Neuropsychoanalysis

We live in the age of neuroscience. So great is the prestige of the new discipline that everyone wants to prefix his discipline with a neuro- … the better to grant it more prestige and more authority.

There are: neurolaw, neuromarketing, neuroethics, neurophilosophy, neuroeconomics, neurotheology and, naturally, neuropsychoanalysis.

Anything to save Freud.

If anyone needs saving, it’s Freud. The practice of psychoanalysis has long since disappeared from the list of effective treatments for medical illness. Freud’s ideas still exert considerable influence on the culture, but who knows how long that will last. 

Enter Mark Solms. The South African psychoanalyst invented what he calls neuropsychoanalysis. Recently, he was the subject of a fawning article by Kat McGowan in Discover Magazine.

Unfortunately, the article reads like the kind of puff piece that a PR agency might send out. It grants Freud credit for ideas that were not his and ignores work that would disprove the neuropsychoanalytic project.

McGowan gives it away in her title: “The Second Coming of Sigmund Freud.” Thereby she shows that the truth of Freud lies in religion, not science. If she had wanted to be Freudian, she should have discussed the return of the repressed. 

The Freud who apparently has returned from the dead is not really the same as the Freud who invented psychoanalysis. McGowan credits Freud with the concept of unconscious mental processing and says that neuroscience now accepts it as something of a fact.

In truth, Freud did not invent the notion of unconscious mental processing. He opened his Interpretation of Dreams by saying that his concept of the unconscious differed radically from other versions that saw it in terms of unconscious mental processing.

The Freudian unconscious was structured like a Greek tragedy; it was filled with depraved wishes that dreams were trying to show fulfilled. Where Solms talks about ordinary human wishes, “to be competent, to be healthy, to be at home,” Freud believed that the secret of dreams lay in your wish to copulate with your mother. Freud was contemptuous of everyday human wishes.

Here McGowan explains Solms’ misinterpretation of Freud:

Freud put the unconscious on the throne of the mental kingdom, but the subjectivity problem led brain scientists to ignore the plentiful evidence of unconscious mental processing for nearly a century. How could they measure mental activity that subjects weren’t even aware of themselves? It wasn’t until the 1980s that researchers began to solve this conundrum. 

Thousands of studies have proven that people process most information, especially social data like other people’s behavior, unconsciously.

The nature of unconscious thought that emerges from contemporary experiments is radically different from what Freud posited so many years ago: It looks more like a fast, efficient way to process large volumes of data and less like a zone of impulses and fantasies.

But, if today’s version of unconscious thought differs radically, as McGowan correctly says, from Freud’s theory, the connection between the two must be more nominal than real.

Also, McGowan ignores completely today’s cognitive-behavioral therapies and the theories that underlie them. One assumes that Solms does also. For most people today cognitive therapy or a variation thereupon has become the treatment of choice for depression. In ignoring it neuropsychoanalysts create a false choice, between medication and psychoanalysis.

Note the following description of a new treatment of depression that would apparently be consistent with neuropsychoanalysis:

Helen Mayberg explains that her work on depression strives to describe the same overarching concepts that Freud invoked, including links between brain circuits and disordered moods. “Analysis has a much richer tapestry of both words and concepts” than neurobiology, says Mayberg. “The things Freud wrote about are things that every awake person on the planet thinks about.” She has pioneered the treatment of profound depression with deep-brain stimulation, a technique that stimulates precise brain locations with electricity, but she recognizes that she cannot yet account for why some patients improve so dramatically and others do not. 

In his second coming Freud is now the inspiration for “deep-brain stimulation.” Does this not sound like ECT, electroconvulsive therapy. As you know, it is anything but a new discovery? Surely, it is not Freudian.

By ignoring cognitive treatments McGowan is showing that neuropsychoanalysis fails one of the basic tests of science. As Richard Feynman said, and as I quoted in The Last Psychoanalyst, true science includes the data that tends to disprove its hypotheses. To ignore alternative treatments that have been shown to be successful is to practice pseudo-science.

Solms offers a fairly standard American version of psychoanalytic treatment. Unfortunately, it is not really Freudian:

The analyst helps the unhappy patient notice destructive patterns in his own life, especially where he avoids painful memories or feelings. “Analysis is about having somebody help you to face facts that you would rather not face up to,” says Solms. In practice, this talking cure translates into deep self-knowledge. 

Yet, Freud had no real interest in having patients face facts. He wanted them to accept their repressed wishes and desires. You might call these facts, if that makes you happy, but they are not objective realities.

And of course, the talking cure does not translate into deep self-knowledge. It translates into knowledge of Freud’s theories, into an ability to wrap yourself up in a mythic narrative.

According to Solms, even patients who have suffered brain damage suffer because they prefer living in their fantasies than facing the facts.

Solms began to systematically evaluate the hallucinations and delusions of his patients in the light of Freudian concepts like denial and wish fulfillment. Simply put, these two ideas propose that we prefer to see the world as we wish it were, rather than as it truly is. Facing the facts is difficult, requiring sustained mental labor and a high-functioning brain. A person who cannot sustain this effort winds up living in a fantasy world. 

Rather than face facts, these patients unconsciously chose to live out the fantasy that they are well. The content of the patients’ delusions revealed ordinary human wishes: It was poignant and fascinating. “There’s much tragedy and pain involved, but from a scientific point of view, it was like being a kid in the toy shop,” says Solms. 

Of course, Freudian treatment is about exploring fantasies and dreams. Its practitioners assume that once they rip away the illusory world of drams their patients will naturally come to inhabit reality.

If you want a treatment that systematically provides a reality check about all of your misapprehensions, you will find it with a cognitive therapist, not with a Freudian analyst.

Solms seems to believe that patients are lost in pleasant fantasies, in a dream world. If he wants to be a true Freudian he should prescribe a multi-year journey into the recesses of one’s unconscious mind to discover that those fantasies are really covering a wish to copulate with one’s mother.

And yet, once a patient discovers that his motives and intentions are completely depraved, he will most likely see himself as a morally deficient being. At that point, he might well become depressed and demoralized, but he will hardly be ready to face the real world of facts.

As for the notion that psychoanalytic thought is humanistic, as McGowan claims, we must note that Freud himself thought that human beings were trash. He was less interested in helping them than he was in making them into Freudians.

In that he has often succeeded.