Unlocking the Neurobiology of Freud’s Psychoanalytic Theories – Neuropsychoanalysis | Part 1 of 4

The evolution of psychoanalysis can be traced back to several psychodynamic paradigms that emerged over time. One of the earliest approaches in mental healthcare was moral treatment, pioneered by Philippe Pinel in Paris around 1750 and later advocated by his student Jean Esquirol.

In England, William Tuke adopted a similar humane approach in the late 1700s, advocating for reforms in the treatment of asylum inmates [Kibria and Metcalfe, 2016]  

Concurrently, Franz Anton Mesmer introduced the pseudoscientific concept of ‘animal magnetism’ or mesmerism, suggesting that doctors could use suggestion to influence the mind’s uncontrollable aspects. A fascinating report by the Royal Commission on Animal Magnetism (1784) can be found here.  

Psychoanalysis was developed by the renowned Austrian neurologist Sigmund Freud. [Freud, 1910] 

Freud was fascinated by his colleague Dr. Josef Breuer and his work with a patient named Anna O, who attended his practice with unexplained physical symptoms.

Under hypnosis, Dr. Breuer achieved symptom improvement by delving into and addressing her unconscious traumatic memories.

Freud subsequently created his first model of the human mind in 1923, giving rise to the now well-known psychoanalytic terms of the id, the ego and the superego. [Freud, 1923]

Freud’s Ego Psychology was developed further by Heinz Hartmann in the 1940s. Influenced by Anna Freud in the 1930s, Hartmann emphasised the role of the ego (the conscious, rational part of the mind) in personality development and functioning.

It aimed to understand how the ego copes with inner conflicts and external demands and helps to foster healthy defences through increased functioning. [Boag, 2014]

Object Relations Theory began as Kleinian theory, founded by Melanie Klein in the UK in the 1930s. Object relations theory explores how early relationships with caregivers shape an individual’s internalised mental representations of others (objects). It emphasises the impact of these internalised objects on one’s personality and relationships.

Melanie Klein’s perspective that developmental drive stems from the need for emotional attachment rather than pleasure-seeking offered a rational alternative to Sigmund and Anna Freud’s earlier perspectives. [Hayman, 1994]

It was developed further by Donald Winnicott and later Otto Kernberg in the US. [Hayman, 1994]

Michael Balint, John Bowlby, and later, Harry Guntrip advanced Klein’s works into Object Relations Theory. [Sutherland, 1980]

Attachment Theory was developed by John Bowlby and Mary Ainsworth in the UK (1930-1958).

They consolidated some of the earlier object relations theories through empirical research studies. Attachment theory examines the importance of early emotional bonds between children and their caregivers. It suggests that these attachments influence an individual’s emotional and social development throughout their life. Ainsworth identified four attachment styles: secure, anxious-avoidant-insecure, anxious-resistant-insecure, and disorganised/disorientated. [Chae et al., 2018]

Jacques Lacan was a Parisian psychiatrist who practiced between the 1930s and 1970s. Lacan cleverly reinterpreted and expanded upon Sigmund Freud’s theories. He emphasised the role of language and symbolic structures in shaping human subjectivity. His work had a significant impact on psychoanalysis in France and beyond. [Perman, 2018]

In the 1980s, postmodernist schools of thought (relational, subjectivist and constructivist) emerged. Their theories accelerated the notion that truth is not limited to the therapist but co-constructed during every therapeutic interaction. [Yakeley 2018]

This is an essential feature in modern therapeutic relationships and the widely adopted Recovery model. [Bellack 2006]

Non-verbal communication and other implicit relational and affective practices between patient and therapist are now considered crucial to the commencement of therapeutic change. [Yakeley 2018]

Several clinicians and researchers have begun to explore the relationship between psychoanalysis and neuroscience. [Gabbard and Westen, 2003] targeted the neurobiological correlates of psychoanalytic psychotherapy, while interdisciplinary researchers [Damasio, 1999], [Panskeep, 2004] and [Solms and Turnbull, 2011]] have studied links between affective neuroscience and the emotions and instinctual drives found in psychodynamic theory.

[Rizzolatti et al., 1996] and [Gallese et al., 2004] discovered mirror neurons, which underlie the experiential understanding of others’ emotions, and they wrote about their role alongside empathy and unconscious communication.

