Neuropsychoanalysis

An Interdisciplinary Journal for Psychoanalysis and the Neurosciences

ISSN: 1529-4145 (Print) 2044-3978 (Online) Journal homepage: https://www.tandfonline.com/loi/rnpa20

Reflections on 20 years of Neuropsychoanalysis

Ross Balchin, Virginia Barry, Ariane Bazan, Mark J. Blechner, Andrea

Clarici, Daniela Flores Mosri, Aikaterini (Katerina) Fotopoulou, Maria Sonia
Goergen, Richard Kessler, Iréne Matthis, José Fernando Muñoz Zúñiga,
Georg Northoff, David Olds, Lois Oppenheim, Doris Reismann-Lagrèze,
Manos Tsakiris, Doug Watt, Giles Yeates & Maggie Zellner

To cite this article: Ross Balchin, Virginia Barry, Ariane Bazan, Mark J. Blechner, Andrea Clarici,
Daniela Flores Mosri, Aikaterini (Katerina) Fotopoulou, Maria Sonia Goergen, Richard Kessler,
Iréne Matthis, José Fernando Muñoz Zúñiga, Georg Northoff, David Olds, Lois Oppenheim, Doris
Reismann-Lagrèze, Manos Tsakiris, Doug Watt, Giles Yeates & Maggie Zellner (2019) Reflections
on 20 years of Neuropsychoanalysis, Neuropsychoanalysis, 21:2, 89-123

To link to this article: https://doi.org/10.1080/15294145.2019.1695978

Published online: 07 Feb 2020.

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NEUROPSYCHOANALYSIS
2019, VOL. 21, NO. 2, 89–123
https://doi.org/10.1080/15294145.2019.1695978
SOCIETY PROCEEDINGS
Reflections on 20 years of Neuropsychoanalysis
Ross Balchin, Virginia Barry, Ariane Bazan, Mark J. Blechner, Andrea Clarici, Daniela Flores Mosri, Aikaterini (Katerina)
Fotopoulou, Maria Sonia Goergen, Richard Kessler, Iréne Matthis, José Fernando Muñoz Zúñiga, Georg Northoff,
David Olds, Lois Oppenheim, Doris Reismann-Lagrèze, Manos Tsakiris, Doug Watt, Giles Yeates, Maggie Zellner
As this journal was founded in 1999, and the 20th Congress of
the International Neuropsychoanalysis Society took place in
2019, this year seems a fitting time to celebrate the 20th anni-
versary of neuropsychoanalysis. The celebration was kicked off
by an in-depth interview of Oliver Turnbull by Christian Salas
in our previous issue. In what follows, other members of the
neuropsychoanalysis community share some personal,
social, and theoretical reflections on the importance of neu-
ropsychoanalysis since the founding of the journal and the
Society. Through personal histories, remembrances of the
“pre-history” and development of the neuropsychoanalysis
community, and discussions of concepts and findings that
have emerged at our congresses and in these pages, a
nuanced landscape of our vital, interdisciplinary project
emerges. – The Editors
New perspectives and new resources
Ross Balchin
My wonderful and enriching journey in neuropsychoanaly-
sis began sixteen years ago at the University of Cape
Town when Professor Mark Solms walked into our first post-
graduate lecture as trainee clinicians and proclaimed that
we were about to learn a unique, yet fundamentally impor-
tant approach to clinical neuropsychology. The dictum that I
heard back then was underpinned by the following two key
tenets, which clinical experience has subsequently shown
me are crucial if one is to correctly understand, diagnose,
and ultimately assist brain-injured patients.
First, the relatively novel (in the neuropsychology world
at least) hypothetico-deductive approach dictates that,
rather than merely measuring a patient’s functions quanti-
tatively and at face value using standardized tests (in
short, a purely psychometric approach), the clinician must
instead aspire to answering a clinical question by generat-
ing and then systematically excluding hypotheses in order
to test and explore patients’ neurocognitive functions. In
doing so, s/he can reach an accurate and practically mean-
ingful clinical impression based on testing and then system-
atically excluding differential diagnoses. This approach
demands careful and decided qualitative observations and
the interpretation of clinical signs and symptoms in relation
© 2019 International Neuropsychoanalysis Society
to the underlying brain pathology. This necessarily requires
an understanding of neuroanatomical correlates of normal
mental functions and how these relate to the specific neu-
rocognitive disorders seen in patients. The clinical task
must ultimately be to ensure that converging lines of evi-
dence from the assessment process all point to one unifying
clinical presentation. Practising in multilingual, multicultural
South Africa, where the population also varies greatly in
terms of level of education, as well as religious and cultural
beliefs and customs, has further emphasized to me just how
valuable, albeit sometimes challenging, this approach is, as
one is obliged to also consider these additional multiple
dimensions when reaching one’s diagnostic conclusions.
The second key tenet, which I would come to appreciate
more and more, is that this multifaceted approach to clinical
practice as a neuropsychologist also requires an under-
standing of the subjective inner experience of each
patient. I was to learn that this involves exploring and
coming to grips with the psychology of patients and the
psychodynamics at play in their lives. Crucially, this then
allows for an understanding of how psychodynamic fea-
tures are interacting with the neurocognitive features of a
patient’s presentation. I soon discovered that incorporating
psychoanalytic insights (if one has the requisite exposure to
neuropsychoanalytic knowledge and training) into the clini-
cal appraisal of the brain-injured patient is vital. Not only
does one then have a richer sense of who the patient is
as a person, but one also has additional converging lines
of evidence at one’s disposal concerning the clinical presen-
tation at hand. This greatly aids in generating and testing of
clinical hypotheses, and ultimately in reaching accurate
diagnostic conclusions. Clinical examples of various neuro-
cognitive impairments seen in patients in the hospital
setting have shown me that psychoanalysis has the
theory, vocabulary, insights, and methods of clinical
enquiry to contribute meaningfully to the appreciation of
key aspects of neurological patients’ presentations that a
purely cognitive, objective perspective simply overlooks.
This insight showed me the benefits of neuropsychoanaly-
sis, not only for arriving at the most accurate and holistic
account of a patient’s clinical presentation, but also for
treatment possibilities. The narcissism frequently documen-
ted in neurological patients with right hemisphere brain
90 SOCIETY PROCEEDINGS
lesions perfectly illustrates the mutual benefits of incorpor-
ating neuropsychological and psychoanalytic (neuropsy-
choanalytic) understandings into the clinical process (e.g.
see Kaplan-Solms & Solms, 2002).
Moving away from clinical applications, the rich new per-
spectives that neuropsychoanalytic thinking have brought
about over the past two decades have allowed for the formu-
lation of many fascinating and important research questions
in various connected branches of the mind sciences, which in
turn has led to important knowledge gains. This has been
especially true in the case of collaborative work incorporat-
ing seminal findings from the field of affective neuroscience.
From a personal perspective, these groundbreaking devel-
opments have influenced the research that I have sought
to undertake. As an illustrative case in point, I was part of
an international team who investigated the effect of exercise
on depression in order to try to explain the physiological
basis of the antidepressant effect of exercise. Based on the
observation that the PANIC (separation distress) system
(associated with feelings of loss) is built on the same brain
pathways as the physical pain system, our study (Balchin,
Linde, Blackhurst, Rauch, & Schönbächler, 2016) hypoth-
esized that just as the body produces endorphins as
natural analgesics in the face of physical pain, so too endor-
phin release is the mechanism underlying the alleviation of
the mental pain associated with depression when mediated
by a certain level of exercise intensity.
A new perspective in my journey with neuropsychoana-
lysis began at the start of 2015 when I was privileged to
begin working for the Neuropsychoanalysis Foundation. In
addition to working with an exceptional and dedicated
group of colleagues, my role as Program Director has
shown me first-hand just how exciting and important the
next decade will be for neuropsychoanalysis, especially in
terms of growth and sustainability. My work has various
dimensions to it, and involves a number of stimulating
and relevant projects geared towards serving and further
enhancing our Society’s membership. As I reflect here, I
think it is important to highlight three such endeavors
which are helping to shape the future of neuropsychoanal-
sysis and serving to grow and further resource and skill our
international membership community. Working on and
helping to develop the following three resources/initiatives
has allowed me to appreciate the value that they each offer
in shaping the exciting future that neuropsychoanalysis has
as a scientfic movement.
The first resource to highlight is our exciting new learn-
ing platform, NPSA Learning (www.npsalearning.org). This
growing tool is designed to promote and provide interdisci-
plinary knowledge across the mind sciences from both clini-
cal and research, and psychodynamic and biological,
perspectives. It offers easily accessible video-based
courses from prominent clinicians and researchers, each
of which is comprised of chapters and assessments. These
courses also come with additional content in the form of
glossary entries, scientific and scholarly literature,
transcripts, images, slides, and extra video clips to illustrate
key points.
The second, pioneering initiative to mention is our
recently established Clinical Register of the International Neu-
ropsychoanalysis Society. This Register serves as our official
record of those Society members who are clinicians and
who have undergone specialist training, based in neuropsy-
choanalytic knowledge, which supplements their basic
training in a clinical discipline. We currently have just
under 100 members on the Register from various clinical
disciplines, and from many different countries from across
the world.
The third resource to make mention of is our website
(www.npsa-association.org) which boasts a number of
accessible learning materials in neuropsychoanalysis,
including: (i) two video series covering an introduction to
clinical neuropsychology, and clinical neuropsychoanalysis
for psychiatrists, neurologists and psychoanalysts, respect-
ively, as well as various talks hosted at the Arnold Pfeffer
Center for Neuropsychoanalysis; and (ii) reading lists on a
wide range of interdisciplinary topics that are of relevance
to neuropsychoanalysis, such as psychodynamic neuro-
science, the efficacy of psychoanalysis and psychodynamic
therapy, and clinical neuropsychoanalysis.
The three NPSA offerings outlined here are all key to
growing neuropsychoanalysis as a movement while at the
same time equipping our community with meaningful
and practical knowledge. They reflect a new stage in the
maturation of our transdisciplinary community, and offer
resources to all who are engaged in developing neuropsy-
choanalysis through the coming decades. I encourage
readers to fully exploit these wonderful resources.
In concluding these reflections, my journey in neuropsy-
choanalysis has emcompassed four perspectives that confl-
uenced into my current career, namely: as an employee of
the Neuropsychoanalysis Foundation, a clinician (clinical
neuropsychologist), and a researcher in neuroscience, all
with an African flavor (I am based in Cape Town, South
Africa). Neuropsychoanalysis has had a significant impact
on my life and the multiple “hats” that I wear have given
me a particular perspective on the progress that has been
made. In closing, I would like to say a big thank you to all
of those who have driven the neuropsychoanalysis cause
with such dedication and passion.
rbalchin@npsa-association.org
Neuropsychoanalysis: Enriching our clinical
work
Virginia Barry
Twenty years ago, when neuropsychoanalysis was in its
infancy, colleagues used to ask me whether neuroscience
had any impact on how I conducted a psychoanalysis.
They asked repeatedly, “What good is it?” I liked to
respond as Michael Farraday responded to William

Gladstone who asked what use was the discovery of electri-
city. Farrady replied, “Of what use is a newborn baby?”
At that time, I would say the same about neuropsychoa-
nalysis – it was in its infancy. In these past twenty years,
there has been tremendous maturation of the field. Admit-
tedly, sometimes the clinical translation of neuroscience
research is not immediately obvious, and the findings of
neuroscientific work being pursued at a granular level not
immediately accessible to clinicians. Indeed, as a clinician,
many times the original papers “sound like Greek to me.”
But over the years, these findings gradually coalesce, and
their clinical usefulness emerges.
Psychoanalysis has always been about trying to uncover/
understand unconscious motivations that drive behavior
and contribute to the woes that bring patients to treatment.
Addressing these unconscious motivations is what dis-
tinguishes psychoanalysis from other psychological thera-
pies; it is because these unconscious scripts have not
been altered that people turn to psychoanalysis after
other methods of treatment have failed. In my experience
and my observations of other clinicians in the community,
the findings of neuropsychoanalysis have shifted treatment
away from trying to discover unconscious content and
toward understanding the unconscious dynamics of psycho-
logical functioning. It is, for me, the understanding of these
dynamics as informed by neuroscience findings that has
matured the most in twenty years.
What follows are some (anecdotal, not inclusive)
examples of the ways neuropsychoanalysis has had an
impact on my clinical work:
. We now know so much more about the organizing and
dispositional nature of affects, and how our mental life
is driven by the need to manage and make use of
these affects. Identifying the emotional system that has
been engaged helps me to see beyond the patient’s
defensive strategies more quickly to help her resolve
the underlying problems. In just one such instance,
rather than engaging with a patient’s obsessional rumi-
nations, I can address the shame of being unable to navi-
gate intimate relationships. Or consider the problem of
anxiety. Jaak Panksepp’s distinction between the
anxiety generated by the FEAR system versus the
anxiety manifested in SEPARATION/GRIEF (Panksepp &
Biven, 2012) informs both pharmacological approaches
as well as psychotherapy.
. Recognizing that people vary greatly in their ability to be
cognizant of their bodies, exploration of how the interior
of the body forms the template of the self (against which
all experience is measured) has influenced the way I
think about anorexia, an illness in which there seems to
be diminished interoceptive awareness, versus
depression when the messages from the body seem to
be weighted such that the information from the world
is diminished. In both cases, the work with the patient
focuses on improving the balance between bodily
awareness and awareness of the world in addition to
NEUROPSYCHOANALYSIS 91
the more traditional work of unpacking meaning.
(Northoff, 2016)
. Understanding that memory exists in multiple forms,
some forms accessible through enactment rather than
conscious reflection, has guided us to assess the rep-
etition compulsion embedded in action, and to search
for language to attach to the non-verabalizable,
motoric expressions of psychological function. In other
words, because of the multiple memory systems and
the reconsolidation of memory that shifts memory
from one system to another, experience may be memor-
ialized in spatio-temporal-procedural ways not accessible
to verbal/conscious reflection. Mark Solm’s examination
of the nature of repression (Solms, 2013) brings these
models of memory systems into the clinical realm.
Influenced by Mark’s ideas, I no longer expect my
patients to recover repressed memories; rather I strive
to understand the way the prematurely automatized sol-
utions manifest themselves in the patient’s life, and con-
tribute to her misery. Only the reliving of the memory as
it arises in actions, expectations, and related feelings
within the consultation room will allow for a kind of
transformation through helping the patient develop
more adaptive life strategies.
. As memory and perception have been shown to be inex-
tricably linked, our views of trauma and how to heal also
have been dramatically altered. I have found it useful to
attend to the shifts in cognition that occur when trau-
matic memories occur unbidden; the hijacking of the
cognitive system by the kind of memory that is “lived”
(implicit, procedural) rather than “remembered” (explicit,
declarative) impacts the manner in which a person is able
to think about and integrate his experience.
To my mind, the most exciting work in neuropsychoana-
lysis is taking place at this moment. Even though the
description of the brain’s hierarchical organization and the
notion of unconscious inference can be traced back to
Helmholtz working in the late 1800s, his successors now
have expanded our knowledge of the interconnectivity
within the brain in which bottom-up and top-down influ-
ences neuronally encode probability distributions or
beliefs about the causes of the sensory signals that bring
the world to our attention (see, for example, Friston,
2010). We are beginning to be able to envision the neuronal
manner in which our expectations (elaborated from experi-
ence) guide our functioning in the world and are not always
susceptible to correction from experience in the world. The
mathematically instantiated concept that prediction and
expectation structure the brain begins to illuminate such
psychoanalytic fundamental concepts such as transference,
self, affect regulation, and so forth, as well as beginning to
account for the way maturational challenges can be con-
ceptualized in terms of the need to revise or encode predic-
tions. Take for example a person whose self-esteem
collapses in response to disappointment in an (pseudo)
idealized other. In such a case, I might hypothesize that
92 SOCIETY PROCEEDINGS
the desperate idealization of another person has been an
attempt to deal with the low self-esteem that resulted
from early selfobject failures. The prediction of a loss of
self-esteem overrides the ability to realistically evaluate
the (pseudo) idealized other, leaving the individual vulner-
able. The psychoanalytic lens shifts, certainly away from
content, but also away from the defense and toward con-
templating the failed prediction.
For neuropsychoanalysis to be strong, psychoanalysis
must be strong. Our theories cannot simply be narrative
truths but must truly and scientifically illuminate psycho-
logical functioning; our theories must be grounded in physi-
ology, the brain and the body, but they must also work in
the clinical setting. I am so grateful that neuropsychoanaly-
sis has provided a path to the future.
vcbarry@gmail.com
Elaborating a science of the mental
Ariane Bazan
The Shevrin lab
I remember having contacted Mark Solms before there was
anything such as a neuropsychoanalytic society; that was
back in 1998. I had a PhD in biology, and was undertaking
new studies in psychology at the University of Ghent.
There, my professors, Filip Geerardyn and Gertrudis Van de
Vijver, knew Mark Solms and his area of expertise, as they
had awarded him a doctor honoris causa and the Sarton
medal in 1996. We then came to the first International Neu-
ropsychoanalysis Congress in London in 1999, where I heard
Howard Shevrin and Linda Brakel asking a question about
rebuses. This question glued me to these people and
when, upon graduating, I was awarded a Belgian American
Educational Foundation fellowship, my adventure with the
Shevrin lab began. I arrived in January 2003 and left in Sep-
tember 2005, and in the meantime participated in at least
four different research projects.
With the Shevrin lab, we suggested that alpha synchroni-
zation – this is, the synchronous pattern of a slow brain
wave of a 8–12 Hz frequency – might play a defensive
role against internal conflict stimuli. In fact, alpha synchroni-
zation was already well known from cognitive research. His-
torically, it had first been characterized as the Berger effect,
a “contamination” of EEG-patterns when the participant
loses his focus on the task at hand and starts mind wander-
ing (Berger, 1929). Therefore, it has first been called an
“idling” effect. However, Klimesch and his group (e.g. Kli-
mesch, Sauseng, & Hanslmayr, 2007) showed this wave
had a much more intentional dimension, and is at play
when the participant deliberately does not want to
process a stimulus. For example, when in bi-aural listening
the participant is asked to only report what she hears in
her left ear, the auditory processing of the stimulus at the
right ear will be disrupted by alpha synchronization.
Figure 1. Natasha Kalaida sitting at Howie’s Tachistoscope in the
Shevrin lab in Ann Arbor.
Howard Shevrin, Michael Snodgrass, Ramesh Kushwaha
and others (including myself) showed that there is also an
increase in alpha synchronization when a participant is sub-
liminally presented a stimulus that is thought to tap into an
unconscious conflict (Bazan, 2017; Shevrin et al., 2010, 2013;
Shevrin, Bond, Brakel, Hertel, & Williams, 1996). This research
was done through a lengthy protocol that involved clinical
listening to each participant so as to distinguish his con-
scious complaint, or symptom, from its unconscious etiol-
ogy, identified based on speculation by the trained
analysts analyzing the material. When short phrases or
word groups pertaining to this unconscious conflict were
presented subliminally, e.g. “mad at dad,” there was an
increase of alpha synchronization. This did not happen
when the same stimuli were presented supraliminally or
when the conscious symptom description (e.g. “public
talks”) were presented either sub- or supraliminally.
I thereby also encountered the powerful experimental
set-up that was the subliminal presentation with the tachis-
toscope (see Figure 1). This mechanical device, working with
mirrors and LED lamps, allows for a very clean 1-millisecond
presentation without mask, which helps analyzing the ERP
and EEG traces of this short stimulation. Shevrin and Fritzler
(1968) had shown before that this kind of strict subliminal
stimulation yielded ERP patterns quite similar to conscious,
supraliminal stimulation, albeit at a lower amplitude. With
these more vulnerable traces, one understands the capital
importance of not having to deal with masking, as is the
case in the modern operationalization through computer
interfaces. When Howie died,1 alas, the tachistoscope got
lost.
Lacanian signifier
During my postdoctoral stay, I myself used the tachisto-
scope for an experiment on the Lacanian signifier. One of
the main elements central to a Lacanian approach is not
simply the idea of a dynamic unconscious, but also that of

