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Psychoanalytic theorists believe that human behavior is deterministic. It is governed by irrational forces, and the unconscious, as well as instinctual and biological drives. Due to this deterministic nature, psychoanalytic theorists do not believe in free will. Freud first began his studies on psychoanalysis in collaboration with Dr. Josef Breuer , especially when it came to the study on Anna O.

How can we understand the unconscious mind?

Today, Breuer can be considered the grandfather of psychoanalysis. The research and ideas behind the study on Anna O. These observations led Freud to theorize that the problems faced by hysterical patients could be associated with painful childhood experiences that could not be recalled. The influence of these lost memories shaped the feelings, thoughts and behaviours of patients.

These studies contributed to the development of the psychoanalytic theory. Sigmund Freud determined that the personality consists of three different elements, the id , the ego and the superego. The id is the aspect of personality that is driven by internal and basic drives and needs. These are typically instinctual, such as hunger, thirst, and the drive for sex, or libido.

The id acts in accordance with the pleasure principle , in that it avoids pain and seeks pleasure. Due to the instinctual quality of the id, it is impulsive and often unaware of implications of actions. The ego is driven by the reality principle. The ego works to balance the id and superego, by trying to achieve the id's drive in the most realistic ways. It seeks to rationalize the id's instinct and please the drives that benefit the individual in the long term.

It helps separate what is real, and realistic of our drives as well as being realistic about the standards that the superego sets for the individual. The superego is driven by the morality principle.

How psychoanalysis was born in Europe

It acts in connection with the morality of higher thought and action. Instead of instinctively acting like the id, the superego works to act in socially acceptable ways. It employs morality, judging our sense of wrong and right and using guilt to encourage socially acceptable behavior. The unconscious is the portion of the mind of which a person is not aware. Freud said that it is the unconscious that exposes the true feelings, emotions, and thoughts of the individual. There are variety of psychoanalytic techniques used to access and understand the unconscious, ranging from methods like hypnosis, free association, and dream analysis.

Dreams allow us to explore the unconscious; according to Freud, they are "the 'royal road' to the unconscious". Whereas latent content is the underlying meaning of a dream that may not be remembered when a person wakes up, manifest content is the content from the dream that a person remembers upon waking and can be analyzed by a psychoanalytic psychologist. Exploring and understanding the manifest content of dreams can inform the individual of complexes or disorders that may be under the surface of their personality. Dreams can provide access to the unconscious that is not easily accessible.

Freudian slips also known as parapraxes occur when the ego and superego do not work properly, exposing the id and internal drives or wants. They are considered mistakes revealing the unconscious. Examples range from calling someone by the wrong name, misinterpreting a spoken or written word, or simply saying the wrong thing. The ego balances the id, superego, and reality to maintain a healthy state of consciousness. If a psychoanalytic approach to the pain of a patient does not take its neural substrate into account, pain can be misunderstood as a uniform experience and that all symptoms are interpretable only from the subjective point of view.

Indeed defenses are arrayed unconsciously and intentionally, making the patient less anxious but also less aware of the determinants of her or his behavior. Every one of us has experienced pain. The psychoanalyst puts herself or himself in the place of the patient to help inform interpretations of unconscious determinants of behavior. In the common case of chronic back pain, patients have usually tried an array of remedies including surgeries, but the pain never stops.

Consequently, many of them take opioid medication, becoming vulnerable to an addiction that involves a pathway related to subjective pain, namely the PANIC system in Panksepp's taxonomy of emotions. PANIC is activated by separation distress. The chronic back patient then comes to a psychoanalytic session to talk about a possible psychosomatic association related to their pain, but sometimes both patient and analyst are not aware of the neurochemical implications of the medication that the patient is taking.

The patient will not feel in need of much human contact when taking an opioid medication, and probably will not talk much about separation anxiety, even if isolated. The transference will be modified by a physical symptom and a common medication.

Psychoanalysis as a Scientific Theory

Understanding the interactions of pain, the PANIC system, and opioid medication in these cases is an essential clinical need. Another important factor can be seen in the description of fMRI results contrasting empathy with a loved one vs. The closer the participants' relationships were with their partner, the greater the deactivation in the right TPJ.

