Sigmund Freud, the founder of psychoanalysis, anticipated current theory about brain correlates of human psychology. What Freud called instinctual drives can be described in modern terms as the basic emotional operating systems that are mediated by subcortical structures. These are modulated in turn by ego functions, which can now be defined as cortical capacities such as intelligence, reasoning, logic, organizing skills, frustration tolerance, capacity to defer gratification, and the like. The psychoanalytic method was designed to enable patients to overcome symptoms that Freud saw as stemming from unresolved infantile conflicts: "Where id was, there ego shall be." (Freud, 1933, p. 80) The more developed our cortical capacities to modulate subcortical processes, the more control we have over our feelings, behavior, relationships, and productivity. Though never traditionally defined this way, psychoanalysis has always had as its

Textbook of Biological Psychiatry. Edited by Jaak Panksepp Copyright © 2004 by Wiley-Liss, Inc. ISBN: 0-471-43478-7

goal the sculpting of subcortico-cortical functions via the relationship between analyst and patient.

In his earliest efforts to formulate a psychology, Freud postulated a quantitative factor, which, in Project for a Scientific Psychology (Freud, 1895) he designated Q. This quantitative factor may be roughly translated as a physical energic factor. It has been compared to the SEEKING system theorized by Panksepp (Panksepp, 1998; Shevrin, 2001). Freud persisted to the very end with the notion of a quantitative factor in his subsequently elaborated metapsychology. In the New Introductory Lectures on Psychoanalysis, Freud referred to the constitutional factor that in 1933 could not be approached directly:

Our analytic experience that [neurotic phenomena] can be extensively influenced, if the historical precipitating causes and accidental auxiliary factors of the illness can be dealt with, has led us to neglect the constitutional factor in our therapeutic practice, and in any case we can do nothing about it; but in theory we ought always to bear it in mind. (Freud 1933b, pp. 153-154)

Later, in his posthumously published Outline of Psychoanalysis, Freud spoke of the probability that definitive treatment of mental illness would be achieved by medication—not along with psychoanalysis but presumably instead of it.

But here we are concerned with therapy only in so far as it works by psychological means; and for the time being we have no other. The future may teach us to exercise a direct influence, by means of particular chemical substances, on the amounts of energy and their distribution in the mental apparatus. (Freud, 1938, p. 195)

Freud treated patients with a wide range of pathology, some with severe mental illnesses. Since no effective somatic or pharmacological treatments were available to him (beyond an early brief infatuation and disillusionment with cocaine), it is not surprising that Freud questioned the effectiveness of the psychoanalytic method in these cases and looked to future advances in psychobiology to address their needs. He did not anticipate that psychoanalysis and its derivatives might someday be used together with medication treatment, but one suspects that he would have championed this combined approach.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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