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       "Philosophical and methodological problems concerning neuropsychoanalysis"



 By Jakub Przybyła 




Jakub Przybyla is a psychotherapist,  member of the Polish Society for Psychodynamic Psychotherapy, living in Kraków (Poland).







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The article criticizes the idea of integrating neurobiology and psychotherapy based mainly on the

study of psychoanalysis and neuropsychoanalysis. The author focuses on the philosophical and

methodological problems which arise from attempts to carry out this integration. The article

presents the view that this approach is a harmful reduction. It also proposes a look at the

relationship between psychotherapy and neurobiology as an area of cooperation that avoids the

confusion of theoretical languages.


1. Introduction

In this article, I would like to discuss the difficulties facing the integration of psychotherapy

and the theory of psychoanalysis with neuroscience. I have already addressed this problem 

in previous publications in Polish (Przybyła 2017a, 2017b), where I indicated the possibility 

 of working out a reasonable compromise between these knowledge orders in the form of a 

so-called explanatory dualism. In this text, I would like to focus primarily on the limitations

related to the methodological and theoretical assumptions that hinder or even make 

impossible the integration of the two fields of knowledge using the example of the best-known

version of this integration, neuropsychoanalysis. The tradition of combining psychotherapy 

and neuroscience, as well as attempts to give new justification to psychotherapy thanks to 

neuroscience, already has its own rich history and collection of cases (Ginot 2015, Schore 

2003). Often, this integration is unfortunately limited to switching the language employed, 

and to applying metaphors from the field of neuroscience to the definitions of psychological 

problems (for example using the concept of neural networks). Another common procedure is

the use of generally-known psychological concepts, such as memory or attachment, as if they

had a clear and established neurobiological sense. At the beginning of this discussion, it is 

worth reviewing the history of this trend in psychotherapy.

   Eric Kandel in his famous text A New Intellectual Framework for Psychiatry (Kandel 1998),

expressed his opinion about the need to integrate the efforts of various human sciences: 

psychiatry, genetics, neuroscience and psychotherapy. He perceived these fields of

knowledge as complementary to each other, and saw their healing effects as a synergy effect 

rather than a particular impact on the psychic or cerebral sphere. Kandel's article, together

with its continuation – in another article, turned out to be a programme-setting text for

researchers who want to combine the psychoanalytic perspective with a neuroscience point 

of view. Such a perspective was also represented in the work of Allan Schore (Schore 2003).

 The presence of an empirical, research and biological perspective is in fact a more and more

visible tendency in psychodynamic psychotherapy.

Representatives include, among others, such clinicians and researchers as Peter Fonagy, 

Otto Kernberg, and Glen Gabbard. There have also been significant studies on the 

effectiveness of psychoanalytic therapies. Falk Leichsenring (Leichsenring & Rabung 2011)

performed a metaanalysis of such studies for various psychopathological units, as well as for 

complex mental problems, such as personality disorders. These studies, despite all

weaknesses related to the methodology of psychotherapy research in general, indicate the 

effectiveness of long-term therapies in the psychodynamic paradigm. The aforementioned 

Glen Gabbard (2000, 2005) emphasized the necessity and value of integrating biological and

psychological knowledge. According to this point of view, the most important thing is

understanding the mutual relations between different fields of knowledge and levels of

human functioning. Gabbard described the division into psychiatrists who deal with the

brain or mind therapists, as a return to a harmful Cartesian dualism. Neuroimaging

studies show in spite of their imperfections that under the influence of psychotherapy and

pharmacotherapy there are changes in the functioning of the brain, sometimes different 

depending on the method of influence i.e. through drugs or through interpretations and

contact with the therapist. This is where the idea of combining psychotherapy and 

neuroscience comes from. However, a risk arises here that psychotherapists will use

biological models in their practice in the service of resistance, without recognizing the

defense-related and countertransference-binding efforts that cause them.