Cognitive science is advancing at a fast rate, and traditional modular and computational methods of testing are being replaced with more advanced neurocognitive organisational models, which might be used in conjunction with new psychoanalytic models. [Yakeley 2018]

The fusion of neuroscience and psychoanalysis has given birth to the term “neuropsychoanalysis,” a coinage attributed to Solms.

Within the context of neuropsychoanalysis, notable developments have either introduced new perspectives or redefined existing concepts in psychoanalysis. These include pain, relatedness, opioids, drive, structural models, dreams, cathexis, and the dynamic unconscious.

Psychoanalysis places a central emphasis on exploring the subjective experiences of individuals, with therapists closely examining the ever-changing dynamics within the human psyche.

This process reveals the patient’s internal world, fantasies, dreams, desires, and motivations, including their anxieties and their conscious, subconscious and unconscious defences. [Yakeley, 2018]

According to Solms, the core psychoanalytic principles of the emotional mind include: [Solms, 2018]

1. The human infant is born with a set of innate needs
2. The main aim of mental development is to learn how to meet those needs
3. Most methods of meeting emotional needs are executed unconsciously
4. Mental disorders arise from the failure to meet innate needs, which are also, at times, known as unmet needs
5. Since methods of meeting emotional needs are enacted unconsciously, they need to be returned to the consciousness to change them. This is the basis of psychoanalytic psychotherapy. 

Sigmund Freud’s theories are probably the most well-known psychoanalytical theories in the Western world. Freud first developed the concept of the levels of the mind, including the conscious, preconscious, and unconscious, in his book “The Interpretation of Dreams” (1900). Freud divided the mind into: 

1. The Conscious: where thoughts, feelings, and motivations are in awareness 
2. The Preconscious/subconscious:  the part of the mind that contains thoughts, memories, and desires that are not currently in conscious awareness but can be easily accessed and brought into awareness when needed. These thoughts and memories are not suppressed like the unconscious but rather just below the surface of conscious awareness. (of explicit declarative memory) 
3. The Unconscious: the deepest level of the human mind where primitive behaviours and instincts are located. 

Freud was confronted with the realisation that some crucial mental processes he initially ascribed to the Preconscious system were, in fact, unconscious. In contrast, repressed elements within the Unconscious system resembled preconscious material.

Consequently, he introduced the terms “id” to replace “the Unconscious” and “ego” to replace “the Preconscious.” Moreover, he recognised the added complexity of conflicts between instinctual drives, external reality, and moral considerations, giving rise to the superego. [Freud, 1910] 

Thus, the psyche was divided into three parts: the Id, Ego, and Superego.  (Original – Das Es, das Ich, and Das Über-Ich translating to The it, The I and Over -I)

1. The Id represents the unconscious drives and impulses,  
2. The Ego represents the conscious, rational part of the mind that mediates between the id and superego and interacts with the external world 
3. The Superego represents internalised moral and ethical standards 

According to Freud, the id, ego, and superego constantly conflict and share the primary aim of meeting innate needs. Some individuals have a more significant number of unmet needs that may result in a more significant conflict between the id, ego, and superego. Freud made the analogy of the id being a horse while the ego is the rider. The ego is  

Translation: 

From Freud S, in Strachey, 1923: 

The ego and superego can be seen as developing protective defence mechanisms as part of their overall function of promoting survival and ensuring the individual’s well-being. However, defence mechanisms can also be maladaptive or dysfunctional if used excessively or inappropriately, and each can contribute to psychological distress or impairment. 

TRANSFERENCE AND COUNTERTRANSFERENCE: 

The intense interplay between the id, ego, and superego takes centre stage in the therapist-patient relationship, manifesting through transference and countertransference.

These intricate dynamics, inherent to the doctor-patient relationship, serve as tangible expressions of the primitive behaviours and instincts residing within the dynamic unconscious, often indicative of unresolved conflicts.  [Freud, 1912]  

While transference and countertransference are not directly observable, they can be inferred from the patient’s and therapist’s behaviour and communication. [Freud, 1912]

For example, the patient may project onto the therapist feelings rooted in earlier relationships, or the therapist may experience feelings of irritation or attraction that are not entirely rational or explainable. 

