Neuroscience Today

 



Psychoanalysis in the age of neuroscience - Who's Who

 

  Vilanayanur S. Ramachandran One of the 100 more influential people in the world, according to Time Magazine (2011), Vilanayanur S. Ramachandran is an eclectic, original and fascinating neurologist and neuroscientist. His origins from Southern India, his impressive scientific background and his vast cultural experience are the foundation of his open- minded, thought -expanding work. He completed his medical studies in Chennai and his postgraduate studies in Cambridge, where he obtained a Ph.D. He is currently Director of the Center of Brain and Cognition in the University of California- San Diego as well as Adjunct Professor of Biology at the Salk Institute.  His titles and awards are too many to list, but it needs to be mentioned that he has been honoured by the most prestigious institutions, from Great Britain to the United States, from Europe to India. World -renowned for his studies on the phantom limb, Ramachandran demonstrated that the persistence of the brain representation of the missing limb underpins the perceptions and the pain linked to the lost limb. Moreover, he proposed a simple and innovative method - the mirror box - to reduce the pain of the phantom limb through the visual stimulation of the contralateral limb, in order to reorganize the neural maps. His research is also related to a vast physio-pathologic brain-mind area, including synesthesia, Capgras syndrome, the relationship between brain and language, consciousness, the neural basis of religious phenomena, and many other topics. With more than 180 publications, Ramachandran is considered one of the most eminent neuroscientists in the world. Ramachandran has never hidden his ambivalence toward psychoanalysis, that is, a profound fascination and simultaneously a distance from aspects that he considers lacking scientific grounding. However, together with the Copernican and Darwinian revolution, Ramachandran values Freud’s conceptualization of the unconscious as one of the three pivotal revolutions in the history of scientific thinking.  Freudian psychodynamics are correlated to neurologic basis in some of Ramachandran’s work, and he shows a particular interest in defence mechanisms. The neurologic grounding sometimes conflicts with the psychodynamic understanding of certain pathology. For example, for psychoanalysis, fetishism has a well-known psychogenic origin as evidenced in the writings of Freud himself and post Freudian authors. According to Ramachandran, the brain representation of the genitals is very close to the representation of the foot, and in some subjects there is a kind of overlapping which explains the sexual arousal due to the foot stimulation of the partner- via the mirror neurons, the stimulation excites the subject. A similar situation occurs in a rare syndrome, apotemnophilia: the patient does not recognize a limb, and feels the irrepressible need to amputate it. According to Ramachandran, a lack of representation of that limb causes the disturbance of perceiving a limb which does not belong- neurologically- to the patient. The desire- or need- to eliminate it is caused by this wrong perception. A psychodynamic explanation of the syndrome is, according to Ramachandran incorrect. But, one may ask, could a certain psychic constellation, during early infancy, or even during prenatal life, induce this particular neurological alteration and consequent lack of rapresentation , which lead to apotemnophilia? According to Ramachandran, some gender disorders can be related to similar forms of brain alterations. In the last years, in continuity with Semir Zekis’s conceptualization of neuroaesthetics, Ramachandran has researched this fascinating area, proposing (along with W. Hirstein), an original understanding of “ beauty”  that is evolutionarily- oriented. Ramachandran’s interests cover numerous areas of different disciplines, from poetry to music, from paleontology (a dinosaur has been named after him, Minotaurasaurus Ramachandri) to archaeology (he published an article on the similarity of Indus and Easter Island scripts). His visionary attitude explains why Richard Dawkins defined him “a latter day Marco Polo, journeying the Silk Road of science to strange and exotic Cathays of the mind”.  


