JEP --> HOME PAGE --> Number 14

J E P - Number 14 - Winter-Spring 2002
An Example of Neuro-Psychoanalytic Research: Korsakoff’s Syndrome

Mark Solms

Keywords: Psychoanalysis - Neuroscience - Brain Lesion - Human Subjectivity - Korsakoff's Syndrome

This paper shows possible convergences between psychoanalysis and neuroscience, above all on the field of personality and human subjectivity, where the author considers possible to build a bridge, with great advantages for both. In the exemple of Korsakoff's syndrome, a very disturbing alteration of personality, the paper shows how reconsidering the cognitive defect from apsychoanalytical point of view. Korsakoff's syndrome has important emotional effects and may not be considered a simple deficit of the machinery of memory. The author sees in patients'reactions great analogies with the four principal characteristics which Freud described as "the system Unconscious".

The following is a very informal account of my research activities, illustrated by just one example. My main interest is the relationship between psychoanalysis and neuroscience.
I believe that psychoanalysts and neuroscientists, or at least what are nowadays known as cognitive neuroscientists (neuropsychologists and behavioral neurologists), are studying fundamentally the same thing. We in psychoanalysis are interested, just as they are, in the human mind: how it works and what laws govern its functioning. As we are both studying the same piece of nature, albeit it from different viewpoints and using different methods, it is absurd that we have so little to do with each other. Surely we should be collaborating.
In psychoanalysis we try to understand the functioning of the human mind from the vantage point of being a human mind, that is, from the vantage point of inner experience. Our perspective on the mind is the internal surface of Consciousness, as Freud would have called it. We study our patients by encouraging them to look inwards, through their free-associations. We make inferences, firstly, about those individual patients and what is going on inside their minds at that particular moment. From that, we make inferences about that person in general; what the structure of their personality is, and the underlying structure of the difficulties for which they have come to analysis in the first place. From there, we make abstractions about how the human mind in general works. Ultimately we are trying to learn about the “functional architecture of the mind”, as cognitive neuroscientists would describe it.
Neuroscientists start from the vantage point of external perception, of looking outwards, observing the mind as it is realized as a physical organ. They try by various methods and approaches to discern what the functional architecture of the mind is. Thus, when neuroscientists describe a model of how memory works, they are talking about exactly the same thing that we psychoanalysts are interested in, to the extent that we have a theory of memory.
Psychoanalysis rests largely on the clinical method. The methods of neuroscience are more various. Yet there is a method, which had the same significance for cognitive neuroscience as our clinical method in psychoanalysis: the method of clinico-anatomical correlation. Broca formally introduced it into neuroscience in 1861 and Charcot championed it. Charcot had a great influence on Freud. The method involves making clinical observations about mental changes in a neurological patient, which follow from disease or damage to a particular part of the brain. The clinical observations as to how the patient's mind has changed are then correlated with anatomical observations, that is, with the site of the lesion in the brain. This correlation teaches us something about what the mental functions were of the part of the brain now damaged. Although this method of study has since been supplemented by numerous other methods, it is still the obvious place for psychoanalysts to link up with the neurosciences.
Starting with this approach, neuroscientists have developed a highly elaborated picture of the functional architecture of the mind. These attempts to infer normal function from clinical observations and the anatomical location of lesions that produced them have been theory-driven. One does not make clinical observations about the mind without a theory with which to organize those observations, whether as a neuroscientist or psychoanalyst. Broca began in 1861 with the theories of faculty psychology, which were fashionable at the time. These theories were rapidly replaced in behavioral neuroscience by the theories of association psychology, which are not that far removed from those which guide the clinico-anatomical correlation approach to mental science today, i.e. cognitive psychology. Behavioral neuroscientists today use a cognitive model to guide their exploration of the functional architecture of the mind. But that model began to falter as neuroscience began to mature beyond the merely cognitive.
