Neuropsychoanalysis, Revisiting Freud, and Living Well: A Conversation with Dr. Mark Solms

Freud's view was the opposite. It was, you got to adjust your methods to the object of study. You don't adjust the object of study to your methods. So Freud studied subjective experience, which is part of nature. It exists. Please notice. Yeah, we are. We're busy experiencing it empirically. It exists. Feelings exist. Fantasies exist. And he tried to bring that into science. And I think that's a very important thing, to not airbrush out of science our very selves.

Hello, I'm Dr. Farrah White.

And I'm Dr. Grant Brenner.

We're psychiatrists and therapists in private practice in New York. We started this podcast in 2019 to draw attention to a phenomenon called the doorknob comment. Doorknob comments are important things. We all say from time to time, just as we're leaving the office, sometimes literally hand on the doorknob.

Doorknob comments happen not only during therapy, but also in everyday life. The point is that sometimes we aren't sure how to express the deeply meaningful things we're feeling, thinking, and experiencing. Maybe we're afraid to bring certain things out into the open or are on the fence about wanting to discuss them. Sometimes we know we've got something we're unsure about sharing and are keeping it to ourselves. And sometimes we surprise ourselves by what comes out. We're here today with Dr. Mark Solmes, a neuropsychologist and founder of the field of neuropsychoanalysis. Mark is a highly celebrated psychologist, author of a recent new translation of the complete works of Sigmund Freud, going well beyond the original translation to include a number of Freud's unpublished papers in neurology, as well as the author of the Hidden Spring, in which he presents a novel and groundbreaking theory of the origin of consciousness. It's impossible to cover all of Dr. Solomon's accolades today in the introduction, and it's a real pleasure to have you here today. Thank you for joining us.

Thank you for having me. It's a pleasure to be here.

So I was sort of curious, Grant, because I know that this is a sort of natural extension for you of some of the interviews and the work that you've been exploring. Can you tell me what Mark's work means to you and what you're most excited to talk with them about?

Yeah, I mean, I really love neuroscience, computational psychiatry. I wanted to focus today, as we often do, on kind of practical matters for a lay audience and focus in on psychotherapy. And so the framework we sketched out was related to talking about your work in the Hidden Spring. On consciousness and maybe the concept of active inference, which includes the work of Carl Friston, who we spoke with a couple of months ago. That was really informative. Discuss the.

The.

The new pearls and the myths and misconceptions that you've unearthed in translating Freud for the last 30 years, and then bring it home to kind of what listeners might take away for how to. To live better or how to make better use of their psychotherapy. For me personally, it's just a huge honor. You know, you're the hero to many people, myself included. I followed your work for many, many years and. And in addition to the ones we mentioned, the work that you've elaborated on meta awareness and how people can most effectively navigate the internal signals we get in order to make better decisions and make use of everything that's happening in this complex internal landscape. So that's where I'm coming from, and I'm hoping not to geek out too much.

Well, those sound like fine topics to talk about. The only thing that slightly puzzled me in what you said. On the one hand, you said that we are speaking to a general audience, and on the other hand you said you had Carl Friston. I don't know how you were able to make Carl comprehensible to a general audience.

You know, I had the similar thought, and I think that episode, as far as could be done, has some things in it that people can follow, but there's a lot of it that requires technical understanding. And so the focus was a lot of it was me translating things and Carl kind of saying, well, you've already answered the question, and here's what I would say to that. And even for me to listen to that episode, I get stuff out of it when I re. Listen to it. Of course.

Makes sense.

So where do you want to start, Farah? I've presented you as being sort of more grounded and pragmatic, not to put any pressure on you. So the hidden spring.

Right, sure, yes. I would love to hear just briefly about how that work came about and, you know, how it might be helpful to the. To the layperson.

Well, how that work came about goes all the way back to the very beginnings of my research, which was in the 1980s and 1990s. I was studying the brain mechanisms of dreaming, and it turned out I'm just. I'll whiz over the details and just come to the punchline, which was that it turns out that dreaming, unlike REM sleep, is generated by a dopaminergic. A pathway, rather a pathway, sort of Too flimsy a word for it. A sort of massive bundle of fibers, part of the medial forebrain bundle. And this is, this is, this arises from the arousal systems of the brainstem, which were always thought of as a sort of power supply, something that sort of switches on the lights, a kind of prerequisite. Like if you want to watch television, first you have to plug it in at the wall. But the electricity supply doesn't actually produce the television. So that's how we saw that part of the brain. And the interesting thing is that this particular bundle of fibers, it's intensely motivational. It has everything to do with emotional life. And it seemed to be something more than just a power supply. I mean, for example, if you upregulate that system, a patient becomes psychotic. If a patient is psychotic, the main line of treatment is to downregulate that system. So you know, it has everything to do with mental life proper.

So dopamine systems have something to do with like pattern recognition or making connections and motivation, reward, right?

Yes. I mean, in a way you could say that all brain systems have something to do with pattern recognition. But I, I would place the emphasis on the second part of what you said. It's if you stimulate that dopamine system in, in, in free range animals, you know, they, they, they become intensely interested in their environment, curious, they explore, they, they, they engage with the world with an enthusiasm and an optimism second to none. And, and in fact, some of our viewers might understand what I'm talking about if I say that snorting cocaine acts on that system. You know, so you think about what happens. I know none of you have ever done it, but I'm sure you've observed other people who have and they become all sort of manic and hyperactive and you know, and sort of supercharged.