an organized, structured unconscious, whereby one of the
organization principles is the signifier. The idea is very
simple: language, before or parallel to being contextually
analyzed, i.e. contextually ripped of ambiguity, is first and
foremost also a phonological object. As a phonological
object,2 language is inherently ambiguous: the phonology
of the sentence “Can certain things happen?” does not
differentiate between “can cer-” and “cancer,” for example.
Thus, independently and in parallel to being a message
which is “correctly”3 understood in the context, the stimulus
is also a phonemic object. That phonemic object can be
endowed with emotional charge and if that charge is impor-
tant – when the word has a specific emotional importance
to the subject – even when contextually analyzed in a
proper way, it will still stir up mental activity.
PhonoCat
This was my theory at hand when I arrived in Ann Arbor. The
final operationalization was much less clinical. We pre-
sented word triads to the participants. For the whole
summer of 2001, I searched for English words that were
reversible in a phonological way. We had the obvious
ones such as cat/tack, the somewhat better ones such as
door/road, fine/knife and then there were a couple of
which I was particularly proud such as moan/gnome,
chance/snatch, spite/types, caught/talk. Indeed, to be able
to differentiate the phonemes from the graphemic effect,
we needed stimuli which were phonologically perfect
inverses, but graphemically (very) dissimilar.
We presented two categories of word triads. In the first
kind, a prime word was followed by a choice between a
phonological inverse and a semantic equivalent, e.g.
door – road/gate; these were the “PS” triads. In a “PN”
triad, a prime word was followed by a phonological
inverse and a non-related word, e.g. rope – pour/list. Due
to my then naïve experimental audacity, both prime and
target words were presented in strictly subliminal con-
ditions, i.e. one millisecond priming followed by a light
mask. Participants didn’t see any of the stimuli but were
still encouraged to pick the most similar choice. Their
experience was one of doing a phantom experiment,
saying “1” for the upper choice and “2” for the lower
choice completely at random. What we found, however,
was that neither the behavioral choices nor the ERP traces
were arbitrary (Bazan et al., 2019). On the contrary, we
found predictable patterns for both but only in the PN con-
dition. The more participants were rated as defensive
through two independent social desirability scales, the
more they would pick the N unrelated target rather than
the related P target. The parallel ERP trace showed results
for the so-called “phonological mismatch negativity:” a
negative wave at 320 ms after target presentation, which
depolarizes (becomes more positive) when phonological
similarity is detected (Connolly, Service, D’Arcy, Kujala, &
Alho, 2001). In some participants this wave indeed
became more positive, and significantly these did pick the
NEUROPSYCHOANALYSIS 93
P choice upon being asked for the most similar choice.
This was logical: the more phonological similarity was
“seen” in the P-alternative, the more this was chosen,
knowing this was the experimental task. However, in a
large number of participants this wave became more nega-
tive, as if the participants were particularly puzzled by this
unusual form of phonological similarity. Logically again,
the more there was this hyperpolarization, the more partici-
pants picked the unrelated N choice. Of course, the amazing
aspect was that all of this was happening totally beyond the
awareness of the participants, and that a brain wave occur-
ing about a second before their choice, significantly pre-
dicted their choice. There was also a significant interaction
effect between brain and behavior: the more the partici-
pants were deemed defensive through the social desirabil-
ity measures, the more there was this hypernegativity of the
subliminal N320. So defensive participants picked more N-
alternatives since brain-wise they were indeed detecting
less similarity in the P-choice than in the N-choice. Defensiv-
ity showed itself not simply in the behavioral outcome but
also in brain reactivity!
We interpreted these results as expressing unconscious
defense on a structural level: defensiveness is not just a
matter of content, it is also a way of processing language,
and language forms. When defensive, we do not simply
shield ourselves from meanings, but we also defend
against ambiguity, in this case of language, because ambi-
guity, by definition, might harbor dangerous side-tracks,
associatively leading to unconscious material, including
unconscious conflicts.
Differences with the neuropsychoanalysis
mainstream approach
After my post-doc in Ann Arbor, I became a professor in
Clinical Psychology and Psychopathology at the Université
Libre de Bruxelles. At the ULB, I developed my thinking and
research, which is by now in many points fundamentally
different from the main approach, or from the Solmsian
approach, of the International Neuropsychoanalysis Society.
First, from an epistemologic point of view, I do not
believe in a constructivist approach implying that a devel-
opment of neuroscientific knowledge will end up in articu-
lating some of the psychoanalytic concepts. My
epistemology goes the other way round: those psychoana-
lytic concepts which will prove the most powerful in clarify-
ing neuroscientific data will get greater validation.
Neuroscience does not make sense in and by itself; it
needs a clinical perspective for interpretation, and psycho-
analysis, which is uniquely constituted from the uttermost
intimacy of the clinical interpretation, is in my view the
best interpretative framework on the human to date.
Second, there is a science of the mental which is not just
an epiphenomenon of the biological, but which is an inde-
pendent science. Much like biology is independent from
chemistry but does not deny it and does not eliminate it, psy-
chology is independent from neurosciences without either
94 SOCIETY PROCEEDINGS
denying or eliminating it. The authority, both theoretically,
and for diagnosis and intervention, comes from within the
field of psychology itself, much as is the case of biological
theory, diagnosis and intervention in relation to chemistry.
In this regard, the Clinical Register to me is a total aberration
if the idea is that there is any authority to gain from neuro-
science training specifically for clinical practice. It harbors
moreover the danger of a false feeling of authority or
mastery. However, psychoanalytic practice involves an essen-
tial epistemological shift from the clinicians as the one who
knows – and who is the “Master” much like Charcot was
Maître Charcot – to the patient as the one who knows.
Indeed, Freud was historically humbled by “his hysterical
patients” – chiefly among whom Lucy R. – who would
teach him his practice, and even essential insights into
unconscious functioning (e.g. “I knew, but I believe I didn’t
want to know,” said Lucy when Freud confronted her with
the idea she was probably in love with her boss). Freud’s
technique involved the certainty that the patients knew
and only needed to believe in him as someone endowed
with special powers, for them to reveal their knowledge –
e.g. when he used his technique of placing the hands on
the forehead and releasing them after a few counts, asking
the patient to say what came to mind at that very
moment. Lacan makes a concept of this “analyst as alibi,”
namely the supposé savoir, the one who is “supposed to
know.” Psychoanalysis works as long as we are aware that
we are alibis for knowledge, not holders of knowledge.
Third, I would argue that the mental is essentially emer-
ging from motor neurophysiology, not from perceptual
input. Representations arise when motor intentions have
not been completely or exhaustively discharged in motor
execution: «these neurons [for an action plan] encode
final configurations (of the environment, of the body, of
the moving segments, etc.) as they should arise at the
end of the action, and (…) they remain active until the
requested configuration has been obtained. If the goal
[of an action plan] were not reached, the sustained dis-
charge would be interpreted centrally as a pure represen-
tational activity and give rise to mental imagery.»
(Jeannerod, 1994, p. 201; Italics added). This is in line
with the following comment of McGonigle et al. (2002,
pp. 1265–1274) on the emergence of a phantom represen-
tation: “Activation in motor regions of the brain may be
sufficient to cause somatic phantom perceptions.” The
shift to a decidedly motor understanding of the mental
is confirmed by Cebolla and Cheron’s (2019, p. 1) recent
position: “oscillatory brain mechanisms integrate move-
ment into the dynamics of the default mode network,
the bottom up and top down modulations, the intentional
actions in social contexts, the individual selfness and body
identity, suggesting that movement may be essential to
consciousness and that the oscillations-movement-con-
sciousness triad should be inextricable.” By processes of
binding, this central motor axis acquires attributions or
affordances such as colors, textures, contours, and associat-
ive characteristics. For an abstract representation, then,
these affordances and associative characteristics are
bound around a central phoneme motor axis, constituted
by the linguistic string referring to the concept. The
name, then, is not just another attribute, but a constitutive
element. Thinking the mental first and foremost as consti-
tuted at the motor end, implies a movement of intentional
selection – or grasping – at the origin of a representation.
This is in contrast with the idea of continuity of processing
when the mental is conceived of as a complexification
from the perceptual input on. This intentional selection
or “cut,” which stands opposite to constructive continuity,
is one of the many ways in which we may understand
the Lacanian concept of “castration.”
Fourth, I believe that there are no instincts or inborn
behaviors. Of course, this can only be an exaggeration. But
when it comes to the outer body, even if there are inborn
motor strings, there is no continuity between internal
body lack and external body behavior. Even when a
newborn first comes into the air and has to find the right
movement to breath, and thus to survive, the way these
instinctive motor strings find themselves associated to the
need of air, is acquired, not inborn. Thus, I believe that every-
thing is a matter of history, no matter how much genetic
patterns there might be. The newborn child who, after a
short or a long, after a smooth or a painful seeking, finds
how to breathe when confronted with the first lack of air,
will have a dopamine release upon the first air coming in,
and that dopamine peak will lead to incentive sensitization
of the mobilized motor patterns, historicizing them.
Five, I believe that it is arousal and not valence which
decides mental life. This is what the intimacy of the clinical
encounter teaches us to start with: we are trapped into rep-
etition and the launching point of this compulsion is an
intense, unexpected event, independently of its valence.
One motor of mental life is the endeavor to actively re-
enact what has first taken us by surprise, and thus has put
us in a passive position, quite independently of the
emotional color of that event. This is also coherent with
the dopamine sensitization seen both for unexpected
rewards as for unexpected intrusions or trauma. I do not
see Panksepp’s (2005) seven emotional systems as deciding
mental life for that reason, though if we were to deconstruct
his proposal, certainly his SEEKING system plays a founda-
tional role. I side with LeDoux (2012) when he proposes
that what is foundational are action prompts or tendencies,
and that the emotional coloring of these action prompts
(e.g. defense, flight, approach etc.) is the result of cortical
integration.
These various differences, and the lack of engagement of
these differences in a dialectic dynamic, have lately brought
me to take a step back from the International Neuropsy-
choanalysis Society.
Université Libre de Bruxelles
At the ULB, I have gathered a team around me of motivated
students doing research, even without money. Sandrine

Detandt graduated with an empirical study on the Lacanian
concept of jouissance and is now a colleague as a professor.
Giulia Olyff’s research on the signifier and the Freudian
primary and secondary processes is still ongoing.
My main endeavor is to lay the structural and dynamic
architecture for a mental apparatus as an independent
organization form of the living and thereby give an inde-
pendent foundation to a science of the mental.4 Next to
my theoretical work with Gertrudis Van de Vijver – we are
writing a book on Lacanian Neuropsychoanalysis – my
empirical work aims at creating a formal and linguistic
toolbox for a mental diagnosis of a novel form. I would
argue that phenomenological approaches such as the
DSM and the ICD are not simply failing, but are inherently
psychopathogenic. With my group we have adapted or
designed a range formal and/or linguistic instruments –
the GeoCat (Brakel, Kleinsorge, Snodgrass, & Shevrin,
2000), WordLists, Rebuses, Metaphors and Tongue twisters
– for a structural distinction neurosis/psychosis and for a
dynamical diagnosis within each structure. This dynamical
diagnosis aims at showing how increased excitation (or
anxiety) is dealt with, be it either invested in increased crea-
tive mental work (e.g. increased rebus solving and/or meta-
phor understanding), or increased defense (e.g. increased
semantic choices in WordLists). Giulia Olyff has shown, for
example, that we all are able to solve rebuses without noti-
cing that we are doing so and independently of the spatial
configuration of the stimuli. In all of our 11 studies until now,
a remarkably constant portion of about 20% of people,
however, read the rebuses as if the images were words in
a transparent way. These 20% percent are now the focus
of our attention: are these people mainly in what is called
ordinary psychosis in a Lacanian approach? Future will tell.
ariane@ulb.ac.be
Neuropsychoanalysis: Landmark
achievements and paths for the future
Mark J. Blechner
When I went to my first neuropsychoanalysis meeting at the
New York Psychoanalytic Institute nearly thirty years ago, I felt
that I had found my home. In graduate school, while enrolled
in the clinical psychology training program, I had done
research on auditory perception related to language, music,
and the cerebral hemispheres. At the neuropsychoanalysis
meeting, here was a group of people who shared my interests
in both clinical psychoanalysis and neurology. Those early
meetings were thrilling, and they continue to invigorate my
thinking. Neuropsychoanalysis keeps us honest – psychoana-
lytic concepts need both psychological and neurological
integrity; likewise, neurology needs psychoanalysis to keep
a focus on all aspects of human functioning and personality,
including those that are difficult to measure, like emotion.
Since the founding of the journal Neuropsychoanalysis,
there has come to be increasing respect between
NEUROPSYCHOANALYSIS 95
psychoanalysts and neurologists and an increased richness
to the ideas and research that bridge the two fields. I will
mention only a few significant areas of study, along with
recommendations for future research and some ways we
might adjust our course.
Confabulation and dreams
A broad project of our field is to compare and contrast the
mental states and symptomatology of people with neuro-
logical syndromes and those with psychopathology. This
was brought home for me by DeLuca’s (2000) paper on
the neurology and psychology of confabulation. How
much is the confabulation due to strokes similar or
different from the confabulation of dreams and schizo-
phrenia? When a person dreams, for example, “She looked
like Susan, but I knew she was really my mother,” isn’t this
like the experience of people with Frégoli’s syndrome
(Blechner, 2000)? And if so, what does this tell us about
the neurology of dreaming? So far, more questions have
been raised than answered, but Schwartz and Maquet
(2002) have made some preliminary progress. Horikawa,
Tamaki, Miyawaki, and Kamitani (2013), by exploring a
method of neurologically identifying visual images in
dreams as they happen, are opening a new pathway to
explore these issues.
In addition, the study of confabulation becomes
enriched when the neurological phenomena are considered
in their interpersonal context (Blechner, 2007b), which
allows us to see problems not only with a person’s own cog-
nition but with the appreciation of the other person’s
mental processes. In this vein, I would suggest that tra-
ditional one-person Freudian psychoanalysis has been dis-
proportionately represented in neuropsychoanalysis, a
skew that needs to be corrected in the future, with more
representation of the interpersonal, relational, and other
schools of psychoanalysis.
Panic attacks
Neuropsychoanalysis has helped psychoanalysis to make its
concepts more precise and its clinical application more
effective. One example is the treatment of patients with
panic attacks. The common presumption among many psy-
chiatrists and researchers about the neurobiology of fear is
that: “During a panic attack, a patient perceives danger, but
no danger actually exists. In this case, anxiety is inappropri-
ate” (Alexander, Feigelson, & Gorman, 2005). Yet in clinical
psychoanalytic practice, we often find this presumption
not to be true (Blechner, 2007a, 2018b). When one conducts
an in-depth psychiatric interview, it turns out that some
patients with panic attacks indeed have something happen-
ing in their lives that should cause them to be fearful. They
have dissociated this cause of their fears, and hence feel the
panic without knowing why. The psychoanalyst can undo
the dissociation and stop the panic attacks, replacing
96 SOCIETY PROCEEDINGS
them with an ongoing state of high fear that is very unplea-
sant, but allows the life situation to be altered in a way that
will prevent further panic attacks. This finding needs to be
integrated with the more common contemporary
approaches of medication and cognitive–behavioral
therapy to provide optimal treatment to patients with
panic attacks (Busch, Oquendo, Sullivan, & Sandberg, 2010).
In panic attacks, we see the dissociation of the emotion
without the cause. It may seem like the inverse of obses-
sional phenomena, where the idea is experienced without
affect. In each case, it would be useful to discover the neuro-
logical processes that allow this dissociation.
The drives
Whereas Freud generally focused on two drives, the libidi-
nous and aggressive drives, motivating much of human
behavior, neuropsychoanalysis has allowed us to consider
the possibility that there may be at least seven basic
human drives (Panksepp, 1998): SEEKING, RAGE, FEAR,
LUST, CARE, PANIC/GRIEF, and PLAY. Panksepp’s research
expanded our ability to identify human motivation and
relate it and contrast it with animal motivation. I believe
the models and perspectives of affective neuroscience
that neuropsychoanalysis has taken on board have
allowed us to integrate much more clinical data, such as
Bowlby’s (1969) focus on attachment.
Nevertheless, Panksepp’s list of drives may be too restric-
tive. Panksepp (1998) and Solms (2013) relegate drives like
hunger and thirst to a group of “appetitive drives” or
“homeostatic affects” and drives like disgust to “sensory
drives,” and these categories are given much less attention.
I think this separation is unwise, since both kinds of drives
are essential to human functioning and are subject to
conflict much as are the other drives (Blechner, 2018b).
Disgust can be an automatic affect that responds to
certain stimuli, but it also can be an acquired response
with multiple affective and ideational aspects, and it can
comprise an essential element of psychopathology. It fits
Freud’s definition of a drive as: “a concept on the frontier
between the mental and the somatic, as the psychical repre-
sentative of the stimuli originating from within the organ-
ism and reaching the mind, as a measure of the demand
made upon the mind for work in consequence of its con-
nection with the body” (Freud, 1915, pp. 121–122).
Sensory affects like disgust have enormous power as
human motivators (Blechner, 2005). We saw during the
United States 2016 presidential campaign how powerfully
disgust can shape human choices (Blechner, 2016).
Further research will clarify which drives are essential to a
neuropsychoanalytic model of motivation.
Psychological defenses
A cornerstone of psychoanalytic theory has been the study
of psychological defenses (S. Freud, 1937; A. Freud, 1936;
McWilliams, 1994). Psychological defenses are processes
by which our mindbrains change reality, suppress or trans-
form drives and emotions, misattribute personality charac-
teristics from ourselves to others or from others to
ourselves, or leave out aspects of reality to lessen anxiety.
Defenses enable our mindbrains to distort who is doing
what to whom, who feels what, what we are feeling in the
moment, or what has happened or is happening.
There are debates about how many psychological
defenses there are, ranging as high as 48 (Laughlin, 1970).
Yet there is great variation in the psychological processes
involved in different defenses, which may be reflected in
their neurobiology. For example, projection changes the
attribution of the attitude (or impulse) from self to other.
“I hate you” becomes “you hate me.” Reaction formation
changes the nature or valence of the feeling, attitude, or
impulse itself. “I hate you” becomes “I love you.” Is reaction
formation a cortical or limbic process, or both? Which
different mindbrain processes are involved in projection
and reaction formation?
Somatization is another defense that seems to operate
quite differently from other defenses. It involves the trans-
formation of unconscious affect into bodily experience.
The neural systems required to perform this transformation
have yet to be specified, but they clearly are not just
involved in suppressing knowledge or shifting attribution
of a characteristic from oneself to another person.
One notes the heterogeneity of psychological defenses
especially when trying to account for them neurologically,
an important endeavor that is still in its infancy (Berlin,
2011), with some notable studies of suppression and repres-
sion (Anderson et al., 2004), dissociation (Reinders et al.,
2006), and catatonic regression (Northoff, Bermpohl, Schoe-
neich, & Boeker, 2007). If we study the neurological pro-
cesses involved in each defense, perhaps our
understanding of how each defense works and how they
differ from one another will be much more precise (Blech-
ner, 2018a; Northoff, 2011; Northoff & Boeker, 2006).
We also need to study the relationship between certain
defenses and neurological syndromes, to better understand
both their phenomenology and the neurological mechan-
isms that underly them. For example, people who have
had a stroke in the right hemisphere sometimes develop
anosognosia, the unawareness and denial of illness
(Babinski, 1914; Prigatano, 2010). The patient’s left arm
may be completely paralyzed, yet she may deny it. You
can ask her: “Mrs. Smith, how is your left arm today?”
“Fine,” she replies. “Please lift your left arm, Mrs. Smith.”
The left arm remains stationary. “Can you lift your left
arm?” “I just did it for you,” she replies.
Anosognosia may be analogous to denial, and the analy-
sis of the neurobiology of anosognosia may clarify the neu-
robiology of denial in people without brain injury.
Ramachandran (1996) proposed that people with anosog-
nosia would show an awareness of their symptoms in
their dreams that they deny in their waking life. He reported
a single case of a woman with anterograde amnesia whose

