanalysis is empirical findings and neuroscientific theories can be enhanced currently a relatively minor enterprise (both within the neuro- by metapsychological knowledge derived from subjective, clin- 10 sciences and within psychoanalysis), we argue that its substan- ical observation and vice versa’. It was named and constituted