And your self esteem goes up too, usually.

Yes, this is what I mean. They become overly optimistic and overly confident and, and it can flip over into megalomania. So when we treat patients with Parkinson's disease, we, we give them dopamine boosting drugs and if you're not careful, you, you push them in that direction and, and not only do they start dreaming intensely because remember, that's where my own research in all of this started. But they become a little bit too optimistic and start gambling compulsively and you know, and start developing religious beliefs that they didn't have before. And then, you know, you know, you, you got to titrate the dosage. But so I, it was really through that my acquaintanceship with that brain system that I became interested in, the brain stem, arousal systems in general, and, and was led to the realization it was always known that they were absolutely fundamental to consciousness. You know, if you have just. Just very small area of damage in those arousal nuclei of the brain stem, the patient goes into a coma. So we always knew they were intimately and fundamentally bound up with consciousness, but we did not realize that they are simultaneously bound up with the generation of feelings, of raw feelings. You know, so all of the most primal emotional drives come from these very same systems. And so that's what ultimately led me to the. The basic premise of the book that you're referring to, the Hidden Spring, which is that, you know, if we're wanting to understand consciousness, why don't we start with this foundational form of it, this elemental form of it, which is prerequisite for any other form of it. We've been focusing on the cortex and on perception. Visual perception is sort of the model example of a conscious state that we've studied and tried to generalize what we've learned from that to. To. To other perceptual modalities and to. And to other forms of. Of cognition. But as I was just saying, all of those higher forms of consciousness are contingent upon brainstem arousal. So that suggests that the most basic form of consciousness is this affective arousal. And so, you know, usually it's a. It's a standard strategy in science that you don't start with the most complex forms of a phenomenon. You start with the most basic forms. So, so the, the view that I took in that gave the sort of impetus to that book. And the basic argument of the book is that if we focus our attempts to discover the. The nature of consciousness, it's how it arises in nature and what purpose it serves, and all of that, we should start not in the cortex, not with perception or, or God forbid, even higher forms of. Of consciousness, but rather down in the brainstem. And we should be looking at, affecting. And that's what that book's about. It's about how the wellspring of all of our consciousness is feeling raw feeling. And then if you. Once you recognize that, I mean, this is not a philosophy, it's an empirical fact, that's where it all starts, with those structures and therefore with that type of consciousness. And if you then take a step back and look at your own life, you realize, hang on. Actually, yes, basically what I'm up to is trying to feel good or feel better, you know, and avoid feeling bad. And all of our cognitive gymnastics Everything that we do ultimately in life is, it pivots on. On feeling. And so that obviously then in turn has implications not only for the basic science of consciousness, but also for the application of, of that knowledge to disorders of feeling, which is what psychiatry is all about, ultimately. Emotional disorders. I mean, that's what psychiatry's sort of bread and butter is. My, my kids, when, when they were little, I overheard my, my, my then little son, one of his children, one of his friends asked him, what does his father do? And he said, my father's a doctor for feelings. I think that's a good description of us.

That. That's. So my understanding is that you were interested in dreams and understanding the subjectivity of dreams. As a neuropsychologist, this was like an idea that people thought was kind of ridiculous. And you, you really are, you know, someone who has been a grant, like a groundbreaker pioneer. And, and it sounds to me like you really had to push through a tremendous amount of professional resistance. And I'm curious what your early experience was like there and how. And how you even became interested in the brain in the first place.

Well, there's a very long story that I'll spare you the details of, but how, how I became interested in the brain in the first place goes right back to my early childhood, actually, because my brother had the misfortune of suffering a brain injury. And I could not but observe that he, as a person, changed dramatically as a result of that. And so I was, in a kind of traumatic way, confronted by the fact that we are somehow our brains, you know, the chap who came back from the neurosurgery department, my brother, that is, was not the same person that I had known before. And so that's. Fast forward from that to then. I, I studied neuropsychology because what is more interesting about the brain than the fact that it somehow mysteriously, semi miraculously gives rise to us, you know, to subjective being in the world. And I thought by studying neuropsychology I'd learn something about that, about how, how does it, how does it happen that the, you know, that this sentient being of the mind arises from these, these anatomical structures and physiological processes. But when in my naive enthusiasm, I asked my professors, you know, these sorts of questions like they were teaching us about, you know, the, the brain mechanisms of memory and language and perception, and it was all these sort of information flow diagrams. And I asked something like, let's just take memory, for example. I asked something like, but why do we actually have the memory you know, if these mechanisms are how learning works and how action is influenced by past, past events and so on, why do we actually experience the memory? And they sort of looked at me as if I'd crawled out of cheese and said things like, no, no, no, don't ask questions like that. You know, the, the questions like that are bad for your career. And so I think most of us get it beaten out of us, the enthusiasm. The very reason why we studied the brain is because of this unique property. It's the only thing in nature that it feels like something to be. And yet this is an embarrassing topic to raise with your teachers. And so the only, broadly speaking, of course, I'm talking about consciousness. How does consciousness arise from, from brain processes? And the only aspect of consciousness that was a respectable topic in the neurosciences of the 1980s, which is when I trained in the early 1980s, was the sleep waking cycle. You know, that the wakefulness and the control of, of, of, of this rhythm of the sleep waking cycle. It was a respectable topic. So I thought, well, let me, let me latch on to that then. And so consciousness and wakefulness were sort of synonymous. And I thought the way that I could squeeze into this, this respectable aspect of consciousness science, the topic that really interested me, which is subjective experience, not the sleep waking cycle, was to focus on this paradoxical fact that the unconsciousness of sleep is punctuated by these periods of wakefulness. I mean, clearly it's not wakefulness because you're asleep, but you're conscious and you're having mental experiences. And so I was able to smuggle in through the back door the topic of dreams under the guise of studying brain mechanisms of sleep. Right.

