This article was downloaded by: [Gazi University]

On: 18 August 2014, At: 22:59

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer
House, 37-41 Mortimer Street, London W1T 3JH, UK

Neuropsychoanalysis: An Interdisciplinary Journal

for Psychoanalysis and the Neurosciences
Publication details, including instructions for authors and subscription information:
http://www.tandfonline.com/loi/rnpa20

The Dialogue between Psychoanalysis and

Neuroscience: Alienation and Reparation
a

Douglas Watt Ph.D.

a

Director of Neuropsychology, Quincy Medical Center, 114 Whitwell Street, Quincy, MA

02169
Published online: 09 Jan 2014.

To cite this article: Douglas Watt Ph.D. (2000) The Dialogue between Psychoanalysis and Neuroscience: Alienation and
Reparation, Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 2:2, 183-192,
DOI: 10.1080/15294145.2000.10773304
To link to this article: http://dx.doi.org/10.1080/15294145.2000.10773304

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the Content) contained
in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no
representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of
the Content. Any opinions and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied
upon and should be independently verified with primary sources of information. Taylor and Francis shall
not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other
liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or
arising out of the use of the Content.
This article may be used for research, teaching, and private study purposes. Any substantial or systematic
reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any
form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://
www.tandfonline.com/page/terms-and-conditions

183

The Dialogue between Psychoanalysis and

Neuroscience: Alienation and Reparation

Downloaded by [Gazi University] at 22:59 18 August 2014

Douglas Watt (Boston)

The irony regarding the historical alienation of psychoanalysis and neuroscience, of which virtually everyone is aware, is that Freud started out as a very
competent neurologist who made several important
contributions to the neurological literature of his time,
including work on aphasia. His "Project for a Scientific Psychology" (1895) was his attempt to give psychoanalytic metapsychology the firm grounding in
neuroscience that Freud thought critical to its scientific
validity. Virtually everyone is also aware that the Project failed simply because the neuroscience of Freud's
day did not have the concepts to provide any such
grounding. The Project ended up being a kind of backwards construction, speculating about largely undiscovered brain processes that would be isomorphic with
the psychological principles of consciousness and unconsciousness that Freud was intuitively developing.
Despite this important starting point, psychoanalysis and neuroscience gradually became virtual adversaries during the second half of the twentieth century.
This happened after decades of hegemony of psychoanalysis in American psychiatry departments, in the
context of a fundamental conceptual split between
psychiatry and neurology mostly organized around the
now fortunately outdated distinction between "functional" and' 'organic." Although psychiatry and neurology have finally moved into an increasingly
productive dialogue over the last two decades, there
has been a much more limited movement toward respectful dialogue between psychoanalysis and neuroscience, and precious few of those limited initiatives
have come from the neuroscience side of the fence.
Only very recently have such notables as Kandel
Douglas Watt is Director of Neuropsychology, Quincy Medical Center; Instructor in Neurology/Psychiatry, Boston University School of Medicine.
I This paper was presented as the closing address to the First International Neuro-Psychoanalysis Congress (London, July 2000).

(1999) suggested that perhaps neuroscience could now

reach a new kind of accommodation with psychoanalysis. However, the attitude of many in clinical neuroscience is that psychoanalysis is irrelevant, if it is not
just plain wrong, while experimental neuroscience
(still more allied with behavioral principles) perhaps
sees psychoanalysis as both dead and discredited, with
bridging not only irrelevant but distasteful. Many in
clinical neuroscience and neuropsychiatry still believe
deeply in core psychodynamic ideas, but public statements to that effect are often deemed risky, and particularly inadvisable when dealing with nonclinical
neuroscientists, who quickly move away, and stay
away. Representatives of the view that psychoanalysis
is totally outdated bunk include Paul Churchland (neurophilosopher and author of the well-regarded connectionist manifesto, The Engine of Reason, the Seat of
the Soul, 1996) and Michael Alan Taylor (editor-inchief of the excellent clinical neuroscience journal
Neuropsychiatry, Neuropsychology and Behavioral
Neurology). "Freud bashing" has become as fashionable as the early, grandiose visions of psychoanalysis
once were, and the pendulum has not swung back toward the reasonable middle in any meaningful sense.
More troublesome is the fact that few outside
psychoanalysis seem to understand that psychoanalysis is a sprawling and heterogeneous discipline, hardly
the monolithic and rigid set of doctrines that are so
often presented in the media as "Freudian psychoanalysis." As a body of thought and practice psychoanalysis contains nearly every position one could possibly
embrace on many technical and metapsychological issues, and somewhere else in the literature the opposite
of that position as well. Thus, any neuroscientist painting a broad brushstroke image of psychoanalysis, characterizing it in terms of consistent and rigid doctrines,
would reveal a fundamental ignorance about psychoanalysis, its history, literature, and technical practice.

