By Levy, Steven T.; Nemeroff, Charles B.
National Forum , Vol. 73, No. 1
The title of our essay, "From Psychoanalysis to Neurobiology," implying as it does a direction of travel or linear relatedness between two approaches to mental illness, embodies what we believe to be an error in conceptualization that we will employ as the starting point for our discussion of the current uneasy state of our psychiatric profession. We wish to underscore certain essential incompatibilities or at least oversimplifications even as we embrace the naive but critically valuable ecumenical spirit of the biopsychosocial approach to psychiatric patients. We will move our discourse to clinical and educational areas to illustrate the problems and potentials of modern biopsychosocial mental health care. We will address mainly the biological and psychological, leaving the social for other commentators in this issue of National Forum. We will conclude by applying our observations to consideration of specific mental disorders and their treatment.
Psychoanalytic and neurobiologic views of human mental functioning are not points on a linear continuum. What are usually referred to as mental phenomena, complex thoughts, fantasies, attitudes, and feelings--mental content with personal, subjective as well as communicative meanings--are not simply the aggregate of more microscopic, biologically organized brain events. Neither are they, mind and meaning, epiphenomena with no independent reality, only subjective observables reducible to biologically "real" parts. Freud in Beyond the Pleasure Principle, written in 1920, thought otherwise.
The deficiencies in our description would probably vanish if we were already in a position to replace the psychological terms with physiological or chemical ones . . . . We may expect |biology~ to give us the most surprising information and we cannot guess what answers it will return in a few dozen years to questions we have put to it. They may be of a kind that will blow away the whole of our artificial structure of hypotheses.
Twenty-five years earlier, Freud had sought, in vain, to transcribe his discoveries about mental life into the language of biological discoveries concerning neuronal function in his ill-fated Project for a Scientific Psychology. Clearly, he never gave up his hope for a reductionistic synthesis or integration, understandable in someone trained during the post-Darwinian natural-science revolution, a period during which all natural phenomena were believed (or hoped) to be reducible to processes obeying a limited, interrelated set of physical principles. There continue to be those who believe that, as our understanding of brain structure and function develops in complexity and completeness, such a reduction of the psychological into the neurobiological will be possible. It is our belief that this is a wrong-minded way of considering the mind-body dilemma, and it is epitomized in the uneasy integration of psychoanalytic and neurobiologic contributions to our understanding of mental illness.
We believe complex mental phenomena, including those observed in patients suffering from mental illness, are inadequately accounted for by neurobiologic events, in no way underestimating the importance of the latter in the pathogenesis of many of the major illnesses or problems for which patients seek psychiatric help. Psychoanalysis and neurobiology function at different levels of abstraction and conceptualization. They can be thought of as "basic" sciences underlying clinical psychiatry, not as competitive or complete explanatory systems. They use different methods of observation, concern themselves mainly with different data, use different methods to validate hypotheses, and when applied clinically, attempt to influence patients in significantly different ways. That brain influences mind is well known. Neural plasticity, the organic adaptation of brain to life experience, is only recently becoming better understood. Primate studies by Bessel Van der Kolk have shown that early deprivation and other disruptions of affiliative bonds produce lasting changes in brain morphology and neurochemistry. …