dreams seemed to show memory for events that she could
not remember in her waking life. It would be useful to
collect much more data on this question. Neurologists
would need to ask their patients about dreams more often.
Unconscious affect
In Mark Solms’ (2013) excellent paper, “The Conscious Id,”
he makes the point that consciousness may not require
the cortex, but does require the operation of upper limbic
structures. However, Solms also asserts in that paper that
all affect is conscious. I think this is not right. There are mul-
tiple lines of data showing that unconscious affect exists
and is responsible for many mental phenomena, some psy-
chopathological. Westen (1998) summarizes substantial
experimental data that affects can be unconscious. For
example, Greenwald and Banaji (1995) showed how prejudi-
cial emotions can operate unconsciously but may power-
fully affect our behavior.
Solms (2013) quotes Freud saying that all affects are con-
scious. However, as is often the case, Freud changed his
mind about many things, so that one can find him saying
the opposite somewhere else. This was true about affects. In
The Interpretation of Dreams (1900), for example, Freud at
times said that affects were unaffected by the dreamwork
(p. 248). At other times, in the same book, he proposed that
affects can be erased by the dreamwork (p. 467). He also pro-
posed that an affect can be transformed by the dreamwork
into its opposite (p. 471). Freud’s (1937) writing near the end
of his life confirms his view that affect can be unconscious.
The id (originally “Das Es” in German, which translated
literally to “The It”) was primarily a concept of unconscious
affect and motivation (Groddeck, 1923; Nietzsche, 1886/
1989). Thus, it seems unwise for neuropsychoanalysis to
abandon unconscious affect, so valuable to clinicians, just
when research scientists are giving the concept increased
credence. Affect may be an essential part of consciousness,
but consciousness may not be an essential part of affect.
mark@markblechner.com
To be or not to be a neuropsychoanalyst …
that is the question!
Andrea Clarici
I do not know exactly why but, after having been asked to
write about my twenty years of experience in the neuropsy-
choanalytic movement, some monologues from the works
of Shakespeare come back to my mind continually. The
first is the monologue from Hamlet, alluded to in the title,
since I believe that, on the one hand, neuropsychoanalysis
as a discipline is unquestionably and undisputedly more
and more important in the scientific world; but, on the
other hand, the question of a specific identity acquired by
practicing and applying in life and one’s own professional
NEUROPSYCHOANALYSIS 97
activity this interdisciplinary dialogue, i.e. of being a neurop-
sychoanalyst, is still to be defined. On this I will say some-
thing below, but before doing that, allow me to write
something inspired by the second monologue I was
reminded of.
The second speech on my mind by the great Bard is that
of Marc Antonio from Julius Caesar (“I come to bury Caesar,
not to praise him”). This one comes to mind because the
true reason I have agreed to write this article is not so
much to celebrate neuropsychoanalysis, but to raise some
important questions [though surely neither do I intend to
bury it [(at least for the moment!)].
Let’s start from this last point: when is it possible to
bury or abandon a discipline? In my opinion, when it
has fulfilled its function. I believe the scientific mission of
the neuropsychoanalytic movement is to establish a
unitary science on the Brain Mind. I do not believe it is
possible yet to abandon the implicit conceptual split
inherent in neuropsychoanalysis (although we have
removed the hyphen between “neuro” and “psycho),”
since an interdisciplinary dialogue between two still
distant scientific sectors is still necessary. Both at the
theoretical level and at the level of public consensus, the
two scientific communities will remain divided for a long
time: psychoanalysts will go on selectively dealing with
that essential part that “is invisible to the eye” (de Saint-
Exupéry, 2018) of our dialogue (the subjective experience
of perception, feelings and how these affect human cogni-
tions, relationships and behavior); while neuroscientists
will deepen their deductions by studying the objectifiable
areas of the brain – that is, by inferring neuropsychic func-
tioning models from the observation of the underlying
activity of structures through our senses (or some exten-
sion thereof).5 Neuropsychoanalysis aspires to highlight
the importance of both our perceptive components, the
one directed towards the external (or exteroceptive)
world and the one directed towards our internal (or inter-
oceptive) world (Solms, 2013). Our discipline was con-
cerned from its beginnings to create a kind of
conceptual bridge, a translation between these two “for-
mulations of our mental functioning” (Freud, 1911), in
order to acquire at least a common language and possibly
a unitary science of our relational life. This dichotomous for-
mulation of our discipline is still current and, I think, reflects
the very nature of our embodied mind, an entity capable of
self-organizing and, for this purpose, of perceiving both the
external environment of our body (where it is possible to
reach the objects that can help it survive) and the internal
ambit of our nuclear, visceral, emotional and affective
self. We cannot therefore abandon this dialogue and
the attached translational effort because, in my view, the
times are not yet ripe for a unitary science of relational life.
Meanwhile, let me argue why I do not think it lies with
me to celebrate neuropsychoanalysis as an interdisciplinary
dialogue in these pages. I do not believe this is necessary:
neuropsychoanalytic research is surely not self-referential,
and this is recognized by its scientific results, evidenced
98 SOCIETY PROCEEDINGS
by the opening up of ever new lines of research, with the
growing interest in psychoanalytic concepts by distin-
guished neuroscience scholars (and journals). For
example, whereas during my training as a psychiatrist in
the 1990s, it was almost impossible to find neuroscientific
articles citing Freud or psychoanalysis, this is quite
different today; thanks to scholars in neuropsychoanalysis
these articles are present in many of the most prestigious
neuroscience journals that normally would avoid anything
with even a whiff of psychoanalysis (see, for example,
Carhart-Harris & Friston, 2010; Kouvelas, 2018; Mancia,
2007; Marini et al., 2015; Turnbull & Solms, 2007 and many
others). Moreover, we have witnessed that the founder of
neuropsychoanalysis, Mark Solms, although he continues
to be intensely involved in research and in clinical neurop-
sychoanalysis, is in fact constantly called to attend and
present at symposia and conferences, at both psychoanaly-
tic and neuroscientific institutes around the world, despite
having repeatedly expressed the intent to withdraw from
spreading the word about neuropsychoanalysis (Solms,
2002). This fact attests to the growing interest in, and
often acceptance of, neuropsychoanalysis in the neuropsy-
chological scientific world.
Certainly this is relevant in relation to psychoanalysis as a
field. It is known that psychoanalysis and psychoanalytic
training institutes have suffered (up to roughly the end of
the last millennium) a period of crisis of consensus (partly
due to the growing domination of biological psychiatry,
but also, in my opinion, a situational indicator of a state of
relative scientific stagnation and of a certain “ivory tower”-
type closure of certain psychoanalytic institutions to scien-
tific comparison). This crisis was not just about concepts:
it coincided with a long period (precisely at the turn of
the year 2000) of decreasing requests for admission to psy-
choanalytic training institutes (Solms, 2010). The example of
the New York Psychoanalytic Institute is in this sense para-
digmatic to understand the impact that neuropsychoanaly-
sis has had in the new millennium: after a series of
neuropsychoanalysis seminars has been introduced in the
curriculum of the new candidates admitted, the candidacies
have increased significantly, and participation in these semi-
nars is also growing. Similarly, the interest in neuropsychoa-
nalysis by scientific journals is growing (Solms, 2004). I
believe that all these results attest to the fact that neurop-
sychoanalytic research does not need to be praised: it has
contributed in a substantial way in the progress of knowl-
edge both of psychoanalysis and of neuroscience, and
these acknowledgments and results obtained speak for
themselves. Nor, as we have seen, can it be buried.
Taking up the first Shakespearean reference, now I take
up the question of neuropsychoanalytic identity: is it poss-
ible to be a neuropsychoanalyst? A few years ago I wrote
that one of the reasons it is not possible to arrive at a
unitary identity on neuropsychic functioning is that very
different methods are adopted by the various clinical
researchers of relational life (psychoanalysts and neuros-
cientists) on the very same patient. In that paper (Clarici,
2015), in essence, I argued that the psychoanalytic
method is based on “psychic facts,” those that can be
inferred only through the essential tools of our subjective
observation, through first-person perpective, i.e. through
introspection and empathy (Kohut, 1959), while the empiri-
cal scientific method is based on “objective facts,” made
objective by the observations shared with others that
come to us from our senses directed towards the outside.
I also argued at the time that there was a kind of “perceptual
conflict” in being simultaneously an analyst and at the same
time a neuroscientist. If in being with our patient, whether
neurologically impaired, or intact but with psychopathol-
ogy, our attention (notoriously, a cognitive process but
also of affective origin) is directed towards a precise under-
standing of the patient’s behavior in order to infer what
happens in his brain, in that very same moment we also
lose our floating attention (Freud, 1912) and the role of
responsiveness (Sandler, 1976) that accompanies and pre-
cedes the emotional understanding of the transference
(what the patient experiences) through the countertransfer-
ence (the analyst’s specific response to what the patient
feels). By analogy, this perceptual conflict reminds me of
those ambiguous images of experimental psychology that
studies visual perception in which at any moment it is poss-
ible to see either only the white vase or the face of Mussolini
(Kanizsa & Gerbino, 1982) (see Figure 2, p. 12).
I therefore argued that neuroscientific facts, at least in
the clinical psychoanalytic setting, may be considered as
“external” or “objective” bits of information that the
analyst may (or may not) keep in mind while sitting with
the patient, but which may also disrupt our comprehension
of what the patient is emotionally trying to share with the
analyst. My answer to the question on the possibility of
being a neuropsychoanalyst was in its essence, “psychoana-
lytical”: arriving at the conclusion that: “It depends … ”. By
this, I meant that if we base our scientific identity on the
method used (psychoanalytic or neuroscientific), the
answer is: “No, there cannot exist a thing that is called neu-
ropsychoanalyst,” because our identity is based on assum-
ing “ideally” an habitual emotional and attentional posture
(Clarici, 2015; Pieralisi, Giuliani, Clarici, & Zanettovich,
2015), and that posture towards the internal world in psy-
choanalysis is different from the emotional and attentional
posture towards the external world in neuroscience. In con-
trast, if instead we consider and limit neuropsychoanalysis as
a kind of “necessary technical addition,” an informative adden-
dum (a sort of neuroscientific vademecum for the psychoana-
lyst, as well as a set of psychoanalytic concepts for the
neuroscientist), the methodological-identity problem does
not arise, and neuropsychoanalysis fully enters as new techni-
cal knowledge of crucial importance for general theory, psy-
choanalytic or neuroscientific as the case may be. In
neuroscience, for instance, this is the psychoanalytical
influence on experimental research in order to obtain a
more solid establishment of psychoanalysis in the medical
and scientific world. These were, therefore, five years ago

my conclusions on the identity problem posed by
neuropsychoanalysis.
I must confess, however, I was not entirely convinced of
my own conclusions. Subsequently, I went on to see
patients, both with neurological disorders and neurologi-
cally intact, in psychoanalytic psychotherapy, constantly
trying to understand both – as it were – only through the
“immersive” lens of trying to identify with them and then
in the effort to reconstruct and visualize what was under-
stood (sometimes sharing this with the patient in the
mutual adjustments of the therapeutic relation). Then I
inserted all these insights in one or the other of the theor-
etical frames learned during my psychoanalytic training
(and implicitly from my personal analysis). At the same
time, in a spontaneous way, I had acknowledge that these
psychoanalytic reconstruction I made up of a particular clini-
cal relationship with the patient regularly “fused”, coincided,
or one could also say was accompanied by “interferences”,
i.e. other explanatory reconstructions in my mind with
what was happening in that particular patient’s brain,
initially in an “objective” view, as if I saw it from the
outside, from the third-person point of view (for instance,
a particular useful neuroscientific theoretical framework
that I often found myself utilizing in the clinical setting
was Panksepp’s ideas on the basic motivational systems
engaged in the specific therapeutic relation; Panksepp,
1998). These perplexities were not limited to my clinical
activity: at the same time, my confrontation and affiliation
with various psychoanalytic and neuroscientific commu-
nities continued to make me reflect on the question of iden-
tity. Here, too, I noted a sense of personal dissonance with
respect to clinical or theoretical expositions in psychoanaly-
tic seminars; they seemed to me presentations that I per-
ceived as rigidly anchored to models officially accepted by
the particular analytical “parrocchia” within which the
speaker was presenting in that particular moment. I would
add to this that I also questioned my own analytical affilia-
tion: my training included 10 years at the Tavistock Clinic in
London, which is notoriously of a Kleinian-Bionian inspi-
ration, and then for another 10 years in the Centro Studi
of Via Ariosto in Milan (Italy), which follows in particular
the thought of Joseph Sandler, former Director of the
Anna Freud Center, also in London. In essence, I began to
feel in different environments, both of psychoanalysis and
of neuroscience, the impression that many public presenta-
tions, especially in institutionalized settings, go on maintain-
ing the scientific status quo, rather than promote
interdisciplinary progress, and I (this at least was my percep-
tion) I witnessed this as diffuse tendency. On occasion, I
could sense authentic but feeble thrusts to constantly
review one’s own theories and models, especially by
opening up to a confrontation with different scientific
ideas, for the sake of congruency and corroboration. Even
neuroscientific or clinical neurology environments, as per-
vaded as they were by amazing presentations on results
stemming from functional brain-imaging, left me with the
impression that the understanding of the patient’s
NEUROPSYCHOANALYSIS 99
subjectivity in the midst of the amazing neuroscience was
reductionistic or impoverished, if not – in not rare
instances – even distorted, pervaded by the aim to adapt
the patient to the fashionable (and often fanciful) theoreti-
cal model. Notably, I never perceived this in the Inter-
national Society of Neuropsychoanalysis. Therefore
continuing to attending this Society, my conclusions from
that article of 2015 have continued to be revised, and
these revisions allowed me to keep at bay the risk of eclecti-
cism, of subversion of the psychoanalytic method, or even
of omniscience, which has been (mistakenly, I believe) a
certain way of interpreting the mission of neuropsychoana-
lysis, which would have a negative impact on psychoanaly-
sis proper (as depicted for example by Blass & Carmeli,
2007).
In the following years, however, I came to think that,
when I had written that our identity in psychoanalysis is
based ideally on assuming an habitual attentional posture
towards the internal world (and that this view is different
and incompatible with the posture towards the outside
world of neuroscience), the problem was that reference to
the “ideal” realm. I now believed that perhaps the
problem of identity could be solved by allowing the
“ideal” and the “real” aspects of this neuropsychoanalytical
effort to come to terms, if not to conflate. In my experience
in these past twenty years, when I spontaneously experi-
ence an immersive identification experience with the
patient’s experiences ( first-person experience; Fotopoulou &
Tsakiris, 2017), it has become difficult for me to think only
in terms of psychoanalytic posture, nor can I think of what
happens objectively to the patient only in neuroscientific
terms (third-person experience), as if the patient had a
brain detached from its relational context. At this
moment, therefore, I am convinced that it is instead necess-
ary in our discipline to take a further step. My current
answer therefore to the question: “To be or not to be a neu-
ropsychoanalyst?,” is currently a bit less diplomatic and
more positive. I believe that “Yes, it may be possible to
become a neuropsychoanalyst.”
But then another question arises: “How may one
become a neuropsychoanalyst?” My current vision on this
(which also attests to what I owe to neuropsychoanalysis)
implies that a neuropsychoanalyst is a person who
“ideally” tends to think of himself and others according
to a unified vision. However, my current definition is not
limited to the realm of knowledge and ideals, but also to
that of reality. In my opinion, one can aspire to be a neu-
ropsychoanalyst when, in his/her lived experience, in
“reality,” one begins to lose the third-person vision of
neuroscience and the subjective first-person perspective
of psychoanalysis, and begins to adopt, more and more,
a unitary vision of the therapist-patient relationship, “in
the second-person perspective” (Fotopoulou & Tsakiris,
2017; Gallese, 2013), as the product of a spontaneous
affective–cognitive elaboration of our relationship with
the other. All this probably requires a “real” constant oscil-
latory attentional movement, or blurring activity (just as
100 SOCIETY PROCEEDINGS
Figure 2. A so-called ambiguous image. These are images with
two possible configurations, distinctly observable, both meaning-
ful. The individual figures (either a vase or the profile of Benito
Mussolini) can be recognized only one at a time, and perceived
depending on the point of observation (for example by turning
them upside down; in this case the perception is objective), or
depending on expectations (subjective illusory component, or
on a predictive basis). The simultaneous apperception of both
is very difficult and requires a blurring of one’s own sight or a
very rapid oscillation from one content to the other.
depicted in the conflictual perceptions in Figure 2),
between one posture (informing on the subjective, on
the Self) and the other (informing on the object). This
activity may witness the spontaneous emergence of an
understanding of our relationship in an authentic second-
person perspective (or we may say “your-relationship-with-
me” between analyst and patient). All this is obviously
facilitated in those who start from a psychoanalytic train-
ing, but nevertheless I believe it is also inherent in many
scholars or clinicians who start from a neuroscientific edu-
cation, and I am convinced that, in order to develop this
“real” competence, every professional must be constantly
trained. What I have illustrated to you is perhaps only
one way to describe a particular scientific development
of a researcher and, like any development, hopefully it is
never – to paraphrase Freud – terminable (Freud, 1938).
At the same time, the Sandlers argued that every scientist
recapitulates the child’s developmental stages, and that
every child basically progressively adopts the same
mental tools of the scientific researcher (Sandler, 2005).
We can extend from the particular of my personal con-
siderations and involvement in neuropsychoanalysis to
the general development of a sort of conceptual reality
testing, reminiscent of how the theory of the mind is gen-
erated and structured in the child (Gallotti & Frith, 2013)
and, I would add, also of how a new unified scientific
discipline may be born, an aim to which neuropsychoana-
lysis aspires.
andreaclarici@icloud.com
There would be no psychoanalysis without
neuroscience
Daniela Flores Mosri
As we know, Freud worked as a neurologist for at least 20
years. He was a neuroanatomist and also worked in clinical
neurology, which eventually led him to face the problem of
hysteria and other neuroses. While it is commonly accepted
that psychoanalysis was created in 1900 with the Interpret-
ation of dreams, many find its origins in previous years,
including Freud’s early years as a practicing neuroscientist.
For example, the importance given to language seemed
to be present in the text On aphasia (1891) but it was prob-
ably The neuro-psychoses of defense (1894) – one of the most
relevant texts – that suggests psychological mechanisms,
i.e. defenses, to diminish the intensity of negative affect
experiences. The Studies on hysteria by Breuer and Freud
(1895) became widely popular for its case presentations,
but it also offers theoretical sections that describe the first
attempts to explain the mind in neurological terms (e.g.
part iii by Breuer), along with Freud’s (1895) key text
Project for a scientific psychology. Thus, many of Freud’s
metapsychological concepts seem to derive from the
neuroscience of the 1890s. But it was not until 1950 that
the Project was published, leaving early psychoanalysts
deprived of this valuable introduction to Freud’s thinking.
Not that the Project is particularly easy to comprehend,
but it is also as though the neuroscientific foundations of
psychoanalysis would be difficult for some to endorse. It is
partially Freud’s doing when he sometimes stated that psy-
choanalysis should not go back to neuroscience, whereas in
other texts, he stressed how important it was to do exactly
the opposite. In any case, many of us in the neuropsychoa-
nalytic community would now argue that, regardless of
what Freud sometimes wanted, or not, the basic science
of psychoanalysis is neuroscience, since the brain is the
organ of the mind. This is the essence of the dual-aspect
monistic position about the brain and the mind.
Neuropsychoanalysis deals with a challenging problem:
subjectivity. Some claim that a goal of trying to understand
the underlying biological mechanisms of subjectivity is not
possible and thus it should not even be attempted. But
clearly we think it’s a possible goal in and of itself, and a
beneficial exercise – neuropsychoanalysis would probably
not exist if we thought it to be impossible. The dual-
aspect monism advocated by Panksepp, Solms, Turnbull,
and others (e.g. Solms & Turnbull, 2002, 2011; Panksepp &
Solms, 2012) becomes a balanced perspective from which
to approach the problem. The mind can be studied from
a first-person perspective as well as from a third-person per-
spective. Jaak Panksepp’s affective neuroscience became an