    Another avenue pointing to the sense of integrating clinical knowledge and 

psychotherapeutic perspectives with the biological perspective are the constantly renewed

efforts of scientists trying to explain human behavior by entering them into the repertoire of

other animal behavior. Ethology, behaviorism, sociobiology, and evolutionary psychology

have all tried to do this. There are many indications that some basic behavioral and 

biological affective and motivational mechanisms are shared by humans and other animals,

or at least with other mammals (Panksepp & Biven 2012). This suggests that the primary

emotional and motivational processes are determined by the action of genes and are related

to the functioning of the human brain and its individual subsystems. This is in accordance

with Freud's suggestion of certain phylogenetic and biological determinants of human

behavior and sexuality as among the most important sources of human motivation. Taking

into account Bowlby's research on attachment, inspired by evolutionism and ethology,

conclusions about the ways of creating relationships with others (object-ralation

theory, ego psychology, self-psychology), psychoanalysis has pointed to the basic phenomena

in the functions that human shares with other mammals. This includes parental care and the

importance of separation stress, creating fundamental bonds and relationships with objects

that mark the foundations of social functioning, sexual function, as well as competitive and 

aggressive behaviours with representatives of both sexes of their own species. In particular,

the issue of bonding with caregivers, attachment and separation is the object of attention of

both developmental biologists and psychotherapists. As Eric Kandel (1999) pointed out, this

is one of those areas that combine psychoanalysis with biology. Moreover it is worth paying

special attention to psychoanalysis as a psychological theory that describes the human mind

in an extremely deep and intellectually satisfactory way. There is no other theory of the

functioning of the mind that would describe it in such a multifaceted and multi-layered way

as psychoanalysis. It captures the issues of norm and pathology, the emergence of human 

subjectivity and its development in the life cycle, and refers to both rational and irrational 

aspects of human behavior. The mind is perceived in a synchronous perspective, through the

analysis of functioning here and now, the functions of the ego, the vicissitude of drives, and in

the diachronic perspective through the history of the creation of the inner world of the

human being. In this sense, the most important and the most interesting problems

in modern psychotherapy are delineated by two areas of knowledge: psychoanalysis and

neuroscience. None of the theories and methods of therapy is as rich in theory as

psychoanalysis. No other therapeutic modality creates a full anthropological vision of the

human being, embodying function and development in the life cycle. But psychoanalysis has

done so.

   Therefore, it seems that the most important branch of available therapies remains the

family of psychoanalytic therapies. It is not a surprise that psychoanalysis is the theoretical

background to which brain researchers refer. Among others Allan Schore (2003), Daniel

Stern (2005) and Mark Solms (2000), referred to psychoanalysis (see also Salone et al. 2016).

The questions of what status the combination of psychoanalysis and neuroscience in the form

of neuropsychoanalysis suggested by Mark Solms will have. Will it be a creative perspective

as Kandel hoped – or rather a harmful reductionism? I will consider in the further part of

the text a few problems related to the answer to the question. An important issue which is

often overlooked when discussing this topic is the internal diversity of psychoanalysis. 

Modern psychoanalysis bases itself on Freud's research but rejects it as well. It is difficult to

talk about psychoanalysis today without mentioning Anna Freud, Heinz Hartmann, Melanie

Klein, Wilfred Bion, Donald Winnicott, Heinz Kohut, and many more. Modern Italian 

psychoanalyst Antonino Ferro even expressed the view that Freud's legacy must be

dismissed as unnecessary and as ballast (Ferro & Nicoli 2017). Another analyst Thomas 

Ogden also proposes to replace Freud with Bion. Neuropsychoanalysis rarely consider the

perspective of modern psychoanalysis. This is one of the many limitations that are associated

with this kind of combination neuroscience and psychoanalysis. The exception is work of

Allan Schore, who refers to a broad psychoanalytic tradition. He refers to classic concepts of

Freud, Klein and post Kleinian tradition (Schore 2003), self-psychology of Heinz Kohut

(Schore 2002), as well as attachment theory (Schore 2000, 2001).

    The best known integration perspective is neuropsychoanalysis (Solms 2000). This was

presented by Mark Solms, who together with Olivier Turnbull wrote an explanatory article

What Is Neuropsychoanalysis? (Solms & Turnbull 2011, 2015). The viewpoint they present is

very general. They point to several research problems which they considered important.

