A collection of papers rather than a cohesive book, divided into four parts, the collection attempts to provide a neuron-anatomical-functional base for what heretofore has been the untestable premise of psychoanalysis: the unconscious. Without a testable and therefore falsifiable premise, there has been no science to psychoanalysis, despite what Mark Solms and others have brought to the table.

In this format, the book seeks to examines putative neurological underpinnings for emotions, memory, unconscious, perception, attention, wakefulness, sleep, dreams, empathy, sharing effects, intentionality, embodied simulation, and aspects of infantile mental development as far as these constructs resonate in the theories generated by psychoanalysts across time so far.

In keeping with the topics, the authors are chosen with a Eurocentric bias and most are from Italy or close by.

From Mancia's introduction, it is clear that the book is an attempt to bridge the divide between the neurosciences and the philosophies and theories of psychoanalysis, with the latter clearly hoping some of the dimness of the light shining on their theories will be brightened by the former: after all, it is nearly 100 years since Freud threatened that one day all of our theories of the mind will be found to have an organic basis. In this vein, Mancia opines that the neurosciences are based on the logic of explanation, whereas psychoanalysis is characterized by a logic of understanding, and here he acknowledges the difference between the two pursuits.

Part one, on memories and emotions, begins with Gilbert Pugh speaking of cooperation not incorporation of the two disciplines, and dealing with the polecat of suspicions around Freud's apparent lack of science behind his opinions, and that neither pursuit will absorb the other and result in its demise.  He begins his discussion with the interpretation of dreams, and Freud's frustration in the middle road between medicine and philosophy.  Memory yields another discussion, discussed within the contexts of procedure, implicit, emotional and Freudian views on implicit processing. This is complete with references to suppressed memories, Eric Kandel, and memory 'objects', completed with two vignettes, the first connecting a traumatic brain injury and early breastfeeding experiences:

"However, what I did not tell him at the time…was that he was also struggling to disentangle the difference between his experience of me now, as a representative of his autobiographical "internal mother" and the reemergence of actual "bits" of feeling memory from the past, possibly from amygdala circuits, as a result of his head injury" (page 55 with a footnote about his four-hourly rigid regime of breastfeeding as an infant.)

Leuzinger-Bohleber and Pfeifer follow on with their belief that the advances in neurosciences are going to contribute to a scientific foundation for psychoanalysis, again with a case vignette by the first author, attempting to show that the idea of working though early memories leads to structural change is now supported by an interdisciplinary series of findings, and hence provides a structure for change of behaviour: how this is healing is not explained.

Mancia returns to show how implicit memory and unrepressed consciousness surface in the transference of the therapeutic relationship, and in dreams.  This is replete with such statements as:

"The voice …is an experience of oneself while one is speaking, but at the same time an expression of the self in relation to the other person.  It sets up transference current recalling a sensory dimension linked to the mother's voice" (109).

Many of these discussions proceed as the above, with the language of neuropsychology inserted into discussions of psychoanalysis, often with nice enough assertions such as in the early part of the quote above, but often again with a switch into the side of psychoanalysis that infuriated feminists.  The obligatory vignette again is replete with references to insight promoting behavioral change, something the Motivational Interviewing researchers would find infuriating. The patient's shrieking out loud on the couch, "You must be out of your mind" is taken as self referential, but I am unsure of that.  The patients sensual dream of the psychotherapist at the foot of her bed, and the connections to her mother's timetables of sleeping, seem to me to have very little neuron-referential material, despite the preceding arguments referencing Dan Shacter, Larry Squire, Antonio Damasio and others.

Sergerie and Armony take a neurobiological perspective of the relationship between emotion and cognition, with some reference to the bible and Aristotle, but moving swiftly on to Hume, Simon, Minsky, Nietzsche, Dostoevsky and then to Kluver and Bucy.  What follows is the isolated discussion of the amygdala, and then the modulation of attention by emotion, and the interactions between memory and emotion, following on the earlier discussion that the amygdala is in fact so multiconnected that it cannot be discussed much in terms of some functional isolation, and leading to the emotional memory modulation hypothesis, and the site of this.  The conclusion, as expected, is that emotional memories are a special form of memory.

A focus of this book is of the right hemisphere as a special and beloved focus, a hemisphere "excellence" for psychoanalysts as the introduction calls it.  Guido Cainotti takes up this particular cudgel: understandable in the light of the lateralization of conversion and the anosognosia of hemiplegia.  Again, the nature of the interactions between emotional and cognitive systems is discussed, with particular reference to the right hemisphere, as the unconscious hemisphere. Rather, the right side is seen as crucially involved in the unconscious emotional memories that are the fertile field for the practice of psychoanalysis.

