Neurobiological Underpinnings of Psychoanalytic Theory and Therapy

This paper discusses the neurobiological underpinnings of psychoanalysis, focusing on innate emotional needs, learning from experience, and unconscious mental processing. It also addresses the neurobiological basis of psychoanalytic treatment mechanisms and reviews empirical evidence on the treatment's effectiveness. The article builds upon previous works (Solms, 2017b; Smith and Solms, 2018) to provide an overarching view of psychoanalysis' core scientific claims.

The core scientific claims of psychoanalysis are:

How the emotional mind works in health and disease.
What psychoanalytic treatment aims to achieve.
How effective it is.

The main arguments are:

Psychoanalysis relies on three core claims about the emotional mind that are now widely accepted in neurobiology.
Clinical methods used by psychoanalysts are consistent with the current scientific understanding of how the brain changes.
Psychoanalytic therapy achieves good outcomes, as good as or better than other evidence-based treatments in psychiatry.

Core Claims of Psychoanalysis

The core claims of psychoanalysis regarding the emotional mind:

Humans are born with innate needs.
Mental development involves learning how to meet these needs, and mental disorder arises from failures in this process.
Methods of meeting emotional needs are often unconscious, requiring them to be brought to consciousness to change them.

These claims are testable and falsifiable scientific premises. Elaborating on these claims with empirical details does not affect the foundational premises themselves. If these claims are disproven, the core scientific presuppositions of psychoanalysis will be rejected. Current evidence in neurobiology supports these claims.

Claim 1: Innate Needs

The human infant is not a blank slate but is born with innate needs. These needs are regulated autonomically but eventually make demands on the mind, which Freud termed the "id." These demands are felt as affects, highlighting the importance of affect in psychoanalysis and Freud's "pleasure principle". Freud did not realize that these demands are felt at their source, i.e., drives become mental when they are felt.

Freud mistakenly thought that id demands are unconscious drive energies registered by the cerebral cortex. Moruzzi and Magoun (1949) showed that consciousness is generated in the upper brainstem (the extended reticulothalamic activating system or ERTAS), not the cortex. This was confirmed by Penfield and Jasper (1954). The role of non-ERTAS brainstem structures like the periaqueductal gray (PAG) and limbic circuits has also been recognized (Panksepp, 1998; Merker, 2007).

Freud (1920) believed consciousness was located in the cerebral cortex. He thought affects were only felt once "read out" in the cortex, even though there was no evidence for this. There is growing support for the view that affects emanate from the visceral interior of the body (Damasio, 1994, 2018).

According to Damasio (1994), feelings, and therefore consciousness in its basic form (Damasio, 2010, 2018), serve as a value system. Pleasurable feelings signal survival and reproductive success, while unpleasurable feelings signal the opposite. The mechanisms underpinning this are located in the upper brainstem and diencephalon, where bodily need detectors activate homeostatic affects (Panksepp, 1998).

There are also more complex types of affect: emotional affects (e.g., fear, attachment bonding) and sensory affects (e.g., surprise, disgust). These are crucial for survival and involve circuits intrinsic to the brain itself. Emotional circuits arise mainly in the upper brainstem and extend into the limbic system (Panksepp, 1998).

Panksepp distinguishes between three levels of affect: drives (homeostatic affects), instincts (emotional affects), and reflexes (sensory affects). All three are generated by brain mechanisms that Freud assigned to the id. Freud himself insisted that unconscious affect was an oxymoron.

Key points:

Consciousness registers the state of the subject, not the object world.
The sentient subject is primarily an affective subject.

Affects release driven, instinctive, or reflexive behaviors, which are innate behavioral tendencies. These are conceptualized as hereditary "tools for survival" or stereotyped action plans (Friston, 2010). Such actions meet biological needs, such as crying, searching, freezing, fleeing, attacking, or copulating.

Examples of emotional needs include:

Engagement with the world: The seeking instinct (felt as interest, curiosity). Partially coincides with Freud's concept of "libido" (Solms, 2012).
Finding sexual partners: Lust (sexually dimorphic). Channeled through seeking.
Escaping dangerous situations: Fear.
Attacking frustrating objects: Rage.
Attaching to caregivers: Panic due to separation, despair due to loss. Related to "attachment theory."
Caring for others: Maternal instinct.
Playing: Forms social hierarchies.