Downloaded by [Gazi University] at 22:59 18 August 2014

184

As a measure of the dynamic nature of the evolution

of psychoanalysis from the beginning, Freud's thinking was constantly evolving and developing. Continued conflict and heterogeneity have defined the fruitful
expansion of Freud's original ideas through concerted
efforts on the part of decades of clinicians and theorists wor king to redress errors and conceptual holes
in Freud's thinking.
Since alienations typically have two sides, we
might look at this the way a couple's therapist might
examine a failed relationship, as an interactive process
with contributions from both parties. From one side
of the border psychoanalysis was guilty of abandoning
the constructive intent in Freud's Project, while neuroscience contributed to the failure by publicly ignoring
and often privately caricaturing the insights contained
in key psychoanalytic concepts such as transference
and the repetition compulsion (Freud, 1914). Where
these omissions were not in evidence, there was an
even more basic avoidance of topics relating to emotion and consciousness/unconsciousness altogether.
Psychoanalysis, following Freud's lead of disowning
his original efforts to ground metapsychology in neuroscience, then retreated into "splendid" isolation,
with little investment in empirical research or bridge
building to disciplines at its borders. Instead, there was
a reification of metapsychology that in my judgment
has cost psychoanalysis dearly, in terms of its scientific credibility and in terms of its potential growth.
Although there were important revisions to the classical core Freudian doctrine (e.g., in object relations
theory and ego psychology, self and relational theories) psychoanalytic metapsychology still lacks the
neuroscientific foundation and cross-validation that
Freud had originally intended. Along with the disciplinary isolation and the defensive management of its
borders, these trends set the stage for the profound
discrediting and isolation that psychoanalysis endured
in the context of "biological revolution" in psychiatry, particularly in the United States.
Together, these mutually defensive postures by
psychoanalysis and neuroscience-of discrediting, devaluing, and mutual avoidance-guaranteed that few
synthetic conceptualizations had any chance of flowering in the arid desert between these two disciplines.
A landmar k article that marked a potential for movement toward consilience, and a potential softening of
decades of formal hostilities, was David Galin's
(1974) article linking topographical concepts of repression (and other metapsychological notions) with
cortical lateralization. Sadly, this article, although
opening up numerous avenues for synthesis, generated

Douglas Watt
no upsurge in fundamental research on the borders of
psychoanalysis and neuroscience, that a number of us
might have hoped for. The mantle was not taken up
by the broader psychoanalytic community, and psychiatry wanted a divorce; it had no need for psychodynamics anymore anyway, as it had discovered
"monoamaine tweaking" and it liked its new toys,
and the increased esteem associated with its' 'remedicalization." There have been a few notable but lonely
exceptions, such as the work of Howard Shevrin
(1996) and several others who have been quietly pursuing questions empirically for many years, often with
faint-hearted support from the analytic community,
and at best a bemused tolerance (if that) from neuroscience colleagues.
A stubborn positivism in much of neuroscience
has prevented questions such as emotion and consciousness from being viewed as neuroscientifically
respectable until quite recently. In this context, we
have seen a renaissance of neuroscientific interest in
both consciousness and emotion, with two major contributors to those subjects being Antonio Damasio
(1999) and Jaak Panksepp (1998). However, as Panksepp has pointed out, behaviorism didn't die, it simply
went into behavioral neuroscience, where the focus is
largely on the ultra-fine-grained level of analysis, with
a fundamental neglect of large-scale-system properties
such as emotion. This neglect has been informed by
four basic assumptions:
1. There is a certain kind of left-hemisphere bias in
which large-scale system properties are not as attractive as the minutiae of fine-grained detail.
2. There is the belief that animals are probably not
sentient creatures and therefore that they do not
have emotions in the sense of feelings (as opposed
to emotional behaviors).
3. Likewise, there is the belief that consciousness is
most certainly not a neuroscientifically meaningful
domain of study in animals, in agreement with
Thomas Nagel's supposition that one can never
know at all what it feels like to be a bat (although
only a few neuroscientists would even know who
Nagel was or what he thought).
4. There is the assumption that fundamental relationships between emotion and consciousness do not
exist, because these are orthogonal processes.
Clearly, these four assumptions are not shared
by all in neuroscience, particularly those coming from
clinical neuroscience, who by and large would disagree with most if not all four of these assumptions.