And you can study patients with different brain damage and see how that affected their dreaming and their sleep.

Yeah, so the correlation between dreaming and REM sleep was made in the 1950s, obviously with human beings. They were woken up during REM sleep and asked for dream reports and they gave them in abundance. And if you wake the same people up outside of REM sleep, in non REM sleep, they report far less streams. So that correlation, once it was made in human beings, then the question was, what are the brain mechanisms that generate the REM state? Because REM sleep is clearly the objective physiological equivalent of the subjective psychological thing called dreams, which is a very slippery fish nobody wants to study. Fleeting fugitive, first person states of mind. So they focused on the hard stuff, you know, the phys, the, the, the, the, the objective physiological biological marker of, of, of dreaming. And that then was studied in other Animals because the kinds of methods that were used were, you know, lening the brain damaging different areas and sticking in electrodes and recording from different areas and whatnot. Invasive techniques, in other words, that couldn't be done in human beings. And so almost all of the research that was done elucidating the brain mechanisms of REM sleep, which were taken to be the brain mechanisms of dreaming because they, the REM sleep correlates with dreaming was done in cats and, and rats. So.

Which appear to be conscious?

Oh sure.

Although they lack a human neocortex.

The, the, the, the, well, both cats and rats do have cortex and they also have REM sleep, of course, but, but, and you know, it's a reasonable assumption certainly in the case of cats, and I would be happy to say, certainly in the case of rats too, that they probably dream. But the problem is from a methodological point of view is you can't ask them about their dreams. And so the content of dreams was sort of left out of that research. We didn't know anything about the brain mechanism. So that was my idea that I wanted to ascertain what, what the relative contribution, the differential contributions are of different parts of the brain to the actual experience of dreams. You know, they're predominantly visual, they're intensely emotional, you know, etc. Presumably damage to visual structures in the cortex will have different effects from damage to non visual structures in the cortex. On the content of dreams. I thought, for example, I hypothesized that the prefrontal cortex, our human sort of evolutionary pride and joy, the thing that distinguishes us most from other primates, let alone other mammals, is our highly developed prefrontal cortex. Now when that's damaged, patients with damage to prefrontal cortex, they, they are no longer masters of their mental houses. You know, they're no longer in control of their impulses, they're no longer able to set goals and, and, and strategies and sort of logically and, and, and, and so on, work through problems. And I thought, well, that's what we're all like in our dreams. We are all just, you know, at sea. And so I hypothesized that the damage there would have no effect on dreams and so on. That was, I thought maybe the prefrontal lobes are not active during dreams. Maybe that's why they have this disinhibited and involuntary kind of quality where you can't, except for in lucid dreams, you know, you can't control things, you can't make things go the way you want them to. So Dreams. Dreams happen to you.

Freud called that like primary process.

Yes, exactly. So I, I thought that. So I was looking at what happens with damage to different parts of the brain in human beings. I studied 360 odd of them and grouped them together according to where the damage was, and they were reliable. Constant changes in the, in the quality of the content of dreams depending on where the damage was. But as I've already told you, the most interesting finding was that this, this dopamine pathway is the driving force of dreams. When that's damaged, dreaming stops and sort.

Of at the heart of consciousness. I had a thought while you were talking about this. You know that animals, yeah, they have a cortex, but they don't have this human prefrontal cortex. I, I sometimes call it the CEO of the brain when I'm explaining how TMS works with people. You know, we start life unconscious, right. Like embryos, you know, aren't conscious. And when you were talking about sleep, wake, I thought, well, in a way, being asleep is more foundational than being awake.

Yes, well, in utero, we sleep a hell of a lot, and little babies sleep a hell of a lot. And they also have a hell of a lot of REM sleep, much more than the adult does. And, you know, so the brain is actually very active when we're asleep. It's not doing nothing, it's doing a hell of a lot. So dreams are the subjective evidence of that, that something's happening while we're sleeping. But looked at from the broader perspective than just my own research, one of the most robust sets of findings about what's going on in the brain from a psychological point of view during sleep is, is memory consolidation. It's very important. Sifting through the events of the day, decide, not deciding in the sense of voluntarily, you know, deliberately deciding. But the brain mechanisms involved are, as it were, deciding, selecting which remembered events are to be retained and which are to be discarded. You can't.

It's part of learning.

Yes, absolutely. It's a, it's a massively important part of learning.

Like the brain is almost practicing while it's asleep.

Yes, it is. And that's easy to demonstrate. You know, if you, you, you teach somebody to one group of students something and then take a nap, and then you test them and you teach the another group of students the same something and they don't take a nap and you test them. The ones who took the nap are the ones who remember what you taught them way better than I remember seeing.