Panksepp (1998) categorizes these as bodily, emotional, and sensory needs, corresponding to drives, instincts, and reflexes. The focus is on emotional needs because they commonly give rise to psychopathology. All of these needs are felt as affects and must be acted upon.

Claim 2: Learning to Meet Needs

The main task of mental development is to learn how to meet our needs in the world. Learning establishes optimal predictions on how to meet needs in a given environment, which Freud (1923) called "ego" development. Even innate predictions must be reconciled with lived experience. Lessons are learned during critical periods in early childhood.

Successful predictions entail successful affect regulation and vice versa; only unmet needs are felt. The meeting of a need is heralded by the disappearance of the relevant feeling (satiation). Lack of affectivity is the ideal state of the organism, which Freud (1920) called the "Nirvana principle".

Freud erroneously equated the Nirvana principle with a drive toward death. Feelings of pleasure and unpleasure are servants of the Nirvana principle. Clinical phenomena explained by the "death drive" are aberrations, not biological goals. They represent a failure to accept that needs are met through effortful engagement with reality.

Learning from experience requires consciousness, which is based on affective experience. Exteroceptive consciousness takes the form: "I feel this about that." Without feeling, there can be no choice, and without choice, no learning from experience. Feeling one’s way through problems is the essence of working memory.

Working memory involves virtual action, not physical action. Thinking is interposed between drives/instincts and action, supplementing innate priors without life-threatening actions. Cognitions become conscious only to the extent that we need to feel them. Thinking entails conscious cognition, binding raw feeling and transforming it from affective to cognitive (Freud's "cathexis").

Working memory (cognitive consciousness) is a limited resource (Miller’s law), so predictive products of thinking must be transferred from STM to LTM rapidly. STM (conscious predictive-work-in-progress) aspires to the LTM condition (unconscious prediction). "A memory trace arises instead of consciousness" (Freud, 1920). The opposite process is called "reconsolidation" (Nader et al., 2000; Sara, 2000; Tronson and Taylor, 2007).

Biological constraints limit how much uncertainty an organism can sustain. Roughly 95% of goal-directed activities are executed unconsciously (Bargh and Chartrand, 1999). The ego prefers problems to remain in the solved condition rather than the unsolved one. This is "resistance," which gives rise to "defense." We prefer to confirm our predictions rather than disconfirm them.

LTM predictions from working memory are stored in the corticothalamic “preconscious” and enacted unthinkingly until prediction error arises. Surprise increases entropy and arousal, which renders the relevant preconscious prediction salient again. Affective arousal broadcasts the presence of an unmet need. Prediction error means a prediction meant to meet a need did not achieve its purpose. Only upper brainstem and limbic arousal can provide the activation necessary for reconsolidation of a corticothalamic LTM trace through working memory. Increased precision means increased post-synaptic gain, which is the function of the ERTAS.

Prior predictions (Freud's "wishes") are subjected to the reality principle and updated via empirical Bayesian processing. This involves only cortical memory systems that generate virtual realities (thinkable images, declarative representations) in the “preconscious”. Iterative transfers of predictive traces occur between short-term “working memory” (Freud’s system Cs.) and long-term “episodic memory” and “semantic memory” (Freud’s system Pcs.). Semantic memory is the deepest of the three declarative systems.

“Word presentations” are more deeply encoded than “thing presentations”. Thing presentations occur in the preconscious, not exclusively in the system unconscious. The unconscious (non-declarative memory) is devoid of “thing presentations.” Images are the exclusive preserve of the cortex.

Claim 3: Unconscious Predictions

Most of our predictions are executed unconsciously. Cognitive consciousness is a limited resource, so there is pressure to consolidate solutions into long-term memory and automatize them. Innate predictions and those acquired before preconscious memory systems mature are effected automatically.