Downloaded by [Gazi University] at 22:59 18 August 2014

Alienation and Reparation

Most encouraging over the past five years or so

has been increasing interest in a neuroscience of emotion ("affective neuroscience"). Concurrent with this
there has been a strong suggestion (generated notably
by Panksepp and Damasio) for the central heuristic
that a neuroscience of emotion has to be one of the
keystones in the arch for a neuroscience of consciousness-a proposition that, of course, Freud himself
strongly endorsed. Unfortunately, psychoanalysis has
been virtually alone and quite isolated in its interest
in the fundamental connections between consciousness and emotion, so that there has been precious little
scientific traffic at the intersection of these topics until
recently. But in just the last two years, we have seen
the publication of two landmark works on consciousness and emotion, one of them from Antonio Damasio
(1999) and the other from Jaak Panksepp (1998). Damasio's theoretical synthesis, in which core consciousness arises from the correlation of body (protoself) and
world mappings, in second order mapping structures,
under the constant guidance of emotion (see Watt,
2000, for extensive review) is fundamentally congruent with basic conceptions concerning the ego in psychoanalysis. I Jaak Panksepp' s careful study in animals
of the chemoarchitectures and distributed networ ks involved in the prototype affective states gives us an
empirical grounding for a science of emotional meaning (see Watt, 1999, for extended review). Jaak's work
gives us a general roadmap for investigating how cortical encodings might link to the prototype states, to
generate the vast panoply of emotional meaning and
emotional associations.
It seems clear to me that these two major works
at the intersection of affective neuroscience and consciousness studies are also intrinsically bridge building
between psychoanalysis and neuroscience, even
though that was not a primary intent of either author.
Mark Solms's work has been instrumental in building
momentum toward a more respectful dialogue between
neuroscience and psychoanalysis, and his summary of
classical psychoanalytic conceptions of affect in this
journal have given neuroscientists a concise and easily
digested text from which they can make judgments
about the potential congruence between psychoanalytic concepts and emerging affective neuroscience
I However, the concept of the ego in psychoanalysis is unfortunately
so multidimensional as to elude any simple definition-this itself being a
potential topic for a whole essay. Blanck and Blanck (1979) have suggested
that careful review of the multiple meanings of "ego" reveals that this
concept subsumes many functions under the rubric of a global organizing
or meaning-making process, rendering it broadly synonymous with almost
all psychical (or higher neurological) activity. This may be a very helpful,
or quite trivial, clarification, depending on one's predilections.

185

concepts (see also Neuro-Psychoanalysis, Vol. 1, No.

1). Solms (1997) has also opened up wide avenues for
discussion between the neuroscience of dreaming and
REM sleep and psychoanalytic theories of dreaming
(see Neuro-Psychoanalysis, Vol. 1, No.2, and the ongoing discussion in this issue).
My hope would be that these landmark works
by Damasio and Panksepp signal that neuroscience is
inching away from the myopic focus on an isolated
cortex and moving (albeit ambivalently) toward a future neuroscience of the whole person. Such a neuroscience must have rich interdigitation with the science
of personal meanings that psychoanalysis has attempted to be, for better or worse, for so many decades. Although Damasio, (1999) expresses optimism
that we are seeing the beginning of a true paradigm
shift, we shall have to wait and see whether or not
these important theoretical contributions trickle down
to influence basic neuroscience research. Without such
fundamental influence on the course of empirical neuroscientific work, including most particularly the reframing of fundamental hypotheses for experimental
investigation, it is hard to see how any of these seminal
ideas are likely to substantially change the still positivistic and behavioristic climate in much of modern neuroscience. If such paradigm-shifting influence cannot
be more widely disseminated, it is difficult to see how
neuroscience could ever hope to do much justice to the
wisdom of the ages (which is largely about emotion's
primary role in sentience), or ever truly expose the
complex neural foundations for our "ground of being" as sentient creatures. Until both sentience and
emotion are much more fully investigated in this light,
it is hard to imagine how we will ever come to fully
understand these scientific "Holy Grails."
How can one conceptualize both the current
state-of-the-art with respect to our fragile bridges between the disciplines, possible lines of theoretical extrapolation' and future clinical and research directions
that would develop those bridges and deepen the dialogue? To return to the couples therapy metaphor, this
bridge building cannot take place in a climate where
the dialogue is dominated by the question of whether
Freud was right or wrong. Bridge building requires
both sides to give up their old defensive (and offensive) behaviors. Also by definition, bridge building
must eventually lead to some degree of fundamental
conceptual change for both disciplines. The disciplines
have to move toward a middle ground. It is not adequate for psychoanalysis simply to find support for its
metapsychology in the discoveries of neuroscience.
This is still a fundamentally defensive retrenching, and

Downloaded by [Gazi University] at 22:59 18 August 2014

186
not adequate to the task that psychoanalysis has to
accept, namely the slow and painful overhaul of a doctrine-based metapsychology and its evolution into an
empirically grounded, neuroscientifically valid, metapsychology. To balance the scales, neuroscience must
accept not just the existence but the primacy of the
processes that psychoanalysis has been studying for
decades.
This "prescription for treatment" may be offensive to some mainstream analysts, but it is the stiff
price of progress for a discipline that has in the past
sacrificed bridge building and ongoing empirical testing of concepts for preservation of its internal authority structures. Neuroscience has its own growth pains
in terms of the need to accept that there truly are such
things as, for example, defenses against anxiety and
painful affect (there has been some progress, albeit
slow, on those fronts recently). Perhaps even more
difficult, neuroscience will have to find a way to accept
the validity of fundamental process concepts from psychoanalysis, particularly what I would take as the clinical core of psychoanalytic insight, in the intrinsically
related concepts of transference and the repetition
compulsion.