outstanding example of the latter by taking the scientific
study of emotions back to neuroscience without diminish-
ing the relevance of their subjective aspects. Panksepp
declared the mind to be primarily affective. His contri-
butions are changing the way we think of psychopathology
and its different lines of treatment. Affective neuroscience
has also provided data that have modified conceptions of
the conscious and unconscious mind. The problem of
affect was precisely what Freud and Breuer tried to solve
back in the 1880s and 90s. Other contributions correspond
to topics such as memory, sleep and dreaming, attachment
and social interaction, and psychosomatics, just to mention
a few.
Hence, neuropsychoanalysis may have been a word to
give a name to a Journal, but it emphasized that someone
was finally giving importance to the very foundations of
psychoanalysis and the study of the mind. We may even
think of it as a return to the starting place of psychoanalysis.
So many of us have been drawn to it because it represented
the opportunity to learn how to integrate neuroscientific
findings to psychoanalytic theory and practice. It is no
minor challenge because of the many complexities it
involves. But the Journal and the Society have given the
chance to work together as a group that has been open
to discussions from different viewpoints, even from those
that express passionate opposition against neuropsychoa-
nalytic endeavors. In the end, opposition enriches a dialo-
gue. A good theory needs to be challenged for it to
become robust. I think this is particularly relevant when
such a theory is used to treat people suffering from
diverse disorders. We need to be better, thus we need to
question our work and concepts.
The 20th anniversary of the Journal Neuropsychoanalysis
is a perfect time to reflect on its history and influence. The
Journal has had an important impact on many psychoana-
lytically oriented minds and it is improbable that at this
point there are people in the field who do not know
about the neuropsychoanalytic dialogue. Many ideas,
much research, and numerous discussions have been pub-
lished, inviting anyone interested to join the conversation.
Freud opened the way. It is in us to expand its scope in
hope of a better comprehension of the mind. It may be a
difficult task, but I have not yet doubted that there would
be no psychoanalysis without neuroscience. Happy 20th
anniversary NPSA!
dannmos@yahoo.com
Coming of age and neuropsychoanalysis
Aikaterini (Katerina) Fotopoulou
I did not have a name for it back then, let alone a clue of
how long it would last, but 20 years ago, in September
1999 I entered what autobiographical memory experts call
a new “life period.” I moved from my native city of Athens
to another capital, London, the population of which is
NEUROPSYCHOANALYSIS 101
roughly the size of Greece, my native country. The con-
scious goal was to stay in this new metropolis only one
year, in order to study theoretical psychoanalysis at Univer-
sity College London (UCL). I do not remember ever con-
sciously, deliberately making this decision, but one MSc
led to another and 20 years later, I am still here, now
working as a Professor of Psychodynamic Neuroscience, ser-
endipitously in the exact same UCL department where it all
started. As I learned later from Martin Conway, a renowned
memory expert, a wonderfully ambivalent friend of psycho-
analysis and my PhD supervisor, my memories would
forever be organized as originating from “before” and
from “after moving to London” life-periods, and my latter
life-period coincides with the history of the field of neurop-
sychoanalysis. The evolution of the field, I will further try to
explain below, became an important part of my academic
life and interests as these evolved in London and beyond.
I remember those early neuropsychoanalysis days with
the sensory acuity afforded to a young, naïve student in a
foreign country. London was grayer and gloomier than
what I had known, yet lecture halls, professors and books
had opened up a big, bright world of geekiness I always
longed for. Like many others, my introduction to neuropsy-
choanalysis started with a remarkably lucid lecture by Mark
Solms. Not all of my classmates were interested in his rather
“mechanistic” thinking, and the whole “neuro” thing
seemed alien to most people’s interests, apart from the
few people in the course. Yet, because I had been ambiva-
lent about the endless theorizing in psychoanalysis, I found
the clarity of Mark’s thought impressive. He managed to
make graspable so many of the tangled concepts I was
reading at the time, and I jumped at the opportunity to
observe him during neuropsychological work and to
conduct my MSc thesis under his supervision – twice, as it
turned out. The topic of my second MSc, supervised by
Mark, was the same topic as the first issue of Neuro-psycho-
analysis: confabulation, or false memories, following
damage to the frontal lobes. I still have my original hard
copy, with almost every other sentence underlined. I am
afraid that the first edition of Clinical Studies in Neuropsy-
choanalysis, first introduced to me by Karen Kaplan-Solms
herself on a dull Thursday afternoon while I was waiting
for Mark to fetch another book from their library, has met
the same multi-colored fate.
I attended every seminar that Mark led at UCL and at the
Anna Freud Centre, including those that led to The Brain and
the Inner World (Solms & Turnbull, 2002). I brought along my
friend and colleague, Manos Tsakiris, the now internation-
ally-recognised Professor of Psychology and a friend of
the field. I met Oliver Turnbull, another now-renowned pro-
fessor in the field, for the first time at the old, Victorian
building of the Royal London Hospital. While waiting for
Mark to give a lecture, we discussed memory, awareness,
and their childhood in South Africa until my head hurt,
and I had to find an excuse just to get out of the building
for some sunlight. On my return, Mark spent a little bit
more time with me and advised me to study
102 SOCIETY PROCEEDINGS
neuropsychology under his supervision. We were going to
try to investigate the emotional content of confabulation.
We were going to try to find experimental ways to demon-
strate that patients with neurological damage do not just
suffer from broken “modules” in the machinery of their
brain, but are actually expressing their longings and preoc-
cupations, no matter how “out of context” they sounded. I
eventually followed his advice and, under the expert and
watchful eye of Oliver, conducted my first neuropsychologi-
cal assessment of a confabulating patient just a year later.
A few short months after this first foray into the world of
neuropsychology was the first conference of the Society. I
remember vividly that first London conference; listening
to and meeting Oliver Sacks, Jaak Panksepp, Antonio
Damasio, and many more. I remember Mark’s contagious
enthusiasm; professional success and a long-awaited ambi-
tion to bring psychoanalysis and neuroscience together
finally coming true. All those emotions bound up with the
happiness and excitement of the birth of his daughter in
the same week. I remember Mark mentioning his confabu-
lation ideas, and even mentioning me at one point. I sud-
denly felt part of something academically important that
was being born after a century of delay. All the speakers
agreed that emotions had been long neglected in neuro-
science. Neuropsychoanalysis was going to be the answer.
The aim was to bring affective neuroscience and psycho-
analysis together in the same room. Emotion would now
be at the heart of how we study the mind and the brain.
“All you need to do is look at an infant,” Mark told us,
“and you see that we start our lives as being not much
more than ‘balls of affect.’”
It was the year 2000, I was still rather young and all this
“birth” happening around the topics I had loved so much
during my studies. It was just impossible to resist! I had
found an academic purpose, I was not going to let go.
And yet, the route to a career in neuropsychoanalysis did
not exist and Mark’s mind was increasingly set on higher
goals and on returning to South Africa. My academic
journey took me from the cold, dark Durham in the north
of the UK to the hot, beautiful but politically complex reali-
ties of Cape Town. Then I found myself at the British mecca
of biological psychiatry and cognitive behavioral therapy at
the then Institute of Psychiatry in south London. At each
step, I was worrying if and where the next job or grant
opportunity would come from. At each step I was feeling
lonely in the competitive world of British academia and
found myself having to justify, or hide my “arcane” and
“unscientific” interest in psychoanalysis. Although I lost
several parts of my Greek-ness and sanity in the process, I
owe my survival and ongoing interest to ample reserves
of Greek stubbornness, the people I shared my passion for
neuropsychoanalysis with, and the psychodynamic nature
of the mind. I will spare you the first factor here and
proceed to the other two.
While I was on a PhD study visit in Mark’s department in
Cape Town in 2003, he asked me to join the infamous Neu-
ropsychoanalysis Action Group. Gyuri Fodor’s brain child, I
believe, the Action Group was supposed to be something
between an executive and an administrative committee.
Our main task was to ensure Mark Solms and Paula Barkay
were not alone in their tasks of running a Society, a Con-
gress, a Journal and all that went with them. With industri-
ous people like Maggie Zellner now on board, these tasks
became efficient and slowly but surely neuropsychoanalysis
became the well-publicized International Neuropsychoana-
lysis Society we all recognize today. To me, deprived of an
actual family during the early “after the move to London”
years, they quickly become my academic family. We met
twice a year in London, as well as at the annual conferences
and we communicated with emails frequently. The salience
of all of these encounters for me made them feel much
more frequent and kept me going at times where nobody
else in my morning job cared about, and was possibly
hostile towards, neuropsychoanalysis. I was the youngest
person by at least a decade. I was clueless in so many
ways, but I quickly understood that while the rest were
more mature, knowledgeable, and professional, we were
all in it for the same sense of purpose and belonging it
gave our working lives. Mark’s charisma and his dream of
changing neuroscience and psychoanalysis were addictive.
His personality and leadership style was seductive to men
and women alike.
The prevailing metaphor from 2003 onwards was not so
much of birth anymore, but of marriage. A lot of our discus-
sions, in hindsight, were how to make this rather seemingly
incompatible couple, neuroscience and psychoanalysis,
realize that they belong together, that they have this child
– the mind – together, and hence they should listen to
each other and they should try to communicate better. I
did not know, nor would I have suspected it back then,
but the marital status of every single person in that group
would eventually change, with divorce and remarriage
being one of the most common outcomes. I did know,
but I did not want to know back then, that my academic
family, with its sublimated topic of marrying the emotional
mother (psychoanalysis) with the more rational, somewhat
emotionally-blind, father (neuroscience), would actually
somehow relate to the history of my parents’ long but strug-
gling marriage and their eventual divorce.
So, was that really it? A charismatic teacher and a subli-
mation shared by a group of friendly professionals? No.
These personal, reconstructed memories and meanings
may well capture some of my persistent motivation to
pursue neuropsychoanalysis. There are many more layers
to my personal story. However, from these early days to
today, long after the bright lights and greater expectations
of our field have been replaced by less grandiose hopes and
more realistic goals for a “psychodynamic neuroscience,”
there is one crucial factor that keeps me persisting in the
field. Psychodynamic theory remains one of the best avail-
able theoretical frameworks to understand the mind and
particularly its depth. I do not accept it uncritically. I cer-
tainly do not accept it all. Some parts of it are irrelevant,
others are just wrong based on current knowledge, and

some others are just too crazy to even engage with. Yet
there is so much wisdom and depth in the theory and the
unique, clinical observations it has afforded. It has been
an anchor for my scientific and clinical thinking since the
first, confabulating patient I interviewed 20 years ago, to
the current theory of anorexia nervosa I have put forward
within the field of computational psychiatry. Time and
time again, in the past 20 years, I found myself reading
something in a neuroscientific article, or feeling something
while being with a patient that compels me to grab some of
my old, and not so old, psychoanalytic books to find that
vignette and its interpretation. Time and time again such
books led me to design novel experiments and test an
idea in a completely new way than the existing one.
Emotion is now a mainstream neuroscientific topic. We
no longer need to fight for it to be taken seriously. Relation-
ships are now studied in earnest, people are put into brain
scanners in pairs, and mothers are scanned while looking at
their own babies. Science got there anyway, our fathers are
now interested in our soft side too, and they are taking
steps to understand their own. Even the dynamics of the
brain are now explored better by theories and methods of
neuroscience. Yet we still have a lot of work to do to under-
stand and treat many sources of human suffering and we
have more and more tools to do so. My work on anosogno-
sia was a persistent exchange between psychoanalytic
reading and hard testing work in hospitals. Our past work
on oxytocin, pain, affective touch and “mentalising homeo-
stasis” owes as much to affective and social neuroscience, as
it does to relational psychoanalysis. Our new work, funded
by the European Research Council, no less, owes as much
to computational neuroscience as to psychoanalytic ideas
of metamorphoses, projection and identification. Psycho-
analytic books remain in prominent positions on my
shelves. I read and re-read them, I meet clinicians, I have
become a clinician myself, I listen, I observe and try to dis-
entangle the bits of the mind puzzle that are worth explor-
ing and that can be studied empirically from those that are
not and cannot, respectively. I keep and integrate the
former bits and I translate them into neuroscientific
language and if I am lucky to have the resources, I design
and test experiments. This is not the only way to do work
within the wider umbrella of neuropsychoanalysis but it is
an important way. I have called it “psychodynamic neuro-
science” to signify that the theory is psychodynamic but
the methods and the field that this research belongs in is
neuroscience. My empirical studies are not and they
cannot be regarded legitimately as part of psychoanalysis.
Importantly, one can pursue this kind of research and this
kind of career in a University and I offer training and oppor-
tunities to new students. I cannot offer them the promise of
a harmonious marriage between psychoanalysis and neuro-
science; something has to give, a loss needs to be accepted,
a position needs to be abandoned. However, I can offer
them a career in neuroscience that is as mindful as it gets
and they certainly do not need to hide their interests and
NEUROPSYCHOANALYSIS 103
human vulnerabilities from their own supervisor. In my lab
we pride ourselves for our “soft,” emotional and relational
take on science.
a.fotopoulou@ucl.ac.uk
Reflections on my contact with
neuropsychoanalysis since 2000 where
everything officially started!
Maria Sonia Goergen
I am a neuropediatrician. My professional life started a long
time ago, when pediatric neurology was overlooked as a
choice of specialization in medical field (1978), as it was
mostly done by neurologists and neurosurgeons. I had
finished medical school and went from Porto Alegre,
Brazil, to Oxford, England (where, for the first time, I
began to deal with being a “foreigner” – looking back on
it now makes me understand many things in the way
about the way I built my own neural network!).
My first patient, during an internship in neuropediatrics,
at HEPAC, Churchil Hospital, Oxford, was a child from a
former English colony in Africa. I was chosen to sit in with
her, to be recorded, mostly because I had an accent in
English (my first language is Portuguese, represented in
my dominant hemisphere), mixed up with a slight
German accent due to my background (represented in my
non-dominant hemisphere); my granny did not speak Por-
tuguese and till the age of five I dealt with two different rep-
resentations binding language and affect. Now I am
convinced that, to build in knowledge, the input that
came through the non-dominant hemisphere was much
easier and meaningful for my autobiographical memory,
and that helped me too to represent knowledge in cortical
associative areas; the language, but mostly the affect. This
does the strengthening on its representation linked and
strengthened by, at the underpinnings of neurodevelop-
ment. And, this helped me to understand, but mostly
opened my mind to new ways to pursue the pieces of the
jigsaw puzzle in ASD and other neurodevelopmental dis-
orders, making the doctor-patients relationship with them
a constant knowledge acquisition. To this extent, this auto-
biographical note is a brief comment upon the ability a
human mind can go throughout life bottom-up/ top-
down: The way we perceive our surroundings and sensorial
input, the way we organize the sequences of our motor
planning, modulated by emotion, and the way the body is
mentalized, will influence our actions, decision-making,
attention, and interactions/inhibitions of the primitive/
immature bottom-up systems by the top-down systems.
In this regard, it’s perhaps not a random crossing of paths
that I put myself into what I do! To make sense of what I was
trained for (pediatric neurology), that is, understanding a
child in its neurodevelopment, recognizing the “bad
104 SOCIETY PROCEEDINGS
clusters” of variables that affect his or her perception/inte-
gration and action, and only then giving a diagnostic
hypothesis, I had to pursue an interdisciplinary consilience.
And here comes another “crossing of paths:” while I was
reading Consilience: The Unity of Knowledge by Edward
Wilson (1998) and applying it in my seminars on transdisci-
plinary integration of neurology for psychologists, using
case studies of Oliver Sacks and linking them to psychoana-
lysis, one of my students came across the announcement on
the internet of the first congress of the International Neu-
ropsychoanalysis Society. She told me: “This looks so
much like the way you bring us the information on consili-
ence … ”
Well! From that moment onwards, I met the authors that
would underpin my theoretical approach to my clinical
work. Never again I would be the same: Affective Neuro-
science by Jaak Panksepp (1998) was all I needed to under-
stand what happens inside my patients’ neural network, as
well as to advance through The Brain and the Inner World
(Solms & Turnbull, 2002). Amazingly, it is such an addictive
experience of learning that I never stopped reading and
learning and updating through the meetings and supervi-
sions, and linking clinical findings and therapeutic decisions.
It is wonderful to learn about the human brain and the way
it works using this consilient approach. It opens your mind
to diversity. It gives you paths to pursue new alternatives to
use the patient’s potential abilities.
For example, Professor Panksepp “infected” me with the
understanding of opioid system, leading to the use of nal-
trexone on my kids on the ASD and self-mutilation; the
use of melatonin in sleep disorders; and explicitly engaging
the bottom-up/top-down system in the substrate for the
methodology of The PLAY Project™ (a parent-
implemented, intensive early intervention program for
young children with autism that is evidence-based.) used
by neuroplaybrasil (http://www.neuroplaybrasil.com/) that
I brought from Ann Arbor, Michigan, to Porto Alegre, Brazil.
The new development of the Clinical Register, which
considers professionals validated with some specialized
knowledge as Clinical Fellows in neuropsychoanalysis
(since 2018) by our Society is a clear way of demonstrating
that the continuing education in a field can take you to new
levels of understanding the complex system of brain/mind
and body, and that it is worthwhile.
A child with his family is a constant puzzle. The pieces
must fit together to make sense. Only then can we get
the right intervention for each child to achieve the develop-
ment of his full potential.
This is an amazing journey; after more than 40 years of
clinical practice (18 of them living in the “back and forth”
between 2 countries/2 cultures), I must say neuropsychoa-
nalysis made all the difference for the results I see and get
back from my patients in my day-to-day practice.
Msonia12@gmail.com
Neuropsychoanalysis: From Brucke to Freud
to Solms
Richard Kessler
Sometime on a Saturday in 1979, in the bowels of G building
at the Downstate Medical Center, our inspiring Chapter 7
teacher, Martin H. Blum, was holding court. He recited one
of Freud’s dreams:
Old Brücke must have set me some task; STRANGELY
ENOUGH , it related to a dissection of the lower part of my
own body, my pelvis and legs, which I saw before me as
though in the dissecting-room, but without noticing their
absence in myself and also without a trace of any grue-
some feeling. Louise N. was standing beside me and
doing the work with me. The pelvis had been eviscerated,
and it was visible now in its superior, now in its inferior,
aspect, the two being mixed together. Thick flesh-coloured
protuberances (which, in the dream itself, made me think
of haemorrhoids) could be seen. Something which lay over
it and was like crumpled silver-paper had also to be care-
fully fished out … (Freud, 1900, p. 452). (In a footnote in
the same passage, Freud remarks that the silver paper is
a reference to “Stanniol”, which was an allusion to the
book by Stannius on the nervous system of fishes.)
Although Freud had commented that one could “easily
imagine what a number of pages would be filled by a full
analysis of this dream” (Freud, 1900, p. 453), Blum empha-
sized how the dream represented the birth of The Interpret-
ation of Dreams and thusly the birth of psychoanalysis. “The
task which was imposed on me in the dream of carrying out
a dissection of my own body was thus my self-analysis which
was linked up with my giving an account of my dreams”
(Freud, 1900, p. 454; emphasis in the original).
It was exhilarating to follow Freud’s dance across the
boundaries of self and other, masculine and feminine and
mind and body. How deftly he had translated the mis-
guided movements and sensations of his hysterical patients
into a mental and emotional vocabulary! Although Dr. Blum
had used a computer metaphor (a Turing machine) to
explain the workings of Freud’s mental apparatus, there
surely was nothing mechanical about it in the animation
of the flesh by the life forces of self- and species- preser-
vation. The metaphors bridging body and mind enlivened
each clinical case and dream specimen.
It is popular to speak today of the embodied mind, but
psychoanalysis was embodied from the beginning! It was
that vision of the mind as originating from the body that
drew me, a college psychology major, to psychoanalysis.
The insight that the mind was the product of the work
demanded upon it by the body seemed inevitable.
However, although intuitively self-evident, it was actually
built on the 20 years of Freud’s painstaking explorations
of the nervous system.
Ernst Wilhelm Brucke had indeed, in waking life, set
Freud some tasks from 1876 to 1882 at the Institute of
Physiology in Vienna. The project, alluded to in the dream,

