Psychoanalysts were powerfully influenced by Freud’s failure to create a psychoanalytic neurobiology (Freud, 1895) and opted for a purely mentalistic model based around verbal reports of internal experience. In the 40s and 50s neurobiology was dominated by mass action theory (Lashley, 1923; 1929) which held that the cortex was largely indivisible from a functional point of view and behaviour could not be usefully studied from the point of view of the brain. Neuroscientists were, by and large, unconcerned with mental health problems, their focus being on deficits of cognitive functioning rather than affect regulation. Psychoanalysis evolved in radical opposition to a prevailing view that mental disorders represented a constitutional vulnerability of the individual, which could not be remedied by environmental manipulations. An unhelpful distinction between so-called functional and so-called organic disorder was accepted within psychiatry and other mental health professions, which although rarely scrutinised from this point of view, ultimately implied the acceptance of a mind-body dualism. '#"L#%((&)+&+%>#"M)"B"LA& While in general, in terms of the quality of patient care and the development of the discipline of psychoanalysis, particularly the unwavering focus on unconscious determinants, it may have been helpful to isolate psychoanalysis from the brain sciences, a number of by-products of this isolationist stance have created problems as the original objections to a closer link between the two disciplines began to shift. The last 30 years have seen a revolutionary advance in all the neurosciences which negated all the historical reasons for the isolated development of psychoanalysis (Westen, 1998). If Freud were alive today he would have an enormously complex set of findings and theories to draw upon in reconceptualising The Project and would be hardly likely to abandon the enterprise of developing a neural model of behaviour. Much is now known about the way the brain functions, including the development of neural nets, the location of specific capacities with functional positron emission tomography and neuroscientists can hardly be said to be exclusively concerned with cognitive disabilities or so-called organic disorders (Kandel, 1998; LeDoux, 1995, 1997). Genetics has progressed, if anything, even more rapidly and mechanisms which underpin and sustain a complex gene-environment interaction belie original naïve assumptions about constitutional disabilities (Plomin, DeFries, McLearn, & Rutter, 1997). To take just a small sample of significant leaps forward which such scientific progress generates in the delivery of mental health care: the effectiveness of selective serotonin re-uptake inhibitors (SSRIs) in both depression and obsessive- compulsive disorder (Joffe, Sokolov, & Streiner, 1996; Piccinelli, Pini, Bellatuno, & Wilkinson, 1995), the undoubted benefits for children suffering from attention deficit hyperactivity disorder to be treated with methylphenidate (Fonagy, 1997b), the relative efficacy of neuroleptics in psychosis (Barbui & Saraceno, 1996; Barbui, Saraceno, Liberati, & Garattini, 1996), the growing recognition concerning the lack of efficacy of prolonged periods of hospital care and – its counterpart – the benefits of assertive community treatment (Holloway, Oliver, Collins, & Carson, 1995; Johnstone & Zolese, 1998), the potential for early diagnosis via brain imaging of neurosurgically treatable lesions (Videbech, 1997) etc. In fact, for the past 15-20 years the field of neuroscience has been wide open for input from those with an adequate understanding of environmental determinants of development and adaptation. 4M(,@?B%(&,"&)+,%L#@,)"+& Paradoxically, the response of psychoanalysts has been defensive rather than welcoming of these remarkable advances in knowledge. Notwithstanding the commitment of most individual analysts to embracing all understanding, however painful and anxiety provoking, by and large the response of the
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