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      The Neuropsychoanalytic Approach: Using Neuroscience as the Basic Science of Psychoanalysis

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          Abstract

          Neuroscience was the basic science behind Freud's psychoanalytic theory and technique. He worked as a neurologist for 20 years before being aware that a new approach to understand complex diseases, namely the hysterias, was needed. Solms coined the term neuropsychoanalysis to affirm that neuroscience still belongs in psychoanalysis. The neuropsychoanalytic field has continued Freud's original ideas as stated in 1895. Developments in psychoanalysis that have been created or revised by the neuropsychoanalysis movement include pain/relatedness/opioids, drive, structural model, dreams, cathexis, and dynamic unconscious. Neuroscience has contributed to the development of new psychoanalytic theory, such as Bazan's ( 2011) description of anxiety driven by unconscious intentions or “phantoms.” Results of adopting the “dual aspect monism” approach of idiographic psychoanalytic clinical observation combined with nomothetic investigation of related human phenomena include clarification and revision of theory, restoration of the scientific base of psychoanalysis, and improvement of clinical treatments. By imbricating psychoanalytic thinking with neuroscience, psychoanalysts are also positioned to make contributions to neuroscience research. Freud's original Project for a Scientific Psychology/Psychology for Neurologists can be carried forward in a way that moves psychoanalysis into the twenty-first century as a core contemporary science (Kandel, 1999). Neuroscience as the basic science of psychoanalysis both improves the field, and enhances its scientific and cultural status.

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          The neural basis of drug craving: an incentive-sensitization theory of addiction.

          This paper presents a biopsychological theory of drug addiction, the 'Incentive-Sensitization Theory'. The theory addresses three fundamental questions. The first is: why do addicts crave drugs? That is, what is the psychological and neurobiological basis of drug craving? The second is: why does drug craving persist even after long periods of abstinence? The third is whether 'wanting' drugs (drug craving) is attributable to 'liking' drugs (to the subjective pleasurable effects of drugs)? The theory posits the following. (1) Addictive drugs share the ability to enhance mesotelencephalic dopamine neurotransmission. (2) One psychological function of this neural system is to attribute 'incentive salience' to the perception and mental representation of events associated with activation of the system. Incentive salience is a psychological process that transforms the perception of stimuli, imbuing them with salience, making them attractive, 'wanted', incentive stimuli. (3) In some individuals the repeated use of addictive drugs produces incremental neuroadaptations in this neural system, rendering it increasingly and perhaps permanently, hypersensitive ('sensitized') to drugs and drug-associated stimuli. The sensitization of dopamine systems is gated by associative learning, which causes excessive incentive salience to be attributed to the act of drug taking and to stimuli associated with drug taking. It is specifically the sensitization of incentive salience, therefore, that transforms ordinary 'wanting' into excessive drug craving. (4) It is further proposed that sensitization of the neural systems responsible for incentive salience ('for wanting') can occur independently of changes in neural systems that mediate the subjective pleasurable effects of drugs (drug 'liking') and of neural systems that mediate withdrawal. Thus, sensitization of incentive salience can produce addictive behavior (compulsive drug seeking and drug taking) even if the expectation of drug pleasure or the aversive properties of withdrawal are diminished and even in the face of strong disincentives, including the loss of reputation, job, home and family. We review evidence for this view of addiction and discuss its implications for understanding the psychology and neurobiology of addiction.
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            Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits.

            Chronic pain conditions are associated with abnormalities in brain structure and function. Moreover, some studies indicate that brain activity related to the subjective perception of chronic pain may be distinct from activity for acute pain. However, the latter are based on observations from cross-sectional studies. How brain activity reorganizes with transition from acute to chronic pain has remained unexplored. Here we study this transition by examining brain activity for rating fluctuations of back pain magnitude. First we compared back pain-related brain activity between subjects who have had the condition for ∼2 months with no prior history of back pain for 1 year (early, acute/subacute back pain group, n = 94), to subjects who have lived with back pain for >10 years (chronic back pain group, n = 59). In a subset of subacute back pain patients, we followed brain activity for back pain longitudinally over a 1-year period, and compared brain activity between those who recover (recovered acute/sub-acute back pain group, n = 19) and those in which the back pain persists (persistent acute/sub-acute back pain group, n = 20; based on a 20% decrease in intensity of back pain in 1 year). We report results in relation to meta-analytic probabilistic maps related to the terms pain, emotion, and reward (each map is based on >200 brain imaging studies, derived from neurosynth.org). We observed that brain activity for back pain in the early, acute/subacute back pain group is limited to regions involved in acute pain, whereas in the chronic back pain group, activity is confined to emotion-related circuitry. Reward circuitry was equally represented in both groups. In the recovered acute/subacute back pain group, brain activity diminished in time, whereas in the persistent acute/subacute back pain group, activity diminished in acute pain regions, increased in emotion-related circuitry, and remained unchanged in reward circuitry. The results demonstrate that brain representation for a constant percept, back pain, can undergo large-scale shifts in brain activity with the transition to chronic pain. These observations challenge long-standing theoretical concepts regarding brain and mind relationships, as well as provide important novel insights regarding definitions and mechanisms of chronic pain.
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              Biology and the future of psychoanalysis: a new intellectual framework for psychiatry revisited.

              The American Journal of Psychiatry has received a number of letters in response to my earlier "Framework" article (1). Some of these are reprinted elsewhere in this issue, and I have answered them briefly there. However, one issue raised by some letters deserves a more detailed answer, and that relates to whether biology is at all relevant to psychoanalysis. To my mind, this issue is so central to the future of psychoanalysis that it cannot be addressed with a brief comment. I therefore have written this article in an attempt to outline the importance of biology for the future of psychoanalysis.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                13 October 2016
                2016
                : 7
                : 1459
                Affiliations
                [1] 1Department of Psychiatry, State University of New York Upstate Medical University Syracuse, NY, USA
                [2] 2Psychology, Universidad Intercontinental Mexico City, Mexico
                Author notes

                Edited by: Andrea Clarici, University of Trieste, Italy

                Reviewed by: Antonio Alcaro, Sapienza University of Rome, Italy; Silvio Arrigo Merciai, Private Practice, Italy

                *Correspondence: Brian Johnson johnsonb@ 123456upstate.edu

                This article was submitted to Psychoanalysis and Neuropsychoanalysis, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2016.01459
                5063004
                e1ee9f92-cbde-4ed1-a539-77bea6d8ddba
                Copyright © 2016 Johnson and Flores Mosri.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 03 July 2016
                : 12 September 2016
                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 82, Pages: 12, Words: 10347
                Categories
                Psychology
                Hypothesis and Theory

                Clinical Psychology & Psychiatry
                neuropsychoanalysis,neuroscience,drive,cathexis,phantoms,dynamic unconscious,pain

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