This is a fact that no psychoanalyst might get to introspectively, and some might wonder if it is useful to know at all. Apart from it showing correlates between the quality of relationships and neuroanatomical structures, which is another piece of evidence of how the mind and brain depend upon each other and are influenced by experience, it also alerts the psychoanalyst that the state of the countertransference may influence the accuracy of empathy.

How close one feels to one's patient influences the brain of the psychoanalyst. The fact that a patient is taking opioid pills might affect role-responsive Sandler, countertransference. This information may contribute to the understanding of different moments of the analyst-patient relationship that would require further investigation.

Psychoanalysis as a human science: Critique and reformulation

Both from the clinical observation of the analyst and from neuroscientific data, this set of complementary sources of information may lead to new hypotheses on how the analytic relationship evolves during the treatment. Pain experience may not be uniform. The discovery that multiple alleles of the SCN9A gene results in no pain, normal pain, or increased pain sensitivity Peddareddygari et al. Due to variable genetic endowment, the analyst and the patient may have different pain systems. Neuroscience informs psychoanalysts about a potential constitutional difference.

The genetic variant might be tested for if the psychoanalyst wondered about unusual pain complaints. This information is useful to consider—that knowing someone else's experience seems to be truly impossible. However, it does not require subtracting one's empathy from a psychoanalytic encounter, or doubting its validity in all cases.

That would remove a key tool from an impossible profession. The neuropsychoanalytic approach would be to use the biological information to inform clinical work, and also to imagine the possibility that the psychoanalyst's insight about developmental history and interpersonal environment might be relevant to nomothetic research. In summary, pain is an affect that has contributions from constitutional factors such as SCN9A gene variant, developmental history, and interpersonal environment.

Empathy for the pain of a psychoanalytic patient, or the patient complaining about their bladder in a general practitioner's office, may have to do with the degree of closeness in the relationship.


Genetic vulnerability is only one factor involved in a focus on the bladder. Panksepp has shown that the pain system, an endowment of all animals to protect against tissue damage, has been adapted by social animals such as humans to modulate relatedness Nelson and Panksepp, Being close feels good. Loss through death or separation hurts Panksepp and Biven, , p. Johnson et al. Johnson suggested that healthy persons use interpersonal relatedness to shift opioidergic tone in a narrow range indicated schematically by the bar at the top of the inverse U.

Too much contact begins to make people uncomfortable as augmented tone becomes dysphoric. They spend time alone. Loneliness begins to make people uncomfortable as diminished tone becomes dysphoric.

Science, Systems and Psychoanalysis

They initiate renewed pleasurable contact. This opioid principle can be described as a biological underpinning of Freud's pleasure principle. Relationship of pleasure and opioid tone in the central nervous system subcortical pathways. Patients maintained on opioids feel and think autistically.

Human contact is not needed.

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Their relatedness is flattened. They are emotionally unresponsive. For patients who dysfunctionally do little but sit on the couch and take opioid pills, a role responsive countertransference might be to feel disengaged, bored, and unable to contribute. Without the concept that opioids cause emotional withdrawal, the psychoanalyst might be misled by their lack of emotional response, with a mismatch of interpretation to the actual condition of the patient. The concept that opioid function is contributor to relatedness has more clinical applicability.

An opposite shift of opioidergic function would also have to be considered in any treatment of a patient with fibromyalgia. These patients may be emotionally unresponsive due to an autoimmune hormonal disorder that diminishes opioid tone Ramanathan et al.

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  • An approach which has promise is correcting the opioidergic deficit by pulsing the brain with a low dose of the receptor blocker naltrexone, which may provoke a rebound augmentation of function Brown and Panksepp, Fixing the biological problem might enable the psychoanalyst to address emotional issues. It is possible that this approach would also improve outcomes in newly detoxified patients with opioid addiction Johnson and Faraone, The therapist can use body language to understand the patient's feelings more efficiently.

    Finally, what is physical pain, what is emotional pain? How are they related? By asking this question, and by not being able to give a full saturated explanation, a psychoanalyst is both in a position to help their individual patient think about a dysfunctional response to pain, and also to help pose questions to be investigated by neuroscience. Differentiating physical and emotional pain is complicated for fMRI research as well as psychoanalysis Hashmi et al.