Theoretical and clinical advances in neuropsychoanalysis: reflections on consciousness, dreams, wishing, and the relationship between inner speech, the superego, and the prefrontal cortex

The articles in this issue contribute to a number of lively contemporary theoretical discussions about fundamental aspects of mental life. They illustrate the powerful creativity that arises when psychoanalysis enriches neuroscience, and vice versa. The pieces in this issue span a wide spectrum of time and space in human life. This is one of the things we value most about neuropsychoanalysis and the people who contribute to it – we take on very big questions, but always attempt to ground these explorations in lived experience. From the longest-range perspective on the human time spectrum, we have an article by Terry Rogers and Ahron Friedberg entitled “A conjecture on the nature and evolution of consciousness. ” They present an extremely big-picture view on this fascinating question. Their deep-time perspective on evolution goes all the way back to the emergence of multicellular organisms, arguing that all animals – not just primates, and not just mammals – may have this profound attribute in common. Integrating work by other contributors to the field, including Bernard Baars, Antonio Damasio, Stanislas Dehaene, Rodolfo Llinas, Jaak Panksepp, Mark Solms, and others, Rogers and Friedberg emphasize the unitary nature of conscious experience, its adaptive function in responding to novelty, and its likely critical role in learning. These aspects of their model, and more, have exciting psychoanalytic implications, and will be of interest to readers following the developments in the consciousness literature. We open the issue at the other end of the spectrum, however – by zooming in on the individual. A very rich Target Article by Christian Salas and Kenneth Yuen, entitled “Revisiting the left convexity hypothesis: Changes in the mental apparatus after left dorso-medial prefrontal damage,” focuses on a single case study of a manwithaprefrontal brain injury.Their careful attention to the dynamics experienced during a psychoanalytic therapywithProfessor Fenriches an emerging depth psychology model of the mind and brain. We find that Salas and Yuen’s powerful and informative Target Article represents the heart of clinical neuropsychoanalysis. They aim to revisit and continue the pioneering work of Karen Kaplan-Solms and Mark Solms in their by now classic book, Clinical Studies in Neuro-Psychoanalysis (2000). That book was a primer in offering a “depth psychology” of the brain through the examination of neurologically injured patients. It was ground-breaking in its combining the clinical neurological aspects with an extensive psychoanalytic understanding of the psychology and subjective experience of the patient. Salas and Yuen point out that although the book was an essential introduction to this integrating endeavor, it has been followed up by fewer papers than was hoped, as Kaplan-Solms and Solms strongly encouraged others to develop the discipline of clinical neuropsychoanalysis and explore its possibilities. In their Target Article, Salas and Yuen add substantially to this small but growing literature. They do this by at first introducing Kaplan-Solms and Solms’ methodology of clinical/pathological technique so that we see its importance. They summarize an example used by those authors – a patient with Broca’s aphasia (located in the lateral prefrontal cortex (PFC)). Salas and Yuen then present a patient with brain damage in the dorsomedial PFC, and elaborate on the clinical description of this patient and the resulting changes in his mental function. The picture includes acquired ego deficits and a dysexecutive state, as well as changes in inner speech and superego function. In doing this they are fleshing out the growing model of brain function linked to anatomical brain lesions, adding a chapter to the work of Kaplan-Solms and Solms, as well as other neuroscientific writers such as Oliver Sacks. The observations that Salas and Yuen make about the case of Professor F, their thoughts on the internal processes in the patient, and the implications for treatment of patients with similar difficulties, are then followed by six very interesting commentaries by clinicians, writers, and thinkers who have already made their own important contributions to this literature. Rudi Coetzer, Fergus Gracey, George Prigatano, Mark Solms, Kobi Tiberg, and Oliver Turnbull bring their expertise to this task by providing a wealth of thoughts that elaborate and extend, and sometimes challenge, the interpretations of the Target Article. The commentators discuss a range of issues, including the technical considerations in working with patients with brain injury, and the human urgency for providing such treatment; important questions about the relationship between language, perspective-taking, and self-regulation; and much more. Readers are strongly encouraged to engage with each of these well-written, humane, and thoughtful commentaries. The authors then respond to these commentaries, including responding to considerations raised by Solms about the medial and lateral prefrontal circuits,