Freud described transference as the way individuals transfer specific emotions about aspects of their lives onto the therapist. Transference can invoke difficult emotions, and countertransference occurs when a therapist consciously or unconsciously transfers their emotions back to the client in response to the transference [Freud 1910, in Strachey J]

1. THE ID (Das Es)

According to Freud, the id is the primitive unconscious level of thought where fundamental and innate demands become linked to consciousness.

The Cognitive Unconscious:

• The unconscious is amenable to the conscious or the cognitive part. 

The Dynamic Unconscious:

• The inaccessible Unconscious that is indelible and more deeply embedded, making it more difficult to access in the higher cortical regions (challenging to bring into consciousness).   

The true Unconscious cannot be accessed by thought and is the basis of Freud’s “primary process.”

Ledoux coined these inaccessible unconscious automated memories or predictive patterns of behaviour as “quick and dirty” and “indelible.” [Solms, 2017]

Considering the functions of the id, its anatomical location is thought to be situated in the subcortical structures of the brain: in the limbic system, the brain stem, the pons hypothalamus, and partially in the temporal lobe, as well as in some olfactory structures, the parahippocampal gyrus, the orbitofrontal cortex and the anterior cingulate cortex. [Torrico and Abdijadid, 2023]

The Id and its neural correlates: [Ramezani et al., 2018]

It is now believed that the brainstem mechanisms derived from the autonomic body are associated with affective consciousness, and the cortical mechanisms derived from the sensorimotor body are associated with cognitive consciousness.

Furthermore, the upper brainstem is intrinsically conscious, whereas the cortex is not; it derives its consciousness from the brainstem. [Solms, 2018]

PRIMARY VS. SECONDARY PROCESS: 

The concept of primary and secondary processes in psychoanalytic theory illuminates the intricate workings of the human mind.

The pleasure principle fundamentally governs the primary process. [Sigmund Freud, Beyond the Pleasure Principle]. 

It operates without regard for external constraints, such as societal norms and regulations, and it seeks immediate gratification of desires. 

The secondary process, often called the reality principle, is under the domain of the ego. [Freud, 1923]

The ego acts as a regulatory entity tasked with reconciling the id’s demands with the external environment’s constraints. It seeks to delay or modify gratification to align with the demands of reality.

THE PLEASURE PRINCIPLE AND THE ID:

Freud’s pleasure principle is a fundamental concept in psychoanalytic theory that refers to the basic human drive to seek pleasure and avoid pain. [Moccia et al., 2018]; [Solms and Friston, 2018]

The pleasure principle is an unconscious motivator that constantly guides our behaviour and shapes our experiences. The pleasure principle is closely related to the id, the primitive and instinctual part of the psyche that seeks immediate gratification of its desires.  

Pleasure is the instinctual driving force permeating every detail of the human psyche and daily life.

It needs instantaneous satisfaction and gratification, whatever the ego, superego or society says; The Human psyche tries to avoid pain or dysphoria and aims to chase the hedonic ways of living; namely, human psychology is built for chasing after “pleasure”, which is innate and hereditary. (Freud, 1905 in [Solms and Friston, 2018])

Homo sapiens are wired to seek pleasure in all its forms, no matter the cost to oneself, others, and one’s surroundings. [Blum et al., 2022]

Drive demands can give rise to affects when an individual encounters an obstacle or is prevented from achieving their goal.

These affects indicate the direction of change in the underlying demand. (Freud, S., 1905, in [Solms and Friston, 2018])

Freud linked the affect of pain or unpleasure to an increase of drive tension and the affect of pleasure to the discharge of drive tension. [Löfgren, 1968]

While affects arise from the visceral interior of the body, signalling the drive tension of an unmet need, we become aware of our needs via feelings.

But feelings (both unpleasurable and pleasurable) disappear once the demand disappears. Satiation removes feelings from the radar of consciousness.

According to Freud, when affects related to innate needs are felt, they constitute the drive. Importantly, they only become drives when they are ‘felt,’ but not before this – feelings are not the same as innate needs.

Needs can exist unconsciously and may manifest as automatised behaviours that are not accessible to the cortex.

Freud himself suggested that the notion of unconscious affect was itself an oxymoron. Solms reinforces Freud’s contradiction of his theory that the id is simultaneously unconscious and regulated by the pleasure principle. [Solms, 2018]

We will cover affects in more detail in subsequent parts. 

