Warning : this text may offend sensitive souls đ
It is often accepted that neuropsychology and clinical psychology are complementary. For example, the complementarity between neuropsychology and CBT (Cognitive and Behavioral Therapy) is often referred to. Conversely, little is said about the complementarity between a psychoanalytical approach and neuropsychology, as these two approaches are often presented as opposed visions. It is true that these two disciplines deal with different aspects : cognitive processes related to cerebral functions for neuropsychology, and psychic suffering related to unconscious mind for psychoanalysis. In this post, I would like to show why, from my point of view, there is no need to oppose these two approaches, and how psychoanalysis can contribute to neuropsychological practice in certain cases. Saying that psychoanalysis can contribute to neuropsychological practice may exasperate some, may even be an aberration for others⊠But I assume this posture because it corresponds to my vision of psychology. For me, the diversity of approaches is precisely what makes psychology so fascinating.
I turned to neuropsychology because this discipline really fascinates me. I had hesitated for a long time about a master’s degree in clinical psychology, because I am very interested in both disciplines. I have always had the idea of combining these two fields of psychology in my practice. But sometimes, I have the feeling that I don’t fully belong in this discipline (neuropsychology), because I also have a particular interest in psychoanalysis, which is (let’s admit it) very little shared within the community of neuropsychologists, and it’s even rather frowned upon.
This desire to link neuropsychology and psychoanalysis is not new and has already been the subject of several publications. Iâm thinking of the article by FrĂ©nisy, Minot, Soutenet, et Amiot (2005). In this article, the authors present a case study of a patient who has had a mild brain injury, which occurred due to a cerebral vascular incident (AVC in french). They choose to analyse the patientâs disorders, using two approaches : neuropsychology and clinical psychology, from a psychoanalytical perspective. Using this double approach bring different interpretations, and allows the authors to better understand the psychopathological and cognitive functioning of the patient. In the course of reading this article, we can see that some disorders are fully explained by the cerebral lesions, whereas other disorders (more of an affective nature) could be the consequence of these lesions as well as of psychopathological processes. What I would like to underline with this article, is that the combination of these two approaches allows for an interesting interdisciplinarity, which is respectful of the patient’s singularity since the interpretations do not lock him into an explanation. We could have done this with another clinical approach, such as systemic or cognitive approach for example, but in this case this article shows that neuropsychological and psychoanalytical interpretations are not necessarily opposed and may even complement each other in some cases.
Psychoanalysis is often said to be unscientific (and therefore useless for neuropsychology). It should be remembered that Freud was a neurologist (and therefore had a scientific academic background), and that he stopped studying nervous system, in a pragmatic way : indeed, to understand the case of neurosis, the scientific study of the brain was of no use to him, since neurosis is underlying by unconscious processes. He therefore founded a psychological method to understand the cases of neurosis he encountered. If psychoanalysis doesnât use a strictly scientific method, it is precisely because what psychoanalysis studies cannot always be explained by science.
I am myself in favor of scientific psychology, especially in neuropsychology where we have to rely on the scientific literature to affirm, for example, that such and such a brain lesion will cause such and such a deficit. Or because we must apply tests with scientifically robust psychometric qualities. Our patients’ future depends on it, because these tests result in treatment. But even if it is important to have a scientific psychology, I must admit that sometimes, when I am looking for reference points to understand a patient’s defense mechanisms, or what is at stake in a clinical interview, scientific articles do not help me, whereas psychoanalysis does. Psychic reality cannot always be understood through the prism of scientific methods, because what it is made up of (unconsciousness, singularity) precisely escapes the scientific method :
Part of psychic reality becomes unconscious and a part of ourselves, enigmatic, escapes us. [âŠ] Psychic reality is also characterized by its hypercomplex and non-linear dimension (Morin, 2005). It thus obeys logics according to which the causalities that organise it are not simply of the type « A lead to B » Consequently, it cannot be restricted to a set of variables that could be separated and studied only experimentally. Psychic reality and consciousness are in fact characterized by their holistic or global character and any reductionist* attempt will therefore be defeated.