Some study where they would have people do a task. And then they would wake them up and ask them their dreams. Say they were practicing on a skiing machine. Maybe. Maybe you conducted this research, for all I know. And then one person, I remember they reported subjectively he was dreaming that he was putting his feet in the footprints in the snow. And with rats and stuff, they can see the maze. Actually, there's like a map of the maze in their brain when they're sleeping. Right. They're practicing.

All of that's correct. So, I mean, this Robert Stickle did the human research you're talking about, that wasn't me. But the last thing that you referred to there, you can record from the hippocampus of the rat while it's learning a maze. You see the pattern of what it's doing when it's navigating the maze to find the reward and the process of learning how to do that. And then you see during dreaming, sleep that night, the very same pattern of activity in the hippocampus in those rats.

So this is the sense of wonderful about the relationship between how we live and what our brains are doing. Farrakh, can. Can you help, just in the interests of time? I'd love it if we had more time to start to talk about how. How you got into psychoanalysis and into translating Freud, because Freud, of course, people may not know, but one of his most famous early works is the Interpretation of Dreams.

Yes, as you said, Farah must ask me, but you've asked me yourself, so I'll answer while Farrow thinks of something else.

He does that a.

But I. It was. I've already told you why I studied brain mechanisms of dreaming. It was because it was the only way I could get into studying consciousness, because it was under the guise of studying sleep and wakefulness. And then two things happened. The one was that I started to realize, as my findings unfolded, that the brain mechanisms of dreaming are far from what we were taught. We were taught brain mechanisms of dreaming are the same as those for REM sleep. Therefore, they're motivationally neutral. Happens every 90 minutes, automatically. It's driven by a brain chemical called acetylcholine, which has no particular motivational properties, and so on. And so it was a great surprise to me to find that the part of the brain that drives dreaming, unlike REM sleep, is the part you would have expected if you were Freud. You know, because that was Freud's whole claim that dreams are motivated. Wishful. You know, they don't look wishful, but Freud said, well, behind the scenes, they are wishful. And I Thought, gosh, you know, the, if there's any part of the brain that's wishful, it's this, you know, medial forebrain bundle, the dopaminergic part of it. And so that made me, I mean, my teachers, like, probably your teachers when you were at medical school, probably told you Freud's. Freud was a pseudo scientist and it's all nonsense and so on.

And I thought I wanted, I wanted to be an analyst when I was like, 12.

No, no, I, I, I was, I shared all the prejudices that, you know, that, that, that Mike, of my peers, that, you know, this was not something that a serious scientist bothered with. But that made me prick up my ears because it was really the most unexpected finding this. It was really the last thing I was expecting to find that while the person is asleep, you know, the, the, the part of the brain that, that, that energizes the most intense exploratory activities is switched on like a Christmas tree. So that made me attend a seminar which was actually taught in the humanities faculty by a professor of comparative literature. And it was on Freud's Interpretation of Dreams. And, you know, so there I learned. It just so happened that this, this professor of comparative literature said to us in this open seminar that I attended that you can't understand Freud's theory in the interpretation of dreams unless you've read an earlier work of his that he wrote, never published, but he wrote it five years before the Interpretation of Dreams. And this was his famous project for a scientific psychology. And this is a neuroscientific work, in fact, a fairly brilliant piece of theoretical neuroscience. So I read that, and then that's how I learned that Freud was a neuroscientist. I had no idea that Freud was a neuroscientist. And I have the good. Well, I don't know if it's good fortune, but in this respect, it turned out to be fortunate that I speak German. And so I then, you know, delved into Freud's other neurological and neuroscientific writings, and, you know, I was just amazed. I mean, this was clearly a great scientific mind at work. In Freud's book on aphasia, which was written in 1891, it was a fundamental contribution. All of that, plus my frustration and disappointment that we weren't studying the mind. Neuropsychology excluded the psyche. And so I thought, well, let me, let me not jump ship, because I never stopped being a neuroscientific researcher. But I, I jumped ship in the sense that I decided that I would also train in psychoanalysis and then, you know, see what I could draw from that, what I could use to bring it into the neurosciences. You know, psychoanalysis and particularly Freud has this very rich conceptual armamentarium that we can use to, to, as, as Freud said it dissect the function, dissect the functions of the, of the mind. But by the mind, I don't mean language and memory. I mean the lived life of the mind, the self, you know. And so that's what I did. I was in the Department of Neurosurgery at the Royal London Hospital by day and I was, I was in Psycho, the Institute of Psychoanalysis by night, Jekyll and Hyde. And I really don't regret it for a moment.

Sorry to interrupt. What, what, what kind of analysis did you train in then? Was it object relational or.

So I had a kind of a funny mixture because I trained in the British Psychoanalytical Society, which is very Kleinian and therefore very object relational, but my own analyst was anything but Kleinian. He was, he was Anna Freud's successor. When Anna Freud retired as the director of the, what was called the Hampstead Clinic, he was her successor. So he was the, he had been the psychiatrist in chief under her directorship, but then when she retired, she appointed him as her successor. So he was, I want to say.

Was it Masood Khan or Wilford York?

Clifford York.

Clifford York.

Masood Khan was an object relational guy. Clifford York was the kind of the, One of the last Freudian standing in the British Psychoanalytical Society at the time that I trained. So I had a very classical Freudian analysis, but a very Kleinian training, to put it simply.

Yeah. And maybe Grant or Mark, one of you can talk a little bit about what that means for the layperson. That there are these sort of different theories and that it is complex, but.