was the dissection of the nervous system of a primitive fish,
the lamprey.6 Thus a 20-year neuroscientific gestation
began that lasted from 1876 through 1896, leading to the
eventual birth of psychoanalysis. Freud’s agonizing over
the Project (Freud, 1895) that year was testimony to how
difficult the labor had been!7
It may come as a surprise to psychoanalysts and neuros-
cientists alike that Freud’s work in that 20-year period made
several notable contributions to neurology and neuro-
pathology. Yet they “have long since been forgotten
despite their pivotal role in launching the discoveries of
other scientists” (Galbis-Reig, 2003). A partial and brief
listing would include:
. Demonstration of the phylogenetic association between
the central nervous systems in lower vertebrates and
humans (Galbis-Reig, 2003).
. Introduction of gold chloride to stain nervous tissues that
lead to the first detailed descriptions of the structure and
function of the medulla oblongata and its connection to
the posterior columns of the spinal cord, acoustic nerve
and the cerebellum (Galbis-Reig, 2003).
. Suggestion of roles for the trigeminal nucleus, the
meninges, and the innervation of blood vessels in the
etiology of migraines (Triarhou, 2010).
. Documentation of coherent evidence suggesting that
the protoplasm of cells consists of a contractile fibrillary
network, the present-day cytoskeleton, making him
one of the founders of the “fibrillary theory”8 (Triarhou
& Del Cerro, 1987).
. The first documentation of movements of nucleoli in
nerve cells, a phenomenon presently known as nuclear
rotation (Triarhou & Del Cerro, 1987).
. Publication of the three volume Infantile Cerebral Paraly-
sis (1897), which has been called revolutionary, masterful,
and exhaustive. Its challenge of the birth trauma etiology
of cerebral palsy formulated by William John Little and
William Osler was eventually validated in the 1980s,
and its proposed classification system of it remains in
current use (Lawson & Badawi, 2003; Longo & Ashwal,
1993).
. Lecture on The Structure and Elements of the Nervous
System (1984) in which Freud “comes close to being
the first to describe the ‘neuron doctrine,’” the foun-
dation of modern neuroscience. (Galbis-Reig, 2003). It is
recognized as such by Santiago Ramon y Cajal9 who in
his 1894 magnum opus, Histology of the Nervous System
of Man and Vertebrates, cites Freud’s work (Triarhou &
Del Cerro, 1985).
Freud was involved in an exciting and revolutionary
international dialogue that characterized the origins of
modern neuroscience. Galbis-Reig (2003) suggests that his
neurohistological work alone was “monumental and pro-
vided the scientific community with the basic foundation
necessary to carry out further investigations that would
inexorably lead to a unified theory of the structure of the
NEUROPSYCHOANALYSIS 105
nervous system” (p. 4) while Bennett (2015) asserts that
Freud’s work made “fundamental contributions to our
understanding of the structure of the nervous system”
(p. 237).
But Freud went beyond the neuroscientific explorations;
they became the springboard for extended insights into the
minds and bodies of patients. His concept of the nervous
system would be greatly expanded in the Project, where
his description of how memory might be represented at a
synaptic level anticipated such crucial discoveries as those
of long-term potentiation properties (Centonze, Siracusano,
Calabresi, & Bernardi, 2004) or Hebb’s 1949 work on neuro-
plasticity and dynamic neural networks (Kiernan, 2011).
Back to 1979! Alas, there was little within psychoanalysis
to sustain one’s interest and convictions about the biologi-
cal core of psychoanalysis except for exchanges with a few
peers and, occasionally, Dr. Blum. Sustenance came from
the work and thought of such luminaries as Stephen Jay
Gould, Jonathan Winson, Gerald Edelman, Jason Brown,
Oliver Sacks and others. However, their writings made
only the most tenuous, if any, of references to psychoanaly-
sis. We were on our own, keeping the faith amid the general
skepticism about and neglect of biologically infused Freu-
dian metapsychology. A new era arrived with the founding
of neuropsychoanalysis by Mark Solms, ending the long
dormancy of Freud’s marriage to evolutionary biology.
Our journal, Neuropsychoanalysis, is in its 20th year. Its
age echoes the gestational years of discoveries and insights
which led Freud to the establishment of psychoanalysis. But
it is also a second coming, an opportunity to test and build
on them by further inquiries and exchanges. It is a forum for
maintaining a stimulating and inspiring international inter-
disciplinary dialogue. It is a platform for the fledgling new
discipline to bring readers together to revisit, revise, ques-
tion and inform, to think anew. In the process, the Journal
reflects the evolution and maturation of neuropsychoanaly-
tic propositions. Among them, major tenets from the
dustbin of discarded biologically-inspired psychoanalytic
theories have undergone reinvestigation within the last
decade. Thus, Jaak Panksepp’s affective neuroscience has
promoted an invigorated look at drive theory and inspired
Solms’ “The Conscious Id” (2013), resuming “Freud’s quest
to infuse Darwinian evolution into an understanding of
Man’s nature by extending it beyond psychology and
more fully to neuroanatomy and neurophysiology” (R.
Kessler, 2013, p. 52). Likewise, Karl Friston’s and Robin
Carhart-Harris’s neurobiological accounts of Freud’s
energy formulations (2010) and their application to under-
standing consciousness (Solms & Friston, 2018) has
offered an updated psychoanalytic metapsychology which
can serve as a common scientific denominator for existing
psychoanalytic pluralism. For psychoanalysis, at its
essence and in all its variations, represents the study of
the “extension of human biology into the psychosocial
sphere” (L. Kessler, 2019).
drrichardjkessler@verizon.net
106 SOCIETY PROCEEDINGS
The International Neuropsychoanalysis
Society and its journal – 20 years later: Some
memories
Iréne Matthis
In May 1995, an international meeting on “Freud’s Preanaly-
tic Writings” was gathered in Ghent, Belgium. Reflecting on
the history of neuropsychoanalysis, this was for me an
important conference, as its subject matter was the inter-
section of neuroscience and psychoanalysis. This was
exactly the interdisciplinary approach I had been looking
for. At this meeting, I met Mark Solms for the first time
and learnt of his engagement in the translation of Freud’s
early neurological articles and his involvement in the
New York Psychoanalytic Institute’s Neuroscience-Psycho-
analysis Study Group, which had been initiated by Arnold
Pfeffer some years earlier.
Having started my psychoanalytic practice in 1972, in the
beginning I also worked with borderline and psychotic
patients. After leaving hospital work in 1976, I moved
more into the practice of treating not only so-called neuro-
tic persons, but patients with somatic diseases. I found that
the treatment had an impact also on the somatic symptoms,
but I was not understanding why. In this work, Joyce
McDougall and Piera Aulagnier in Paris became my special
mentors and teachers. They brought the body into the
field in a way that was of paramount importance for my
clinical work. During the 1980s I spent a lot of time in
France. I had earlier studied Lacan, and I translated and
introduced his work, as well as other French psychoanalysts,
in Sweden.
And, now, here in Ghent, in 1995, I met Mark Solms. He
widened the psychoanalytic clinical field even more, by
bringing in the processes of the brain. I was delighted.
The year after, he came to Stockholm presenting his
paper: “What is Consciousness?” and in September 1997
he came back presenting his paper on “Psychoanalysis
and Neuropsychology.” I had by this time presented my
medical dissertation at the University of Umeå: “The Think-
ing Body. Studies on the Hysterical Symptom.” Based on a
detailed reanalysis of Sigmund Freud’s case studies in
Studies on Hysteria (1895), I explored two intertwining
themes: the dynamics of the relationship between the
patient and the physician, and the border and the transition
between the psychic and the corporeal spheres – apparent
in the hysterical symptom seen as a model for (psycho)so-
matic symptoms in general.
The ball was rolling. The same year The Body Mind Study
Group of the Swedish Psychoanalytic Society was initiated
and some groups from this starting point are still continuing
their work today.
In 1996 I had spent the summer months in Berkeley, Cali-
fornia, taking part in a research seminar “On Consciousness.”
With John Searle and George Lakoff as seminar leaders, and
with many prominent lecturers (Antonio Damasio, Donald
Dennett, Frank Churchland, Roger Penrose, et al) it was an
important time for deeper reflection. At this time, I also
started commuting from Stockholm to New York in order
to take part in the New York Psychoanalytic Institute’s
Neuroscience-Psychoanalysis Study Group’s meetings
every month. With Mark Solms and Oliver Turnbull I share
many good memories from these years. I also visited and
spent time with other researchers and their groups, such
as Howard Shevrin, in Chicago, and Luis Chiozza in
Buenos Aires.
In July 1999, in Santiago, Chile, we had our first panel at
the 41st International Psychoanalytical Congress. The
subject was not easy: Biological and Integrative Studies on
Affect. Luis Chiozza (Buenos Aires), David Olds (New York)
and I myself (Stockholm) each presented a paper. Mark
Solms was the moderator and Regina Bucci the reporter.
My paper, “Sketch for a Metapsychology of Affect,” was
then published in Int. J. Psychoanal. (2000) 81, 215–227.
The founding committee of the International Neuropsy-
choanalysis Society. Front row, from left to right: Arnold
Pfeffer, Iréne Matthis; back row, left to right: Mark Solms,
Jaak Panksepp, Howard Schlossman and Oliver Turnbull.
During the same time span, the first issue of the Journal
Neuro-Psychoanalysis was prepared and published.10 Then
the planning of and the opening in July 2000 of the First
Neuro-Psychoanalytic Conference in London took place,
on the subject of Neuroscientific and Psychoanalytic Perspec-
tives on Emotion. This was of course a historical moment for
all of us. It was vitally important to us that the spirit of these
first moves live on. And so it did. In April 2001, the Second
International Conference was held in New York, on the
subject of “Neuroscientific and Psychoanalytic Perspectives
on Memory.” Then in September 2002, at the Third Inter-
national Conference on “Neuroscientific and Psychoanalytic
Perspectives on Sexuality and Gender,” I was given the trust
to organize this third meeting in Stockholm. As it, at the
time, was a rather touchy topic, I thought it called for a
special arrangement. I also was a member of COWAP (Inter-
national Psychoanalytical Association Committee on
Women and Psychoanalysis) and had been asked by the
committee to organize a COWAP conference. So I thought
a juxtapositioning of the two meetings could lead to inter-
esting new perspectives. During two days preceding the

Neuro-Psychoanalytic Conference, the COWAP conference
was held on “Sexuality and Gender Issues Related to Feminin-
ity and Masculinity.”
At Stockholm we also introduced a Research Day follow-
ing the main neuropsychoanalytic conference. Since then
this has become a day of increasing importance in our work.
From the outset of the journal in 1999, I edited the “Bul-
letin of the Neuro-Psychoanalysis Society,” which has been a
regular continuing feature of the Journal. This meant con-
necting to societies all around the world, encouraging
people interested in the subject of neuropsychoanalysis or
body/mind issues to form study groups. For many years I
corresponded regularly with some 30 groups, and after
eight years alone at the job, Maggie Zellner, from
New York, volunteered to give me a helping hand. A year
later, to my great joy, she took over that section. And in
recent years, as you know, she has served as a brilliant
Editor of the whole Journal, as well as taking on a great
responsibility for the Education Day at our conferences, a
day that preceded the main conference and was introduced
in 2003.
So many things happened, and so fast, during these few
years in the end of the twentieth century and the beginning
of the 21st, that it is difficult to separate them out from each
other, or tell what were the most important inputs. It all
came together as a powerful outflow of energy, curiosity,
and togetherness. For me, three people stand out: Not
only Mark Solms, our grand master, but also Oliver Turnbull
and Paula Barkay. Oliver co-ordinated everything and Paula,
at the secretariat, held her supporting hands around all of
us, all the way through.
Today, when I no longer fly around the world, I rejoice in
the continued success of the Journal and the Society. The
theoretical and clinical achievements that I read about in
the Journal are still encouragement to me and material
for the seminars I continue to give in Sweden, on neuropsy-
choanalysis and related subjects.
irene.matthis@gmail.com
On books, muses, instincts and their cortical
vicissitudes
José Fernando Muñoz Zúñiga
For me things began, as it is the case for many, with the
Project. History has it that for some of us, Freud’s ghost
apparently can’t rest in peace until his Project for a scientific
psychology (1895) comes to good terms. I read the 1895
manuscript as a medical student, and became fascinated
by the idea of trying to comprehend psychodynamic con-
cepts like repression, the pleasure principle, the ego and
so on, from a neuroscientific point of view, even if it had
its fair dose of speculation and century-old neurobiological
concepts.
With this early Freud as my muse, I began reading both
kinds of literature; and so the reading of an enigmatic book I
NEUROPSYCHOANALYSIS 107
bought in 2006 had to wait until 2010, when I was a first-
year psychiatry resident: Clinical Studies in Neuro-Psychoana-
lysis (Kaplan-Solms & Solms, 2000). When I finally did, there
it was: these authors were trying to accomplish, with great
clinical courage, what Freud could only dream of. These
texts paved my way to get to know other authors like Pank-
sepp, Northoff, and so on. I mention this literary journey
because, as a young adult, these authors gave me ideas
and dreams. Thus, among other reasons, I was thinking
about neuropsychoanalysis when I decided to become a
neuropsychiatrist; and then, again, I had neuropsychoanaly-
sis in mind when I chose to become a psychoanalyst. There
was a dream of being able to exist between both fields, to
go beyond each field’s data constraints, to gain a more
perfect understanding of the mindbrain.
I do not know if that will end up being the case, but what
I do know is that, without this conceptual background, I
would have missed the opportunity one day in 2013 of
asking myself what exactly had been irrevocably changed
in the inner world of a patient my neuropsychiatric
mentor and I had recently interviewed, a patient who
suffered from a Klüver-Bucy syndrome (KBS) (Muñoz
Zúñiga, Ramirez-Bermudez, Flores Rivera Jde, & Corona,
2015). This is a devastating neuropsychiatric syndrome,
associated with bilateral damage in temporolimbic and
paralimbic areas, consisting of severe affective and behav-
ioral symptoms like hyperorality, hypersexuality, hyperpha-
gia, loss of fear and loss of aggression, among others. Long
described in the animal research literature and in neurology,
it’s possible that questions about the inner world might not
have occurred to a conventionally trained neurologist or
psychiatrist, who might have focused on the impaired
top-down control aspects of the disorder, in a somewhat
mechanistic way. However, the more I listened to her, the
more I realized she seemed to live under the ruthless
control of raw affects that had to be satisfied in peremptory
and socially inappropriate ways. So one could find her
keeping food in her mouth, while impulsively grabbing
objects in her surroundings, and approaching the medical
staff with inappropriate questions about their sex life and
proposals of intimacy; all this in less than a minute, in a
sort of libidinal cacophony. As it was described in the neu-
ropsychoanalytic case report, published in this journal
(Muñoz Zúñiga, 2015), one was left wondering, not as a
theoretical, but as a very real issue, how much of an incur-
sion of affect the ego could tolerate before it started to
become undifferentiated from the id itself – that is, follow-
ing the inverse direction Freud proposed for the develop-
ment of the psychic apparatus. I could not help this
patient; her symptoms were too severe to allow neuropsy-
chotherapy, or psychotherapy for the brain-injured
patient, to happen, and she remained mostly refractory to
pharmacological treatment, as it is often the case with
patients with KBS. But, through her suffering, she gave us
precious knowledge about the nature of affects and about
what happens when the hierarchical organization of
108 SOCIETY PROCEEDINGS
neural networks involved in emotional processing becomes
disrupted.
The experience of thinking about this patient in this way
also gave me the kind of confidence that proved useful
some time later, when I received a patient with the so-
called organic aggressive syndrome (OAS). The OAS is
associated with damage to orbitofrontal cortex, and is
characterized by sudden, reactive, explosive, non-reflective
and ego-dystonic anger outbursts. Once it became evident
that pharmacotherapy had reached a plateau in controlling
his aggressive behavior, a dynamically oriented short-term
supportive therapy was begun by common agreement. At
a metapsychological level, it seemed like a fracture in
inner ego boundaries had taken place, one that appeared
clinically as a keyhole through which one could observe
aspects of the workings of the id. The patient acted out
these id intrusions in endless cycles of affective attacks in
a repetition compulsion-like fashion. Slowly, as it was
described in another piece in these pages (Muñoz Zúñiga,
2017), we began to understand that, besides the hypoth-
esized damage to executive control centers of the RAGE
system, the ambivalence the patient harbored towards his
mother through the course of development seemed to
function, to a certain extent, as a template for the outbursts,
as evidenced in the scenarios and triggers that strength-
ened the possibilities of an attack taking place.
Currently, I’m working with a patient who sustained a
lesion in his right ventral caudate nucleus, and subsequently
developed impulsive and addiction-like episodes of candy
eating. Apparently, the lesion produced quantitative and
qualitative changes to the experience of wanting sugary
foods, and to the hedonic experience of consumption as
well. Of interest, during those episodes the patient experi-
ences oral phantasies of finding lots of candy, “delightful
and exquisite” candy. The patient has drawn these phanta-
sies, representing himself with childish enthusiasm and
euphoria over the ingestion of what is seen as something
akin to an archaic good object that will make him feel
truly happy and satisfied.
While I believe that it is true that “the primal affective
layers of the mind [are] most easily studied in animal
models,” as Panksepp put it (Panksepp & Solms, 2012),
these kind of neuropsychiatric cases, with lesions in limbic
and/or paralimbic areas, have shown me that they may
give us unique insights about affects and the hierarchical
nature of the mindbrain, with the benefit of having at the
same time access to declarative tertiary affective processes,
similar to the insights developed by Solms and Kaplan-
Solms with patients with cortical injuries. This, in turn,
may help us to recalibrate and expand metapsychological
concepts like the drives and the conscious id (Solms,
2013). So far, clinical findings suggest to me that we can
characterize as a group some common metapsychological
consequences of the neurological lesion pertaining to
these patients. For instance, we see that when brain areas
that sustain different levels of affective processing are com-
promised, this correlates, among other things, with fractures
in inner ego boundaries and ego-id dedifferentiation. The
psychic apparatus thus follows an inverse trajectory to
that of psychological development, with one difference:
unlike early childhood, where the proto-ego has to learn
how to use the id’s energies to deal with the external
world, here we have an injured ego that capitulates to a
pathologically strengthened id. The injured ego becomes
unable to structure id intrusions, leading to affects gaining
free access to the motor pole; as Freud would put it, the
commerce between both systems has been lost. Following
Green (2003), these neuropathologies of the id seem to dis-
sociate the two dimensions of affects, that is, affects as both
quantitative – the quota of affects – and semantic phenom-
ena – signifiers of the state of the inner body –; leading to
stereotyped behavior, where affects are no longer
meaning-carrying units, but quantities that must be dis-
charged through acting-out.
In order to both listen and try to help these patients in
modified, dynamically-oriented forms of neuropsychother-
apy, several challenges must be taken into account. First
and foremost, there is often an anosognosia, that, when
severe, may jeopardize any attempt of creating a therapeutic
bond. In addition, anosognosia may sometimes collude with
primitive defense mechanisms like negation. Also, the pres-
ence of global aphasia, global amnesia, and severe behav-
ioral symptoms may prevent patients from benefiting from
psychotherapy. This has led me to study authors who prac-
tice psychotherapy for individuals with brain injury not
necessarily within the psychoanalytic tradition, since for
these cases focusing on early childhood experiences and
relying on introspection alone is of limited use (Coetzer,
2010; Klonoff, 2010; Laaksonen, 2013; Ruff & Chester, 2014).
Hopefully these clinical and theoretical elaborations may
help to illustrate why I feel that neuropsychoanalysis has
helped me to integrate, and to some extent to stabilize,
my hybrid training. With some neuropsychiatric patients I
get to see the primal layers of the mind; with my psychoana-
lytic patients I get to feel the most sophisticated layers of
affective experience, through lapsus, phantasies, defenses,
and transference and countertransference phenomena.
Big challenges remain, for neuropsychiatry and neuropsy-
choanalysis, in the comprehension of affects and their
place in the normal functioning of the mind, but who
knows what (neuropsychoanalytic) dreams may come?
lucesdeeuforia@hotmail.com
Brain and subjectivity – A contradictory
couple at the heart of neuropsychoanalysis?
Georg Northoff
Brain and subjectivity – Can they go together?
Brain and subjectivity? That does not fit together at all. The
brain is considered an object and therefore not related to
anything that is subjective. Brain and subjectivity thus

