The (Philosophical) Foundations of Neuropsychoanalysis *new entry*
Neuropsychoanalysis is the attempt to bridge psychoanalysis and neuroscience. It aims at understanding the totality of the individual through the attempt of objective empirical science investigating the brain and the exploration of clinical data to explore the mind. This new field raises important philosophical questions such as how is the mind/body problem dealt with and whether neuropsychoanalysts take a materialist or idealist stance?
Psychoanalysis falls in a unique place in the spectrum of Weltanschauung. Freud places it under science in his New Introductory Lecture on Psychoanalysis. However, since the field was not born in a lab, the patient was elevated as an epistemological source. Patients provided the framework for psychoanalysis, which means that its philosophical foundations might not based on the scientific method and its collateral side effect of materialism. The question then becomes what are its foundations?
Neuropsychoanalysis, based on dual-aspect monism, argues that individuals are made of something that can be perceived in two ways, which, as stated before, are the brain and the mind. However, we cannot know the mind in itself, but rather experience phenomenologically what it is to be human, which creates an incomplete representation of the mental apparatus.
This notion of skeptical idealism states that we are unable to know, but rather perceive a representation of reality, which we express through models such as Freud’s model of the mental apparatus. These representations occur in all fields such as biology with microscopes. Moreover, neuroscientists don’t have a complete depiction, which renders it inaccurate, of concepts they study such as addiction when they explore the brain. For example, when they investigate substance use disorder in the brain, they make models out of the abnormal dopaminergic post-synaptic receptor activation in different pathways. This attempt to study objective empirical evidence is useful, but incomplete when we evaluate that we are missing the subjective perspective. For example, the field of neuroscience has made us aware that the ventromedial prefrontal cortex is important in dreaming. But the brain, at least with the current state pf technology, cannot provide us with an answer on what people are dreaming or why they dreamt what they dreamt. We extract that information from clinical data
The communication, which goes both ways, helps improve the representation we have of the individual. As Freud stated in his biography, “ideas as these are part of a speculative superstructure of psychoanalysis, any portion of which can be abandoned or changed without loss or regret the moment its inadequacy has been proved. But there is still plenty to be described that lies closer to actual experience." The study of dual-aspect monism will inform the practice of psychoanalysts and remind neuroscientists of the self.
21 August 2019
Rhythm as the scaffolding of meaning
Working with troubled teenagers, especially in the early stages of therapy, I have recurrently felt the need to say something, however trivial. When I was pondering for too long, a vicarious sense of anxiety urged me to speak. Just talking, making contact through words, sometimes felt important beyond the meaning of my words. Showing my willingness to express and share my interest with a certain level of openness about my developing thoughts, is usually an important part of establishing a therapeutic relationship. But with often some teenagers with a history of emotional neglect or abuse, speaking to them personally feels like a first contact, tentatively reaching out, bridging a gap that seems devoid of meaning. Establishing a conversational rhythm can feel like an indispensable prerequisite for therapy.
These thoughts crossed my mind after listening to Katerina Fotopoulou speak about studies using affective touch in clinical cases of asomatognosia. It was in the Amsterdam congress of the Neuropsychoanalysis Association in 2015. I remember her discussing the treatment of a woman who denied ownership of her right arm, where Fotopoulou used affective touch as part of the treatment. Affective touch – as we learn on the website of the International Association for the Study of Affective Touch – involves slow and gentle stroking of hairy skin (in this case of the arm) within specified limits; a stroking velocity between 1 and 10 centimetres per second and applied pressure up to 2.5 mN. This kind of touch uses another kind of neurophysiological system than is used for the discriminative qualities of touch, when we aim to register the physical qualities of an object. Specialised so-called CT afferent fibres are involved in registering the positive affective quality of touch and skin contact, and contributes to the experience of social support and a sense of body ownership. In this case affective touch was used while talking about the woman’s plight in the hospital bed with that strange thing lying in it “that was not her arm”. This approach resulted in fragmented episodes wherein the woman could relate to her arm and experienced intense emotions towards it. Fotopoulou’s presentation was moving and scientifically intriguing.
Later on, freely associating on these highly specific parameters, I started to think about the rhythm of my verbal interventions and the meaning of rhythm. Somehow it made good sense to think of an intervention as a verbal affective touch, actively reaching out and emotionally accepting. Especially when working with neglected or abused patients who display insecure hyper-actived or hypo-activated attachment pattern (or a disorganised pattern of both), as a therapist I can feel the need to become more or less verbally active and adjust the rhythm of my interventions. A rhythm can be reassuring because of its predictable course in time, providing a temporal frame for the present moment. It can also be a sign of emotional availability, given that it is not too fast or too slow, something that could be indicative of a state of hyper- or hypo-arousal within me as a therapist. When I sense that there is something very pressing that can’t be reflected upon yet, I take my verbal tempo into account and try to avoid negligent silence or verbal smothering, acting on a sense of leaving too much space or no space at all. First there has to be an experience of stepping together, before patterns and missteps can be thought of and talked about.
The teenager that I think of in particular, had trouble maintaining a position wherein she could think about herself, her body and others in terms of mental states, infused with feelings, thoughts and desires. She was diagnosed with Body Dysmorphic Disorder and often experienced a severe loss of mentalizing capabilities, when she was in the room with me talking about her personal situation at home. On a symptomatic level she also experienced bouts of intense depersonalisation. She seemed to enter a state wherein “she was not her body”. Physically she could be in the room, while emotionally I could sense her being in a timeless and impersonal sphere. I wonder if it can be described as voids in our interactional rhythm, making the music of our communication staccato, like hitting a note that burns and only can be touched for a fraction of a moment. Prolonged silence was a large part of her emotional music.
