Psychiatry And Psychoanalysis: Clinical Dialogues

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

An open interview with Mark Solms took place yesterday evening, in which he presented his recommendations to practicing analysts. I hasten to publish the translation, which is somewhat hasty, but this is not an article for the magazine. I think everything is clear.

Guidelines for Clinicians Practicing Psychoanalysis Mark Solmes

1. Mental states cannot be reduced to physiological states of the brain and vice versa. Psychoanalysis and neurophysiology provide two points of view on the same thing. Freud called our object of observation "mental apparatus", and he unambiguously recognized that the psyche can be studied from different perspectives.
2. To create his own model of the mental apparatus, Freud used the data of the neurosciences of his time. In particular, he developed the idea of the connection between consciousness and perception and their functional localization in the cerebral cortex. That is why we have every reason to correct Freud's ideas in this regard, using the modern achievements of neurosciences.
3. In this regard, two discoveries are of the greatest importance:

A) Consciousness arises from two structures of the brain stem, performing the functions that Freud attributed to the [structure] "It". Therefore, It is not unconscious. B) the cortical I is in fact unconscious and extracts its abilities for consciousness from the trunk It. Therefore, I am not the source of consciousness. 4. As it turned out, consciousness is a fundamentally affective function. And this discovery is not very different from my own ideas; a similar point of view is defended by A. Damasio and J. Panksepp (we will indicate only these most outstanding specialists). 5. If It is conscious, then a natural question arises: what is the unconscious, and in which parts of the brain is it localized? 6. Neurophysiological studies demonstrate that the systems of unconscious (non-declarative) memory are mainly localized in the subcortical ganglia of the forebrain. It is important to note that these memory systems generate action programs (responses), not ideas (images). 7. My personal point of view, which is consistent with Friston's ideas, is that these programs take the form of preliminary predictions, i.e. preliminary forecasts of what a person needs to do in order to satisfy his desires and needs. Memory is needed for the past, but programs are for the future. 8. The goal of any training is to automate these predictions. Uncertainty and delay are the mortal enemies of predictive systems. Automation employs a mnestic process called consolidation. 9. Some preliminary forecasts are automated with good reason, while others are automated unnecessarily (prematurely). The second type of forecast is called “crowded out”. “Repressed” consists of the least-bad predictions that a child can make when he is overwhelmed with insoluble difficulties (ie, inappropriate needs). 10. Non-declarative memories cannot (by definition) return to consciousness, ie. they cannot be "reconsolidated" into declarative memory. When they are activated, and not held [in the form of memories], then they act out. Consequently, the repressed cannot be canceled by means of memorization-recall. 11. Our drives and needs become conscious in their source in the form of feelings (therefore [my article is called] "Conscious It"). Reasonably automated predictions successfully regulate such feelings by fulfilling the underlying drives; and baseless predictions are not. Therefore, our patients mostly suffer from feelings. They suffer from unresolved emotional needs. 12. Freud understood all this as "the return of the repressed"; but the “repressed” does not in itself return, and unregulated feelings do. 13. Secondary “defenses” (which are not synonymous with repression) are designed to eliminate the feelings that arise from the inevitable failures of repressed predictions. That is why the onset of the disease coincides with the breakdown of defense mechanisms. 14. Neurophysiological studies show that we are governed by more than two drives. Using Panksepp's taxonomy, the inability to fulfill the emotional needs of the drives most often causes psychopathology. Bodily impulses (homeostatic and sensory) are easier to curb. The necessary preliminary forecasts are generally amenable to reflection. And taming emotional needs - which also conflict with each other - requires much more profound learning through experience (i.e., taming and providing instinctive responses). 15. I am confident that our clinical practice will greatly expand if we can use the unregulated feelings that our patients suffer from as a starting point for our analytic work. By relying on conscious feelings, we can track unmet emotional needs. This in turn makes it easier to identify the repressed predictions that the patient (unsuccessfully) uses to meet needs. 16. The superseded predictions are tracked from the transfer. Note that the transfer is an automated programmatic action. It is impossible to recall it (see above), but it is reproduced; it is automatically played out. 17. Transference interpretation unfolds as a result of four successive steps: A) Do you see that you are constantly repeating this behavior? B) Do you understand that it is necessary to fulfill such a need? Q) Do you understand that this does not work? D) Do you understand that this is why you suffer from this feeling? 18. Debunking transference allows patients to form new and more adaptive predictions, but they do not reconsolidate, and therefore eliminate old, maladaptive predictions. Therefore, although patients gain insights from transference interpretations, they continue to act out old programs of action. Therefore, transference interpretations should be repeated until patients can use them for their own purposes, ideally as long as acting out is in effect, and not after they can change course (using new, more adaptive predictions). This is called “working out”. 19. It takes a long time to automate new forecasts. In cognitive neurosciences, it is common to say that non-declarative memory is "hard to learn and hard to forget." This is why psychoanalysis requires many sessions at high frequency. (Those who want quick treatments should be aware of how slow learning works.) 20. New forecasts are gradually being favored over old ones because they do work; they do satisfy their underlying emotional needs. But the old ones are never destroyed. This is why our patients can return to their previous path, especially under the pressure of circumstances. 21. The foregoing: A) reconciles our psychoanalytic theory with the modern data of neurophysiology; B) allows us to explain the scientific rationality of psychoanalytic therapy to other colleagues in accessible language; C) opens psychoanalytic theory and therapy to ongoing measured scientific research and improvement. 22. I understand the fact that neuropsychoanalysis mainly focuses on the elementary ideas of Freud, but we have to start somewhere. And these ideas are our common point of contact. I am also aware that many of the points I have outlined already form the central tenets of some post-Freudian approaches. And this is not surprising; we use what works. But we now know a lot more about why they work.