Neuropsychology has begun in very recent years to grapple with something that it previously excluded: the problems of personality, complex emotions and motivation. This provides a unique opportunity for psychoanalysis to build a bridge to neuroscience, because psychoanalysis has a highly elaborated theory about these very aspects of mental life, which neuroscience is now starting to grapple with. I believe that psychoanalytic theories might be of particular help to neuroscientists who are beginning to tackle these problems of human subjectivity. I align myself in this respect with the most recent winner of the Nobel Prize in Medicine, Eric Kandel, who stated in an article entitled “A new intellectual framework for psychiatry” (Kandel 1998; 1999) that this is the future of cognitive neuroscience. In order to grapple with this aspect of mental life, cognitive neuroscientists need to make a bridge to psychoanalysis, which still offers, in Kandel's words, “the most coherent and intellectually satisfying view” of personality, motivation and complex emotion (p. 105). There are enormous advantages both for neuroscience and psychoanalysis. If we can find links between our psychoanalytically derived concepts on how the mind works and the concepts of neuroscience, then we can open our theory to an entirely new range of methodological possibilities, for testing hypotheses that we had previously been content only to generate. The psychoanalytic method is very useful for generating hypotheses about how the mind works and for making inferences, but psychoanalysts have historically not been very good at testing their hypotheses. There is a limit beyond which the psychoanalytical method cannot go. By making links to the neurosciences, we create the possibility of testing some of our hypotheses in ways that might make it possible to move forward in what Freud called our metapsychology, our general theory of how the mind works.
My wife, Karen Kaplan-Solms, is my primary collaborator in using the method that I am going to describe, but we are being joined increasingly by more than a handful of colleagues. We are aware that these are the very first steps. We are drawing very broad brushstrokes, the ABC's of trying to make anatomical or physiological descriptions of our basic psychoanalytical concepts. The method that we use is in fact not radically different from the clinico-anatomical method that I described a moment ago. We study patients with damage to circumscribed parts of their brains, just as cognitive neuroscientists do. We try to understand how their minds are altered by the changes in their brains. However, the method that we use to make our clinical observations and the theory that we use to organize those observations are psychoanalytical. We study these patients psychoanalytically in order to be able to understand how the brain lesion has altered their personalities and their emotional and motivational life. This gives us an initial rough sketch of how these aspects of mental life, as we understand them in psychoanalysis, might be represented in the tissues of the brain. So, basically we use the good old-fashioned “meat and veg” clinical method of behavioral neuroscience. The only difference is the nature of the clinical observations. Cognitive neuropsychologists use psychometric testing to elucidate the cognitive changes. This method is not adequate for capturing the subjective aspects of mental life. In contrast, we try to capture the changes in these patients' minds by studying them psychoanalytically. We have used this method with a wide range of different lesions. We study patients with damage to various parts of the brain, trying to group them together by anatomical region. For example, we researched a group of patients with damage to the right hemisphere convexity; we studied the anasognosia-neglect syndrome which emerges with damage to that part of the brain, and which results in some very interesting personality changes. By looking at these patients psychoanalytically, we did in fact learn some interesting things (I reported on our findings with this group of patients [Solms 1999]).
The syndrome that I am going to discuss psychoanalytically by way of an illustrative example is Korsakoff's syndrome. This is a very bizarre, disturbing alteration of personality that occurs when there are lesions in front of the third ventricle. There is some controversy about precisely what nuclei have to be involved in order to produce this syndrome. The dorsal medial thalamus seems to be an important focus in the production of the clinical syndrome. Lower down, the hypothalamus and the mamillary bodies are also important anatomical structures involved. The basal forebrain nuclei in the frontal lobe, and at least some tissue of the frontal cortex itself, are also increasingly believed to be implicated. The relevant areas are thus the dorsal medial thalamus, hypothalamus, basal forebrain nuclei and frontal cortex.
I am going to describe the clinical picture of this only when the brain damage is in this particular part of the brain. Obviously, if the damage were in a different part of the brain, a radically different personality change would result. Moreover, Korsakoff's syndrome is not to be confused with Korsakoff's disease. That is a disease entity which was described along with Korsakoff's original description of this syndrome in 1887. A second paper on the disorder appeared in 1889. The earlier paper elucidated a particular disease process, essentially a vitamin deficiency, a result of chronic alcoholism, which affects this part of the brain. It was subsequently realized that any disease process that affects this part of the brain produces the same syndrome.