Through the stillness of my countertransference I got a sense of utter meaninglessness; it felt like it truly didn’t matter if I was there or not. These disorganizing experiences seeped through the mute cracks of what she could tell me. For her, stepping together wasn’t part of her blueprint. Tragically she recognized this state of affairs only all too well in both her early and recent family history. There had been several severe disruptions of the “going on being” in familial life. In therapy she experienced these moments of depersonalisation initially as blissful (at least that is what she told me), as free from burdensome contact, but later on she could make contact with a deep feeling of loneliness and helplessness. In order to create sufficient therapeutic backdrop, we decided to heighten the frequency of the appointments, looking for the right rhythm within and in-between sessions. Fortunately it helped her to sense that she did want something more than “plain nothingness”. Attention to frequency and rhythm helped us to focus on the present moment, where change resides. Variations in rhythm also helped us to pay attention to surfacing experiences that are in need of understanding. It guided us in our tracks.
23 May 2019
The embodiment of abstract thought
When psychoanalytic and neuroscientific perspectives on subjectivity meet
To start off this new section on the IPA web with a disclaimer seems really off-putting to me. So I will start with a personal impression instead.
During the theoretical years of my psychoanalytic training the one thing that I found most strenuous, was the same thing that finally got me through. What burdened me was the recurring experience that certain parts of psychoanalytic literature that I tried to grasp intellectually, kept on slipping my mind. No matter if I had made personal notes, reminding myself that this was an important piece of theory, the next week I could be forgotten what is was that struck me as important.
Good psychoanalytic literature goes to the heart of the matter. So training as a psychoanalyst isn’t an intellectual exercise; it affects us on many levels, that are hard to comprehend all at once. The way I was able to incorporate and digest psychoanalytic theory, was to let the courses sink in and accumulate what bodily made sense to me. Linking theoretical insights with bodily felt experiences from therapeutic encounters, personal analysis and supervision; it became essential in my efforts to get a personal grasp of psychoanalysis.
And as years went by, something grew within me, something different than an intellectual grasp of psychoanalytic theory. What psychoanalysis has done for me, is that it has strengthened my trust in unconscious processes and intuition. It has highlighted the value of daring creativity. I have learned to put trust in experiential and imaginative processes for understanding what is going on inside a patient and for finding words that make heartfelt sense. And as I opened up emotionally for my own intuition and creativity, my views on what psychotherapy and psychoanalysis could bring changed. Also I recognised how difficult it is to place your vulnerable trust in such a fragile process.
When an old pathological pattern is seen in a new light, dare we trust our changing bodily feelings to accompany us in our search for veracity? Or do we back down from emotional turbulence and close our eyes for what might unfold? Dare we give that what we haven’t articulated yet the benefit of the doubt above what we tell ourselves and others? In my opinion this is a question that sooner or later pops up in every psychotherapy.
But what has that got to do with neuroscience, you might wonder. What has neuroscience got to offer us that we don’t know from psychoanalysis already? Why bother to take notice?
Though I don’t dismiss these questions, I refuse to wear an eye patch when neuroscience comes up with new discoveries on the workings of the mental apparatus. I would like to take a not-knowing stance and reflect before closing a topic prematurely. Because we all have explicit and implicit models of the mind in our minds. Freud’s Body Ego for instance might well be envisioned as the infamous homunculus, laying upside down in the motor and somatosensory cortices. It was the Berlin 2015 congress of the International Neuropsychoanalysis Society where I learned about the multitude of neural body representations (instead of a single homunculus), each adding a vital aspect to the way that we experience the inside and outside of our bodies, and the skin-deep interface in between. The way that I think about the foundations of the Ego has become more versatile after that.
A purely intellectual base of psychoanalytic knowledge is an illusion. Therefor I am not afraid of psychoanalysis running the risk of being encapsulated by neuroscience. Imagination goes beyond neuroimaging. And what neuroscience can tell us about the process of imagining something, doesn’t diminish the value of psychoanalytic perspectives on subjectivity.
The rubber hand illusion is an experimental setup that is widely used by neuroscientists to study the way in which awareness comes about of “this is me and that is not me”. In order to create this illusion, the participant’s real hand and a rubber hand are simultaneously stroked, while only the rubber hand is visible for the participant. After a certain amount of time seeing the rubber hand being stroked and feeling the real hand being stroked, participants get the illusory sensation that the rubber hand is their real own hand. In other words, that what we synchronously perceive through multiple sensory channels and what is connected to the body, is perceived as belonging to the body, as “me”. The experiment tweaks this process to create an illusion, but it seems to tell us something fundamental about the fragile process of the development of a sense of self.
Personally I needed the simultaneous occurrence of theoretical understanding and bodily felt experiences to get a firm grasp of psychoanalysis. I know where I come from and I won’t mistake neuroscience for my real professional hand. But I certainly want to learn more from people who are doing these kind of experiments. Thinking and dreaming about possible implications of new findings is challenging and enjoyable.
So I make a plea for synergy and play. Play as in an open encounter between psychoanalytic and neuroscientific perspectives on subjectivity, using intellectual acuity and imaginative liveliness. And play is work of course (as a child once said to Donald Winnicott). But play is also a primary emotional necessity. This view is also championed in the work of the late Jaak Panksepp, who studied the neural PLAY circuitry in all sorts of animals. I hope that the interdisciplinary debate (on subjectivity and other matters) can be such a playing field and a transitional space. And that this new topic “Focusing on…” can make a contribution.