It'S, it, it's been characterized by a tremendous amount of arguing and internecine fighting and more obfuscation.

Most important thing to say about it, you know, that it's, it's, it's a highly unfortunate state of affairs in, in, in a discipline that purports to be a science that you have to support one or another football team. You know, it's. And that's got something to do with the psychoanalytic method that as, as, as heuristic as it is, psychoanalytical method of investigation reveals things which you can't learn in any other way. Like I said about dreams, you know, you can't analyze the dreams of a rat you know, so, so you know, you talking to people, you learn something about this, their subjective experience. And this is a very important source of information about how the brain works. Presumably subjectivity, experience, feeling is all doing something, you know, and so if you, if you leave that out of account, you, you're leaving out half of what you can learn about it.

So there was a lot of infighting among Freud's inner circle. Carl Jung was supposed to be his successor, and then they got odds with friends. It's a long story, but I think.

It'S, it's got to do with the method. This is what I was going to say. So they all have these different theories, theories derived from the same method. And that's because the method can't decide between the theories. It's, it doesn't, it doesn't allow for falsification of, of hypotheses because it's not an experimental method. It's an exploratory sort of heuristic method. So that was the whole idea. Although I, in training as a psychoanalyst, my aim was to bring psychoanalytic concepts into neuroscience so that we could put the psyche into neuropsychology. And then it rapidly became clear that in doing so, you know, you can't just make speculations. You've got to do research. You've got to sort of see, okay, what is, say, for example, repression and defense and whatnot. You've got to study the brain mechanisms of these things by studying these phenomena. You know, like, for example, I studied patients with damage to different parts of their brains who then displayed characteristic, like, there's a phenomenon called anosognosia where patients are paralyzed down the left side of their bodies. It's absolutely obvious that they can't move their left arm or leg. Obvious to everyone except for the them. They say they're just fine. Thank you. So that looks like denial. You know, that's the Freudian defense mechanism of denial. The way in which we can deceive ourselves. I mean, here's a model example. And, and yet here we know which part of the brain is involved. So that gives us the opportunity to start studying the very same psychodynamic processes that were postulated by psychoanalytic investigation, but now to investigate them using neuroscientific methods. So the, the, the, the, I think that's the way out of the, this kind of argumentation that you were referring to in psychoanalysis, that you need to bring empirical methods to bear on these questions which can decide between competing hypotheses. And so that's what I've, and after doing this dual training, that's what I ended up doing with the rest of my scientific life. And I developed something, you mentioned it in your intro, which, which has this strange name, neuropsychoanalysis, which is an attempt to, to, to bring psychoanalytic theories into the 21st century by subjecting them to the most rigorous and fantastically enlightening new technologies. You know, that we have to be able to, to be able to reach more, more, more definite conclusions about them. But at the same time, I say again, it's a two way street. I, I've also, why I called it neuropsychoanalysis was because I wanted to make clear, because neuropsychology, the neuropsychology I was taught there was no psyche there. As I said, you might as well have been called neurobehaviorism. So I, I, I wanted to use the word neuropsychoanalysis to make plain that what I mean by the mental side of this, this interdiscipline between brain and mind, what I mean by the mental side of it is this is the mind, the subjective experiencing mind, the real mind, you know, not, not a flow diagram.

Well, I find it bizarre because as you know, it's, many psychoanalysts essentially don't believe that understanding how the brain works in general or their patient specific issues, some, some of which may have a neurological basis matters, whereas many psychoanalysts pay attention to it. For me, I think it's, it's a no brainer, you know, if I understand kind of how someone is wired, I find it's very informative to how like I work with them and especially, you know, being someone who does transcranial magnetic stimulation, you know, I, we're doing like network surgery on particular circuits. To your point about anosognosia. But do you see that, say with something like ocd, where there can be higher or lower insight and the level of insight seems to determine how well the patient might do in treatment. How do you think about anosognosia with psychiatric illness?

So before I answer that, let me comment on the first part of what you said when you said most psychoanalysts are not interested in the brain. I have had that argument thrown at me a lot. For example, a colleague, gosh, how interesting from a Freudian point of view. I've forgotten her name. Rachel Blass. That was her name. She, I had a debate with her and she said a pianist doesn't need to know how a piano, you know, what, what doesn't need to know about the, what's going on under the lid. You know, you just play, doesn't matter what's going on under the lid. And I said to her, but we are not pianists. We, we psychoanalysts are more like the people who are trying to tune the piano when it's not playing properly, you know, when it's not working properly. And you can't tune the piano if you don't know how the plotting thing works under the lid. And so that's to your point.

You know, we have stuff under our own lids too, right?