The patient I am going to describe did not have Korsakoff's disease, but a different one, which caused him to suffer from Korsakoff's syndrome(2). What I am about to discuss is the clinical Korsakoff's syndrome, which occurs with damage to this part of the brain regardless of what the cause of the damage was or what the pathological process was. One of the other patients described in our book (Case G, p. 215) had an anterior communicating artery aneurysm, which is a kind of hemorrhage in that area. Another (Case H, p. 207) had a self-inflicted bullet wound in that area.
I am going to focus on a patient (not reported in our book) whom I saw in London. He had a tumor, a meningioma in the aforementioned area of the brain, which was surgically removed. After the surgery, he woke up with this syndrome.
Korsakoff's syndrome has two main features. The first is amnesia: a profound loss of memory. These patients cannot lay down new memories. Thus, they might meet you at one o'clock today; you might walk out of the room and come back in at five-past-one and they won't know you. They will believe that they have never met you. They live from minute to minute without having any recollection of what happened in the previous moment passed. This amnesia affects primarily the most recent events, especially those that occur after the onset of the disease. It does however also affect the older memories, but progressively less so, so that we have a temporal gradient: the further back one goes in time, the more secure the memories are. The more recent the memories are, the more unreliable (or non-existent) they are.
The second core feature of the syndrome, which distinguishes it from other amnesic syndromes, is that of confabulation. Rather than simply saying, “I don't remember” if, for example, one puts a direct question to them in relation to a memory test, these patients invent memories. They make up stories. They have false beliefs. So these cases have not only a loss of memory but also a replacement of the gaps in their memory, as it were, by these florid inventions, which create the impression of a psychosis. This is why the syndrome is also sometimes described as Korsakoff's psychosis.
What theories do we have to explain this syndrome? Although there are controversies and all sorts of diverse opinions, most theorists agree that there seem to be two or perhaps three deficits, three parts of the functional architecture of the mind that are missing or broken. The first is that there must be some disorder of the memory systems. These patients have great difficulty in searching their memory stores, thus there is a deficit of finding the correct memory. The second deficit is that the memories that they do actually manage to retrieve with this defective search method, inaccurate though they may be, are not appropriately monitored. There is not an adequate questioning of whether a particular memory is correct or not. The third deficit, which some think is also necessary, is a more general executive abnormality. In other words, they have a more general difficulty in monitoring and organizing their mental processes altogether, in gaining insight and reflecting on the adequacy of their performances. This is the generic theory in cognitive neuroscience today.
Now what happens when one takes a patient like this into psychoanalytical treatment? And must, incidentally, be psychoanalytical treatment that you take such patients into. If one is going to gain access to the inner life of a human being, one needs to try to help him, to win his trust and involvement in the task. Only future research will tell us the extent to which we might be able to help these patients with these devastating changes. But when one gets to know these patients as people, as opposed to giving them a behavioral checklist or a questionnaire to answer, or scoring them against some sort of objective criteria, what emerges is something which would be absolutely self-evident to any psychoanalyst sitting with one of these patients, but which is missing from the neuropsychological literature on them. What emerges is that these confabulations, random associations, bizarre thoughts and inventions, are in fact far from random and far from meaningless. There is an underlying structure and coherence to the train of thoughts that these patients uncontrollably spew out, when one listens to them in a psychoanalytical consultation.
I saw this particular tumor patient every day over the past two weeks (six sessions a week) and for the first time tape-recorded the sessions. I have been surprised at how disappointing the result of tape-recording is. Reading through the transcript of his extended ramblings, I realized that it really does not convey anything close to what I experienced with the patient. What follows is an excerpt of the transcript of my tenth session with him(3).