Joseph Le Doux
Joseph Le Doux is the  leader and songwriter of the rock band “The Amygdaloids” - a surprising side of one of the most famous and eminent neuroscientists of the world. Born in Louisiana, Le Doux lives and works in New York City, where he is director of the Emotional Brain Institute and a Faculty Member of the Center For Neural Science, New York University. He is also a member of the National Academy of Science. His pivotal studies about neuronal circuitries, and in particular about the defensive survival circuit underpinning  emotions such as fear and anxiety, are well known since the eighties, when his research highlighted the importance of the limbic system and in particular the role of amygdala.  LeDoux points out the importance of cortical circuitries in the experience and understanding of fear and anxiety disorders. He recently reframed his theory as a “two system” conceptual division corresponding to two classes of responses to a threat: a) changes in brain and body response b)  conscious feeling states of fear and anxiety. In contrast with the mainstream of current neuroscientific theory, which relate fear to the subcortical brainstem neuronal activity, LeDoux focuses on the multicomponent language system as an indispensable cortical function of the mind that is necessary to assess and recognize emotions. The extremely complex concept of consciousness, with its triple levels i.e. first-order, higher-order representation (HOR) and higher-order representation of a representation (HOROR), is  another area of his research, interwoven with emotions and memory.  For psychoanalysts, Ledoux ’s thinking is highly relevant from a theoretical point of view in fundamental ways:  because of its implications about the synaptic plasticity of the neuronal system, and the consequent effectiveness of psychotherapy; regarding  the understanding  of emotions and the importance of language; with respect to his studies on consciousness and its relation with the unconscious and  defensive mechanisms. Moreover, from a clinical point of view, the neuronal dynamics of anxiety, fear, panic attacks and phobias are extremely useful in regard to diagnosis and treatment.  
by Claudia Spadazzi, M.D. Full Member, Italian Psychoanalytical Society (SPI)
 

In Focus


The Self and its world at the time of COVID-19
The current international crisis situation caused by the COVID-19 pandemic is having a strong psychological impact on our subjectivities and our sense of relatedness with others and the world. We are constantly and continuously threatened by the danger of i) being infected, ii) infecting other people, and (iii) by the loss of social relation.

Departing from these premises, our investigations aim to investigate the psychological and neuro-dynamics of this complex phenomenon.

In our work on existential fear, we discuss about recent psychological and neuronal findings on fear and its disorders, related to an unbalanced intero-exteroceptive processing and emotional regulation.  Secondly, we move to the psychological and neuronal dynamics of self and others characterized by a temporo-spatial alignment with the world. Due to the neural overlap of emotion and self and the deep-reaching neuro-ecological layers of self, emotional feelings like fear and anxiety cannot be detached and dissociated from the world; they signify the world–brain relation, and, more specifically, our self-other relation.

Read full paper
Andrea Scalabrini PsyD, PhD and Georg Northoff MD, PhD, 2021

 


The (Philosophical) Foundations of Neuropsychoanalysis
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.

Ivan Herrejon, 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.

Daniel Helderman, 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.

Daniel Helderman


Neuroscience and Psychoanalysis - Books


May 2022
Rosa Spagnolo: Anil Seth interview 
Introducing: “Being you: A New Science of Consciousness”. 
Penguin Random House, 2021.

1. What is the motivation behind the writing of the book? 
 
1.        What is the motivation behind the writing of the book? 


Consciousness – and what it means to be a ‘self’ – are endlessly fascinating subjects, not only for researchers, but for people in general. I wanted to write a book putting together my way of thinking about these fundamental issues from over 20 years of working on these topics.  I wanted to write something that was both widely accessible, that would connect with people at an individual level, and that also advanced the science and the philosophy.

2. What is so important to write a book focused on this topic/issue?
 
2.        What is so important to write a book focused on this topic/issue?


There are many books on consciousness and self, but I think my own view is distinctive and worth writing about. I bring together a number of different ideas having to do with the potential for science to explain consciousness, measuring consciousness, the brain as a prediction machine, free will, and the possibility of consciousness in non-human animals and in machines. I hope that people reading it will find enlightening new ways to think of themselves and their relation to others and to the world.

3. It seems to me we are trying to go beyond Chalmers, about the hard problem of consciousness, introducing the neurophenomenology of Francisco Varela, ideas about affective consciousness, and distinctive models of the computational mind. 

3.        It seems to me we are trying to go beyond Chalmers, about the hard problem of consciousness, introducing the neurophenomenology of Francisco Varela, ideas about affective consciousness, and distinctive models of the computational mind. 