Caveats and Obstacles in the Dialogue between

Two Traditional Adversaries
Psychoanalysis must redress lingering confusion about
the role of insight and what are essentially higher cognitive factors versus the primary role of more affective-interpersonal and attachment-related processes in
the resolution of long-standing characterological structures. Insight alone is not sufficient as an agent of
change, and nor in a strict sense is insight the real goal
of life. The goal instead is a fundamentally euthymic
affective balance in which we have stable, enduring,
and even deepening connections to loved and valued
people, places, and endeavors, with well-modulated,
contained, and context specific activations of the defensive prototype systems of fear and anger that successfully remove or resolve threats, and that do not
dig us in deeper and destroy relationships. Similarly,
insight is either impossible to achieve or it is empty
intellectualization in the context of a primary therapeutic relationship in which the recapitulation of old
historical traumas is not just a negative component of
the transference but a reality, in the absence or failure
of a stable empathic "hold" offered by the analysttherapist. This view may be rejected by some as an
attempt to smuggle the concept of corrective emo-

Douglas Watt
tional experience through the back door. I would want
to reassure everyone that I do not want to smuggle it
in the back door, I want to widen the front door and
bring it right into the foyer. To avoid misunderstanding; I am not suggesting that insight is not important, rather that separation between concepts about
the therapeutic alliance, corrective emotional experience, and empathic holding, on the one hand, and the
traditional emphasis on insight on the other hand, need
to be reconceptualized as complementary outlines of
more affective versus more cognitive processes promoting characterological change, and not competing
conceptions about change agents in the process of
analysis and psychotherapy. However, almost any version of an evolutionarily sophisticated perspective
suggests that we must consider the affective factors as
a primary base on which the cognitive factors can
potentially operate. From the perspective of the two
clusters of affective systems (see table below), real
effective-behavioral change (what analysts have
called structural change) must stem from the experience of emotional safety lessening the activation of
the "organism defensive states" of fear and rage, and
the lessening of separation distress. We do need insight to see what we are doing, where we have been,
and why, but without the safety of an empathic accepting connection where trauma is not happening we
will not be able to take off the character armor no
matter what cognitive working memories we can entertain about our own internal operations.
The following table outlines what is currently understood about the prototypic affective states from animal research, and might well form the foundation for
a reworked and modern psychoanalytic theory of
drives and affects. It is worth emphasizing that the
table suggests that Freud was partially right: there are
two large groupings of primary affective states, but
not in terms of a simplistic' 'sex versus aggression"
typology, more along the lines of an "organismic defense system" that would subsume fear and rage, and
an "attachment to conspecifics" system, that would
include play, sexual bonds, attachment, separation distress, and nurturance. There is a third, nonspecific system that Panksepp calls the "seeking" system that
appears to function as a kind of master "gain control"
for virtually all of the other affective states (Panksepp, 1998).
Clearly these important questions and controversies about curative factors in psychotherapy and psychoanalysis have already been discussed in many
places in the psychoanalytic literature (and in the
many psychotherapy literatures). Considerations from

187

Alienation and Reparation

TABLE 1
Distributed Midbrain-Diencephalic-Basal Forebrain Chemoarchitectures for Prototype Emotions.
(From Watt, 1999, extracted from Panksepp, 1998)

Affective Behavior

Structures/Neural Networks

Neuromodulators

Nonspecific Motivational ArousalSeeking & Exploratory

Behavior

Ventral Tegmental Area (VTA) to more

dorsolateral hypothalamic to PAG, with
diffuse mesolimbic and mesocortical
"extensions' ': nucleus accumbens as
crucial basal ganglia processor for
emotional "habit" systems
Medial amygdala to bed nucleus of stria
terminalis (BNST) to anterior and
ventromedial and perifornical
hypothalamic to more dorsal PAG
Lateral and central amygdala to medial and
anterior hypothalamic to more dorsal
PAG to nucleus reticularis pontine
caudalis
BNST and corticomedial amygdala to
preoptic and ventromedial hypothalamus
to ventral PAG
Anterior cingulate to bed nucleus of stria
terminals (BNST) to preoptic
hypothalamic to VTA to ventral PAG
Anterior cingulate/anterior thalamus to
BNST/ventral septum to midline and
dorsomedial thalamus to dorsal preoptic
hypothalamic to dorsal PAG (close to
circuits for physical pain)
Parafascicular/centromedian thalamus,
dorsomedial thalamus, posterior
thalamus, to more dorsal PAG (septum
inhibitory re: play)

DA (+), glutamate (+), many

neuropeptides including opioids,
neurotensin, CCK

Rage/Anger ("Affective Attack")

Downloaded by [Gazi University] at 22:59 18 August 2014

Fear

Sexuality

Nurturance/Maternal Care

Separation Distress/Social Bonding

Play/Joy/Social Affection

?Social Dominance

Substance P (+) (ACh, glutamate

[ +] as nonspecific modulators?)

Glutamate (+), ACTH,

neuropeptides including DBI,
CRF, CCK, alpha MSH, NPY
Steroids (+), vasopressin and
oxytocin, LH-RH, CCK
Oxytocin (+), prolactin (+),
dopamine, opioids both (+) in
moderate amounts
Opioids (- / +) oxytocin (- / + ),
prolactin (- / +) CRF (+) for
separation distress

Glutamate (+), Opiods (+ in small

amounts, - in larger amounts),
muscarine (+), nicotine (+).
Monoamines all appear to be
largely (-) (!?)

Not clear if separate from activation of play

systems and inhibition of fear systems?

