Objective Subjectivity: A Basic Theory of Neuropsychoanalysis
Freud’s ideas about the mind, evolution, and culture were revolutionary. Psychoanalytic theory was brought into service to treat mental illness because it was developed in a medical context. But the methods of psychoanalytic investigation, especially ‘free association’ and dream analysis, were most suited for learning about the mind, not ‘fixing’ the mind. The theory involved thinking objectively and scientifically about normal and pathological subjective experiences such as ‘feeling anxious’ and ‘feeling depressed’. Psychoanalytic ‘therapy’ involves largely telling a patient “this is how your mind works” and “this is why it works this way”.
‘I hadn’t started out per se to ‘study’ serial murderers, now many years ago. I was doing neurological research on the NASA Skylab and Apollo-Soyuz Test Project. Increasingly I was becoming interested in neuropathology of primitive personalities. In biochemistry we go to the molecular structure of a compound to see what its chemical signature is composed of. What then was the signature of what may be the most primitive form of man; who represented man at his serially worst: A murderer who killed for seemingly pleasurable gain and who used power, control and dominance, as a way of torturing his victims before he murdered them. In those days the term ‘serial killer’ was not yet in the public sector as it resides today nor did the idea of a serial killer carry the current voyeuristic allure.
Neuropsychotherapy: emerging from the shadows Within the broader world of psychology and clinical psychology, neuropsychology has had a reputation for being overly academic and assessment-focussed. When I joined the profession over twenty years ago, we had our elegant models of cognitive function and dysfunction, and the neurologists and GPs could expect long and complex neuropsychological assessments from us, which pin-pointed areas of difficulty. However, a casual observer might rightly wonder aloud, ‘So what? How does this help the distressed patient and their family?’ Over the last twenty or so years, the expectation has rapidly grown that clinical neuropsychologists will produce programmes of cognitive rehabilitation and help people re-integrate into their lives and societies. Most clinical neuropsychologists have always recognised the emotional havoc caused by an acquired brain injury – such as stroke, tumour, or trauma – and will have tried to adapt models of psychotherapy to deal with it, such as cognitive behavioural and personal constructs therapy. But it is only in relatively recent times that the discipline of neuropsychotherapy has begun to emerge from the shadows in its own right. Whilst recognised models and systems of psychological therapy – including psychodynamic psychotherapy and analytic therapies – are important contributors to the development of this new discipline, there are a range of workers (including in the UK) who have gone beyond merely adapting these approaches and have developed their own systems and modes of neuropsychotherapy. Our new book, Practical Neuropsychological Rehabilitation in Acquired Brain Injury, features a key chapter given over entirely to the concepts, principles and practice of neuropsychotherapy with acquired brain injury. Within the chapter, the reader is taken on a comprehensive tour of how to adapt models of neuropsychotherapy, and is invited to consider a helpful generic model of psychotherapy for brain-injured patients. A single case is presented and a range of treatments proposed, which embraces cognitive behavioural, psychodynamic psychotherapy, family/systemic, narrative and cognitive analytic therapy. We hope that our exciting new book will act as a staging post in the further development of neuropsychotherapy. ]]>