Multiple unconscious (non-declarative) memory systems exist. Procedural and emotional memory bypass thinking (Freud’s “repetition compulsion”) and define the mode of functioning of the system unconscious. The aim of learning is to permanently solve problems. Automatized predictions are transferred from cortical to subcortical memory systems (basal ganglia and cerebellum).

These systems entail non-representational action programs. Truly unconscious memories are not subject to updating in working memory; they are indelible (LeDoux, 1995) but highly efficient. This is the neural basis of Freud's (1911) "primary process." Via these circuits, stimulus X triggers response Y, without thinking.

Non-declarative memories can only be activated through embodied enactment. Some (especially emotional memories) are automatized from the outset. Fear conditioning and early sexual experiences entail single-exposure learning. Attachment bonds are established slowly but are difficult to change. Procedural memories are “hard to learn and hard to forget.”

Automatized predictions do not mean by-passing affective consciousness. The system “preconscious” is localized in the cortex, and the system “unconscious” is localized in non-declarative memory systems beneath the cortex (Solms, 2017b). The cognitive unconscious consists of legitimately automatized predictions that reliably meet underlying needs. The repressed is illegitimately (or prematurely) automatized when the ego is overwhelmed.

The Oedipus complex exemplifies an insoluble problem. The child must cut its losses and automatize the least-bad childish prediction. Repression implies that a deeply automatized prediction does not manage feelings, but the prediction is treated as if it does work well, making it immune to reconsolidation. Prediction error is the threat of “the return of the repressed”. Only the affect returns, not the memory. Such memories are purely associative action tendencies. No thinking occurs.

Not only successful predictions are automatized. Illegitimately automatized predictions (wishes, not realistic solutions) are called "the repressed.” Repressed predictions are immune from declarative reconsolidation, despite prediction errors.

Psychoanalytic Treatment and Brain Change

Psychological patients suffer mainly from feelings, which represent unsatisfied needs. Psychological treatment aims to help patients learn better ways of meeting their emotional needs. Drugs are symptomatic treatments.

Psychoanalytical therapy aims to change deeply automatized predictions that cannot be reconsolidated in working memory. Psychoanalytic technique focuses on:

Identifying dominant emotions.
Revealing the meaning of the symptom.
Identifying the pathogenic predictions indirectly.
Achieving reconsolidation through activation of non-declarative traces via their derivatives in the present (“transference” interpretation).

Non-declarative predictions cannot be retrieved into working memory, but patients can be made aware of their enactments. Repression entails intense resistance to the reactivation of insoluble problems. Psychoanalytic treatment takes time to facilitate “working through.”

Repression leads to endless repetition. Patients cannot re-think the repressed, but they can think about what they are doing now because of the repressed. This allows their predictions to be reconnected with affects, enabling the ego to come up with better predictions.

After transference interpretation comes "working through," as the establishment of new procedural memories is slow. Patients suffer from feelings by invalidly using repressed predictions to meet their emotional needs. The analytic task is to bring these predictions back to consciousness by re-directing the feelings to the repressed predictions. This is done via derivatives of the repressed. The unconscious remains unconscious. New and better predictions must be consolidated alongside the old ones.

Symptoms improve after termination of psychoanalytic treatments, called the “sleeper effect”.

Efficacy of Psychoanalytic Therapy

Psychoanalytic therapy achieves good outcomes, as good as or better than other evidence-based treatments in psychiatry.

Key points:

Psychotherapy is a highly effective form of treatment.
Psychoanalytic psychotherapy is equally effective as other forms of psychotherapy and its effects last longer.
The therapeutic techniques that predict best treatment outcomes are:
- Unstructured, open-ended dialogue.
- Identifying recurring themes.
- Linking feelings to past experiences.
- Drawing attention to unacceptable feelings.
- Pointing out avoidance of feelings.
- Focusing on the therapy relationship.
- Drawing connections between the therapy relationship and other relationships.

Psychotherapists tend to choose psychoanalytic psychotherapy for themselves (Norcross, 2005).

Conclusion

The neurobiological assumptions and hypotheses provide a neurobiological understanding of psychoanalytic theory and therapy, where the core theoretical claims and technical practices of psychoanalysis have gradually acquired neurobiological support.