The promise of affective science to advance psychoanalytic object relations theory

Abstract

It is an honor and a privilege to comment on Dr. Kernberg’s landmark article. I met Dr. Kernberg personally 45 years ago as a senior medical student when he gave a visiting lecture. I greeted him afterwards and told him that I had a long-standing friendship with a close friend and colleague of his, the now late William Grossman. We shared a moment of connectedness through Bill that I have not forgotten, and I felt elevated by making a real connection with someone who was already a leading figure in the field. I share this anecdote to illustrate that I know Kernberg to be a legendary leader in psychoanalysis for over a half a century, someone who may arguably be the foremost authority on borderline personality disorder in the world. From that perspective, evaluating Kernberg’s contribution, including its pros and cons, feels somehow inappropriate. Who am I to pass evaluative judgement on the most recent thinking of a legend? This brings to mind the question of how advances in psychoanalytic theory take place. Psychoanalytic treatment is a unique context for observing and exploring the nature of the human mind, including its conscious and unconscious elements. The field of neuropsychoanalysis aims to realize Freud’s vision of understanding the mind based on its neural underpinnings. And yet in order to be considered knowledgeable enough to comment on the nature of the mind in psychoanalysis from a neural perspective, one must ideally have vast experience as a psychoanalytic practitioner. Following from the long tradition of Freud as the ultimate authority in the field, I believe the field only takes seriously highly experienced, blue-ribbon psychoanalysts as suitably knowledgeable to propose changes in psychoanalytic theory. It is for that reason that Kernberg’s article proposing fundamental changes in our conceptualization of drives and the dynamic unconscious based on neuroscience is to be so warmly welcomed. I agree with the broad outlines of Kernberg’s new ideas. I agree that we should revise our concept of drives to be fundamentally based on affect systems; I believe that a revision of our concept of the dynamic unconscious in light of advances in neuroscience is very much needed; I applaud the developmental perspective that he offers and broadly agree with the basic notion that behavior and fantasy are based on representations of self, others and the affective connections between them. There are many, many other statements and comments in this paper with which I agree, too numerous to mention. I think neuropsychoanalysis is fortunate that Kernberg has shared his perspective with us. I believe it really helps advance the idea that psychoanalytic theory can be updated by the integration of clinical experience and neuroscientific knowledge. Given the traditions of the field, and Kernberg’s enormous stature, other psychoanalysts are likely to follow his lead. We are therefore seeing progress in the making. As welcome as this is, it is also important to understand why views on these topics may continue to evolve. Although progress requires alignment between deep psychoanalytic knowledge and experience and the latest neuroscientific knowledge, there is a diversity of opinion in both the psychoanalytic and neuroscientific domains on key topics. As such, the theoretical perspective that one adopts in relation to psychoanalysis will influence the position one holds regarding the relevant neuroscience, and vice versa. As a psychodynamic psychotherapist, psychiatrist and neuroscientist, I have focused my academic career on emotion as it applies to physical health, mental health and psychotherapy. I believe the switch from instincts to affect proposed by Kernberg is very useful because we know so much more about emotion and affective systems than we did a century ago, or half a century ago. Moreover, and this is key, the science is now sufficiently developed that it will be an engine for