seem to be a rather contradictory couple. Neuropsychoana-
lysis tries to overcome that contradiction.
What is neuropsychoanalysis? At first glance, one would
say that it is about combining the brain with psychoanalysis.
That is the easy road to an answer. However, there are two
underlying questions, which are more difficult to answer.
The first is to question what psychoanalysis is by itself.
The answer to that question provides information to at
least one half of our initial question. The other half consists
in the question of what the brain is. That seems to be a see-
mingly banal question which, as it will turn out, is a rather
difficult one.
Subjectivity in philosophy, psychoanalysis, and
psychiatry
Let us start with what psychoanalysis is about. What
attracted me to psychoanalysis is that it takes into consider-
ation the essential subjective nature of the human psyche.
What do I mean by subjectivity though? Subjectivity can
refer to experience, the experience of ourselves and the
world – and often these days, the concept of experience
is equated with the one of consciousness. This amounts to
a rather narrow view of experience in terms of conscious-
ness. That was not the case in Freud’s time, though. At
that time, experience was referred to as a much broader
concept, including both unconscious and conscious states.
What makes experience subjective is its essential perspecti-
val nature – we stand and experience ourselves in a perspec-
tival way relative to the world and thus cannot but take a
certain point of view, a perspective on ourselves and the
world. Such point of view is the basis of any kind of perspec-
tive including the perspectival differentiation of first-,
second-, and third-person perspective (Northoff, 2018a,
2018b).
Subjectivity is manifest in all three, first-, second-, and
third-person perspectives. We, as humans, can never go
beyond such perspectival access to ourselves and the
world – God certainly must be able to take a non-perspec-
tival view without any specific point of view, and perhaps
future robots or artificial intelligence may do so as well.
But for humans, there is thus a basic perspectivity to our
being in the world – that is what I mean by subjectivity.
Importantly, my concept of subjectivity is much larger and
wider than the one often entertained these days in philos-
ophy of mind and neuroscience. In those domains, subjec-
tivity is restricted to the first-person perspective as
distinguished from the seemingly objective third-person
perspective. The dichotomous split of first- vs third-person
perspective entails the split of subjectivity vs objectivity:
everything that is related to the first-person perspective is
conceived as subjective while all that we can observe in
third-person perspective is thereby rendered objective.
That is to neglect though that both first and third-person
perspective are only possible on the more basic and funda-
mental point of view that constitutes an intrinsic subjectiv-
ity within the world. Conceived in such way, subjectivity is
NEUROPSYCHOANALYSIS 109
conceived as more basic or fundamental as well as in a
broader sense including both first- and third-person
perspective.
As I see it, Freud aimed to describe the basic empirical
manifestations of such subjectivity in our psyche: the ego
and its different layers, the consciousness as the tip of the
iceberg of an underlying multi-layered unconscious, the
defense mechanisms, and various other features. His
strong sense of subjectivity as the basic feature of the
human psyche strongly attracted me especially as a
psychiatrist.
What I see in psychiatric disorders like depression, mania,
anxiety disorders, and schizophrenia is a change in that very
basic subjectivity, the experience of oneself and the world.
The patients do not come because of their symptoms. They
come to the psychiatrist because they cannot make sense of
their experience and thus their subjectivity anymore – that
is what disturbs them, and it is that to which they react with
seemingly abnormal behavior which the psychiatrist, taking
an objective stance, calls “symptoms” (Boeker, Hartwig, &
Northoff, 2018). Hence, in order to explain these symptoms
and provide proper diagnosis and therapy, we need an
account of the basic changes in these patients’ experiences
and their subjectivity.
Subjectivity – Investigation and method
How can we probe and investigate experience and subjec-
tivity? This raises the question of fruitful methodological
strategies for investigation. First and foremost, we need to
distinguish between the subjectivity of experience, its sub-
jective nature, on the one hand, and the subjectivity vs
objectivity of our methodological strategy to investigate
that very subjectivity. Methodologically, we need an objec-
tive approach, a third-person based approach, to study sub-
jectivity, e.g. experience, in a scientific sense.
There is thus a fine line between the target of our inves-
tigation – subjectivity as manifest in experience – and the
method we apply to and use in that investigation, as that
requires objectivity. That fine line has often, unfortunately,
become rather blurry in the history of psychoanalysis, for
which reason it has often been discredited by the sciences.
Hence, what we need are third-person based methods to
explore subjectivity and experience, a “first-person neuro-
science” as I have called it (Northoff, 2011; Northoff et al.,
2007; Northoff & Heinzel, 2006).
This line has also been blurred in psychology, albeit in
the reverse way. Here the psyche is also investigated by
using a third-person based objective methodological strat-
egy. That need and aim for methodological objectivity was
often, however, taken to be identical with the need for an
objective target – that what is investigated must be as
objective as the method of our investigation. Subjectivity
and experience were thus a “no-no” in such objectively-
tuned approach – which was well manifested in the beha-
viorism of previous decades, and even to some extent in
the the cognitivism in our times.
110 SOCIETY PROCEEDINGS
We are thus confronted with psychoanalysis and psy-
chology as mirror images. On the one hand, psychoanalysis
aims to tackle the basic subjectivity and experience of the
human mind in an often methodologically subjective way.
On the other, psychology strives for a methodologically
objective approach, which leads to a tendency to impute
an objective nature to the human mind. When neuroscience
took off and brain imaging developed around 30 years ago,
both disciplines had great hopes to provide the missing
pieces of their puzzles. Psychoanalysis aimed to find an
objective ground – the brain – for the subjectivity and
experience of mind, while psychology could finally com-
plete its search for objectivity of mind in the objective
nature of the brain.
Subjectivity in neuroscience
Have these promises of neuroscience, with their quasi reli-
gious-like expectations, been fulfilled? Yes and no. Yes, as
we certainly have much more knowledge about how the
subjective processes described so well in psychoanalysis
may be correlated with specific processes in the brain,
while psychology has been able to make some progress
in “mapping” and localizing the “objective,” especially cog-
nitive, features of the mind onto the brain. Taken in such
perspective, the introduction of neuroscience into both psy-
chology and psychoanalysis has been tremendously
successful.
But there is also the other side, the no. No, a fundamental
aspect of the dreams of both psychoanalysis and psychology
have not yet been realized. Their dreams consisted in under-
standing why and how mental features, being considered in
an objective (psychology) or subjective (psychoanalysis)
way, are yielded on the basis of our brain and its neuronal
activity. Philosophers have described this as the “hard
problem” of consciousness (Chalmers, 1995); going beyond
their limited account, I would prefer speaking of a “hard
problem of subjectivity” (Northoff, 2004, 2018a, 2018b):
why and how is there subjectivity as manifest in experience
and perspectivity, in our seemingly objective world?
This is the question that drives me and my work in all
three disciplines, philosophy, psychiatry, and neuroscience.
None of the three disciplines has yet provided an answer to
that question. We simply do not know why and how the
brain’s neuronal activity transforms into mental activity as
manifest in subjectivity with experience and perspectivity.
Neither current neuroscience nor psychology or neuropsy-
choanalysis can provide an answer to that. This leads to a
deeper question, the question for how we conceive the
brain and what model of brain we presuppose.
Model of brain – Dynamic and temporo-spatial
The brain has long been conceived as a purely mechanical
device that operates according to input-output relations.
Such views dominated the early days of neuroscience in
the first half of the twentieth century, when the main
focus was on sensory and motor functions. That rather
limited view of the brain was extended and complemented
by the inclusion of cognitive functions – cognitive psychol-
ogy emerged and was further extended, at the end of the
twentieth century, into cognitive neuroscience. The objec-
tive cognitive functions were localized and mapped upon
the brain and its different regions/networks. That brought
amazing insights which often have also been applied in
neuropsychoanalysis.
Where does this leave us with subjectivity as manifest in
experience and perspectivity? For all its inclusion and novel
findings, I believe that this is the “missing ingredient” that is
left out in a mechanical cognitive view of the brain. We
need, I argue, a different model of the brain, one that
extends beyond the currently dominant cognitive mechan-
ical model. Such a more extended model of the brain must
be able to account for subjectivity, i.e. the point of view and
its subsequent perspectival differentiation into first-,
second-, and third-person perspective. One paradigmatic
manifestation of subjectivity are, for instance, emotions,
that can be approached in both as feelings in first-person
perspective and as neural features of the brain in third-
person perspective (Panksepp, 1998; Solms, 2019).
However, I suggest that even affectivity is just a manifes-
tation (albeit probably the most direct one) of a more
basic underlying essential subjectivity at the bottom of
our brain, beneath its various functions, e.g. affective, cogni-
tive, social, sensory, motor, etc., which have been well
explored in recent years.
My guiding assumption here is that the very bottom
level contains the seeds of subjectivity, experience and per-
spectivity, and requires a different model of brain, to comp-
lement the limits of the mechanistic cognitive model. What
could such a model look like? In my recent book “The spon-
taneous brain. From the mind–body problem to the world-
brain problem” (Northoff, 2018a, 2018b), I spend eight
chapter in outlining one.
I believe that this model must conceive of the brain in a
dynamic sense; I argue that the brain constructs its own
time and space in a dynamic way, which I call “temporo-
spatial dynamics” (Northoff, Wainio-Theberge, & Evers,
2019). I do not mean the time and space in the way psychol-
ogists and neuroscientists typically do. They think of time
and space in terms of discrete points in time and space as
we perceive and cognize them. Instead, I refer to the time
and space as they constructed by the brain itself, i.e. its
“inner time and space,” in a dynamic way independent of
our perception and cognition of the brain in time and
space, i.e. “outer time and space” (Kant, 1998; Northoff
et al., 2019; Northoff & Huang, 2017).
Instead, my dynamic view of time and space is more
oriented towards the ways in which those concepts are
used in physics and engineering – as dynamic constructions
where continuous change, e.g. dynamics, is generated and
yields temporo-spatial patterns. Hence, I suppose that the
dynamic temporo-spatial features provide the basic level

on which cognitive functions are build, i.e. organized and
structured (Northoff, 2018a, 2018b; Northoff et al., 2019).
Temporo-spatial dynamics – “Common currency”
of neuronal and mental activity
How can we investigate and measure the brain’s temporo-
spatial dynamics and how can it account for the subjectivity?
Physics and engineering have developed a huge array of
different tools and measures to investigate temporo-spatial
dynamics, including entropy, autocorrelation window,
scale-free activity, to name just a few. We can now apply
these measures of temporo-spatial dynamics to the brain
during both rest and task states – what the cognitive
approach describes in terms of cognitive functions is then
complemented by a more basic dynamic temporo-spatial
level. Most importantly, we assume that this basic dynamic
temporo-spatial level makes it possible to inject subjectivity,
e.g. experience and perspectivity into the system.
Our data show that these measures of temporo-spatial
dynamics are closely related to subjective features like
self, consciousness, and psychiatric disorders. For example,
some of our studies demonstrate that the degree of scale-
free activity in the brain’s spontaneous activity predicts
the degree of self-consciousness on an individual level.
This led us to develop a spatiotemporal theory of self (as dis-
tinguished from cognitive, affective, bodily-based etc, the-
ories of self) (Northoff, 2016). The same applies to
consciousness, where we observed changes in various
dynamic temporo-spatial measures like scale-free activity
to be related to reductions or changes in consciousness –
this resulted in the development of a “temporo-spatial
theory of consciousness” (Northoff & Huang, 2017).
Finally, and most importantly, we could observe changes
in temporo-spatial dynamics in the spontaneous and task-
evoked activities in psychiatric disorders like bipolar disorder
(Martino et al., 2016; Northoff et al., 2018), depression
(Northoff, 2016), and schizophrenia. This lead us develop a
spatiotemporal approach to psychopathological symptoms,
e.g. “Spatiotemporal Psychopathology” (Northoff, 2016a,
2016b, 2018a, 2018b; Northoff & Duncan, 2016). Due to
these encouraging findings, we suppose that the brain’s
temporo-spatial dynamics are central for transforming neur-
onal into mental activity, e.g. neuro-mental transformation
(Northoff, 2018a, 2018b; Northoff et al., 2019).
I suggest that temporo-spatial dynamics provides the
“missing ingredient” that links neuronal and mental activity,
e.g. their “common currency” (Northoff et al., 2019).
Temporo-spatial dynamics is not only manifest in the brain’s
neuronal activity during both rest and task states but also in
mental features like consciousness, self and psychiatric dis-
orders – we experience time and space in a subjective way,
such as in our inner time consciousness, with its own speed
and duration (Northoff, 2018; Northoff et al., 2019). Mental fea-
tures are thus primarily temporo-spatial which, in turn, pro-
vides the basis for their manifestations in the brain’s various
functions, e.g. affective, sensory, motor, cognitive, etc.
NEUROPSYCHOANALYSIS 111
Temporo-spatial dynamics and subjectivity
How does all that provide an answer to my question of
where subjectivity is coming from? I propose that subjectiv-
ity can be traced to the temporo-spatial dynamics of our
brain in relation to the ongoing temporo-spatial dynamics
of the world. The temporo-spatial dynamics of both world
and brain are not identical; there is always a discrepancy
as the temporo-spatial range of the world is obviously
much larger than the one of the brain (as part of the
world). And it is that discrepancy that accounts for the
basic subjectivity including experience and perspectivity. I
therefore speak of “spatiotemporal subjectivity” in my
latest book (Northoff, 2018a, 2018b).
I am now ready to close the loop and come back to neu-
ropsychoanalysis. Freud, in his remarkable unpublished
1895 paper, tried to develop a dynamic conception of the
brain. Due to the lack of resources at this time, he had to
abandon this project, and could not really develop a
dynamic view of brain such that he could link it to the
dynamics of the psyche he so wonderfully described. We
are now ready to do exactly that, with a dynamic model
of the brain (rather than a cognitive or affective model). I
postulate that such a dynamic model of the brain will
enable us to link the temporo-spatial dynamics of
world and brain, the world-brain relation (Northoff,
2018a, 2018b), to the basic subjectivity of our mental
features, e.g. their experience and perspectivity, which is
manifest in the subjective nature of affect, cognition, per-
ception, etc.
We may thus want to re-describe essential psychody-
namic features like ego, unconscious, defense mechan-
isms, etc, in primarily temporo-spatial dynamical (rather
than cognitive or affective) terms as that would allow
us to link them to the temporo-spatial dynamics of the
brain. I tried to do exactly that. I took a spatiotemporal
approach to defense mechanisms and self in my earlier
book on neuropsychoanalysis (Northoff, 2011). This was
later extended to brain and consciousness as such in
my two-volume book Unlocking the brain (Northoff,
2014a, 2014b) and to psychiatric disorders (Boeker
et al., 2018).
Most important, this temporo-spatial approach allows us
to apply an objective methodology, borrowed from physics
and engineering, to the basic subjectivity of the brain and
our very human existence. Subjectivity can thus finally
become an object of science. Psychoanalysis can be
extended into neuropsychodynamics. Such neuropsycho-
dynamics makes it possible to combine its search for the
basis of subjectivity of our brain in its relation to the
world, e.g. world-brain relation (Northoff, 2018a, 2018b),
with the need for objectivity in our investigation and its
methodological strategy. Two for one without contradic-
tion, what do you want more? Even Freud would probably
agree!
georg.northoff@theroyal.ca
112 SOCIETY PROCEEDINGS
20th anniversary reflections
David Olds
This is a wonderful idea, on our 20th anniversary, to assemble
comments from our members about neuropsychoanalysis
and its role in our lives. I have been a member of the Inter-
national Neuropsychoanalysis Society since the beginning,
my first congress being the one in London, in 2000.
Leading up to that congress, I also regularly attended the
monthly Pfeffer meetings in New York, which in the 1990s
featured those great visits by Mark Solms, who introduced
most of us to the basics of our field. Those meetings are con-
tinuing; and they have enriched our intellectual climate,
drawing a wide audience of workers from several disciplines.
The Journal has been very important to me, and it has
been an honor and a pleasure to serve as the Target Articles
Editor for the past ten years. Shepherding these original and
often groundbreaking articles, and the wise and provoca-
tive commentaries that they stimulate, has always been
exciting and fulfilling.
The question of how these efforts have contributed to
clinical practice is interesting, and has occasioned much
thought. In 2006 I wrote a paper (Olds, 2006) on what – at
that time – we could see as contributions to psychoanalysis
from several disciplines: the mirror neuron model, and its rel-
evance to interpersonal interactions, to imitation and
empathy, and the discussions about the use of the analytic
couch; the research in different modes of memory and the
recent interest in the non-repressive unconscious; the
phenomena of cognitive deficits, and their effect on analytic
technique and potential modifications thereof; trauma and
its brain sequelae; the thinking about complex systems,
and their effect on analytic theory and predictability; and
the research in affect models, and the evolving interaction
with psychopharmacology. The clinical implications of
these contributions tend to be obvious, although complex,
and the long-term effects for many of us include a gratifying
sense of a more solid foundation about the internal mental
systems underlying our work. What I’m realizing now is
that the neuropsychoanalytic lectures made up a long and
intensive course for me, producing a steady diet of the gath-
ering information, which fed me in teaching and in develop-
ing as an analyst. And, these were punctuated by the
congresses, so warmly organized by Paula and her team,
and which brought us all together once a year. Following
up 12 years later, Ellen Rees and I wrote a paper on integrat-
ing the burgeoning information from other sciences with
psychoanalysis (Olds & Rees, 2018), and how this was used
in an advanced theory course in the Columbia Psychoanalytic
Center. That paper also deals with some of the resistances to
this endeavor, as in the conflicts about reductionism, and the
difficulties in integrating several different levels of biology.
That course has been evolving over the past 20 years, has
been very well received, and potentially could make a
major contribution to psychoanalytic education.
ddo1@cumc.columbia.edu
Neuropsychoanalysis: fMRI in prose and paint
Lois Oppenheim
As the author of numerous texts (books and papers) on lit-
erature written from a philosophical perspective – more
precisely, from the phenomenological perspective of Hei-
degger and Merleau-Ponty – in mid-career, I found myself
increasingly drawn to psychoanalysis as a means of contex-
tualizing the literature on which I was focused. Indeed, psy-
choanalysis, despite its growing emphasis on the relational
and interpersonal over instinct and drive, not only revealed
itself as useful to critical thinking, but seemingly now com-
pelled it. How not to consider the inter- and intrapsychic
phenomena at play in creativity, in the making of
meaning and the generation of imaginative expression?
But broaching the work of Samuel Beckett, the French
“New Novelists,” and other authors by putting the writer
on the couch never seemed entirely justifiable to me.
Choosing, moreover, between the philosophical and psy-
choanalytic ways into a literary work was never an option.
Rather, I struggled to find a connection, a legitimate way
of thinking about literature – and about painting, progress-
ively becoming a primary focus of my writing – that might
engage simultaneously the philosophical and psychoanaly-
tic points of view. Thus, as aesthetic experience, that of both
writer and reader and visual artist and viewer, took center
stage, neuropsychoanalysis came to my attention.
Neuropsychoanalysis offered the connection I had been
seeking and more: It became necessary to my thinking and
writing. As my awareness increased that “There must, after
all, be objective laws which account comprehensively for
the part of nature that we call the human mind,” as Mark
Solms was to write in the foreword to my first book on neu-
ropsychoanalytic aesthetics, A Curious Intimacy: Art and
Neuro-psychoanalysis (Routledge, 2005), I became preoccu-
pied in my professional work with the universals in creativ-
ity. Part I of that initial effort, entitled “Art and the brain,”
took me from human biology to the “feminine” in art. Part
II, “A new direction for interdisciplinary psychoanalysis,”
allowed me to make the argument for neuropsychoanalysis
as the necessary foundation of thinking on aesthetics by
focusing on Beckett, Paul Klee, and Martha Graham. The
prize-winning Imagination from Fantasy to Delusion (Routle-
dge, 2013) and For Want of Ambiguity: Order and Chaos in
Art, Psychoanalysis, and Neuroscience (Bloomsbury, 2019;
co-authored with Ludovica Lumer) would follow with
more to come. But the point is this: The neuroscience of
affect and emotion, the mechanisms of cognition, and the
homeostatic origins of drive, along with the psychoanalytic
conceptualizations of inter- and intrapsychic processes,
have not much, but everything to tell us about the making
and reception of art. Neuropsychoanalysis is notable for
the scope of its interdisciplinarity as well as both its neuro-
biological and existential legitimacy: As a modality for
regarding aesthetic experience, it avoids the reductivism
of psychobiography while centering on the psychology of