Clinical Vignette

I had been seeing him for nine days, Monday to Saturday. What I am reporting is the Thursday session of the second week. Each day, he fails to recognize me. He does not know who I am; he has never met me before, as far as he knows. I have nothing to do with brains or minds. I am one thing or another. One day I was a university mate of his, we were on a rowing team together; another day I was a soccer mate; yet another day, a drinking partner. Frequently, I had something to do with his business activity (electronic engineering)--a client, a colleague, a business partner. But on this particular Thursday he thinks of me as a doctor. This, I believe, represents progress. The minute that I come down to the consulting room to fetch him, his hand goes up to his head, where he has a scar from the craniotomy, and he says, “Hi Doc!” I was really taken by that. So I go upstairs with him to my consulting room and sit down.
As I sit down I say to him, “You pointed to your head when we met in the consulting room”, wanting to try to retain this new development. He says, “I think the problem is a cartridge is missing. We must...we just need the specs”, by which he means specifications. “We just need the specs. What was it? A C49? Should we order it?” I say, “What does a C49 cartridge do?” He says, “Memory. It's a memory cartridge, a memory implant”.
The implant refers to the previous session where in his mind I was a dentist. In reality, he had implants and other dental work done a few years ago. So this immediately comes to my mind. He says, “But I never really understood it. In fact, I haven't used it for a good five or six months now”. His surgery, by the way, was about ten months ago. “It seems we don't really need it. It was all chopped away by a doctor, what's his name, a Dr. Solms, I think.”
Clearly he did not know me from a bar of soap prior to his consulting me after his surgery and after the onset of this amnesia. So there is this name, “Dr. Solms”, somewhere in his head, and it got in there since the onset of his amnesia. “What's his name? Dr. Solms I think. But it seems I don't really need it. The implants work fine.” So I say to him, “You're aware that something's wrong with your memory but...” and he interrupts me and says, “Yes, it's not working one hundred percent, but we don't really need it”. Again, I think it is really an enormous step forward for him to recognize that his memory isn't working, let alone knowing that we are talking about memory at all. “Yes, it's not working one hundred percent, but we don't really need it--it was just missing a few beats. The analysis showed that there was some C or C09 missing. Denise brought me here to see a doctor.”
Denise is his first wife. He is now remarried and his new wife, who has a different name, actually brought him in.
He says, “Denise brought me here to see a doctor, what's his name again, Dr. Solms or something, and he did one of those heart transplant things and now it's working fine again, never misses a beat”. Now he is referring to heart transplants. He did in fact have angioplasty many years before. So he has had some minor heart surgery but not a heart transplant.
I say to him, “You're aware that's something's amiss. Some memories are missing and, of course, that's worrying. You hope I can fix it just like those other doctors fixed the problems with your teeth and your heart. But you want that so much that you're having difficulty accepting that it's not fixed already”.
He says, “Oh I see, yes, it's not working a hundred percent”, and he touches his head again. “I got knocked on the head, went off the field for a few minutes but it's fine now. I suppose I shouldn't come back on, but you know me, I don't like going down. So I asked Tim Noakes…” (a sports medicine specialist) “…because I've got the insurance, you know, so why not use it, why not go to the best and he said, fine, play on”.
Obviously he is talking about his memory. Although he is talking in fact about all sorts of other things, underneath there is something guiding him, an awareness of his memory loss, which is a new development. I keep trying to point this out to him, that this is what is really worrying him. Eventually he starts to become a little bit agitated and starts to talk about explosives and says, “Well, in this factory” (now we're in a factory) “there are a lot of detonators lying around and it can be very dangerous and it's, you know, it's not good for youngsters to not follow the correct procedures. There can be an explosion”.
I interpret this as his pointing out to me that this is getting dangerous, he is starting to feel very unsettled by what I'm talking about; some emotion is starting to get involved here, it is not just an intellectual matter. I get through to him again, so that again he is focusing. Awareness again dawns on him that he has got a memory disorder and he doesn't know whether he is coming or going. He is really lost. It is extremely distressing. Then he stands up and starts searching in his pockets for a piece of paper which he says he has lost, but there is no piece of paper in his pockets and I say to him that perhaps he has left it elsewhere; I didn't see him bringing any piece of paper in here. He is searching in his pockets and takes off his trousers and shakes the trouser legs looking for the piece of paper, now in a really agitated state, the sort of state that you get into when you've lost something important, something that really matters to you, and you're looking for it. Then he takes the chair and looks under it, and I started to feel a little bit anxious for my safety with this big guy with a chair in his hands.
I will break off the description of the session there. He was showing me how agitated he was feeling about what he had lost, his memory.