That’s right. David Chalmers is well known for proposing the ‘hard problem’ of consciousness, which is the problem of explaining how and why conscious experiences – the subjective, private, experiential aspects of consciousness – are related to physical mechanisms, such as brains.  Why is consciousness part of our universe at all? This is a deep philosophical challenge, but I don’t think addressing it directly is the most productive approach.
 
4.        Indeed, you introduce “the real problem of consciousness”. What is ‘the real problem’?

For me the real problem inherits from traditions of neurophenomenology, but in distinctive ways.  In a nutshell, the real problem is the challenge of explaining why particular neural processes – patterns of activity, and so on – are accompanied by particular kinds of conscious experience. It is the challenge of moving beyond finding mere correlations between brain activity and consciousness, and building explanatory bridges that help account for aspects of consciousness in terms of processes in the brain and body. One important aspect of this is that the real problem doesn’t treat consciousness as one single big mystery in search of one Eureka solution.  Consciousness has many aspects, and by addressing the real problem my hope is that the hard problem will be dissolved, rather than being solved.
4. Indeed, you introduce “the real problem of consciousness”. What is ‘the real problem’? 
5.        There are many different aspects of consciousness, would you say something about your focus on ‘level’, ‘content’ and ‘self’ as core properties of your approach?



For me the real problem inherits from traditions of neurophenomenology, but in distinctive ways.  In a nutshell, the real problem is the challenge of explaining why particular neural processes – patterns of activity, and so on – are accompanied by particular kinds of conscious experience. It is the challenge of moving beyond finding mere correlations between brain activity and consciousness, and building explanatory bridges that help account for aspects of consciousness in terms of processes in the brain and body. One important aspect of this is that the real problem doesn’t treat consciousness as one single big mystery in search of one Eureka solution.  Consciousness has many aspects, and by addressing the real problem my hope is that the hard problem will be dissolved, rather than being solved.

5. There are many different aspects of consciousness, would you say something about your focus on ‘level’, ‘content’ and ‘self’ as core properties of your approach?

Indeed, this is my preferred real-problem strategy for understanding consciousness.  We have here three fundamental aspects: how conscious you are (level); what you are conscious of (content), and the experience of being you (self). These are not completely independent, of course, but addressing each somewhat separately helps us make progress.

6. Measuring consciousness sounds familiar speaking of “level”, and in Chapter 2 you talk about that, how you measure consciousness. Could you give us some examples? 
6.        Measuring consciousness sounds familiar speaking of “level”, and in Chapter 2 you talk about that, how you measure consciousness. Could you give us some examples?



In the history of science, measurement has always been critical to understanding a previously mysterious phenomenon. This applies to consciousness too. Some of the work in my research group is focused on developing and testing new measures of conscious level that can be applied both in research labs and in the clinic – for example, to measure the depth of anaesthesia. A lot of our work in this area is inspired by the Italian neuroscientists Marcello Massimini and Giulio Tononi, who have developed similar measures based on tracking the ‘complexity’ of brain dynamics.
 
7.        You like to think of the brain as a prediction machine. Throughout all the book you talk about “Predictive Brain”. Would you say something about which model of computational mind theory you found more useful for the purpose of this book? 

The idea of the brain as a prediction machine is a central theme in the book. As a model, what it basically says is that the brain is constantly making predictions about the causes of its sensory inputs, and uses these sensory inputs to update the predictions in a never-ending dance of ‘prediction’ and ‘prediction error’.  This is quite an old idea, but it has far reaching implications.  Perhaps the most important is that it suggests that what we perceive is not simply a ‘read out’ of information in sensory inputs, but it is the brain’s ‘best guess’ of what’s out there. Drawing on the words of others, I call this the ‘controlled hallucination’ view of perception. 
7. You like to think of the brain as a prediction machine. Throughout all the book you talk about “Predictive Brain”. Would you say something about which model of computational mind theory you found more useful for the purpose of this book? 