Note: This table omits biogenic amines, which are much more nonspecific, and the higher cortical areas in mostly temporal and frontal
regions deeply involved in the further elaborations of emotional processing and emotional meaning, particularly in animals with considerable cortical evolution.
Keys [( -) inhibits prototype, (+) activates prototype] [CCK = choleocystokinin, CRF = corticotrophin releasing factor, ACTH =
adrenocorticotropic hormone, OBI = diazepam binding inhibitor, ACh = acetylcholine, DA = dopamine, MSH = melanocyte stimulating
hormone, NPY = neuropeptide Y]

neurodevelopment (and any version of an evolutionary perspective) suggest that cognitive processes are
an extension of emotional processes just as emotional
processes are an extension of homeostasis and more
primitive foundations for organismic pain and pleasure. Although the constancy and empathic attunement of a competent analyst-therapist may
initially seem a poor second cousin of whatever love

and gratification were missed in the childhood of the

patient, we learn that such empathic attunement is precisely what was absent in our pathogenic traumas, that
such gifts of basic decency and attunement are not
bought, and that instead they constitute the essential
foundations for all competent and good relationships
between conscious creatures. Psychoanalysis offers a
framework in which we reexperience our deepest fears

Downloaded by [Gazi University] at 22:59 18 August 2014

188

and wishes in the transference, appreciate them with

complex working memory and cognitive operators (insight), and lessen the activation of pathologic defenses
that intrinsically limit our empathy for others via distortions of their internal states. Most importantly, psychoanalysis or psychotherapy opens up wide avenues
for creative adaptation previously unavailable in the
context of pathologic defense, because the trauma
does not really happen (of course, these avenues in
turn depend deeply on an identification with the analyst's empathy and attunement). We are unconsciously
convinced that the traumatic repetition will happen,
we do our utmost to make it happen (what Freud called
the "uncanny" nature of the repetition compulsion),
but it doesn't bloom into an emotional reality (a truly
repeated trauma), because the analyst-therapist (we
hope) doesn't do anything traumatic. However, to the
extent that the analyst-therapist is recruited by virtue
of his or her countertransferences to act in the patient's
drama, we have to talk about a partial or complete
failure of the therapy or analysis. This basic perspective, of an alliance characterized by neutrality and
boundaries, nonjudgmental acceptance, low-key
warmth, and deep (not superficial) empathy, is ultimately what enables the consistent focus on fundamental affective issues. These concepts, along with
the process concepts of transference and the repetition
compulsion, constitute an explanatory and treatment
framewor k of unequalled power that neuroscience
needs to build a bridge to. As I said in an earlier paper
(Watt, 1990), if psychoanalysis, despite all its metapsychological convolutions and problems, has provided countless therapists with an explanatory
framework for understanding the complex relationships between affects, cognitions, previous experience, current behavior, and current context, then
psychoanalysis contains vital insights about how the
brain works as a whole that neuroscience badly needs
to appreciate better.
Psychoanalysis must supplement a scientifically
dated metapsychology with concepts from affective
and cognitive neuroscience, and its traditional historical reliance on metapsychological infighting between
different schools and camps must be replaced by a
new reliance on empirical validation of its primary
concepts. Psychoanalysis can no longer afford a defensive posture in which its primary exchange with other
disciplines runs along the lines of attempting to validate Freudian doctrine, as opposed to admitting that
perhaps some of Freud's ideas were simply wrong,
less than optimally framed, or in need of radical overhaul. An authority-driven conservativism must be re-

Douglas Watt

placed by a scientific conservatlvlsm driven by

primary research. This may be hard for some in psychoanalysis to swallow, but psychoanalysis has been
perceived by many in neuroscience (and by those in
other sciences as well) as ideological and either nonempirical or even antiempirical. This perception has
certainly been reinforced by its reliance on a special
jargon that, when abused (due to its high levels of
abstraction and some intrinsic vagueness) seems to
produce mystification and obfuscation of subjective
experience rather than deepening appreciation.
For sure, there are difficulties in advocating a
new empiricism for psychoanalysis. At the very top
of the short list of these would be the manner in which
any technology introduced into the therapeutic situation (in order to monitor the neural systems of the
patient) becomes a fundamental distortion of the analytic framework. Clearly, the mandate to preserve the
framework has been perhaps the strictest of all psychoanalytic mandates, one that we are taught never to
trifle with. 2 However, in an age of increasingly sophisticated noninvasive technologies such as MEG and
functional MRI, psychoanalysis may have to make
some modest concessions on this point in order to get
essential data. Such a new empiricism within psychoanalysis would supply the critical passport of admission to the circle of scientific credibility. Just one
possibility: noninvasive functional monitoring of neural systems in an analytic patient would give us important insights into the long hypothesized laterality
aspects of psychodynamic processes, along with insights into the poorly appreciated vertical integration
of brain systems vis-a-vis psychodynamic variables
(and further insights into the anterior-posterior integration of brain systems).
Although psychoanalysts will rightly wonder if
all of a sudden they are being expected to become
neuroscientists, that is not the prescription here at all.
In fact, the most immediately available avenue for
bridging between the disciplines lies in the clinical
domain in which psychoanalysts spend most of their
professional lives. Simply put, clinical syndromes
might be more fruitfully studied if we adopted a conjoint psychodynamic/developmental and neurobiological point of view (see below, "Bridging Heuristic No.
2 Psychoanalysts have long been taught to resist' 'parameters of technique," and this has at times resulted in a certain inflexibility about the
framewor k, rather than the principle that the treatment frame has to reflect
titration of the level of negative transference that the patient is exposed
to, to ensure the alliance is not swamped by intolerable ambivalence and
anger (worse case scenarios refer to "psychotic transferences"). Again,
these are complex issues with a rich albeit conflicted representation in the
analytic literature.