Here is a written excerpt by Freud describing his concepts of drive and desire: 

Freud’s “feelers” were seen to remain unconscious until they reached the cortical system. [Javanbakht and Alberini, 2019]

Nonetheless, according to current understanding, the ‘id’ rather than the ‘unconscious’ extends its tendrils of influence towards the cortex. 

The id demands take the form of unconscious energies (drive) that become conscious when registered by the perception-conscious system (PCS), known as the W process. [Solms, 2018]

Freud’s foundational concept of the pleasure principle, deeply ingrained within psychoanalytic theory, resonates strikingly with the modern understanding of reward-seeking behaviours from a neurobiological perspective.

Both concepts share a fundamental connection rooted in the innate human drive to pursue pleasure while avoiding pain, highlighting the convergence of psychological and neurobiological paradigms.

Human behaviours are driven by rewards, support learning, motivation, economic decision-making, and positive emotions, ultimately ensuring our species’ survival, reproduction, and propagation.

Essential rewards such as food, drink, sexual attraction, and nurturing offspring have evolved to underpin the reproduction and survival of Homo sapiens.

Natural rewards, crucial for survival and appetitive motivation, elicit beneficial biological behaviours. However, experimentation with addictive substances and behaviours can directly affect reward pathways, leading to their deterioration and promoting hypodopaminergia.

The intricate neurobiological underpinnings of the “Brain Reward Cascade” (BRC), which encompasses endorphin and endogenous opioidergic mechanisms, have been studied extensively in animals and Homo sapiens. [Blum et al., 2022]

Remarkably, this parallel between Freud’s psychoanalytic insights and contemporary neurobiological revelations gains particular prominence through the concept of reward deficiency syndrome (RDS).

This multifaceted syndrome represents a disruption in the intricate cascade of reward neurotransmission stemming from genetic and epigenetic influences. Such disruption leads to a deficiency in the pleasurable experiences associated with fulfilling our fundamental physiological drives. [Blum et al., 2022]

As the neural correlates of the id show, the id is now thought to be linked to the brain’s reward system, mediated by dopamine release in regions such as the ventral striatum and prefrontal cortex.

This system has been found in recent studies to play a vital role in motivational processes and reinforcement learning. It is thought to be involved in shaping behaviour based on the anticipation of rewards or punishments. [Marche et al, 2017]; [Lewis et al, 2021]

These findings have substantial implications for psychoanalytic metapsychology because the upper brainstem and its associated limbic structures are now recognised to perform the functions Freud attributed to the id. In contrast, the cortex (and its associated forebrain structures) performs the functions Freud attributed to the ego.

Shared ego as the primary driver of consciousness, has also been identified in other recent studies [Boag, 2014]; [Calamandrei, 2022], helping to build a new evidence base and clarifying some of the ‘theoretical chaos‘ which dominates longstanding discourses around consciousness. [Madison’s, 1956]; [Shill, 2004]; [Green, 2005]

2. THE EGO

The ego is the place in the outermost cortex where perception and consciousness are integrated, i.e., the perceptual consciousness system (PCS). The perception-conscious system is localised to the cortex. [Abbass et al. 2014]

Freud proposed that the PCS is a unified system that can be activated by two sources: exogenous stimuli that generate perceptual consciousness and endogenous stimuli that generate affective consciousness. [Solms, 2018] 

In other words, the system can be activated by external stimuli that we perceive through our senses and by internal stimuli that arise from our thoughts, emotions, and bodily sensations.

The system is not divided into separate parts for perceptual and affective consciousness but operates as a whole that can be influenced by internal and external factors.

*In original German

The ego may be linked to the prefrontal cortex and its intrinsic cognitive processes, such as working memory, attention, and decision-making.