The idea of the brain as a prediction machine is a central theme in the book. As a model, what it basically says is that the brain is constantly making predictions about the causes of its sensory inputs, and uses these sensory inputs to update the predictions in a never-ending dance of ‘prediction’ and ‘prediction error’.  This is quite an old idea, but it has far reaching implications.  Perhaps the most important is that it suggests that what we perceive is not simply a ‘read out’ of information in sensory inputs, but it is the brain’s ‘best guess’ of what’s out there. Drawing on the words of others, I call this the ‘controlled hallucination’ view of perception. 
 
8. You write: If perception is controlled hallucination, then — equally — hallucination can be thought of as uncontrolled perception. Could you explain to us what you mean by these terms? 
 
8.        You write: If perception is controlled hallucination, then — equally — hallucination can be thought of as uncontrolled perception. Could you explain to us what you mean by these terms?


Indeed.  Finding the right words is always tricky, and it is important not to take them out of context.  I use the word ‘hallucination’ to emphasize that all perceptual experience – whether in normal life or when we perceive things that others’ don’t – all of it comes from within.  But in normal perception, the control is just as important as the hallucination. Our brain’s best guesses are closely tied to external reality through this cycle of prediction and prediction error – through the brain’s operation as a prediction machine.  Importantly though, we perceive the world not ‘as it is’, but in ways that evolution has decided is best suited for our survival.  Although it seems as though the world just pours itself into our minds transparently, every experience we have is a creative act, and act of imagination guided by objective reality.
 
9.        Who am I? What is it like to be you?  In few words The “Self”:   An important aspect of this sense of self is what you call the subjective stability of the self, I call that Self Continuity, Is this sense of the Self  independent of the contents of consciousness?

The nature of the self – of what it is to be you, or to be me – is really the heart of the book. A key message in the book is that the ‘self’ is not some ‘thing’ or ‘essence’ that does the perceiving. The self is a perception too – another kind, a special kind of controlled hallucination.  And yes, an intriguing aspect of the experience of selfhood is that is seems to change very little when in fact it may change quite a lot over time – what you call self continuity, and what I call self change-blindness. An interesting exception is during illness. For example, for the last few weeks I’ve been suffering a lot of post-COVID symptoms and my experience of self continuity has been significantly challenged. There is a real sense in which the experience of being me is very different from how it was just a couple of months ago.
9. Who am I? What is it like to be you?  In few words The “Self”:   An important aspect of this sense of self is what you call the subjective stability of the self, I call that Self Continuity, Is this sense of the Self  independent of the contents of consciousness?

The nature of the self – of what it is to be you, or to be me – is really the heart of the book. A key message in the book is that the ‘self’ is not some ‘thing’ or ‘essence’ that does the perceiving. The self is a perception too – another kind, a special kind of controlled hallucination.  And yes, an intriguing aspect of the experience of selfhood is that is seems to change very little when in fact it may change quite a lot over time – what you call self continuity, and what I call self change-blindness. An interesting exception is during illness. For example, for the last few weeks I’ve been suffering a lot of post-COVID symptoms and my experience of self continuity has been significantly challenged. There is a real sense in which the experience of being me is very different from how it was just a couple of months ago.

10. What implications do psychedelics have to the study of consciousness? you name some: Increasing diversity neuronal activity, less predictability,  Ego dissolving and Self separation, and the issue of the time: all that seems to me limiting the mind brain prediction to some functions, leaving out our creativity, fantasy, free will.

Well there’s a lot here! Psychedelics are interesting in very many ways. Most of all, they substantially alter conscious experiences in a highly controlled and reversible way, offering a unique opportunity to study what happens in the brain when consciousness changes very profoundly.  We’ve done a number of studies on this, some of which I talk about in the book.  The issue of free will is also very interesting and is one part of the book I’m particularly proud of.  Free will causes so much confusion among both philosophers and scientists, but I think there’s a really simple way to think of the issue, which leaves with exactly the kind of free will we need and want – but nothing more. 

11. To sum up: What the book trying to tell us?

That consciousness can be understood scientifically and philosophically, that the way we experience the world and the self are varieties of perceptual experience – of controlled hallucination – and that our experiences of the world around us, and of being a self within it, are very closely tied to our nature as living creatures. We are part of – not apart from – the rest of nature.

