Depth Neuropsychology And Issues Of Methodology

In order to properly conduct a depth neuropsychological investigation, a method must be developed/utilized to allow one and the same thing to be simultaneously studied from both the psychoanalytic and the neuroscientific perspectives, so that the two sets of observations and the resultant theoretical accounts refer to the same reality. Only this enables us to link the subjective and objective approaches in mind/brain realities rather than merely semantic constructs. One suitable approach is the well-established clinico-anatomical method, familiar to those with experience of the theoretical underpinnings of internal medicine in general, and clinical neurology in particular. This method was explicitly introduced into neuroscience some 150 years ago, by JeanMartin Charcot, the world's first professor of neurology, famous for his work at the

2The term depth neuropsychology has also come to be used interchangeably with the term neuropsycho-analysis.

Salpetriere Hospital in Paris. The method involves systematic clinical correlation of compromised mental functions with anatomical damage to particular areas of the brain. The goal is to establish lawful, clinico-anatomical correlations between the different mental functions and the different parts of the brain. This approach has been the central method in neuropsychology for many years, uncovering the basic neurobiological correlates of psychological functions as diverse as language, memory, and executive functions.

What is required, for the purposes of a depth neuropsychology, is the simple extension of this method to psychological functions beyond cognition. In many respects, this is a simple extrapolation. People who suffer brain tumors, strokes, and other injuries are still people, with well-developed personalities, complex histories, and rich internal worlds. Since these things are the stuff of psychoanalysis, such patients can be studied psychoanalytically as can anyone else. In this way, basic clinico-anatomical correlations can be drawn, directly linking psychoanalytical concepts with neurological ones and thereby integrating them with each other on a valid empirical, rather than speculative, basis. By taking neurological patients into psychoanalytical assessment and therapy, one can determine whether, and in what way, a particular function of the mental apparatus has been affected by a brain lesion. A therapist with appropriate training can simultaneously help them come to terms with what has happened to them. Observed changes can then be correlated with the brain area that has been damaged. This reveals the contribution that the part of the brain in question made to the organization of that mental function. If, for example, we observe that patients with ventromesial frontal lobe damage suffer a near-total breakdown of what psychoanalysis would call secondary process inhibition (a process that one might describe in neuroscientific terminology as that of executive regulation of emotion), we may reasonably hypothesize that this psychoanalytical function is co-extensive with the neuropsychological functions of the ventromesial frontal region (see Fig. 19.1).

Figure 19.1. Ventromesial frontal lobes.

This assumes that the correlation between the observed lesion and the observed mental change was not simply a coincidence. That assumption is tested by checking one's observations in the individual case against analogous observations in as many similar cases as possible. In this respect neuropsychoanalytic research is no different from any other branch of neuropsychological research. By investigating small groups of patients, it is possible to discern reliable patterns of association between brain regions and mental functions of psychoanalytic interest. Kaplan-Solms and Solms (2000) describe three small groups of this sort, for three separate brain regions. The results appear to be quite reliable, but this research tradition is still in its infancy (see Solms and Turnbull, 2002).

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Anxiety and Depression 101

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