The experience I have of the patient is that it is like trying to find a radio station or a television channel: you turn the knob and you're just off the station, then you're on the station and it's all in focus, and then it goes off again and there's all this fuzzy sort of noise, and then you're just about on the station and you can see the picture flickering and you know that's the one that you want, and you try to tune it back in again, and so on. That is what his associations are like; that is how it feels to listen to him. He, or at least part of him, is trying to find the real station, the actual memory or the awareness of what is actually happening in his world right now. As he goes onto that station, he cannot stay there, he fades away again. But he does not go away just anywhere, he stays more or less within that waveband. He is just about on the spot that he is looking for. Thus he throws up all these images, thoughts and memories, which are in some way connected with the thing that he is looking for.
In sum, he is trying to find a certain thing, but what he finds instead is a whole lot of things around it that are symbolically connected, in the broadest sense, to the topic that he is actually looking for. It is like being in a dream, as we understand dreams in psychoanalysis, where the images are not random. Underneath or behind these images are other thoughts, which connect them in a coherent way. It is exactly like this with this type of patient, as if they are speaking symbolically or metaphorically, and all one has to do is make these very simple “interpretations” and you get them back on track, and then they go off again.
This cognitive account is the first thing one can see by looking at the content of the patient's associations, although we are more interested in the content than perhaps a cognitive neuroscientist would be. Yet it is more than that. It is not just that the patient's thoughts go off focus. There is clearly an emotional factor at work here. This is the second thing we notice. There are certain “wavebands” that he cannot tolerate. He has a reduced tolerance of reality, so that when he becomes aware of the very disturbing state in which he literally does not know where he is, he cannot retain the focus. This patient does not know what happened a minute ago or who this guy is sitting in front of him, and he cannot bear that awareness of the reality he is in. Then a sort of delusional psychotic process takes over, in which he replaces what he observes (if he does manage to observe it) with something more bearable and more tolerable. Thus, it is not simply a cognitive defect. There is an emotionally based factor too which accounts for the symptoms in Korsakoff's syndrome. This, I am afraid, is the only discovery that we can offer cognitive neuroscience about this syndrome. One is seeing not simply a deficit of the machinery of memory. There is something that rises up to fill the gap left by that deficit--there is a dynamic interplay. The reality-monitoring part of the mind is weakened, and some other force, which is usually held at bay, rises up, commensurate with the weakening of that reality-monitoring force. I now want to briefly describe this positive sympto-matology.
The type of thinking that arises in these cases to replace these patients' sense of reality can be summarized under four headings. I shall use some of the patients in the aforementioned book as examples of these more general points.

1. Replacement of External by Psychical Reality
Firstly, there is a replacement of external by internal reality. These patients give a disproportionate weight to psychical reality at the expense of material, objective reality. An example is the patient just described. The objective reality is “brain”. What we are talking about is brain and memory disorder. Internally to him, however, these are connected to other images which have to do with teeth and hearts, and these take precedence over the objective reality. These internal thought processes, connected to the objective topic, are treated as if they too are objectively relevant. There is an emotional or wishful factor here too. His teeth and heart were cured. His memory problem is in all likelihood incurable. Thus, in replacing the external reality with an internal one, there is also a shift of a tendentious kind.
Another patient described in Karen's and my book (Case G, p. 218) was a man who experienced all of the psychotherapy sessions as conference sessions. He saw me as part of a course. Moreover, he experienced being moved from one ward to another in the hospital as being dropped from the football team. Thus, internal associations take precedence over external facts.
Many of these patients described the most amazing things that they had done the previous night. These descriptions are an over-valuation of dream experiences, which are then treated as if they too were real experiences.
One patient (Case H, p. 211) was always talking about pyramids and the shifting sands outside the hospital and so on, as if we were in a desert in Egypt. We subsequently learnt from one of the nurses that he was busy reading a book about the pyramids at Giza. To this man, he was actually in Egypt; his fantasies were just as valid as his actual experience of being in the ward. He also believed that he was in a hotel in the Caribbean and that he was on holiday on a barge while he was in our ward (Case H, p. 208). Here the theme seems to be confined space, with strangers.