Yes, indeed. Of course, this is one of the strange things about psychoanalytic training is that you have to be a patient yourself. And I think that's a jolly good thing. You, that you learn by your own, by understanding your own foibles, you learn how to empathize with and understand the foibles of your patients. But you were saying about ocd, you were saying, how does this relate to psychiatry? I mean, I'll just give you an example off the top of my head. If you look at FMRI functional magnetic resonance imaging of, of patients with ocd, the thing that lights up more than anything else and correlates with the active symptomatic states that define the condition, it's the anterior cingulate gyrus. The anterior cingulate gyrus is involved in all these kinds of error monitoring and decision making and so on that are so obviously central to the cognitive state of ocd. But it is also the top end of what we call the panic system. You know, there's circuitry in the brain, mu opioid mediated circuitry for attachment bonding, which is absolutely fundamentally important for mammals. Mammals and birds can't look after themselves without a caregiver. So I mentioned opioids for the reason that we become addicted to our caregiver. That's what we call attachment. And then if you separated from your caregiver, then you have separation distress. That's panic. It occurred to me when I looked at these FMRI scans of our OCD patients, I thought, well, it's not just a conflict monitoring in the cognitive sense of the word. This is also the upper end of the panic system. I wonder if the quality of the anxiety that these patients suffer, whether it isn't perhaps panic, you would have thought it's fear, but maybe it's panic. And so we did a study of that. I mean, a self rating sort of thing where they had to check off the patients, had to check off questions and statements about I am this, I am that. And they checked off way more panic anxiety items than fear anxiety. So that led to an insight, you know, that actually the nature of the anxiety in OCDs is separation distress. It's an anxiety about losing control and trying to regain control over an object that might run away, might abandon you and so on. So from, you know, from an FMRI study at the one end, you know, you end up with insights of a kind that help you with this understanding the internal psychological struggles of these patients, for sure.

And I do think that a lot of people could probably relate to this idea that the sort of roots of ocd, certain compulsions or intrusive thoughts can sometimes surround loved ones. Something happening to a beloved parent or a baby. And so we just sort of see that natural progression into full blown OCD symptoms.

But the comorbidity, the comorbidity between OCD and, and major depression and panic disorder, they all on, I think they're all just different facets of one and the same thing, which is this massive attachment and separations system. Mu opioid dominated attachment system.

Right. And our diagnostic system is not based on, for example, understanding different patterns of brain network disconnectivity. And it could be, I don't know if, you know, Glenn Sachs's work.

We constantly saying in psychiatry that, you know, we want a biologically based diagnostic scheme and so on and never getting there. And I think the reason why is because the kind of neuroscience that psychiatrists are exposed to, it's sort of you go from neurotransmitter receptors to clinical phenotypes. It's like nothing in between. And you can't start with molecule and then go to a syndrome. So in between those things are complex systems. And clearly the systems that we need to, I would say the systems that we need to take as our, as our kind of basis for differentiating between different types of emotional disorder are the different basic types of emotion. And these, I've spoken about them, you know, two or three times already in our conversation. Now that dopaminergic one, that's one of our basic emotional. It's the sort of, it's engaging with what's interesting and exploring the world. I spoke about this mu opioid mediated attachment system and there are many other such. They're based in neuromodulators that mediate these basic kinds of emotional state. And I think that if we try to classify mental disorders or emotional disorders on the basis of those basic types of emotion and motivation, we would get a lot further than starting with different types of serotonin receptors.

Right, Yeah, I agree. I think it's also so important really for patients to know because a lot of the time I'll hear, well, I understand all of this, you know, theoretically, and it all makes sense, but why can't I stop doing it? And it's hard for me to say, well, this is actually physiological programming and there has to be a sort of top down, bottom up, collaborative, you know, treatment to, to help the symptoms resolve.

Yeah, let me, let me, let me put in here one of the most basic in the sense of simple ideas and fundamental ideas, you know, that I've, that I found useful is that we must remember that these arousal systems, which are, which are the basic emotional systems of the brain, they're expressing different types of need. I mean, that's, you become aroused by the fact that you're tranquil and placid if you know, your needs are met. And you become agitated in these various different ways depending on which of the emotional needs we're talking about, when those needs are not met. So pharmacological treatment, you know, damps down those systems. But the need, you need to learn over a lifetime how to meet your emotional needs. So I think that the whole of mental development, you could sort of say, fundamentally what it's about is learning from experience how to meet my emotional needs. So what you've just said there, it has to do on the one hand with these chemically mediated arousal states, which is announcing a need not met. And then there are the, the, the, the learning, the memory systems, the, the higher top down systems, which is, you know, what, predictions, I like to use the word predictions for this. Memories are about the past, but they for the future. The whole, the whole purpose of learning from the past is to better predict in future what works and what doesn't work in terms. So I think psychotherapy acts on those predictions, helping our patients to find better predictions, better ways of meeting their emotional needs. And psychopharmacology acts more on the arousal systems themselves, in other words, the announcement of the need. And so I think that they're two sides of the same coin.

So if you do therapy, would you teach patients those basic motivational systems? And I'm quite sure you're referring to, among other things, the work of Jacques Panksep.

Right, yes.

In case people want to look that up.

Yeah, he was a great, great scientist and a great friend of mine. It's very sadly passed away, what is it, seven years ago now. And yes, he, he did more than any other neuroscientist to systematize what we've learned over the last few decades about brain mechanisms of emotion. And he, he knew nothing about psychotherapy and, and, and, and, and psychoanalysis and so on, but he was very interested in it. And so I, I, I, I have. One of the main things that I've done in the direction of trying to contribute to psychoanalysis is to import into psychoanalysis a more sophisticated modern view of what the basic motivational drives of, and they certainly are not the ones that Freud thought. So I've drawn much more on Jaak Panksep than Freud. Freud always looked forward to the day when we would learn more about the biology of the basic motivating forces that he called drives. But not all of his followers were as interested in revising his views as he himself was.

