To introduce the thematic, Kendel is focusing on the gap between the biological psychiatry and the psychoanalytical psychiatry. Indeed, since the 50’s, the US psychiatry center is clearly influenced by the psychoanalytical theory. That state of fact is contradictory. Undoubtedly, this conceptual perspective brings to psychiatry a clinical insight and a sensitivity to explanatory. However, psychiatry lost its link with experimental medicine and biology. But the main reason of this split is the slow maturation of the brain sciences. For example, for 40 years, the main theory of brain was not able to consider relations between mental functions and brain regions (« the equipotential cortex »). But the first separation was made by Freud who tried to conceptualize a neurological model of unconscious implication in the behaviors. The immaturity of the biological knowledge convinced him to abandon that way for a purely mentalistic model. In consequence, psychiatry has been developed in two branches which was doomed to find each other since the 80’s for 3 reasons : the former is the new therapeutic armamentarium, the second is the new objectives criteria in mental illness and the latter is the genetics interests in illness like depression and schizophrenia.
For several decades, psychiatry, psychoanalysis and neuroscience have beeing in a new and better position for a rapprochement. This new proximity “would allow the insights of the psychoanalytic perspective to contribute to the search for a deeper understanding of the biological basis of behavior.” (Eric & Kandel, 1998).
Firstly, this clinical perspective was interested in the field of neurological diseases e.g. head trauma, cerebral vascular accident, brain tumor. This illnesses have obliged the scientists and mental health professionals to rethink the psychics functions of this people in a convergent way whose links neurosciences and psychology notably psychoanalysis (Ouss-Ryngaert, 2007). Today, it is increasingly recognized that these two fields of mental health are entangled.
The researches about a link between brain functions and the mind highlight 5 principles :
1- All mental processes come from brain processes. Brain is not only at the origin of motor behaviors (walking, eating…), it also manages all the complex mental and cognitive processes (thinking, speaking, being conscious…) (Kandel, Schwartz, & Jessell, 1991).
2- Combinations of genes are a major component of the development of mental illnesses e.g. schizophrenia, depression, addictive behavior… (Kallmann, 1938; Heston, 1970; Rosenthal, Wender, Kety, Welner & Schulsinger, 1971; Gottesman, 1991; Kandel, Schwartz, & Jessell, 1991).
3- The second principle is modulated by environment. The only genes combinations could not explain the development of mental illness. The environment (parenting, social…) potentates the genetics alteration and this combination causes the development of mental diseases. (Seltzer & Frazier, 1978; Jones, 1995).
4- The expression of altered genes changes the pattern of brain connections. These modifications of neuronal pathway can be responsible of the beginning and maintaining of unadapted behaviors. Kandel, 1995).
5- Psychotherapy can help to change the expression of genes. (Merzenich, Recanzone, Jenkins, Allard & Nudo, 1998; Bailey & Kandel, 1993).
Because of progress of brain imaging, scientists have beeing able to demonstrate the variations of brain in neurological illness, but also during a psychotherapy progress. To illustrate that point of view, the author take the example of OCD (Obsessive Compulsive Disorder). This illness is characterized by obsessions, unwanted thoughts and compulsions which are considered like an attempts to deal with anxiety. The first opinion (a biological opinion) of that problematic is the role of the cortical-striatum thalamus brain system in the regulation of symptoms, and more specifically the right caudate nucleus. The purpose of the medication is too use SSRI which are serotonin reuptake inhibitors. But the other possibility is to lead a behavioral modification based on exposure and prevention techniques. A comparative study argue a significant decrease of activity in the right caudates nucleus with the use of SSRI and white behavioral therapy. This element (among other) shows that the therapist, during a therapeutic work don’t only make eye and voice contact : the psychotherapeutic intervention produces changes in the patient brain, in the same way that the medicine.
Nowadays, neurosciences and psychoanalytic perspectives are more linked than ever. As we saw in the beginning of this digest, it took many years to consider that neurosciences and psychoanalysis can be consider together in one perspective. At dawn of the 20th century, Freud, who was neurologist and neurosurgeon, try to impose this link between brain and mind. However, his theory has been excluded of the neurosciences to become the “depth psychology”. The end of the century signs a reborn of his theories, and the 21st century could be the time of the “neuropsychoanalysis”.
In the future, the mental health professionals will need important knowledges in neurology. These knowledges will be necessary to train and to improve their practice. They brought a significant impact to different patient and treatment for autism, mental retardation… But the rapprochement of these two approaches, biology and psychiatry/psychoanalysis, are complex and there is many paradoxes. Mental illnesses are composed by a lot of mystery and this raises a lot of questions.
This rapprochement could bring benefits to psychoanalysis which is suffering from a lack of scientific culture.
Psychoanalysis and biology work together to study individual cases (e.g. Broca). The future of psychoanalysis is to work with new technologies such as the neuroanatomy and human genetics. A biologically-based psychoanalysis could allow further discoveries about the brain and its functions.
Valentin Naudé, Richard Renaud & Raphaël Saddier.