189

Downloaded by [Gazi University] at 22:59 18 August 2014

Alienation and Reparation

6"). There is increasing evidence that current DSMIV categories are wastebaskets reflecting the clumping
of similar but probably somewhat different disorders
that need to be further unpacked. The variables affecting this heterogeneity probably include significant
variability in the genome among sufferers of a particular disorder, possibly predisposing them to somewhat
different neurobiological derailments under stress. As
we have seen from the experience of dozens of syndromes in neuropsychiatry and neuropsychology,
there are many ways to "crash" a higher brain function, given that these functions depend not on a single
structure or brain region, but on complex distributed
networks. Thus many different lesion locations can
generate very much the same syndrome. This should
be instructive for those in biological psychiatry still
trying to chase down a specific neuroanatomical "lesion," even if only in a functional sense, or any' 'phrenology of neuromodulators"
(the notion that
disruption of a specific neuromodulatory system could
provide an adequate explanation for the syndromes
of DSM-IV). The current heterogeneity (wastebasket
nature) of virtually every syndrome in DSM-IV will
have to be supplanted by a more differentiated nomenclature (derived from much further empirical work)
before we can expect the kind of predictive and treatment successes that we are looking for.
A second crucial variable beyond genotypic variability likely to contribute to the heterogeneity of current DSM-IV categories may be crucial life history
and psychodynamic variables. Clearly genotype, early
history, personality, and characterological issues, precipitating psychological and biological stressors, and
neurobiological derailments are all somehow interdigitated in the epigenetic landscape that generates clinical syndromes. Thus, we probably have a long way to
go to truly understand the interactions of nature and
nurture. But we shall never understand them if we
persist in experimental methodologies that leave out
psychodynamic and early developmental variables and
that therefore are swimming against the current of
modern concepts about development and epigenetic
landscapes. These reductionist research methodologies reflect a lingering separation of mind and body,
of present and past, of nature and nurture. So, psychoanalysis has an opportunity, by virtue of its being a
profoundly developmental clinical discipline, in concert with its neuropsychiatric and neurological and
neuropsychological colleagues, to reexamine the clinical syndromes in DSM-IV. Such research designs
have, to my knowledge, never been implemented, and
they do not require that patients in a prospective re-

search study receive a full analysis. However, they

would instead be informed by careful thinking about
ways in which the psychodynamic and life history
variables could be profitably operationalized and assessed in a consistent fashion (with decent interrater
reliability). Additionally, and just as crucially from the
standpoint of the "couples therapy" metaphor, such
bridging work with clinical neuroscience colleagues
would stop the slow but steady marginalizing of psychoanalytic thought within the medical community,
and would reinvigorate psychiatry.
These powerful concepts (the repetition compulsion and transference) informing an epigenetic perspective on the gradual accretion of human emotional
meanings constitute a very sturdy pillar for bridge
building from the psychoanalytic side of the divide.
One should lead from strength.

Bridging Topics for the Coming

Decade-Initial Heuristic Clusters3
Topics
Group 1: Lateralization, Emotion, and the NaThere have been
ture of the Dynamic Unconscious.
several heuristic lines of speculation about the investment of lateralized right hemisphere processes in the
fundamental phenomena that psychoanalysis has been
concerned with for decades, particularly in terms of
how these processes help us understand the core concept of transference. In two papers (Watt, 1986, 1990),
I reviewed an extensive body of clinical and neuroscientific material suggesting that transference is mediated by right hemisphere processes. We have a long
and well-established empirical tradition documenting
differences in the affective valence of the hemispheres,
in terms of a relatively more dysphoric right hemisphere versus a relatively more euthymic left hemisphere; but this description may not fully characterize
the issue of lateralization with respect to affective valence. I suspect that a better characterization would be
that the right hemisphere may possess our full ambivalence as it were, while the left hemisphere has a kind
of benign, day-to-day, routinized, and more delimited
set of affective representations, yielding a weakly positive (if somewhat superficial) kind of affective valence. Lesions to either system disturb the balance
3 I am referring to these as groups or clusters, as they obviously load
on more than one concept or question, and are an effort to get at several
intrinsically related questions.