12. Finally, can you explain what is the implication of the theory of neuroscience in the book for clinical practice? If you think there are some useful for clinicians.

There are many implications for clinical practice, especially when thinking about perception as a kind of brain-based prediction. This provides a powerful way to think about all kinds of clinical phenomena – from hallucinations and delusions to anxiety and depression. The key insight is always to convey the realization that how things seem is not how they are, and that our brain’s predictions – whether we are aware of them or not – give rise to our experiences, and can also change the physiology of the body too. Although I am not a medical doctor, and do not prescribe particular practices in the book, I’ve had lots of very positive feedback from all manner of clinical folk about how the ideas in the book have benefited their practice.

13. Where can people find out more?

Much more about my work is on my website www.anilseth.com, and follow me on twitter @anilkseth. Being You is currently available only in English – an Italian translation is in process, but it will still take quite a while!
 

By Rosa Spagnolo
[email protected]
 



Brett H.Clarke – A cat is not a battleship, thoughts on the meaning of “Neuropsychoanalysis” INT J PSYCHOANAL, 2018 VOL. 99, NO. 2, 425–449

Can psychoanalysis address the epistemological complications that neuropsychoanalysis brings into play? as well as the very real consequences that inevitably creep into the way we build our theories and develop our clinical practice based on those ideas? These are the questions put forth by Brett H. Clarke, director of the Cincinnati Center for Psychoanalysis, ask in an article that, right from the title, takes the reader to the heart of the controversial relationship between psychoanalysis and neu-roscience. Clarke avoids falling into antagonism, but is direct in asking how psychoanalysis can take advantage of the discoveries of neuroscience, and thus incorporate aspects of (non-psychoanalytically based) neuroscientific theories, without radically transforming the core elements of psychoanalytic thought. Psychoanalysis runs great risks, according to Clarke, above all that of foregoing its own identity as an “idiosyncratic science of the single subject”. A fatal risk that derives from a false dia-logue that confuses epistemology and methodology, that does not take into account the semantic dif-ferences between the discourse of psychoanalysis and the discourse of the sciences that base their re-search on objective evidence negates the necessarily different epistemological obligations of and the neurosciences. Such a position is only one step away from granting an advantage to objective or sci-entific interpretations. The difference between objective and subjective knowledge highlights the diffi-culty in bridging neuroscience and psychoanalysis. Clarke, in accordance with to some authors critical of neuropsychoanalysis (Blass and Carmeli, 2007), argues that the biological dimension does not en-rich knowledge of psychological phenomena. Since psychoanalysis operates at the mental level where meanings are generated, an objective explanation of psychoanalytic concepts risks reducing them to biology, and consequently losing the subjective meanings that psychoanalysis privi-leges.
Psychoanalysis, the author recalls, is rooted in individuality, emotionally based and unconsciously in-fluenced by subjective experience: “This is where psychoanalytic thinking begins and where psycho-analytic thinking ends, wherever else it might travel in between". The neurosciences, on the other hand, impose objective research methods, speak to the "brain", not to the "mind", and violate the no-tion of psychoanalytic subjectivity through a biological epistemology, which risks undermining the assumption on which the intimate coherence of psychoanalysis as a discipline rest. Despite what Solms suggests, psychoanalysis and neuroscience do not look at the same thing from different points of view. For Clarke, neuroscience is a "different epistemological animal", not equipped to grasp the "ontological density" of our subjectively experienced, embodied "lived biology". Dialogue with related disciplines, the author concludes, can only take place as long as psychoanalysis continues to insist up-on and benefit by remaining within its own domain, without rebuilding itself according to the rules of other disciplines organized on the basis of different principles and different theoretical, methodological or epistemological assumptions.
From this point of view, Bob Hinshelwood also emphasizes this same aspect of the relation-ship between psychoanalysis and neuroscience highlighted by Clarke. Hinshelwood (2016, pp. 485-490), argues that: "a central concern is that the experiments of neuroscience seem to always have to be interpreted in terms of the subjective experience of the single individual, since there is no way to arrive to subjectivity through, for example, functional magnetic resonance imaging (fMRI) ". But if it is not possible to find the subjectivity of a cat (or a battleship) through neuroscientific methods, the subjectivity of human beings always derives from the interpretation of neuroscientific findings in sub-jective terms. Therefore, which theory - and which epistemology - is able to make sense of these in-terpretations? The reality, Clarke suggests, is that to achieve an understanding of the experience of a human mind, a human mind is required - our only research tool - and since psychoanalysis is the one and only science of subjectivity, it is to psychoanalysis that we should always turn to investigate sub-jective experience.

