Neuroscience, Psychoanalysis, and Their Discontents

(Originally published in Italian in Corriere della Sera on 28th November 2018 [link].)

When I lived in Milan, once a week, I caught the number two Metro line from my flat near Porta Genova over to Centrale station. There, I would walk a couple of streets south, and spend an hour with a therapist named Sara. Sara was brilliant, but she never once asked about my mother. There was no discussion of anything erotic, and none of my dreams were revealed to be laden with obscured meaning. The most illuminating thing Sara ever offered me was a description of the brain as an onion — with its ancient, instinctive parts clustered in the hard bitter core, and its evolutionarily new, reasoning parts making up the flaky outer layers.

This is not psychotherapy as Sigmund Freud would have recognised it. He might have founded psychotherapy, but for many modern therapists, he now represents an ignominious historical footnote. Sara’s onion metaphor symbolises Freud’s fall from grace. Today, we live amidst what the philosopher Thomas Metzinger has called a grand “naturalistic turn in the human image.” And neuroscience is king. When a depressed person is given a chemical that boosts production of the neurotransmitter serotonin, it is because we believe that emotions are fundamentally a physical thing — that happiness, in some sense, is serotonin. Compared to the clean physicality of chemical manipulation, lying on a couch and relating your childhood memories to untested and lurid theories now seems amateur and prescientific.

But the notion that Freud’s ideas have entirely withered under the stern gaze of the modern sciences of mind isn’t quite right. Of course, Freud got a lot wrong — ludicrously, colourfully wrong. (Try walking into a modern psychology department and arguing that young women want to give birth to sons because it’s the closest they can get to having a penis.) However, he didn’t get everything wrong, and it appears he might have got some big things right, at least in the abstract. In recent years there has emerged a field bearing the name of neuropsychoanalysis. Adherents to this research programme — spearheaded by the neuropsychologist and psychoanalyst Mark Solms — are keen to rehabilitate Freud’s reputation for the age of the brain.

Freud’s central philosophical innovation was to propose that man is “not even master in his own house” due to the massive effects of the unconscious. As Erik Kandel explores in The Age of Insight, “that most of our mental life, including most of our emotional life, is unconscious at any given moment” is largely borne out by modern neuroscience. Kandel also points to two other things Freud got right. Firstly, “that the instincts for aggressive and for sexual strivings, like the instincts to eat and drink, are built into the human psyche, into our genome.” Secondly, that “normal mental life and mental illness form a continuum.” Kandel isn’t alone in supporting (some of) Freud’s ideas. The evolving state of the science has led various influential brain scientists — including Antonio Damasio, Joseph LeDoux, V S Ramachandran and others — to give Freud credit where credit is due.

Beyond its attempt to mediate between modern brain science and psychoanalytic theory, though, neuropsychoanalysis speaks to something deeper in the Freudian project. Although neuropsychoanalysis always starts out with dry descriptions of conciliatory research, this isn’t really what the field is about. Neuropsychoanalysis dramatises a tension between two basic ways of thinking about what it means to be a human being: subject or object, mind or brain, animal or soul.

In today’s physicalist environment, introspection is out of fashion. I don’t just mean for psychiatrists, but for culture at large. Most modern conceptions of psychic self-improvement appeal to the parts of us studied by biologists, not philosophers. We regard happiness as essentially a physical challenge; when we are unhappy or anxious, we seek things that influence the chemicals and muscles of our anatomy. Does anything carry more authority today than those ubiquitous your brain on x images? You might have noticed that your friends no longer eat chocolate simply because they like it; they eat chocolate because someone told them it releases endorphins. Most of my friends seem to conceive of sunbathing — a rare, exotic indulgence for the British — in terms of vitamin D levels. These interventions aren’t as heavy-handed as Prozac, but the principles is the same: acting externally upon the body to improve the mind.

By contrast, psychoanalysis is built on the belief that subjective experience is primary, that introspection has power. If you believe in psychoanalysis, you believe that talking, and then reflecting on this talking, can reshape one’s internal landscape. You believe that the stories you tell about yourself come first.

Specific sites of conciliatory research aside, it is this part of the Freudian project that neuropsychoanalysis wants to resurrect. Really, Freud is less important to neuropsychoanalysis than what Freud represents. Much of modern brain science, Solms told me, is “embarrassed” by the mind. Above all, neuropsychoanalysis wants to stop this embarrassment, in the belief that however much Freud got wrong, the gravity and sincerity of what he was aiming for deserves tribute. Regardless of his personal and professional failings, in the weird game of historical reputation, Freud has come to embody the belief that an exploration of subjectivity is possible, that such an exploration might help us live. Those who share this belief have no choice but to at least partly think — and work — in his shadow.

That Freud’s broad mission retains an appeal highlights modernity’s ambivalence about hard, brain-centred explanations. Scientists might be our new priests, but there remains something deflating about subverting our individual experience to the species-wide logic of biology. Most of us, deep down, want our inner lives to be more than the random effluvia of the organ in our skull. We want our thoughts to be of consequence. This can all get very overheated: Freud had a “neurotic” longing for Rome, but was unable to visit until he was 45 years old, because he identified so deeply with the Carthaginian general Hannibal. But while such overheatedness is always a risk, our self-narratives do matter. Freud knew this. This is why culture can’t, and perhaps shouldn’t, shake him.

The neurosciences are a miracle of science, and have relieved millions of terrible suffering. We need them. To this day, I find Sara’s onion metaphor very useful, and recycle it in chats with friends when they are psychically suffering. But there remains something valuable about the Freudian project, however imperfect.

I spent six months in Milan. During that time, I was, at moments, beset by a nameless but profound despair. In the UK, shortly before I had left for Milan, a harried doctor had wanted to prescribe antidepressants. I had told myself I’d give it another six months and then go to the pills if I was still a wreck. One evening, I came across the final paragraph of Italo Calvino’s Invisible Cities, with its vision of how to survive the “inferno of the living.” I read it again and again, and then I went out and sat at the top of the Naviglio Grande and watched the dying daylight mottle on the surface of the canal. I was on the edge of crying, but I also felt lifted, as though some of the dumb matter of my body had been converted into pure air. I never did take the Zoloft, and over the past seven years the things I have read, heard, seen and discussed have helped rescue me. Calvino’s paragraph remains the only piece of Italian I can recite from memory. My recollection of that first reading, and the feeling of it singing in my skull as I watched the water, remains a bright point, an anchor, a treasure. How these sorts of personal discovery but be incorporated into a neuroscientific framework, I’m not sure. But, as Freud knew, we should try.