subjective experience, and it authenticates understanding
based on the somatopsychic universality of imagination.
Neuropsychoanalysis has, of course, been the primary disse-
minator of work in this arena; it is a journal without which
those whose clinical work and / or thinking and writing in
adjoining fields would simply not have had exposure to
the most current research, discussions, and their implications.
For me, personally, it is neuropsychoanalysis – and Neuropsy-
choanalysis – that have allowed me to integrate the phenom-
enology of perception (à la Merleau-Ponty) with that of
sublimation (à la Freud) while respecting the primacy of
artistic expression as the experience of an individual.
oppenheiml@montclair.edu
NPSA 20th anniversary – Reflections
Doris Reismann-Lagrèze
With great interest I have been attending the NPSA confer-
ences since 2010.
As a clinician, it has been fascinating to broaden my experi-
ence by including neuroscientific and neuropsychoanalytic
thinking into my work, allowing me to see clinical situations,
affects, behaviors and psycho-somatics in light of the basic
emotional systems and neural structures and networks that
we understand thus far.
The hard problem – the interface between mind and
matter, brain and inner world – is becoming more palpable
from this vantage point.
I was enthusiastic when reading The Brain and The Inner
World by Mark Solms and Oliver Turnbull. It changed my
clinical approach and stimulated my curiosity to learn more
about neuroscience, even if I am a “layperson” in relation
to neuroscientific research. Mark Solms’s new ideas and sti-
mulating thoughts, his enormous input, are inspiring for
our NPSA society and have an impact far beyond it.
Personally, here I can find a community of like-minded
people bringing in their fields of research and expertise
and taking the message to the larger scientific community.
In this vein, Mark Solms’s excellent online course “What is a
mind?” made neuropsychoanalysis an adventure for an
increasing number of people out there, making it accessible
and motivating people to address basic questions of our
human condition.
Jaak Panksepp and his emotional systems have become
a basic perspective in my clinical work, and it is a great loss
he is no longer with us. With his animal research he encour-
aged a new approach for me to also look at animal minds, a
dimension Oliver Turnbull has also been pursuing. Extend-
ing our human mind to the animal mind seems to be a
step towards a more universal approach to understanding
various forms of life and in this context of great importance
in our current discussions on climate, nature, AI, and where
our planet is heading.
Globalization, digitalization, climate change and AI are
under scrutiny posing pressing questions of how we want
NEUROPSYCHOANALYSIS 113
to live in the future. AI being a big challenge, spurring on
our insatiable hunger for further knowledge and power,
with great potential,but also carrying the intrinsic risk of
installing advances and techniques prematurely, so they
may get out of control potentially with longterm negative
effects on the future that we are unable to judge today.
The task is to assess the fine line between what is possible
and what is an ethically responsible way towards a good
future for generations to come, how to preserve our human-
ity in a global society. This comes with a great responsibility,
and I believe the neuropsychoanalytic lens is one way of
helping us to think in such broad terms.
Neuropsychoanalysis has been an important society and
community for me to develop further my professional skills
in a very pleasant, accepting, and lively academic and clini-
cal environment, where it is fun and inspiring to meet with
colleagues and friends and feel connected.
Congratulations! Thank you NPSA, and thank you all!
d.reismann.lagreze@gmail.com
Twenty years on and still haven’t started my
analysis … but we’ll always have
neuropsychoanalysis
Manos Tsakiris
At the age of fifteen, I decided to study psychology. The
(conscious) motivation was simple. At that time, I was
reading Freud’s translated works in Greek. The (conscious)
aim was also simple, or at least it seemed so back then: to
study psychology and then become a psychoanalyst. In
1995, I entered the Department of Psychology at the Pan-
teion University of Social Sciences, in Athens, and on my
first day there I met another fresher who confessed to
me that her initial plan had been to do media studies rather
than psychology, as her aspiration was to become a journalist,
or a writer to be more exact. For reasons that have to do with
the complicated university entry system in Greece, she had
performed so well in her exams that she was accepted in
the Psychology rather than the Media Department. If she
wanted to switch to media, she would have to wait one
more year. I tried my best to convince her to give it a try
and see if she liked psychology. She gave it a try and she
decided to stay. And for reasons that will become clear in a
moment, I hope that the neuropsychoanalytic community
will thank me for insisting she stay in psychology.
Throughout our BSc years, we studied psychoanalysis
and got to meet several Greek psychoanalysts, but unfortu-
nately we heard very few things about the brain during our
courses. We graduated in 1999, 20 years ago, roughly at
the time that Neuropsychoanalysis was born. That same
year, we both moved to London. She would read for the
MSc in Psychoanalytic Studies at UCL and I would attend
the MSc in the Philosophy of Mental Disorders at King’s
College.
114 SOCIETY PROCEEDINGS
While studying at King’s I became disillusioned with the
course, as it was far from what I expected. Instead of studying in
greater depth all the continental philosophers that had
shaped my thinking while in Greece, thinkers such as
Nietzsche, Foucault, Deleuze, and Lacan, I found myself in the
dry land of analytic philosophy. With two exceptions: firstly,
the lectures of Jim Hopkins and his work on Wollheim’s
reading of Freud, and secondly an in-depth exposure, for the
first time in my academic education, to the workings of the
brain.
In January 2000, the aforementioned friend who was
studying psychoanalysis invited me to join her at the
Anna Freud Center, where a rising star of neuropsychology
and psychoanalysis was giving a series of lectures on the
neurology of mental life. I feel privileged to be in a position
to say that I was there, hearing about Mark Solms’ ideas of
affective consciousness by Mark himself. I then took Mark’s
ideas on board, read Damasio, unearthed Freud’s Project for
a Scientific Psychology, and read it in parallel with the
famous Chapter 7 of The Interpretation of Dreams. I asked
Jim Hopkins if he was willing to supervise my Master’s
thesis on an integration of Freud’s Project, Solms’ concept
of affective consciousness, and Damasio’s somatic
markers. He kindly agreed, and guided me and inspired
me through the process. That thesis opened up new
avenues, as it showed me ways by which I could re-read psy-
choanalysis through the prism of brain sciences. And as I
was hungry for more brain sciences given my previous aca-
demic life in Greece, I subsequently enrolled for the MSc in
Cognitive Neuropsychology at UCL, a degree I completed
together with this soon-to-be-revealed dear friend from
Athens. After that second Master’s, I went on to do a PhD
at UCL on the neurocognitive mechanisms of sense of
agency and body-ownership, during which I moved a bit
further from psychoanalysis but closer to phenomenology
and the embodied approach of Merleau-Ponty. My friend
went on to do her PhD on neuropsychological patients pre-
sented with confabulations, testing for the first time a
hypothesis that was directly motivated by the newly
formed field of neuropsychoanalysis.
For those who haven’t guessed it already, my friend’s
name is Katerina Fotopoulou. I am certain her work is well
known to all the readers of the journal and all people inter-
ested in neuropsychoanalysis. I am also certain that her
ethos, personality, and career have served and will continue
to serve as excellent and inspiring models for all of us who
never thought of psychoanalysis and neuroscience as two
incompatible epistemological approaches; after all, what
has been the central tenet of neuropsychoanalysis is pre-
cisely the insight that psychoanalysis and neuroscience do
study the same apparatus from their respective perspec-
tives. I am of course grateful to Katerina for far too many
things over the 25 years we know each other, as well as
for introducing me to Mark Solms 20 years ago.
Twenty years on, I still haven’t started my analysis,
let alone take any steps towards the realization of my aspira-
tion to become an analyst. But what I found instead, thanks
to neuropsychoanalysis and all the people who flesh out the
neuropsychoanalytic ideas, was a space where an exercise
of mutual enlightenment and constraining between the
mind and the brain is possible, and more so, necessary. Neu-
ropsychoanalysis enabled me to keep a different perspec-
tive on my own research on the embodied brain, and
slowly, as neuropsychoanalysis became more interested in
embodied cognition, I felt that my basic science research
was also relevant and appreciated by neuropsychoanalysis.
I felt welcomed by your field, at your conferences and more
informal meetings, and had the great opportunity and privi-
lege of co-authoring with Katerina one of the journal’s
recent target articles on “Mentalizing Homeostasis” (2017),
an article that is primarily the reflection of Katerina’s innova-
tive insights on psychodynamic neuroscience.
As neuropsychoanalysis celebrates 20 years, I am mindful
of the observation that cross- or interdisciplinary research
does not happen between disciplines, but between people
who are willing to work in these in-between spaces. And
the history of neuropsychoanalysis, when it will be written,
will be about the people that made it happen. First and fore-
most, Mark, but also, for me personally, Katerina, Oliver,
Maggie, Paula, and Jim. Happy Birthday my friends!
manos.tsakiris@rhul.ac.uk
Reflections on Neuropsychoanalysis at 20
years – Where have we come from and where
are we going?
Doug Watt
How has neuropsychoanalysis affected your
practice, thinking, or social/personal life?
Actually, I was interested in the venture of bridging disci-
plines many decades before there was ever a journal
called Neuropsychoanalysis! Interdisciplinary points of view
have been my milieu ever since my early undergraduate
years at Harvard College, when I rebelled against the meth-
odological straitjacket of single-discipline points of view
that was promulgated as some kind of ideological badge
of serious scholarship. That rigidity and distrust of interdis-
ciplinary work was indeed softening by my senior year,
but it was still a struggle to carve out some version of an
independent study major that one’s professors would
regard as anything other than a fashionable but intellec-
tually lazy dodge of serious work. It was amazing to me –
even then – that anyone interested in the pursuit of
elusive truths would not consider interdisciplinary perspec-
tives as virtually de rigueur. I believe that even more so
today, and find any version of exclusive intellectual loyalty
to one single perspective or discipline as pretty much
anathema. So I wouldn’t say neuropsychoanalysis has
changed my practice or thinking, it’s just that I have
found an environment much more aligned with my own
long-term beliefs, approaches, and interests. It’s as though

one comes home after wandering a long time in a strange and
foreign land. It’s good to be home.
How did I land where I landed? It always seems so seren-
dipitous, but of course it’s not, although there is a decent
amount of dumb luck in ending up in a great and fitting
place. After three years of immersion in an eclectic psycho-
analytic literature as an undergraduate, along with dabbling
in philosophy and religion – all in search of an understand-
ing of human values, illuminating the order inside the chaos
of human behavior – I was deeply disappointed to discover
that there were many in psychoanalysis who believed in the
same strange concept of methodological purity and disci-
plinary isolation. To my dismay, many seemed to believe
that psychoanalysis could be best promoted by being pro-
tected in an ivory tower of isolation from other disciplines. I
could not understand why psychoanalysis would not
indeed be eager to bridge to every other discipline of the
mind and brain, to share its insights as well as deepen its
potential appreciation for what it might not know.
In any case, when I was searching for other disciplines to
bridge to my understanding of psychodynamics, I found
that cognitive neuroscience, in its concepts of hemispheric
lateralization, was describing something very similar to psy-
choanalytic notions of primary and secondary processes.
This clearly suggested that some of the unconscious analo-
gical cognition that underpinned the critical phenomena of
transference might be preferentially organized by the right
hemisphere. This began a long intellectual journey of trying
to bridge the disciplines of psychoanalysis and neuro-
science, including my first review article written in 1985
while I was working on my dissertation, on transference
and right hemisphere cognition. I was hooked, and in my
clinical work, much of which was with traumatized and
depressed patients suffering from multiple Axis I conditions,
I found myself progressively convinced of the urgent need
to create a fully functional bridge language between psy-
chodynamics and neuroscience.
Combined with a sense that classical drive theory was a
limiting, metapsychological straitjacket, but yet still lacking
Panksepp’s clear vision of prototype emotional systems – as
I had not yet met Jaak or even read any of his work until the
mid 80s – I turned to ego psychology, object relations
theory, and attachment theory. By the beginning of my doc-
toral training in the late 1970s and early 1980s, I saw that
psychoanalysis could not be an exclusive intellectual
environment, and I began to search within biology and
neuroscience for ideas that seemed “simpatico.” Psychoana-
lysis in its heyday in the United States (1950s to early 1970s)
missed an opportunity to bridge to an immature but bur-
geoning neuroscience early on, before it frittered away its
intellectual hegemony and lost the ability to influence in a
meaningful way clinical trainees in multiple disciplines, par-
ticularly psychiatry. Within the majority of psychiatric resi-
dency programs, it has not reclaimed any of this lost
influence, although in residency programs where psycho-
analytically trained clinicians were allowed continue, they
still have influence.
NEUROPSYCHOANALYSIS 115
This gradual marginalization and expulsion of psycho-
analytic perspectives from residency training has had a pro-
found impact. Generations of psychiatrists, in my opinion,
have been raised in a reductionist milieu in which they
appear to believe in the clinical utility of a “mindless
brain” ontology, and where relational processes like social
stress, social defeat and attachment failure, and the result-
ing burdens of a negative affective balance with inevitable
affective regulatory failure, are not seen as fundamental and
etiologic to all psychiatric disorders – at least not typically
within these biological psychiatry training programs. I
believe this has been an almost invisible but very real scien-
tific catastrophe for the mental health sciences, represent-
ing a well-paved four-lane highway for Big Pharma to fill
the conceptual vacuum with its seductive “chemical imbal-
ance” meme. This conceptual “takeover” of mental health
sciences has been driven mostly by commercial incentives
and has led to a virtual co-option of mainstream American
Psychiatry by Big Pharma. This “chemical imbalance”
meme has become the central concept that patients, their
families, and even the majority of educated lay people
use, when asked about psychiatric and emotional disorders.
While a fuller discussion of the serious epistemological and
conceptual problems with this reductive meme is beyond
the scope of this brief essay, in Watt and Panksepp (2009)
we discussed in detail how simple brute force reductionism
obfuscates the real social biology of depression, its poten-
tially intimate connections to other evolutionarily con-
served shutdowns (esp. sickness behavior and
hibernation), and how deeply intertwined it may be with
the core biology of social attachment. This displacement of
an attachment-centric developmental psychoanalytic psychol-
ogy (admittedly flawed in its metapsychology and lacking a
research and empirical commitment outside of later NPSA
initiatives) by a seductive chemical imbalance meme cannot
be undone at this point, but in its current extreme form, it
should never have happened. Instead, a social brain and
attachment-centric regulatory process should have been
understood as the proper metapsychological anchor and
base from which to study the brain’s signaling systems and
their role in both health and dis-ease, but this would have
required a vigorous NPSA initiative at the time of the begin-
ning of the so called “Psychopharmacology Revolution,”
instead of PSA’s deep complacency and lack of interest in
interdisciplinary work. Reintroducing social brain concepts
(with their intimate connections to the stress axis, the
immune system, basic neuroplasticity, and the “reward”
(AKA SEEKING) system) into psychiatric residencies now
appears to be a potential path towards mitigating some
of psychiatry’s blind spots, and hopefully re-forming psy-
chiatry back into the truly interdisciplinary science that it
once was. Of course, these social brain concepts are a
very short distance indeed from core psychoanalytic ideas
– if there is any distance at all – just don’t tell anyone that!
116 SOCIETY PROCEEDINGS
What has changed in the world of psychoanalysis,
or in neuroscience, since the journal’s founding in
1999? Has neuropsychoanalysis played any role
in those changes?
Not nearly as much has changed as one might have hoped
for, 20 years in. Perhaps my disappointment comes from my
impatience with the glacial nature of scientific progress. In
my experience, psychoanalysis is still regarded within
most sectors of neuroscience as a kind of kooky nineteenth
century cult-like enterprise without any intellectual respect-
ability or any validated status as a true science, and perhaps
at best an interesting if quaint philosophy of mind, but one
without any relevance for the daily work of neuroscience.
Moreover, I would estimate that over 90% of neuroscientists
regard psychoanalysis as simply synonymous with classical
Freudianism, as opposed to its real sprawling and highly
heterogeneous nature. Similarly, most neuroscientists are
unaware of the empirical psychoanalytic contributions
made in early developmental studies of attachment and
its profound impact on trajectory of social and cognitive
development. When I explain to those in neuroscience
that there are many prescient concepts in PSA, that it
explains much about otherwise mysterious interpersonal
dynamics, who we choose to love and why, the tragic repe-
titiveness of our interpersonal traumas, the transgenera-
tional nature of much of human suffering, and the
developmental foundations for the failure and rupture of
adult human relationships, most are surprised, some are
more skeptical, but very few if any serious neuroscientists
would initially appreciate much of any of this. Instead,
most would assume (and often argue) that psychoanalysis
can’t truly explain much of anything, as what they have
truly absorbed of psychoanalysis consists of only a few
bad psychoanalytic clichés loaded with metapsychological
mumbo-jumbo. When I say that psychoanalysis was really
the first systematic affect-centric theory of mind, and that it
was the first discipline to argue that we carry our attachment
history around inside of us – for better or for worse – as the
largely invisible core of an executive/operating system, this
appears to at least get people’s attention, particularly
those who either intuitively or more explicitly understand
affect as a central regulatory process energizing human
behavior, and especially for those who have already long
accepted Aristotle’s core insight that humans are above all
else deeply social creatures. For those in neuroscience
who are not much interested in the problem of affect or
human social dependencies, that would typically lead to a
whole other discussion about whether a theory of mind
should be more affect-centric or whether computational
metaphors and cogno-centric ideas are quite sufficient!
As an index of real progress, however, I would say that
the centrality of affect as a foundational organizing
process for the mind is starting to gain increasing accep-
tance within neuroscience. This progress has been ener-
gized by increasing empirical neuroscience illumination of
phenomena such as addiction, and many other related
clinical disorders including depression and PTSD, and
increasing appreciation of the behavioral centrality of the
“reward system” (what Jaak Panksepp [1998] more properly
framed as a generalized motivational arousal or “SEEKING”
system). There is also increasing focus on the now quite
compelling and intellectually respectable puzzle of con-
sciousness, as we have moved past the behaviorist view
that consciousness and mind were epiphenomenal phan-
tasms of no real scientific value. Many of us within neurop-
sychoanalysis have always felt that the puzzle box of
consciousness could not be unpacked without an affect-
centric notion of mind, as affects are the true “reinforcers”
for all behavior providing vital anchors for cognitive pro-
cesses and behavior that is otherwise untethered and has
literally no point and no arbiter. And within this puzzle
box of the emergence of consciousness, we are starting to
gain momentum towards an acceptance of how the mind
must emerge from within dynamic and always shifting dis-
tributed networks – Sherrington’s “enchanted loom” – that
run from the brainstem all the way up to the neocortex, as
opposed to having any narrow or simple localization. We
still lack an understanding of how the brainstem and meso-
diencephalon enable the functioning of complex distribu-
ted networks in the forebrain beyond simple “arousal”
metaphor concepts. One has to believe that, instead of
simple “arousal” (an overextended battery metaphor for
the brainstem’s role), the extended reticular brainstem
and mesodiencephalon create a distributed virtual body
that neurodynamically grounds (both recruiting and inhibit-
ing) the rest of the activity in the forebrain. In other words,
the evidence indicates that inside the mind is the re-instan-
tiation of the living body, consistent with basic evolutionary
principles that consciousness had to be adaptive to have
been so massively selected. Almost immediately and logically,
consciousness becomes intrinsically adaptive by giving the
body “basement-level access” so to speak to the machinery
of the mind,as the body’s mandates, as expressed both in
homeostatic imbalances, and in their evolutionary extensions
in prototype emotion, have a potent central registration in
that consciousness machinery. This set of core ideas and
assumptions remains to be fully “cashed out” as Jaak Pank-
sepp would say, but they have not been remotely falsified in
any substantive way to my knowledge. Both Panksepp and
Damasio have created an extended set of concepts based
on these simple and elegant core assumptions. There is of
course still lots of work in front of us to further extend
and develop these foundational concepts, and as always
in science, time will tell.
What are some key contributions made by our
interdisciplinary dialogue to date?
Many of the target articles in the Journal over the past 20
years have furthered key pieces of bridgework, including
around such seminal topics as the nature of dreaming
and sleep in the very first issue, the nature of affects and
instincts which appeared in the second issue, the nature