By Massimiliano Spano & Federico Tavernese. 

References
Blass, R. B. and Z. Carmeli. 2007. “The Case Against Neuropsychoanalysis: On Fallacies Under-lying Psychoanalysis’ Latest Scientific Trend and its Negative Impact on Psychoanalytic Discourse”. The International Journal of Psycho-Analysis, Vol. 88: 19–40.
Hinshelwood R. 2016. “Cosa resta della psicoanalisi. Domande e risposte”. Psicoterapia e Scienze Umane, Vol. 50, n°3. 485-490. Franco Angeli. Roma. 
 




Mark Solms, Oliver Turnbull, Chris Mathys, Robin Carhart-Harris and Filippo Cieri
are promoting a new Research Topic, called Frontiers in Psychodynamic Neuroscience (https://www.frontiersin.org/research-topics/23259/frontiers-in-psychodynamic-neuroscience), within the journal Frontiers in Human Neuroscience.  As editors, they are inviting researchers, neuroscientists and psychoanalysts to submit papers (research, case reports, review articles, hypothesis and theory, commentaries, etc.) that deploy, review, compare or develop the methods and theories of psychodynamic neuroscience and neuropsychoanalysis.



Mark Solms: The Hidden Spring - a Journey to the Source of Consciousness
 Profile Book Ltd, London, 2021
 
Could we keep having a psychoanalytic model of the mental apparatus that does not contemplate any reflection on consciousness? We know that Freud neglected the study of consciousness to emphasize the unconscious, around which he built all his theories. Therefore, consciousness has remained  the prerogative of philosophy (debate on quality) and neurology (debate on quantity) for a long time.  Solms's book gives it the right value within the neuroscientific, psychoanalytic, and philosophical panorama, putting forward a new theory of consciousness.
Psychoanalysis, alongside neuroscience, is something familiar  by M. Solms. He conveyed all his scientific research on both disciplines; the challenge, through this book, is to be able to provide psychoanalysis (and neuroscience) with a concept consciousness, which is still considered "unfamiliar" (Uncanny). Indeed, the book opens with a private episode of experience of Unheimlichkeit (the uncanny), something familiar that becomes uncanny (eeriness) and shakes little Mark, who begins to wonder what the mind is made of and how much it transforms us by transforming itself.
Freud, finding the consciousness erratic, inconsistent, assumed that it could only be explained by implicit links of which we are unaware. Although he wrote: "Biology is truly a land of unlimited possibilities. We may expect it to give us the most surprising information…" (Freud, 1920, SE, p.83), at that time biology could not support his research and he abandoned the Project. Today we can resume this investigation knowing that, according to Solms, thoughts and feelings can be studied neuroscientifically (Link 1, below).
Solms overturns the primacy of the cortex (Cortical fallacy) in giving rise to representations, which in turn gives rise to psychic life. According to the author, affects, feelings, and emotions are at the origins of the psychic world and, thus, of existence. For human beings feelings are the only way to monitor their biological needs, adapting them to environmental conditions, that are not always predictable; feelings enable to prioritize action to make the best choices to survive. If we did not have these experiences continuously, if we were not therefore aware of our feelings, how could we navigate a world of uncertainty?
Read full review by Rosa Spagnolo
May 2021



Clara Mucci: Borderline Bodies: Affect Regulation Therapy for Personality Disorders
W. W. Norton & Company, New York/London, 2018, p.357