Downloaded by [Gazi University] at 22:59 18 August 2014

190

between the two, with the left having crucial inhibitory

functions vis-a-vis the right, while the right hemisphere-as the cortical system in the brain most concerned with the big picture and with global state
functions like emotional, attentional, and executive
functions-is obviously crucial to all of the cortical
elaborations of affect. Although there is talk in some
quarters of a left hemisphere' 'Interpreter" being essential to consciousness, the literature on right hemisphere damage suggests that it might be better termed
a left hemisphere Confabulator.
Lateralization itself is still a perplexing topic,
without an overarching integrative theory, but we do
have tantalizing clues in terms of important neuromodulatory, structural, and even (now) neurodynamic
differences between the hemispheres. There is a large
body of work suggesting that the hemispheres cannot
be characterized simply in terms of verbal versus spatial functions, but rather must be characterized in
terms of a more fundamental "processing style" distinction. Hemispheric relations, both conjunctive and
disjunctive, thus may be a basic ground for mapping
psychoanalytic concepts about the dynamic affective
unconscious onto neural substrates-as David Galin
(1974) argued more than two decades ago. The potentials for bridging in this basic initiative are still largely
unrealized, although many of us who believe in the
fundamental truths of psychodynamics, myself included, have pursued bridging via this particular channel. In any case, the established primacy of the right
hemisphere in generating higher encodings with regard
to both expressive and receptive processing of affect,
interdigitates richly with preliminary formulations
coming from psychoanalytic theorists about transference, other kinds of conscious emotional processing,
and laterality.

Group 2: Transference, Countertransference,

the Repetition Compulsion, Intersubjectivity, and Dynamical Systems Theory. There are unappreciated
congruencies between notions of chaotic attractors in
dynamical systems, the process of intersubjectivity,
and the manner in which people "get to know each
other." Recently, chaos theory has emphasized the notion that ultracomplex systems can have "strange attractors" which cycle the systems into repetitive
states. They have also emphasized that systems have
attractor "basins," and that interacting ultracomplex
systems (any human dyad) are going to find certain
attractor basins in the overall attractor landscape that
both systems move toward repetitively. These cycle
between a relatively limited set of affective states,

Douglas Watt

having an epigenetic landscape that evolves, depending upon the nature of the positive and negative
states activated. As I become a player in your script, in
some way that allows your right hemisphere to define
affectively who I am in relation to you, my own internal set of interactive social-emotional categories for
you also "shakes down," and you find a place in my
drama too. This mutual "shaking down" and activation of emotional categories is what we conventionally
term "getting to know someone"; but we mostly get
to know what each of us "primes out" from the other.
However, there is really no clear leader or follower,
just a kind of curious circular causality, sculpting
semistable attractor states. To the extent that these
scripts repeat old injuries for both of us, cycles of
idealization and traumatic disappointment, we can talk
about transference and countertransference and (once
again) the uncanny nature of the "repetition compulsion." To the extent that we forge an avoidance of
those cycles, and there is mutual empathy, affection,
and support, we can talk about a successful "real"
relationship. But even those, as it turns out, are repetitive of early successes in attachment, recapitulations
of loving and gratifying connections from early in life.
Emotional meaning is thus an intimately personal-historical accretion, as psychoanalysis has rightly emphasized for many decades.

Group 3. The Potential Intersections between

Psychotherapeutic Process, Attachment, Positive Affective States, and the Monoaminergic Therapies: The
Likely Role of Love and Affective Safety in Balancing
the "Symphony of Neuromodulators." It is clear
from Jaak Panksepp's work that neuropeptides and
not the monoamines are probably the great frontier in
psychopharmacology. Neuropeptides have much more
behavioral specificity than classical neuromodulators,
although the evidence also suggests that we will never
find the kind of neat phrenology of neuromodulators
that American psychiatry was looking for in the 1960s
and 1970s, in which a single neuromodulator performs
a single function and yields a single behavior, the disease of which yields a single disorder. We know next
to nothing about the (likely essential) role that good
attachments and positive affective states play in harmonizing what is understood only in the most global
and vague terms as the "symphony of neuromodulators." It is hard to believe that these positive affective
states, activated in good attachments, have anything
but the most central of roles in achieving such a global
and very poorly mapped balance.

191

Alienation and Reparation

Downloaded by [Gazi University] at 22:59 18 August 2014

Group 4: The Nature and Functions of Dreaming. The controversies and complexities of this subject have been the focus of an excellent recent issue
of Neuro-Psychoanalysis (Vol. 1, No.2) and will also
be the focus of an upcoming issue of Behavioral and
Brain Sciences (Vol. 56, No.6). This is obviously still
a deeply controversial and incompletely understood
process, with the spectrum of current positions ranging
from the notion that dreaming is epiphenomenal to
classical psychoanalytic positions on dream interpretation. I would agree with Mark Solms's basic point
that we know much more about the neural substrates
of REM sleep than we do about dreaming (Solms,
1999,2000).
Group 5: The Nature of (Neuro) Development. In many ways, this is the great frontier in neuroscience where all of our theories will be subject to
the most acid of acid tests, and many of them I suspect
will be found wanting. Molecular genetics, neurodevelopment, and neurodynamics are three great frontiers in neuroscience, and their potential interdigitation
is largely uncharted. Clearly, affective processes, and
specifically the vicissitudes of attachment, are primary
drivers in neurodevelopment (the very milieu in which
development takes place, without which the system
cannot develop). Psychoanalysis has been one of the
very few disciplines that has understood this and attempted to pursue this line of inquiry systematically.
However, from a neuroscientific perspective, we know
next to nothing about such profound and foundational
events as the infant's first smiling at mother, or the
infant's first separation cry. These are topics that many
neuroscientists consider not particularly important. Instead, we see legions of researchers chasing down the
subtleties of visual awareness. This may be tantamount
to attempting to learn the complexities of calculus before we have learned how to count on our fingers.
Group 6: The Basic Psychobiological Nature of
Clinical Syndromes, Particularly Depression, Anxiety
Disorders, oCD, Bipolar Disorder, Schizophrenia,
Sociopathy, PTSD and the Dissociative Disorders, and
even the Personality Disorders. We have suffered
too long from thinking that was "either psychodynamic or neuroscientific." This distinction should finally be seen as scientifically unacceptable, and we
should frankly have less tolerance for these kinds of
simplistic and polarizing notions. There is overwhelming evidence that life experience plays a role in OCD,
anxiety, depression, and probably most forms of bipolar disorder. While its role in schizophrenia is less

