When Freud Meets fMRI

I am in an apartment on the Upper East Side of Manhattan, surrounded by psychoanalysts. At moments, if I half close my eyes, I can imagine I’m in some European city, circa 1930: “The Kleinians have this very disturbing, I think, notion of countertransference as being something the patient does to you. They’re moving too far away from Freud’s understanding…” But in fact it’s 2010, and the conversation is new.

The experience of sitting on the edge of the huddle of analysts is, I imagine, like reading Dickens in the original serial: ongoing storylines, full of vivid characters, perpetually left in suspense. One analyst describes her work with Theo, a 30-year-old left in a wheelchair with global brain damage after a car accident, whose mother brought him to analysis with severe mental impairments and memory problems. Another discusses the progress he has made with Harry, left aphasic after a stroke, still able to comprehend but unable to express language.

Mark Solms, the neuropsychologist and psychoanalyst who founded this group in 2001, and continues to oversee its progress, is hardly the first to turn to brain damage seeking insight. Many of neuroscience’s greatest and most legendary discoveries have tumbled forth from damaged brains—from Phineas Gage, the 19th-century railroad worker whose frontal-lobe injury illuminated the brain mechanisms of self-control, to the patient known as H.M., whose radical surgery provided scientists with the ultimate test case for how the brain organizes memory.

But instead of waiting for these case studies to turn up, Solms decided to seek them out himself, and to see what might come from applying to their injuries an unorthodox means of investigation. Solms has spent his career bringing Freudian theory into the room where only biological fact had previously existed. He is a leading figure in a new interdisciplinary undertaking—along with a growing number of analysts, scientists, and others—named neuropsychoanalysis.

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In the popular imagination, the term “psychoanalysis” conjures up silent doctors in dimly lit rooms, witnesses to the unfurling of dream images and childhood memories. And couches, lots of couches. This is the stereotype, the myth, but the field wielded an enormous authority throughout the 20th century, and continues to influence our most basic assumptions about human nature, like the power of the unconscious mind, the profound importance of early childhood experience, and the fact that memory is fundamentally dynamic.

Psychoanalysis has since taken on the aspect of the underdog. Many—maybe most—are unwilling to call the study of inner reality, psychic conflicts, dynamic forces and repressed material a science. And until recently, there has been relatively little empirical proof that psychoanalysis even works. Up against the quick and easy fixes of prescription medication or short-term, practically oriented cognitive-behavioral therapy—and under the skeptical eye of insurance companies—psychoanalysis faces an uncertain future.

Today, neuroscience is the golden child, commanding newspaper headlines, substantial government grants, and an ever-increasing portion of the public imagination. With its armament of modern tools and acronyms, it offers a seemingly endless list of options for looking at the brain. Neuroscientific findings are morphing into cultural truths: We are “hardwired,” a collection of parts, of “circuits” and “networks” that “light up” when “activated.” The brain has become our modern metaphor; it is where we look to find out what’s really going on. Already, neuroscientific research has penetrated the field of economics, the courts, and beyond. It is decidedly less common to hear psychoanalytic concepts invoked in these same circles.

With their starkly different goals, methods, and cultures, psychoanalysis and neuroscience can appear to be two different species, mutually alienated, as if preoccupied with two altogether different pursuits. But to some, like Solms, they are merely two views of the same object. Psychoanalysis looks at the brain from the inside out: What does it feel like to be this thing? Neuroscience looks at the brain from the outside in, measuring its behavior, investigating its physical mechanisms.

Solms supervises the progress of his group of New York psychoanalysts on monthly trips from South Africa. Tall, solid, and thick-wristed, Solms is in his late forties, but looks older. His gray hair, poking up in all directions, is completely unattended to, like a member of the family with whom he is no longer on speaking terms. In New York, he listens to developments in the group’s roster of psychoanalytic cases. In Cape Town, he is a professor of neuropsychology, making rounds in the University of Cape Town’s teaching hospital, and chairing the university’s neuropsychology department. He leads a kind of double life—one that began in the early days of his career, when he worked with brain-damaged patients by day at the Royal London Hospital, training at the Institute of Psychoanalysis by night.