Capelli presents a chapter on anxiety "in perspective' going over the ground presented before in the book, as well as "pleasure-unpleasure and the primary ego, identified anatomically here as being somewhat represented by the organs of the periaqueductal gray matter as a simple, Ego-like-Life-Form which translates into the acronym of SELF. In this way, Capelli believes that the process of uncovering these memories into the here and now in the context of panic is somehow therapeutic, but I am unsure that there is any literature supporting the idea that cathartic release actually helps.

Pally speaks of repeating the past in the present, and why predictions are so heavily weighted toward the past. For Pally some evidence thus is that early memories are not laid down, not because they are suppressed, but because the brain at that time is immature. Hence, there are not only psychological forces but neuronal at play. This would then describe why enduring change is so difficult. Pally then lets his patients know that part of their difficulty in shedding the chains of the past is not their fault, they just have brains that are unable to release these chains.  As naïve as these pronouncements are, Pally is the first to really integrate the findings of those who examine childhood abuse and neglect, and the idea that our current ills reflect the conflicted past. Steven Suomi's monkey studies, and Mark Solm's views are seamlessly integrated into Pally's discussions.

Lehman and Koukkou discuss the brain's experience-dependant plasticity, state-dependent recall, and creation of subjectivity of mental functions.  Well, that is the title of this chapter. Although they mention the activity of the first 100ms after the brain is exposed to a stimulus, they do not mention that we may in fact act after that unconscious apperception by responding in such a way that confirms what the brain has already decided on, as we update working memory: this surely would be worthy of discussion in linking psychoanalysis and the neurosciences. But, Lehman and Koukkou focus on their own and their colleagues' research, and produce a less than satisfying argument.

Part two engages with the shared emotions; Avenanti and Aglioti speak of the sensorimotor side of empathy for pain, theory of mind and mirror-neuron stuff for sure. The idea they pursue is that empathy for another's pain my rely not only on affective motivational representations but also on fine-grained somatic representations, so that it is based on different types of sensory, motor and emotional simulative mechanisms.  An interesting aside would have been to explain how the social dimensions of pain extend to the very basic sensorimotor levels of neuronal processing, in someone such as concentration camp guards, or in human evil.

Osaka, one of the only outsiders, presents a fMRI study driven by mimic words, and I am unsure how this contributes here. Gallese's chapter on intentional attunement, embodied simulation and its role in social cognition again takes up the early argument of mirror neurons and the understanding of intentions, and the intentional attunement hypothesis: "The shareability of the phenomenal content of the intentional relations of others, by means of the shared neuronal underpinnings, produces intentional attunement.  Intentional attunement, in turn, by collapsing the others' intentions into the observer's ones, produces the peculiar quality of familiarity we entertain with other individuals" (289).  This is then related to schizophrenia, described as a lack of attunement in creating a cohesive picture of their social world: this is interesting, and if taken further, might predict a 40HZ gamma synchrony problem, but as with the discussion of autism that follows, the bridge to neuroscience is not carved out.

Part three enters the world of dreams, with Mancia returning to discuss the dream as a royal road to a possible dialogue between neuroscience and psychoanalysis. The historical overview of dreams since Freud is interesting, but the very recent insights into the interaction between the prefrontal and limbic areas in terms of the instructions that pass to process and perhaps dump information during sleep were delivered to late for this weak chapter despite its 78 references.  Anderson comes in to deliver a cognitive science approach to repression, which he does, with reference to both his own neuroscience formulations, as well as then applying these to Freudian Repression (page339) distinguishing usefully between suppression and repression.  Bassetti, Bischof and Valko look at neurological views of dreaming, with an extensive and unnecessary history that goes on for pages, but with an interesting review overall, but with no apparent bridge to psychoanalysis.

Piontelli finishes off with a single chapter on the "onset of human fetal behavior" and applies these to such conditions as claustrophobia, rest, startle responses, hiccups amongst others.

The book ends abruptly; there are no closing chapters, no index.

Overall an unsatisfying meal.  One is reminded of tourist restaurants where the service and menu are incomplete and abrupt, sometimes all over the place, seldom focused, not prompting one to return.

It is absolutely essential to bridge psychoanalysis and neuroscience, in the same way it is essential to move from nosological entities to more valuable biological markers of mental or social phenomenon, in the same way in which general cognition provides a good marker for overall wellness, or slowing a marker for depression or dementia. To attempt to do what Mancia sets out to do, is noble, but the authors fail overall to come to the part: to fail is most disappointing.  Nowhere does this collection cohesively enable psychoanalysis to engage with human suffering on a neuronal level, or add anything at all to the practice of the Neuropsychiatrist or Neuropsychologist.  Psychoanalysts must deal with what they cannot visualize, neuroscientists deal only with what they can.  For psychoanalyses to truly become a behavioral neuroscience, they have to embark on a much more dialectical journey, with more coherence than this offering.

 

 

© 2007 Roy Sugarman

Roy Sugarman PhD, Director of Clinical and Neuropsychological Services, Brain Resource Company, Ultimo, Australia

Categories: Psychoanalysis