Beginning with the work of four psychodynamic clinicians, Ferenczi, Kernberg, Fonagy and Shore, Clara Mucci proposes a new integration of neuroscience and psychoanalysis. She states that working with borderline personality disorders means facing the traumatized body, as well as problems of identity diffusion, narcissism, suicidal tendencies, hypochondria, antisocial traits, just to mention the content of some chapters. The author, competent in both neuroscience and psychodynamic psychotherapy, offers a way to deal with impulsivity, the internal void, problematic relationships, severe dissociation, perversion, attachment, in accordance with Schore’s developmental model of psychopathology. This model, based on the right brain/mind/body pathogenesis and attachment theory, is illustrated by clinical vignettes and case histories in several chapters which explain the psychotherapeutic work with the somatic self's severe symptomatology and earlier traumatic relationships. Quoting Allan Shore (foreward, p. xiii ) "Thus, for Mucci, the reconstruction of the relational origin of borderline dysregulation, destructive behavior, and negative self– other representations is the starting point for treatment, aiming at a reconstruction of the map of attachment relationships, including early relational traumata, deprivation, loss, and maltreatment."
Borderline Bodies highlights the role of this "first other", the body, in various domains. The starting point is early relational trauma, defined according to the author, on two levels rather than what the DSM-5 (2018) categorizes as “trauma and stress related disorders”.  The etiopathogenesis of early relational trauma and disorganized attachment is strongly connected to dissociative defense mechanisms, which cause the formation of split parts in the functioning of the borderline subject. "Dissociation results from disorganized attachment and derives from intersubjective relational trauma between caregiver and child, strongly affecting the right hemisphere of the child and his or her capacity for future higher- order organization and control". (p. 9)

 The book also reviews the process of "mentalization" (Fonagy,  1995) which is  highly damaged in personality disorders. In these cases, and under the influence of the affective dysregulation, the body acts as a "foreigner", a “not- me”, an alien inauthentic self, sometimes becoming the repository of the "death wish", following a classical psychoanalytical position. According to the author: "The alien self not only is formed through the lack of constant tuning and the lack of congruent and coherent marking of the affects of the child on the part of the caregiver, but also is built and embodied intergenerationally in the future subject through negative affects and feelings translated from the mother to the child". (p. 19)  

Many grids and figures in the book guide the readers towards a better understanding of the many borderline disorder models as well as of the mechanisms by which adverse childhood experiences influence health and well-being throughout the lifespan. While an in depth discussion of the book is beyond the scope of the present review,  certain key questions are noted that may be of particular interest to the reader.  Are personality disorders a peculiar right- brain disorder?  Do the domains of neuroimaging and genetics confirm most of what we know at present? Do right - brain treatment for personality disorders exist? The author provides many clinical vignettes which attempt to illustrate how to best treat significant forms of psychopathology such as severe personality disorders, post-traumatic stress disorder, hypochondria, as well to address problems such as suicidality that frequently arise in the course of treatment.   

Rosa Spagnolo
 


Antonio Damasio: The strange order of things
Pantheon Books, New York, 2018

The journey proposed in the book The strange order of things by A. Damasio starts from primordial life and ends with the more complex forms of social organization linked to the production of culture. How should we read the book? Not as the nth neuroscience publication, but following the indication that the author provides in the introduction: we humans are storytellers and love telling stories about the beginnings. But not only on the beginnings. We continue to produce, create and generate culture in a continuous effort to face human tragedies. And a primary and significant role is played by feelings in this continuous production. 
Starting from the primordial life forms, A. Damasio is taken by surprised by the term “strange”. In fact, “strange” is the word used in reflecting on the complexity of human life that evolved from simple organisms, such as bacteria. Again, it is “strange” that a single word such as “homeostasis” “is sufficient to describe the development of life both in simple and complex terms. If “homeostasis” is perceived as feelings in the organisms with a nervous system, this has created, over millions of years, an unbreakable bond between body and mind, a partnership that spawned culture and civilization. This is the strange order of things. The complexity contained in the simple unfolding of things that make human existence complex. 