2. Exemption from Mutual Contradiction
Secondly, there is an excessive tolerance of mutual contradiction. These patients hold two or more things to be true which cannot in fact be true at the same time. For example, one of the patients (Case F, p. 203), a woman, believed that the man in the bed next to hers was her husband. Although he bore no physical resemblance to her husband, she told everyone that he was her husband and she treated him literally like her husband. She also recognized that her husband came and visited her daily, and when her other “husband” was there, they were both her husband. She could tolerate the idea of them both being her husband at the same time.
One patient (Case H, p. 209) came excitedly to his therapist, my wife Karen, to say how pleased he was to have seen in the hospital an old friend who had died some years ago in Kenya. Once again, in a strange place, the patient recognizes a familiar face. Karen asked him, “But how can you have met him here in the hospital if he died twenty years ago in Kenya?” He stopped for a moment and replied, “Yes, that must present interesting legal problems, being dead in one country and alive in another!” It is notable that there is something funny about much of what these patients do. (We have a theory about humor in psychoanalysis, which is pertinent in these cases.) These patients commonly report that relatives of theirs are dead, but at the same time they assert that these relatives are alive. That is tolerance of mutual contradiction. We even had one patient (Case G, p. 216) who believed that he himself was dead, telling others about the experience of being dead and still being there to describe it. (There is no such thing as death in the unconscious.)

3. Timelessness
The third feature of these cases is timelessness. Time is not an objective fact but rather a theoretical construct that one can use at will. One patient (Case H, p. 209) even said, when contradicted on a certain point about time, “Well, there are many different types of time. There's your time, there's my time, there's adjusted time, there's municipal time, there's hospital time”. With them, time can be used in various ways depending on your needs. That same patient always believed it was 5:00pm no matter what time of the morning, afternoon or night it was. If he had just had breakfast, it was 5:00 pm. It happened to be the time that his wife visited him every day. Thus, the wishful or emotional element is apparent again. As this particular patient was leaving the consulting room, he said to my wife, “Oh, 5:00 pm. You know Buffy's going to be here”. His wife's name was something like Buffy. Karen replied: “No it's not 5:00 pm; it's 11:00 am”. He then saw a No Smoking sign on the wall with a red diagonal line through a circle, which he took to be a clock-face, and said, “Look, it is 5:00 pm” pointing to the sign. Once again, wishful inner reality overwhelms external facts.
In fact achronogenesis, a failure to sequence events in time, is a well-described aspect of this syndrome, even in the cognitive neuroscience literature. A condensation of time also is seen. This is not only a failure to order events, but events happening on top of each other, as in the previously mentioned female patient (Case F, p. 203). She had had a hysterectomy, a previous hospital admission, and a deep vein thrombosis in her leg. She described all of these conditions and all three of these hospitals as what was happening to her now: she was here for a hysterectomy, she was here for a brain operation, she was here for deep vein thrombosis; she was in this hospital, that hospital and the other hospital simultaneously. Again, one sees the dream-like quality of these patients' thoughts.

4. Primary Process (Mobility of Cathexis)
The last of the four positive features of these cases is a primary process type of “mentation”: one object replaces another at will. Depending on the patient's need, a strange man can be your husband if you need him to be your husband; this thing in your head can be a dental procedure if you need it to be a dental procedure. Additionally, there is a visual concretization and objectification of abstract thoughts. The patient described initially was aware that there was something wrong with his memory, and turned it into: “I've lost a piece of paper that was in my pocket which contains specifications”. All of the displacements, condensations, visual representations and concretizations evident in these patients are recognizable from dreaming thought. The wishful thread is readily apparent all the way through.