First of all, it is important to study psychic phenomena, especially those postulated by

psychoanalysis. On the other hand, they are interested in psychoanalytic work with

neurological patients who have specific brain damage. Analysis of the functioning and

psychoanalytic understanding of such patients should allow us to establish the relationship

between disturbances of brain functioning and psychodynamic phenomena. The authors of

the article adopt a monistic vision of the human being. This means that the brain and mind

are two aspects of the same thing. It seems, however, that their position is to a large extent

an ideological declaration and requires a deeper philosophical analysis. They do not pay

attention to the fact that language produces a certain ontological universe. Therefore, it is

important to note that psychoanalysis and neuroscience use different languages and operate

in different theoretical and ontological fields. Both also have their own terminology and

research methods. One can say, according to Alfred Tarski's concept of truth, that their

integration will be possible only when one can find a common language ona higher level in

which both fields could be described.



2. Critical reflection

This part of the article will propose critical arguments for the project of building a new

theory for neuroscience-based psychotherapy, as well as a critical look at the possibility of

combining neuroscience with psychoanalysis. I will present here the basic philosophical and

methodological problems in which this project is involved. I will focus here on the criticism

of neuropsychoanalysis. These arguments have already been presented in Polish (Przybyła

 2017a, 2017b).

   The first argument, which will appear in subsequent parts of the text, has already been

formulated during the discussion of the article by Solms and Turnbull: authors and 

researchers, connected with neuropsychoanalysis, quite willingly and freely refer to the idea

of psychophysical monism and claim that phenomena described by clinicians and

psychoanalysis can be reduced to brain phenomena. Firstly, this seems to be, above all, a

certain ideology, and secondly, a kind of hope associated with it, and not a current state of

knowledge. Furthermore, it mixes together two irreducible languages: the language of

psychoanalysis and the language describing neuronal phenomena. At the same time, it does

not offer a common language in which these areas can be described together. It is important

to emphasize the fact that “neuropsychotherapy” very often merely switches the language.

 Instead of the mind, one talks about the brain. Instead of emotions, one talks about

neurobehavioral systems or neurotransmitter secretion. In addition, neuroscientists

freely use psychological concepts such as memory, learning, attachment, as if they were 

describing the well-known facts of the brain's functioning in this way. They forget that this

language describes correlates, and not identical phenomena.

   Another argument will be illustrated by three cases from research practice. This argument

claims that you can not speak about psychotherapy simply based on neurobiology. One can

not change metapsychology on this basis, because the data obtained from neuroscience

research are far from clear interpretation. The first example is not a case describing the 

practice of neuropsychoanalysis, but it shows a general trend which also exist in 

neuropsychoanalysis. This is the case of research on mirror neurons. These extremely

interesting brain cells were discovered in the 1990s by examining macaques observing the

actions of other monkeys. The main thesis about the role of these cells is that monkeys and

humans have a brain system of nerve cells which "map" the actions of other individuals in

the brain. On the basis of data of unclear significance many different theories about the

genesis of language, causes of autism, social brain activity, human intersubjectivity, learning,

empathy, identification, etc, have been put forth. The problem is that as Gregory Hickok

(2009) argues much of the interpretation of the available data is incorrect. It is

worth paying attention to how unclear data from laboratory become the basis for

formulating far-reaching-conclusions.

   Other examples come from the journal Neuropsychoanalysis. They are intended to

illustrate how far neuropsychoanalysis makes use of uncertain data, which, for example,

does not prevent Solms from proposing a revision of psychoanalytic theory on their basis.

This problem can be clearly seen in the discussion about Heather Berlin's article The Neural

Basis of the Dynamic Unconscious (Berlin 2011). This work attracts attention due to the

richness of data, the quoted research procedures, and the references to unconscious

phenomena, which met with enthusiastic reception from, among others, Eric Fertucka

(2011). Vaughan Bell (2011) notes that the author refers in the text to disease entities whose

existence is debatable (such as DID, dissociative identity disorder). When we examine the

brain function of people with such a diagnosis, then what are we actually examining? 

Another critical voice is the commentary of Morris Eagle (2011), who points out that the

majority of operations carried out in experiments on the functioning of unconscious

processes examine the descriptive form of the unconscious rather than its crucial form for

psychoanalysis and psychodynamic therapy. According to Eagle, these studies are therefore

characterized by low ecological validity.

   Another example taken from Neuropsychoanalysis is a new concept, which was formulated

by Mark Solms. This is the theory of the conscious id (Solms & Panksepp 2012, Solms 2013).