Well, I think this will be super helpful, particularly for people who are going through their own psychotherapy and want to have a better understanding of this grant. Do you have any more questions?

Well, I like to stay on script and I know we're a little short on time, but there's a huge thing that I think you've been translating, retranslating Freud's works and finished recently after what, a 30 year project. And my understanding is that not only did you translate the original volumes that Strachey had translated, but you also translated Freud's prior entire opus, opus of essentially his neuroscientific work, which undergirds his later psychoanalytic work. And I've heard you talk about some of the distinctions you've made as a German speaker, where we may have misconceptions. So the rapid fire session, you know, what are, what are the things that you found out that maybe Freud didn't intend, that people have come to ascribe to him. And what do you think are the main things? I like to ask Compound questions, as you may have noticed. The main things that we can still learn from Freud today and use in our lives.

Yeah. So the comical fact is that I actually had no intention of, of doing this thing that took me the last 30 years to do. I was only interested in translating Freud's neuroscientific works because they'd never been translated, apart from a handful. You know, Freud published more than 200 titles in neuroscience. And so I thought, because of my own experience, which I've already recounted to you, of discovering, wow, Freud was a neuroscientist. And gosh, you know, these psychoanalytical ideas have a, have a foundation in neuroscience. And it. It made me really better appreciate and better understand what those psychoanalytical ideas were and where they come from, what the underlying assumptions are, you know, a whole. So I wanted to translate those. And then the publishers of Freud's psychological works asked me, because I was already busy with this. They said, you know, would I. Would I take on that task? Had I known what an enormous task it was, I don't think I would have so readily agreed to do it. But I don't regret it because, you know, if I may be so immodest as to say this, I think I understand Freud better than anybody. You know, because you take sentence by sentence, you know the German, and you have to ask yourself, what is this chap trying to say here? What is the idea that's cloaked in these words? Because you have to now cloak them in different words. You know, you have to cloak them in English words. So that's just by way of the background. Now you ask about what. What have I had to change in. In the. In the way that Freud was translated? What new insights do we gain, you know, and why does Freud still matter? I think that's what your compound question was. So I'll give one example of what we have to change. In German, Freud uses two words to speak about something that Strachey translated with one word. So the English word instinct, Strachey uses, where Freud uses two different words. Sometimes the word that Freud uses is instinct, which sounds a lot like instinct because it means the same thing. But at other times, Freud used the word trib, which does not mean the same thing as instant. These are two different words. But Stretchy translated trib as. As instinct, too. So the reader doesn't know when is Freud speaking about the one and when is he speaking about the other. So an instant is an instinct. It's a stereotype behavioral response to a need. A trib is the need itself. It's the demand made. It's a drive. The English word I've used for that is drive. It's what. It's. It's. It's the. And it is the font of feeling. You know, going back to what I was saying earlier, these arousal states are drive states. They are deviations from where we need to be. It's. The basic mechanism is homeostasis. You know, that if you are where you need to be, great. If you're not, then you feel it in the form of a. You know, think of, for example, hunger or thirst or sleepiness, you know, and in emotional life, think of fear. It means where I need to be is safe. Oh, shit, I'm not safe. You know, that's. That. That's. That feeling of fear is a drive that motivates you to do something. An instinctual behavior is one of the things you might do. You freeze or you flee. Those are. That's a response to the drive. So that's an example of a. Of a. Not only a mistranslation, it really misleads. Because if you, if you're an English speaker and you read about these instincts, you get the wrong idea of what Freud's speaking about. He's not speaking about inbuilt behavior, Pat. Speaking about the, The. The. The sort of basic source of. Of. Of feeling life. And, and what, what drives us. Literally, what drives us to do what we do. Another example, maybe I've just quickly mentioned it, but I. I don't have time to go into detail. The German word lust can be translated in English as pleasure, which It. Which typically is how straight she translates it. But lust is also lust in the sense that. So lust is. In English, we speak of the appetitive desire and the consummatory, you know, satisfaction of that desire. In German, both of them is one word, lust. Lust covers both. Lust is the appetite and the consummation. So that has all sorts of implications. I mean, I'm sure even the most. The listener to this. Who knows least about psychoanalysis? At least they'll know it's about these things. It's about.

Very salacious. So I think you'll get a lot of readers out of this.

I think that you asked me what's important about Freud. You know, I would say it's been the red thread that's run through our whole conversation is. It's. It's. Freud was interested in, first of all, bringing the mind into science. You know, the behaviorists, Freud's great adversary, they thought we have to change the object of study to suit the methods. So we scientists, we can't study subjective states, so we'll just study behavior. And that, like, excludes the mind. You know, the mind is subjective. No, we can't study it, so we'll study behavior instead. And that literally excludes, you know, the mind from science. Freud's view was the opposite. It was, you got to adjust your methods to the object of study. You don't adjust the object of study to your methods. So Freud studied subjective experience, which is part of nature. It exists. Please notice. Yeah, we are. We're busy experiencing it empirically. You know, it exists. Feelings exist, fantasies Exist, you know, it's desires and thoughts and you know, and all of that. And he tried to bring that into science. And I think that's a very important thing, you know, that to, to, to not airbrush out of science our very selves, you know, and, and then the, as I said, it's the red thread running through our whole conversation. The heart of that is feeling. And so, you know, I think that bringing, taking seriously, not, we don't want to go back to Freud in the sense of, you know, these are theories that are 100 years old and more. But, but the approach to the mind, the, the embracing of subjectivity as, as a serious subject of study and, and, and you know, recognizing that what the brain does, you will never understand if you don't take account of its experiences, you know, that this is clearly, you know, you will never understand what my behavior unless, you know, I have feelings and, and the decisions that I make and the actions I take are in large measure driven by those things. So yeah, it's a matter of bringing that perspective into modern mental science and neuroscience, building upon what Freud taught us rather than sort of saying, oh, that's not science, you know, we're going to, we're going to leave it out.