Solms first trained in neuropsychology—a branch of neurology that draws links between people’s external behaviors and the specific regions of the brain involved in producing them—thinking that of all the subsets of neuroscience, neuropsychology was, as he puts it, “where you’re most likely to find out about the person himself.” But he was disappointed. Neuropsychology seemed to avoid everything that had to do with questions of personality, emotion, motivation—in other words, the things we mean when we speak of “human nature.” Instead, the operating gaze was trained onto the strictly quantifiable: How many digits could the patient hold in his working memory? Neuropsychology, Solms discovered, asked black-and-white questions that could be answered on standardized tests.

“Oliver Sacks has this saying: Neuropsychology is admirable, but it excludes the psyche,” Solms says.

Solms first heard of Freud as an undergraduate, when he stumbled across a seminar in the comparative literature department. He showed up a few weeks after the start of the semester, just as the class was assigned Freud’s lesser-known Project for a Scientific Psychology, a summary of his attempts grapple with neurology in the years before he turned his full attention to the psychological. After completing his training as a neuropsychologist, Solms began to school himself in Freud’s ideas in earnest, and when he moved to London in his late twenties, began to train as a psychoanalyst. For the past decade, in his off hours, he has been working on the revision of James Strachey’s original English translation of the complete Standard Edition of Freud, all twenty four volumes. He often wonders what he’s gotten himself into.

It took Solms some time to understand that his inclination to combine two branches of psychology would be seen by many as controversial or problematic; that the two disciplines, psychoanalysis and neuroscience, are mostly indifferent to each other, and even, at times, opposed. But for Solms, they were intuitively compatible.

“I say it was obvious to me—why wasn’t it obvious to everyone?” Solms told me. “Like everything else, it was personal. My brother was brain-injured. When he was 6, he fell off the roof and suffered a closed head injury. I saw that my brother is not who he was. His personality is different and our whole family is different. All of that because this organ is not functioning as it was before.”

Solms and his work have a magnetic pull. People uproot their lives and come to South Africa to enter into his orbit. When I visited Solms in Cape Town, there were two such examples on hand: a Swiss expert on neuropeptides and a psychoanalyst from Vienna, both of whom had both moved to Cape Town specifically to work with Solms. The latter was preparing to begin a study that Solms had designed: psychoanalyzing a population of patients with Urbach-Wiethe disease, an extremely rare genetic disorder in which a person’s amygdala gradually calcifies until it is almost completely defunct. Solms was particularly interested in what effect this might have on the content of their dreams.

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“Biology is truly a land of unlimited possibilities. We may expect it to give us the most surprising information, and we cannot guess what answers it will return in a few dozen years to the questions we have put to it.”

So reflected Freud in 1920. Having spent 20 years toiling away in labs, peering down microscopes, he arrived at the conclusion that the questions he wanted to answer about the human mind couldn’t be answered by what was then understood—or understandable—about the human brain. The knowledge wasn’t there, and neither were the tools. He continued to emphasize, however, that eventually, long after his own lifetime, the moment would come when brain science would be ready to fill out the psychoanalytic principles that he was busy laying down. Solms and his followers believe that moment is here.

It can be difficult to see how someone like Solms fit into the neuroscientific landscape. To say “Freud” to scientists engaged in the pursuit of empirical truths is to risk making yourself instantly suspect and quickly irrelevant. Yet however unlikely the idea, however unimaginable the design, neuropsychoanalysis may offer something valuable: a sketch of inner life where creativity isn’t simply explained as patterns of electrical waves, sadness as the number you circle between one and nine, and love confused with the mating habits of prairie voles.

As Solms told me: “There can’t be a mind for neuroscience and a mind for psychoanalysis. There’s only one human mind.”

This article is adapted from Casey Schwartz's book, In the Mind Fields: Exploring the New Science of Neuropsychoanalysis.