The main thesis is that consciousness is generated by the brainstem and is primarily

affective. Solms takes issue in this way with the statement that consciousness arises in

connection with the activity of the cerebral cortex, which would be connected with what

Freud called the ego, not with the id, which was seen as unconscious. One of the arguments

that Solms invokes in his dispute with Freud's standpoint is the presence of very fundamental

perception in people with lesions of CNS cortical centers, and the fact of demonstrated

emotional reactions in cases of congenital cortical deficiency in humans (called 

hydranencephaly). This theory for Solms means that one should think critically about the

basics of the psychoanalytic vision of the mind and the purpose of the therapy that Freud

formulated, that is, making the unconscious conscious, and - in later publications -

replacing the id with the ego. Solms claims that the id is conscious, and that would make 

Freud's suggestion pointless. However the data referred to by Solms are not so

unambiguous. In her discussion of his publication, Heather Berlin (2013) noted that the facts

about the existence of consciousness in animals without a cortex and after brainstem lesions

do not clearly indicate the thesis of Solms, that there can be consciousness without cortex,

but cannot occur without the activity of brainstem structures. Besides, the fundamental

problem is what Solms understands under the concept of consciousness. Berlin suggests that

this understanding may be limited to certain automatisms and reflexes. This seems far from

the common understanding of consciousness, not only as a state of vigilance, but as an

auto-reflective state, which consists of various emotional and cognitive components. Robin

Carhart-Harris (2013) made similarly critical remarks stressing that the relation of the ego

to id reflects rather the associations of the cerebral cortex with the limbic system, and in this

sense, Freud's description of this relationship may be quite adequate. Another comment was

formulated by Larry Kunstadt (2013) showing that Solms unites in a loose way different

concepts of neuroscience and psychoanalysis, e.g. affective states and id. This is probably

a wider problem. However, theoretical concepts cannot be changed without consequences.

Each of them creates an ontological universe and is therefore not reducible to any other.

   At the end of a critical look at the relationship between neuroscience and psychotherapy, it

is worth considering the remarks formulated by Rachel Blass and Zvi Carmeli (2015) in

their discussion of the publications of Solms and his colleagues. These authors discuss the

neuropsychoanalytical perspective defending the idea of self-reliance of psychoanalysis and 

the harmfulness of attempts to base it on biology. They referred to Yovell, Solms and

Fotopoulou's presentation of the main ideas of neuropsychoanalysis in The International

Journal of Psychoanalysis. In Blass and Carmeli's opinion, the attempt by Solms and his

colleagues to equate the mind with the brain is invalid. According to the authors of this 

criticism, these two spheres: the brain and the mental sphere, are separate and irreducible

levels of description. In this sense, the mental and brain orders are ontologically different,

although it may actually describe the same thing from different perspectives and on different

levels. The equation of one description level to another is also harmful because it destroys

the uniqueness and the advantages of each discipline. Blass and Carmeli employ the analogy

of a song performed on a musical instrument: to analyze music, we do not necessarily need to

know the details of the instrument's construction and playing technique, although it can not

be denied that the music and the instrument on which it is played are directly related to

each other. Another argument of the authors is an analysis of the clinical example

presented by Solms and colleagues in which they had some harmful intervention. They 

changed the analysis of the subjective meanings of the patient into an analysis of his cognitive

functioning, and thereby referred to psychological theory, and not a neurological analysis as

they would like to present it. By introducing an intervention based on explaining the

phenomenon of memory function, they leave the analytical paradigm and omit the work of

interpretation, which is the heart of the analytical approach. Such an intervention might

calm down or inform the patient, but it does not have a healing effect on his subjective world

of experiences. It is worth emphasizing that the abandoment of interpretative activity is

usually a therapeutic acting-out which is often related to the involvement of the therapist in

a transference-countertransference process, or proof that the identification of therapists

with the psychoanalytic paradigm is declarative and selective rather than self-evident.

Taking into account the above remarks, Blass and Carmeli concluded that the approach

proposed by Yovell, Solms and Fotopoulou is detrimental to psychoanalysis itself.