* Reductionism : current of thought that consists in explaining the world by separating and studying the different elements that make it up and therefore taking the risk of restricting it to one of its facets.
Rabeyron, 2018, p. 177
For my future practice (clinical or neuropsychological) I am often looking for reference points. All the currents of clinical psychology have something to teach us: CBT, systemic therapy, humanistic psychology… All of them teach us about human functioning and suffering. But psychoanalysis is probably the one that has been most interested in clinical interviewing. Not just talking about transference and counter-transference, but also about defense mechanisms. When reading psychoanalysis, we realize our responsibility as psychologists: we must handle a patient’s defense mechanisms carefully, because they are really survival mechanisms. But to do this, we must be able to identify these defense mechanisms. Psychoanalysis gives me real points of reference, which may also be useful to me in neuropsychological practice, since I will often carry out clinical interviews. Psychoanalysis can also have its place in neuropsychology, to understand the mechanisms at stake in the relationship. It is not because we are neuropsychologists that we are spared from the mechanisms of projection, identification, cleavage, repressionâŠ
Psychoanalysis is often seen as an unglamorous vision of the human being (because it speaks of impulses, of fantasy, but not only that) but this is not the case. In my opinion, it is extremely human because it recognizes weaknesses in everyone and therefore calls for our humility as psychologists, because we too have shadowy aspects of which we are not always aware (psychotherapy work can serve precisely for this purpose). Psychoanalysis has the merit of being the first to have spoken of respect for singularity and defense mechanisms.
A neuropsychologist may well rely on psychoanalytical theory to guide his or her understanding of the patient and the therapeutic relationship. Just as a psychoanalytically oriented psychologist can use certain neuropsychological data to enrich his understanding of the patient, especially when dealing with brain damaged patients. If he doesnât, he probably deprives himself of valuable keys to understanding.
Neuroscientists study the functioning of the brain, the organ of our psyche, as subtly as possible and in the most reproducible way possible. Psychoanalysts study as subtly and intimately as possible the functioning of the psyche, a product of our brain. [âŠ] the brain is the sensitive embodiment of our psyche, the psyche is the emergence of our brain, they are as real as each other and form two aspects of our unique psychophysical reality. Neuroscientists and psychoanalysts ultimately study two aspects of the same thing : our « being », ourselves.
Guénolé & Marcaggi, 2015, p. 233
I consider that any discipline of psychology can have its place in our practice. This only enriches our professional culture, our clinical and ethical thinking, and affirms our clinical posture. It is precisely the richness of the currents that makes psychology a wonderful discipline. To lose this diversity would be a disaster and we would risk being locked into dogmatism, a domination of the more popular currents of thought, which would be very dangerous for our patients.
Of course, everything I said corresponds to my vision of things at the moment, which may of course change in the future. I hope that I will continue to learn and to nuance my ideas, always in order to be more useful to patients and to have the most ethical practice possible.
Words I learnt :
- What it is made up of : ce qui le/la compose
- To be spared from : ĂȘtre Ă©pargnĂ© de
- At stake : en jeu
- Frowned upon : désapprouvé
- It was of no use to him/her : cela ne lui Ă©tait dâaucune utilitĂ©
References :
- FrĂ©nisy, M.-C., Minot, D., Soutenet, M., & Amiot, N. (2005). Accidents vasculaires cĂ©rĂ©braux : approche psychopathologique et approche neuropsychologique. A propos dâun cas : MJ. Annales MĂ©dico-psychologiques, revue psychiatrique, 163 (1), 65-72. https://doi.org/10.1016/j.amp.2004.11.009
- Guénolé, F., & Marcaggi, G. (2015). La neuropsychanalyse: une neuropsychologie des profondeurs. Revue de neuropsychologie, 7(4), 233-235. https://doi.org/10.3917/rne.074.0233
- Rabeyron, T. (2018). Psychologie clinique et psychopathologie. Armand Colin.
Written by Emeline Sanz