What do these observations tell us about the functional architecture of the mind? What is it that this part of the brain does that a psychoanalytical study of these patients elucidates? Alternatively, how can we represent our model of the functional architecture of the mind in this syndrome? What, psychoanalytically speaking, has gone wrong with these patients? I am going to describe in the most rudimentary theoretical terms different psychoanalytical perspectives on this.
We see in these patients the four principal characteristics described above, which Freud described as the four “principal characteristics of the system Unconscious”. His paper on “The Unconscious” holds that these four things (1) replacement of external reality by psychical reality, (2) exemption from mutual contradiction, (3) timelessness and (4) primary process (mobility of cathexis) are the principal functional features of the unconscious. All four characteristics are apparent in these patients. One does not need to infer them: they are there, the unconscious is on the surface.
What theoretical sense can we make of this? It seems that whatever it is that normally suppresses this type of mentation is weakened by a lesion to this part of the brain. Remember: This happens only with damage here. Other brain-damaged patients are different. Something essential to what Freud called the system Pre-conscious or the secondary process, the reality-oriented part of the mind or something essential to it, is missing in these patients. The reality principle breaks down with damage to this part of the brain.
We cannot localize the whole system Pre-conscious in this part of the brain, yet we know that some function performed by that part of the brain is essential for that entire functional system. With that function removed, what comes through or replaces it is what Freud called the system Unconscious, the primitive, wishful, reality-ignoring aspect of the mind.
So, what does psychoanalysis add to cognitive neuroscience's description of the cognitive deficits in these cases? It adds the realization that their positive symptoms, these more primitive tendencies in the mind that are released, account for much of what is actually seen in Korsakoff's syndrome. It is not simply a matter of deficit.
It is possible, using the method of clinico-anatomical correlation, to find a foothold in functional anatomy, in order to link our basic psychoanalytical concepts with the functional anatomy of the brain. I have described just one syndrome and used one theoretical concept to make sense of it. Of course, when one studies all the different syndromes that arise with damage to all different parts of the brain, one gets a much richer picture, a much more fully elaborated theoretical understanding, of what exactly is occurring in each of these syndromes. For example, a release of primary-process types of thinking occurs, in different ways, with other syndromes as well. By studying all these syndromes together, we get a picture of the different aspects of this broader complex phenomenon that we call secondary process thought, and in the process we manage not only to make links between our psychoanalytical theories and physical tissues, but also to understand in more detail what the global “secondary process” might be in smaller bits. We develop a deeper understanding of what that broad brushstroke concept is all about. In attempting to correlate our theoretical concepts with functional anatomy, we also find the flaws and the shortcomings of our theory. In this way, we can build a better theory of how the mind works, which is ultimately the aim of both neuroscientists and psychoanalysts.
We also need to communicate our findings with neuroscientists working on the same problem. Sadly, neuroscientists have historically been uninterested in psychoanalysis. Anyway, we have sought to create dialogues between psychoanalysts and neuroscientists, mainly by starting an inter-disciplinary journal, Neuro-Psychoanalysis, with an equal number of leading analysts and neuroscientists on its editorial board. Here we publish our findings and psychoanalytical observations on topics of neuroscientific interest.


Kandel, E. (1998, 1999) “A new intellectual framework for psychiatry”, Amer. J. of Psychiatry, 155: 467-69. (Also 156: 505-24)
Kaplan-Solms, K. and Solms, M. (2000) Clinical Studies in Neuro-Psychoanalysis (London: Karnac Books).
Solms, M. (1999) “The deep psychological functions of the right cerebral hemisphere”, Bulletin Brit. Psycho-Anal. Soc., Vol. 35, No.1, pp. 9-29.


1 Paper presented at the Annual Research Lecture of The British Psycho-Analytical Society on 7 March 2001.
2 He is one of a group of patients described in more detail in our book (Kaplan-Solms & Solms, 2000).
3 I have edited it slightly-which was necessary if it were not to be completely incoherent. It did not feel so incoherent at the time.

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