of romantic love, and numerous clinical disorders including
particularly addiction, PTSD, and of course, depression.
Depression is now the single most expensive disorder of
any kind, medical or psychiatric, plaguing all the Western
technological societies – the clearest indication that the
“psychopharmacology revolution” is missing something
(we have never had more antidepressants, both on and
off patent!). This deep penetration of depression into
Western technological societies also indexes that some-
thing is fundamentally if not profoundly wrong with the
way that we are living in Western societies.
I worry however that these many fine reviews and target
articles through 20 years of the Journal have no real visibility
from within Medline/Pubmed or Index Medicus, although
they are at least being nicely picked up by Google Scholar
searches. [We are working on this; stay tuned! Eds.] I
remain concerned that much of this work is largely invisible
to those within neuroscience. I’d love to be proven wrong
on this point, but the prejudices against psychoanalysis
still run deep in neuroscientific circles, and I think we
have barely moved the needle on that point, unfortunately.
For sure, the best long-term antidote is more empirical
research exploring core psychoanalytic process concepts,
while investigating phenomena of interest to both fields. I
also believe that neuroscience itself has been slowly
forced towards a more social brain meme, as the motiva-
tional and neurodynamic inadequacies of the cognitive/
computational and sensory-centric brain sciences as any
kind of full understanding of mind have become more
obvious to many. A full embrace and eventual integration
of social brain concepts within the mental health sciences
will make substantive rapprochement with psychoanalysis
a lot more doable, particularly as examination of the social
brain will of necessity require an increasingly universal rec-
ognition from neuroscience that there are such things as
basic social needs, as the mandates of attachment, along
with such basic vulnerabilities as separation distress. Con-
cepts about psychogenic defense – or if you prefer
“affective regulation strategies” – will be simply inescapable
at that point. Once sitting in that highly fertile territory, and
asking those questions, there is not much real controversy
or gulf in perspectives. That is one of the truly great
things about science – it does build a long-term confidence
that we will eventually move past certain chronic blind
spots, however fashionable they may have once been.
What issues are now ripe for exploration?
That’s a tough one! I’m not honestly sure what is more ripe
for exploration, but I can tell you what I’m personally and
professionally most interested in – the continuing
problem of clinical depression, as it sits at the intersection
of healthcare economics as the most expensive disorder
in Western societies, the Renaissance of the social brain,
and the mandates of attachment, and it is just in so many
ways the paradigmatic clinical affective disorder of the
mind. Jaak Panksepp and I missed a critical opportunity
NEUROPSYCHOANALYSIS 117
while he was still alive to submit an update to our original
2009 position paper on depression, but that is an oversight
I hope to rectify this coming year.
Have we made any wrong turns or mistakes that
need to be corrected?
None that are substantive that I can see, and the key mis-
takes that pushed psychoanalysis into its marginalized
status were made many decades ago, as outlined in the
prior sections. I think we could do a better job of clarifying
that many within both the neurosciences and even the
mental health sciences have absorbed what is a caricatured
image of psychoanalysis rather than a more accurate image
of the diversity of (oftentimes conflicting) perspectives and
interests that psychoanalysis has in fact represented
through its more than 120 year history. We could do a
better job of portraying psychoanalysis as having had a
long-term empirical investment in childhood and develop-
mental research from the very beginning, in terms of
fine-grained observation of maternal infant dyads and
attachment dynamics. We could do a better job in terms
of getting faculty into medical schools and into mainstream
psychiatric programs that are sophisticated about psycho-
analysis, as it is shaping and training – and most of all stimu-
lating and opening – the minds of the next generation of
clinicians and researchers that will carry the scientific day.
drdougwatt@gmail.com
A Triple-Aspect Monist Triumph, but the
Clinical Application Needs to Play the Long
Game
Giles Yeates
Neuropsychoanalysis (NPSA) came bursting forth into my
clinical thinking in the summer of 2002. I was a trainee clini-
cal psychologist, nearly finished with my clinical training
and reading around for new ideas on the conceptualization
and rehabilitation of awareness difficulties in survivors of
brain injury. I remember after several months of reading
dry neuro-cognitive models on the one hand and psy-
chotherapy vignettes which omitted the organic reality of
brain lesions on the other hand, the seminal book “Clinical
Studies in Neuropsychoanalysis” by Kaplan-Solms and
Solms (2000) was the game-changer of all game-changers.
The chapter on peri-sylvian lesions that integrated atten-
tional, visuo-spatial and interpersonal processes within
one post-Freudian formulation had the effect of rotating
my whole view of clinical phenomena, and my role within
these, a full 180 degrees. My first attendance at an NPSA
congress soon after (Rome, 2004) developed this paradigm
through stimulating conversations and sharing of work with
colleagues, and before long I was approaching all my clini-
cal work – as a now-qualified clinical neuropsychologist –
118 SOCIETY PROCEEDINGS
with a NPSA-informed simultaneous eye on the organic,
intrapsychic and relational (feeling often like triple-aspect
monism to me). This has remained a constant position
throughout the subsequent 15 years of my clinical and
research career.
My experience has become even richer as the diversity of
theoreticians and applied clinicians in the NPSA community
has grown. I have personally benefited from the kind
support of the Neuropsychoanalysis Association with a
research grant from the Neuropsychoanalysis Foundation,
and the lively dialogue with members of the London
study group. This support has allowed me to conduct my
own research, disseminate the date and clinical appli-
cations, and contribute to the development of NPSA
myself. I have often taken the ideas back to colleagues in
my clinical neuropsychology professional community in
the UK, and enjoy seeing their eyes widen when they
grasp the significance of the epistemological shifts that
NPSA thinking stimulates.
Where does NPSA fall short and where does it need to go
now? In my opinion, the clinical application of neuropsy-
choanalysis (and the recursive influence on theory building
that such work stimulates) has nestled too long within acute
and post-acute clinical settings. Recovery and positive
changes in functioning, sometimes prematurely attributed
to the impact of a specific NPSA therapeutic intervention,
occurs within a dynamic period of organic recovery of func-
tion, and when multi-disciplinary input from other pro-
fessionals has also been extant. It is my view that people
with neurological conditions (and those who are connected
to them) need NPSA-inspired thinking and work later on in
their journeys. Social devastation of relationships, alongside
heterogeneous physical, cognitive and emotional changes,
typifies many neurological conditions, with these complex,
interacting needs increasing over time. Thus, while many
common service models are now brief and time-limited,
service-users actually need supportive minds and relationships
for the long haul of their condition. Psychoanalysis knows how
to do this, and NPSA offers a lens through which to understand
the complex and disturbing nature of experience in the
accounts of survivors and those close to them.
I would like to see the next 20 years of NPSA be character-
ized by growth in the clinical application of longer-term inter-
ventions in community contexts, away from the ward and the
immediate few weeks and months after injury. In return, I
believe the NPSA knowledge base will reap huge rewards
in terms of existential engagement, and widen the scope
of its exploration of the fragility of the human condition.
drgilesyeates@gmail.com
Finding nerd heaven in neuropsychoanalysis
Maggie Zellner
Since I discovered that it’s possible to explore the material
basis of what we experience subjectively, I’ve been
hooked on neuropsychoanalysis. There have been countless
“aha” moments at meetings, while reading, and in numer-
ous discussions. For a nerd like me, that’s food for the
soul! As a community, we have made real progress
towards understanding how the mind and brain work.
This journal and the International Neuropsychoanalysis
Society have been central to that progress, as Richard
Kessler, Irene Matthis, David Olds and others have already
noted in the preceding pages.
For me, it started in 1997, when I heard Allan Schore
(1994) speak about concrete evidence that childhood experi-
ence shapes how the nervous system develops. My hair stood
on end with excitement as I learned this. It was amazing to
learn there was something “underneath” how my own
childhood had affected me. Perhaps some actual structural
changes were happening in my brain during the course of
my personal analysis! I was dying to learn more. As I
sought out more neuroscience information, I kept seeing
strong correlations with the concepts I was learning about
in my psychoanalytic training at NPAP in New York. For
example, I found a paper by some guy named Doug Watt
called “Higher Cortical Functions and the Ego” (1990). That
paper was revelation: brain functions were so clearly con-
nected to dynamics like affect regulation, reality testing,
delay of gratification, imagination, and trial action. I was dis-
covering that learning about the brain could give me a
more solid foundation for appreciating our psychoanalytic
models. And I was seeing that a psychodynamic perspective
could bring together the disparate “peppercorns” of neuro-
science knowledge (as Jaak Panksepp used to say) in a way
that made sense – without a larger context of subjectivity
and human relationships, those somewhat mechanistic
tidbits of brain function did not begin to tell a full story.
Then a colleague told me about a lecture series at the
New York Psychoanalytic Institute, exploring connections
between the brain and psychoanalysis. Wow! Here were
some people bridging brain and mind on a regular basis!
One Saturday morning, I happened to hear a wonderful
presentation by Jaak himself, who was very welcoming
when I approached him. As we chatted briefly, another
guy stepped up, and Jaak said, “Do you know my friend
Doug Watt?” How exciting this all was! And violá, my con-
nection to the neuropsychoanalytic community was estab-
lished. In the subsequent meetings I attended at the
Arnold Pfeffer Center for Neuropsychoanalysis, I soaked
up the perspectives, and was especially nourished by
Mark Solms’ brilliant discussions of each presentation.
My connection to neuropsychoanalysis became perma-
nently consolidated when I went to London for the first
International Neuropsychoanalysis Congress in 2000, and
met scores of other people who, in various ways over that
previous decade, had also been linking brain and mind,
and therefore naturally connected to Mark Solms as he wan-
dered the globe. In meeting this community of nice, inter-
esting people who were sincerely interested in taking on
neuroscience and the complexity of psychodynamic
thought at the same time, I had really found my people.

Over the years, I got more involved with the administrative
work of neuropsychoanalysis, first with the Action Group
(the executive committee that supported Mark for a
number of years), then becoming the Executive Director
of the Neuropsychoanalysis Foundation, where I have
been supporting much of the “infrastructure” and program-
ing of the Neuropsychoanalysis Association, including the
Society’s Congresses, communications with Regional
Groups, and more. Finally, since 2012 I have been the
editor of this journal, and co-editor since 2018, when
Richard Kessler joined me; I am now delighted to hand off
that role to Richard’s new co-editor Iftah Biran, while I
move into more of a managing position.
To me, neuropsychoanalysis is utterly vital to under-
standing how the brain and mind really work. Neuroscience
and theoretical psychoanalysis feel incomplete by them-
selves. On its own, neuroscience is far too mechanistic for
me – mapping the detailed cellular processes in the hippo-
campus, for example, only feels truly relevant if it’s
embedded in the lived experience of spatial navigation or
autobiographical memory. Likewise, on its own, psychoana-
lytic speculation can be too intangible, and grounding in a
model of the material infrastructure of its organ, the brain,
gives us new parameters for assessing its utility. Moreover,
any perspective on brain and mind, whether mainstream
neuroscience or cognitive psychology, that does not take
into account a dynamic inner world, both conscious and
unconscious, is missing a huge piece of what really makes
us tick.
One of the biggest things that has changed since the
founding of the journal in 1999, and the founding of the
Society in 2000, is the extent to which we can now be
open about our neuropsychoanalytic thinking. Topics like
emotion, the self, fantasy or imagination, unconscious pro-
cesses, and more, have become respected and legitimate
topics in neuroscience. Likewise, bringing the brain into psy-
choanalytic discussions is becoming more acceptable (and
hopefully useful!) in analytic meetings and institutes. The
International Neuropsychoanalysis Society and this journal
have played key roles in these developments, dovetailing
with advances in neuroscience techniques that allowed
for studying more “internal” brain processes. For newco-
mers to neuropsychoanalysis, it may already be hard to
imagine, but in the 1990s and early 2000s, many of us
had to be “in the closet” in various ways – hiding our neuro-
science interests at our psychoanalytic institutes, and dis-
guising psychodynamic perspectives in neuroscience
publications by strategically using terms acceptable in cog-
nitive psychology. But this seems to have been changing
steadily. Although there is still some skepticism (and
occasionally hostility) towards neuropsychoanalysis in the
psychoanalytic world, and continued indifference towards
or dismissal of psychodynamic perspectives in the neuro-
science world, the climate is very different than it was in
1999. And thank goodness for that!
NEUROPSYCHOANALYSIS 119
I look forward to many more decades of equally exciting
developments, as we build on the foundation we’ve been
constructing as a community since 1999. The Neuropsy-
choanalysis Association is devoted to bringing more edu-
cational materials to the various disciplines that overlap
with neuropsychoanalysis. We are expanding into explora-
tions of how neuropsychoanalysis can inform treatment
with non-neurological patients, and we hope that more
neurological patients will have access to psychodynamic
treatment as the work of clinical neuropsychoanalysis
becomes more widely visible. The Society and journal can
begin to take on more explicitly relational topics. And we
will surely witness an explosion of “take home” ideas that
can be spread far and wide, as the neuropsychoanalytic
researchers from around the world, and various domains,
return each year to our Congresses and deepen their
groundbreaking work.
As an organization, we are moving into a new era. A
number of writers in this issue have described the first 20
years of neuropsychoanalysis as our infancy and adoles-
cence. During that time, we had several major donors
who supported our activities. Now, as we move into our
early adulthood, the Society and Association must
become more fully self-supporting, as we reduce our
dependency on a small handful of donors and expand our
reliance on income from Society membership dues, our
online learning content, and other activities. Each Society
member plays an important role in maintaining our vitality
as a community! In addition, we are moving out of the
difficult “puberty” phase described by Gokce Ozkarar
(2019), when administrative tasks were shifted to the
New York office, and I became a bottleneck in a number
of capacities that used to be so beautifully managed by
Paula Barkay. Our globally distributed admin team now
includes Ross Balchin, our Program Director based in Cape
Town, who manages our website content, the Clinical Reg-
ister, and the NPSA Learning Platform; Ana Delgadillo, our
part-time administrator based in Mexico City, who supports
Society membership activities; our editorial assistant
Sabirah Adams, also working from Cape Town, who
manages manuscript submissions for the journal; Anne
McPherson, a Program Director for the Chapman-Perelman
Foundation, based in New York City, who supports the Neu-
ropsychoanalysis Association in our programing activities;
and our favorite Paula Barkay, based in London, who con-
tinues to support Mark Solms in his numerous neuropsy-
choanalytic activities.
For more information on the activities of the journal, the
International Neuropsychoanalysis Society, and the Neurop-
sychoanalysis Association, please visit our website at www.
npsa-association.org. I look forward to many more years of
exciting conversations with my fellow neuropsychoanalysis
nerds around the world, as we try to understand the brain
and mind in all its complexity and glory.
mzellner@npsa-association.org
120 SOCIETY PROCEEDINGS
Notes
1. Howard Shevrin, born in New York in 1926, died in Ann
Arbor on January 18, 2018.
2. Freud, as well as Lacan, refers to an “acoustic object”;
however, a mass of data in psycholinguistic literature
(e.g. Corballis, 1999; Liberman, Cooper, Shankweiler, &
Studdert-Kennedy, 1967; Liberman & Mattingly, 1985;
Studdert-Kennedy & Goodell, 1995; for review, see
Bazan, 2007), stress the idea that the linguistic object is
first and foremost an articulatory gesture, i.e. a motor
object. It indeed becomes a heard object but secondarily,
i.e. indirectly: the sensorimotor feedback of our proper
rearticulation in order to match the acoustic trace –
which at that stage is non-linguistic – helps the
hearing of language as language (Rizzolatti & Arbib,
1998), such as illustrated by the McGurk effect (McGurk
& MacDonald, 1976).
3. i.e. according to the “logics” of the secondary process;
there is another logic going on in parallel, that of the
primary process – indeed, we know with Hamlet, that
though the primary process without secondary process
“is madness, there is method in it.”
4. Moreover, I believe that the fact that there is no such
independent science, together with the fact that psy-
chology is now either feeding itself at neurosciences or
at social sciences for credibility, is the root cause of an
amount of violence in society. Lacking a distinct identity,
it appears to me that psychology has no professional
pride and does not play its role in putting damaging
practices to an end. Indeed, the history of violence in
mental health care has not in any way been halted nowa-
days, but rather is now taking on modern forms, from
overdiagnosis to overmedication, violent treatments in
institutions, and pathologizing the normal, emptying
public financing for damaging diagnostic, screening
and medication purposes, thereby also creating social
pressure groups around diagnoses (e.g. Asperger,
ADHD, autism etc.), with claims of even more recognition
and financing. This lack of identity of the field of psychol-
ogy thereby contributes to bringing public treasury to a
general bankruptcy without bringing relief to public
mental health(see also Shedler, 2019). Moreover, ethi-
cally, as long as the mental is either seen as a product
of the biological or of the social, or of a complex inter-
action of the biological with the social, subjects remain
objects, i.e. victims, of an external determination and
there is no conceptual ground to think subjective
freedom, and thus responsibility.
5. Just as the stethoscope is a tool that allows us to under-
stand the functioning of the heart by amplifying our
hearing, so can we think of fMRI machines as a particular
extension of our eyes that allows us to see the inside of
the body and brain, and thereby deduce its functions.
6. Freud’s first actual research was the study of the struc-
ture of eel testes assigned to him by Carl Claus (Triarhou,
2009). In order to fully appreciate Freud’s neurohistologi-
cal career one must place it firmly into the context of
evolutionary biology. Ritvo (1990) refers to it specifically
as ‘evolutionary oriented research’” (p. 162). “The subject
which Brucke had proposed for my investigations had
been in the spinal cord of one of the lowest of fishes
(Ammocoetes Petromyzon); and I now passed on to
the human central nervous system” (Freud, 1924,
p. 10). Freud was not just faithful in his commitment to
the nervous system “but to the ‘evolutionary orientation
instilled in him by Claus’” (Ritvo, 1990, p. 167).
7. In the April 27, 1895 letter to Fliess he described himself
as being overworked and devoured by the slow and
difficult business of the Project (Freud, 1950). After
toiling for most of 1895, on January 1, 1896 he
announced to Fliess that he had revised the Project and
called it his metapsychology.
8. This theory that neurofibrils formed the structures along
which actional potentials were conducted was sup-
ported by most prominent histologists including Cajal
but was eventually found to be incorrect (Bennett, 2015).
9. For 16 years inspired by his oft vocal opposition to
Freud’s theory of dreams and in particular to the
notion that they reflected repressed desires, Cajal kept
a dream diary. His own dream theory was complicated,
but largely reflected his belief that dreams were a
sequence of random images unfiltered by the pre-
frontal cortex. (Ehrlich, 2016). Sadly, a glance at his
diary shows anything but random sequences as they
poignantly recount chronic struggles with childhood
trauma, anxiety, loss and failing health.
10. In 2009, we removed the hyphen in the name, to facili-
tate online literature searches and indexing – Editors.
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