including too many bibliographic citations to non-psychoanalytic work amongst their references (Green, 2000). The fear appears to be that fields adjacent to psychoanalysis have the potential to destroy the unique insights offered by clinical research. Whilst this is not a dominant view in psychoanalysis, and most psychoanalysts welcome the insights which knowledge from related areas can bring, instances of active collaboration with neighbouring disciplines are patchy, unsystematic and usually focussed on specific findings, discoveries or ideas which are already consistent with a particular author’s preconceptions (c.f. Wolff, 1996). Contrary to the suggestion that closer proximity to sciences with similar interests to ours may destroy psychoanalysis, Kandel (1998) made a strong case that the rich insights from psychoanalysis are most likely to be preserved through closer integration with biological psychiatry. He based his argument on three general principles: All functions of the mind reflect functions of the brain. This principle may be maintained even if it is found that, for many aspects of behaviour, a biological analysis may not prove informative. Psychoanalysts may have a certain unease about the notion on two counts. First, that a biological account is invariably reducible to genetics, and second that genetic transmission leaves no space for environmental causation. Kandel, however, convincingly demonstrates that the ability of a given gene to control the production of specific proteins in a cell is subject to environmental factors and the fact that only 10-20% of genes are transcribed or expressed in each cell leaves plenty of room for social factors: “social influences will be biologically incorporated in the altered expressions of specific genes in specific nerve cells of specific regions of the brain” (p. 461). Genes contribute importantly to mental function and can contribute to mental illness but behaviour itself can also modify gene expression. Twin, adoption and pedigree studies have provided ample evidence that genes determine about 50% of what we traditionally call personality. Variables such as tastes, religious preferences, and even clearly environmentally determined neurotic disorders such as post traumatic stress disorder have substantial genetic components. On the other hand, studies of learning in simple animals have demonstrated some time ago that experience can produce lasting changes in the effectiveness of neural connections by altering gene expression. These interactions suggest that the traditional distinctions between organic and functional disorders are unsustainable. All mental disease is organic since functional imaging techniques can reliably demonstrate that the biological structure of the brain is altered (Jones, 1995). This observation is a trivial consequence of the previous principle. The outstanding two-fold question is how biological processes modulate mental events and how biological structure is modulated by social factors. It is in answering the second of these questions that a scientific psychoanalysis has a clear role to play. Alterations in gene expression as a consequence of learning impact on the brain by causing changes in patterns of neural connections. By the same token, psychological interventions such as psychoanalysis must also produce changes in gene expression which alter the strengths of synaptic connections. It is possible to argue that both pharmacological and psychotherapeutic interventions produce functional and structural changes in the neural circuitry. The former may be more non-specific than the latter and therefore more effective for some mental disorders than others. Alternatively, the two may function synergistically - each acting on slightly different systems but enhancing the benefit to be derived from the other. The evidence from combined pharmacological and psychotherapeutic interventions implies that there is considerable benefit from an integrated treatment approach (Roth & Fonagy, 1996). The same set of arguments could be made for the further integration of psychology and psychoanalysis. As long ago as 1982, I proposed that much that has been learned in psychology about mental processes was applicable to psychoanalysis and should be integrated with it (Fonagy, 1982). Since that time, together with a number of colleagues, I have been working on integrating the mental function associated with the representation and understanding of mental states with psychoanalytic ideas. This is just one of a wide range of mental processes or modules (Fodor, 1983). Systematic study could achieve a high level of integration and a great deal of increased sophistication in the way that psychoanalysts talk about remembering, imagining, speaking, thinking, dreaming and so on.
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