3. Conclusions

I would like to emphasize here above all the positive aspect of the inability to integrate

neurobiology with the language of psychoanalysis. On the one hand, this difficulty can be

described as philosophical or ontological. This is the discussed lack of a common language

for both areas of knowledge which would enable their theoretical and conceptual

integration. On the other hand, there is another difficulty which can be simply described as

a methodological one. It is the inability to operationalize clinical knowledge in the way that

would recognize the proper sense of psychoanalytic terms. In practice, the point is that

neurobiologists cannot reliably and accurately examine the processes and phenomena

observed in the therapy process. The operations that scientists make are a distant and

insufficient approximation of the clinical sense of the studied phenomena. Another difficulty

that excludes integration is the still uncertain status of interpreting data from

neurobiological research, which undermines the sense of introducing changes in


   The right way to procede is to use a double method of description. This is a description

that does not reduce one discipline of knowledge to another. Of course, it is not known

whether the same phenomenon can be described in two different ways. Nevertheless, one can

generally treat human mental activity as such, which can be in some aspects described by

neuroscience, and in others aspectss (or the same) by psychoanalytic theory. However, these

languages should not be reduced to one another. Firstly, because the restrictions and

opportunities for translation from one conceptual system to the other are unclear. Secondly,

because it would probably lead to a reductionism that loses the specificity and richness of the

theoretical and practical proposals of both fields of knowledge. This position is also

connected with the proposal of the existence of neurobiologically-informed psychotherapy

and seemingly consistent with Kandel's proposals neuroscience that takes into account the

results of psychoanalytic investigation. It seems that in practice, it is this model that is very

often present in the approach of therapists and researchers themselves, especially from the

neuropsychoanalysis trend. Mark Solms argues that neuropsychoanalysis is not

neurobiologically informed psychoanalysis. It seems however that this is what we are mainly

dealing with within this trend.

    In summary, we can say that differencess in perspectives is valuable in the deliberations of

neuroscience and psychoanalysis about the human mind. Possible dialogue should be based

on the principle of cooperation and not incorporation. However, this dialogue will lead to

theoretical and methodological abuse and perhaps also in practice (in working with patients)

if it does not take into account the fundamental irreducibility and limited translatability of

the two orders of knowledge. On the one hand, one should be aware of the possible abuse of

neuroscience's prestige in the explanation of various phenomena (Satel & Lilienfeld 2013).

On the other hand, the recours of practicing psychoanalysts to neuroscience does not bring

anything new in the understanding of the therapeutic process. They are therefore an

additional legitimation for analytical practice. This is precisely the kind of use of 

neuroscience proposed by the outstanding Italian psychoanalyst Franco De Masi (2009, 


   It is worth considering what form of psychotherapy is the most compatible with the

findings of neuroscience. This is not question about creating a new form of therapy based on

the results of biological research. As I have tried to show, it is a methodologically

inappropriate strategy. Therefore, it is worth considering which of the forms of existing

psychotherapy is already consistent with certain findings of neurobiology. It is mainly a

question of appreciating emotional experience as a factor shaping and changing the

personality. It seems that in this respect the most interesting option is the the psychodynamic

psychotherapy focused on transference (TFP) developed by Kernberg and his team (Salone

et al. 2016) The practical usefulness of this therapy is not undermined by critical voices

about its coherence and theoretical clarity (Christopher et al. 2001). TFP pays particular

attention to the importance of dyad self-object, and the affect that connects them. These

dyads are activated in a therapeutic relationship, which becomes the object of work. This

point of view also assumes the significance and indissolubility of the self and object

pair, which shows that human personality from the beginning is associated with interaction

with significant others. This assumption is consistent with research on child development,

research in the paradigm of attachment, as well as with the research which has been

recently presented in the neuropsychoanalysis community (Fotopoulou & Tsakiris 2017). 

Kernberg's psychoanalytic approach assumes that mature psychic structures (id / ego /

superego) are based on an unconscious substrate built from the relation of self-affect-object,

which are formed in the first three years of human life and are probably stored in implicit

memory. They also decide the dominant attachment pattern in affective reactions of the

patient. Identification of these original structures becomes the basis for interpretive work.

This work is to lead to change a restructuring in the mind of the patient. This applies to the

whole spectrum of psychopathology excluding the psychotic organization. This therapy is

therefore used in treatment of borderline personality organization as well as neurotic

personality disorders (Caligor et al. 2007, Yeomans et al. 2015) It seems to me that the

example of TFP and its juxtaposition with the results of neuroscience research clearly show

how reasonable and methodologically consistent relations between the various fields of

knowledge can be.



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