You've done that so well. And, and you know, psychoanalytic work, right. Is self exploration and it creates this framework which is grounded in neuroscience, in my opinion too, of being self evidencing creatures, as Carl Friston says. But Freud really was that pioneer who started by analyzing himself and kind of opening up his own lid and taking a peek beneath it.

Yeah, well that's the thing about subjectivity is you can only ever observe your own. This is why it's such an embarrassment to science. But as I said, you know, it's part of nature. This part of nature works like that. So it's no accident that Freud started out by studying his own, his own mind because that was the only one he could directly observe and then you know, generalized from there. And this is, this is, continues in the tradition that I mentioned earlier that people who train in psychoanalysis, they have to start off by being psychoanalyzed themselves because, you know, that's the only direct encounter you can have with mental phenomena is with your own. The only direct encounter you can have is.

So do you think there will ever be like an artificial intelligence, machine learning hooked up to some kind of brain scanner which can tell you what your subjective experience is with any degree of accuracy?

Well, I'll tell you where what I'm I mean, I'm. I know we all have to go, so probably we'll end on this. On this topic, I, I would never have dreamt in, in my younger years as a, as a scientist that I would end up where I am now. I was never interested in artificial intelligence because I thought these things are not minds. To call them artificial minds is to completely mislead us. The essence of the mind is that you experience it. And I've said to you, the driving force of the mind is our needs. Computers don't have needs. There was a. There was a Canadian philosopher whose name I'm also forgetting. He said, computers don't give a damn. And so I thought, well, yeah, and so I'm not interested in artificial intelligence. Got nothing to do with the mind. I'm a mental scientist. But until my work. You mentioned Carl Friston earlier. I started to collaborate with him. Well, I started to have interesting conversations with him about 10 years ago. And then I started to work scientifically together with him since about six years ago. And to cut a long story short, if you go back to what I said earlier about feelings, that they are the very foundation of consciousness and they arise from these arousal systems. These arousals, as I keep saying, announce needs, deviations from our homeostatic set points. Homeostasis, therefore underpins consciousness and feeling. And homeostasis is not a complicated mechanism. It's a. Feeling is an extended form of homeostasis. Then it should be possible to, you know, write the algorithms that, and, and, and the, the computational formalisms, you know, that regulate it. So that was the work I did with, with Carl Friston was to try to reduce to a simple causal mechanistic explanation how feelings arise. And once we had done that, then I, I realized, well, you know, in fact, there was a famous physicist, Richard Feynman, when he died, on his blackboard was written this phrase, if I can't create it, I don't understand it. And so I thought, well, if we really believe that, that the, that the equations that Carl and I wrote. Well, actually, he wrote the equations, but the causal mechanism whereby feelings arise, if we really have understood it, we should be able to engineer a robot that has, that operates by these mechanisms. In other words, we should be able to create a computer that does give a damn. And so this is what I'm working on now. That's what I said. It was the biggest surprise of my life to find. This is where I've ended up up, that we are trying to engineer an artificial agent, that the only principle upon which it. It operates is it's trying to continue to exist. It's. In other words, it has. It needs to meet its energy supply. Usually a computer. You just go and plug it in. Our one has to find the energy resources for itself and it has to maintain its viable temperature bounds and all of these sorts of things. And so do I think you were saying that there will ever be an artificial consciousness or an artificial intelligence that is able to probe conscious states? I think that we're going a step further than that. I think that I really. I'm sorry if we end our conversation with all of our viewers thinking that they've been listening to a Dr. Frankenstein or some kind of nutter. But I really do believe we're on the brink. Not just my lab. I think that we in the computational and neurosciences are on the brink of being able to engineer an artificial consciousness. I no longer think it's a matter of if, but rather when.

Quite exciting stuff. I hope you'll come back and tell us about that.

Yeah, I'd be glad to. I'd be glad to. Was really great talking to you. Thank you very much for your interest and. And for your interesting thoughts and questions.

Thank you too.

And where can our viewers find you if they are.

Your.

Your books are on Amazon. Do you have a website or.

I don't have a website. No, they. But my books are on Amazon. And you know, if. If you go to YouTube, although I don't operate a YouTube account, you just type my name in on YouTube you'll find zillions of videos. And also if you want to contact me on. I like to call it X Twitter. X Hyphen. Twitter. Once upon. Once Upon Twitter. My.

My.

My Twitter handle is. Is at Mark Underscore. Mark Underscore Storms. And so you. You can. I'm always telling my followers on that. What's going on.

We'll put that in the show notes too on the website. Thanks very much.

It's been a pleasure. Thanks so much.

Cheers.

Send my best to your father, Farah.

I will. Thank you.

Thanks.

Okay, remember the doorknob comments podcast is not medical advice. If you may be in need of professional assistance, please seek consultation without delay.

Let me say 1, 2, 3.

I want.