certain, the roughly 50% concordance for monozygotic twins argues that even in this heyday of genetic
explanations, we need deeper scientific investigation
of the interactions between experience and genetic
predispositions.
Finally, turning once more to the theme that pervades almost every effort to build bridges between our
disciplines, both sides have to move beyond the issue
of whether Freud was "right" or "wrong." This issue, as a primary focus, is just not constructive. For
the record, at least in terms of my own assessment,
Freud was hardly right about everything; in fact, he
was tragically wrong about some important things. But
he did leave an important legacy through trying to
map the rich vicissitudes of human ambivalence. The
fertility of many different clinical and therapeutic
schools of thought owe much to Freud's view that
a deeper appreciation of human "drives" and their
ambivalent nature might be a good starting point for
a fundamental emotional wisdom. In teaching us to
continually appreciate the shades of gray in ourselves
and each other, I would argue that this legacy is the
best way of balancing both the earlier Ernest Jones
style of idealizing Freud and the now popular Freudbashing. It is a pity that Freud himself seems to understand in terms of the more empathic shades of gray
that his work taught us to respect more deeply. I cannot
imagine that our current range of concepts concerning
emotional interaction and internal psychological processes would have anything resembling their present
depth without Freud, even though some of that depth
may have come from those of Freud's followers who
struggled with the many limitations in his original formulations. But isn't that how we make progress anyway? We still have to admit that science (and culture)
exists and advances only because we stand on the shoulders of giants.

References
Blanck, G., & Blanck, R. (1979), Ego Psychology, Vol. 2.
New York: Columbia University Press.
Churchland, P. (1996), The Engine of Reason, the Seat of
the Soul. Cambridge, MA: MIT Press.
Damasio, A. (1999), The Feeling of What Happens. Body
and Emotion in the Making of Consciousness. New
York: Harcourt Brace.
Freud, S. (1895), Project for a scientific psychology. Standard Edition, 1:281-391. London: Hogarth Press, 1966.
- - - (1914), Remembering, repeating and working
through. Standard Edition, 12:145-156. London: Hogarth Press, 1958.

Downloaded by [Gazi University] at 22:59 18 August 2014

192

Galin, D. (1974), Implications for psychiatry of left and

right cerebral specialization. Arch. Gen. Psychiatry,
31 :572-583.
Kandel, E. R. (1999), Biology and the future of psychoanalysis: A new intellectual framework for psychiatry revisited. Amer. J. Psychiatry, 156(4):505-524.
LeDoux, J. (1996), The Emotional Brain. The Mysterious
Underpinnings of Emotional Life. New York: Simon &
Schuster.
Panksepp, J. (1998), Affective Neuroscience. New York:
Oxford University Press.
Shervin, H., Ed. (1996), Conscious and Unconscious Processes: Psychodynamic, Cognitive, and Neurophysiological Convergence. New York: Guilford Press.
Solms, M. (1997), The Neuropsychology ofDreams: A Clinico-Anatomical Study. Mahwah, NJ: Lawrence Erlbaum.
- - - (1999), Commentary on Allan Hobson: The new
neuropsychology of sleep: Implications for psychoanalysis. Neuro-Psychoanal., 1(2): 183-195.
- - - (in press), Dreaming and REM sleep are controlled
by different brain mechanisms. Behav. & Brain Sci.

Douglas Watt

Watt, D. F. (1986), Transference: A right hemisphere

event? An inquiry into the boundary between psychoanalytic metapsychology and neuropsychology. PsychoanaI. & Contemp. Thought, 9(1):43-77.
- - - (1990), Higher cortical functions and the ego: The
boundary between psychoanalysis, behavioral neurology
and neuropsychology. Psychoanal. Psycho 1., 7(4):487527.
- - - (1999), Emotion and consciousness. Part I. A review of Jaak Panksepp's Affective Neuroscience. J. Consciousness Studies, 6(7): 191-200.
- - - (2000), Emotion and consciousness. Part II. A review of Antonio Damasio's The Feeling of What Happens. J. Consciousness Studies, 7(3):52-73.

Douglas F. Watt, Ph.D.

Director of Neuropsychology
Quincy Medical Center
114 Whitwell Street
Quincy, MA 02169