Homeostasis, feelings, consciousness and subjectivity were already found in his last book: Self comes to mind (2012); so, what is the perspective presented in this new endeavour? First of all, and perhaps above all, the homeostasis, feelings, consciousness and subjectivity sequence is described as an increasing degree of complexity and generativity of culture and sociality society . Feelings contribute to this by providing a motivation to the cultural process, by monitoring the success and failure of the instruments used and by participating in negotiating over the eons.

The book opens with two fundamental questions that are thoroughly analysed in the third part devoted to the cultural mind at work. Is this sequence the prerogative of the human mind or does it also involve other living beings in different ways? And why would feelings push the mind to act in an advantageous way? 

We may also start from the answer to the second question: if they did not do it, life would be a continuous indifferent mental flow; instead, by pushing the mind, they give it the positive and negative qualities we ascribe to it. Going back to the starting point, we may ask, ”Was this always the case for any life form or not?” The author’s unmistakable answer is: “probably not”. Only the appearance of the nervous system, organized in a continuous neural network contiguous to the body was able to generate the human mind by giving it consciousness and subjectivity. Even primitive life forms are able to recognize and repel one another through surface molecules; they can aggregate and cooperate in dealing with adverse situations. But is this enough to bring the development of sophisticated human behavioural rules back to such a simple primitive mechanism? Without the development of feelings linked to the perception of what is good and what is bad, that is, what is beneficial and what is detrimental, the development of the human mind would not have proceeded evolved . A small percentage of invertebrates (bees, wasps, ants and termites) shows organized social behaviours. They cooperate by following genetic rules that entail very stringent routines which have allowed them to survive for hundreds of millions of years. But no other living organism has ever been investigated on with respect to its origins, on the meaning of group belonging or on its death; so, these social cooperative organizations cannot be compared at all to the cultural and social development produced by the human mind. 

The element in common to all living beings is homeostasis. That is, on a primary/physiological level, we share the regulation of life by maintaining it in a specific homeostatic range which not only makes survival possible, but which has paved the way to the differentiated flowering of life. The differentiated flowering towards the human mind was made possible by the birth and the subsequent organization of the neural network. Only the organisms with a nervous system can feel impairments in the homoeostatic regulation as negative, as negative feelings, while its readjustment to appropriate levels can be perceived as positive, as positive feelings. Therefore, life is certainly possible in the systems with a homeostatic regulation, but it evolved in a different way with the appearance of feelings:  - that is, with the perception of the quality of homeostasis. But this is still not enough to think of living organisms as having a mind. A new ingredient is necessary, i.e. consciousness. It is only through consciousness that it is possible to monitor, regulate and change, that is interfere with, the homeostatic automatisms. Changing the homoeostatic regulation and representing this variation, can be considered as a first form of cultural production. 

In other terms, fighting against the regular tendency to proceed from order to the lack of order calls for accepting the genetic imperative of maintaining the hereditary homeostatic range;  and at the same time, the creation of always new forms of homeostatic control (and this concept can be applied not only to the physiology of organisms but also to maintaining group/social homeostasis).  How was this possible? Through the creation of images that map the inner/external state of the body moment by moment. In sum, this is the differentiating line with other non-human life forms. The possibility to create maps/images is given by the complex organization of the nervous system, a capability that is missing in simpler organisms. Why is the production of images so important and differentiating?  Because the lack of this ability results not only in the absence of feelings (maps/images of the quality of homeostasis), but also in the absence of consciousness and ultimately of subjectivity. In fact, it is only by creating images that an organism is able to represent its inner and external state and hence adjust the response according to the images stored and transmitted both horizontally in the social organization and vertically, generation after generation. The addition of our more recent acquisition, i.e. verbal language, to the stage linked to the production of images completes the journey proposed in the book. The development of the nervous system, its cortical organization and the development of verbal language have facilitated the transfer of acquired advantages; and by promoting a different social set up (for example with respect to other primates), all this has created new and unparalleled forms of culture with respect to other non-human living species: art, construction skills, music, faith and much more that we gather under the term: human mind. 

Rosa Spagnolo