The prefrontal cortex has extensive connections with other brain regions, such as the limbic system, and may play a key role in integrating emotional and cognitive processes. [Menon, 2011] 

The ego and its neural correlates: [Ramezani et al., 2018]

THE DEFAULT MODE NETWORK (DMN) AS THE EGO:

The Default Mode Network (DMN) is a neural network composed of the Medial Prefrontal Cortex (MPFC), the Posterior Cingulate Cortex (PCC), the Inferior Parietal Lobules (IPL), and the Hippocampal Regions (HP). [Carhart-Harris and Friston, 2010]

The DMN is involved in emotional regulation, social cognition, future-oriented thinking, and autobiographical memory. [Yang et al., 2013]

When individuals are engaged in memory-related, perspective-taking, or future-thinking tasks, the DMN exhibits heightened activity, particularly when they are internally focused, engaging in activities such as self-reflection, mind-wandering, and contemplating past or future events. [Luo et al., 2014]

Conversely, during tasks that demand attention and external focus, the activity within the DMN decreases. [Alves et al., 2019]

This pattern of activity aligns with the concept of introspection and self-referential processing that characterises the functioning of the DMN.  [Molnar-Szakacs and Uddin, 2013]

Abnormalities of the DMN are associated with difficulty falling asleep due to ruminative thoughts, postnatal depression, melancholic depression, ruminative negative thoughts, and intrusion symptoms of PTSD.

In ADHD, the DMN, a task-negative network, negatively correlates with the task-positive attentional network and is weaker, resulting in inattention symptoms. [Mowinckel et al., 2017]

The DMN’s functioning and its relationship with other networks are now thought to play a central role in decision-making between instinctual drives and social rules. 

Carhart-Harris and Friston believe that the DMN’s most crucial role is to mediate between external and internal stimuli and to build dynamic mental simulations based on past memories. [Carhart-Harris and Friston, 2010]

They suggest that the development and functioning of the DMN and its functional relationship with its anti-correlated networks is consistent with that of the ego. 

Some authors have labelled this the ‘Default Self’. [Beer, 2007]; [Qin and Northoff, 2011]

It could be said that: 

The DMN’s top-down mode of operation, converting free energy into bound energy to maintain physiological equilibrium, mirrors the ego’s function in mediating between the id’s desires and external reality.

Carhart-Harris and Friston suggested a connection between the Freudian secondary process concept and the DMN’s functions, which involve self-organisation and the regulation of free energy, including uncontrolled endogenous activity from the limbic and paralimbic systems.

This aligns with the brain’s ongoing effort to maintain states within physiological boundaries and minimise potential surprises, in harmony with the DMN’s neurophysiological role. [Carhart-Harris and Friston, 2010] 

THE SALIENCE NETWORK (SN) AND THE CENTRAL EXECUTIVE NETWORK (CEN) AS THE EGO: 

Carhart and Harris proposed the DMN aligns with Freud’s ego, but Dimkov argues the ego comprises the SN and CEN. [Dimkov, 2019]

According to Menon,  the SN is the ultimate brain controller, managing DMN and CEN transitions, receiving sensory input, and maintaining mind-brain homeostasis. [Menon, 2011] 

The SN detects salient features, engaging the CEN, jointly determining responses and prompting motor actions.

When SN and CEN are overloaded, the DMN activates, mediating low-level imaginative thinking processes, like spontaneous, stimulus-independent, and mind-wandering thinking. DMN also operates during tasks like memory retrieval, envisioning the future, and adopting others’ perspectives. [Dimkov, 2019]

Dimkov introduced the concept of a third thought process, bridging primary and secondary thought processes and characterising DMN’s functions as third-process thinking. [Dimkov, 2019]

The SN regulates CEN-DMN interactions, integrating sensory, visceral, autonomic, and hedonic inputs, emotions, homeostasis, and reward processing.

SN and CEN align with Freud’s ego concept (the “rider”), while DMN is associated with cognitive control, low-level secondary thought, and primary process ideation (the “horse”). [Dimkov, 2019]

In summary, a new hypothesis suggests Freud’s ego comprises the SN and CEN, not DMN alone. DMN primarily embodies low-level secondary thought processes compared to CEN and SN.

CORTICOLIMBIC INHIBITION AS A DEFENCE MECHANISM 

The ego is postulated to keep the id in check.

This is akin to the description of the corticolimbic inhibition vital to emotional regulation, the dysfunction of which is present in disorders such as PTSD. [Solms, 2013] 

Cortico-limbic inhibition plays a vital role in trauma-related disorders.

The cortico-limbic pathway generates two phenotypes, one the emotional under-modulation versus the emotional over-modulation.

The inability of the cortex to inhibit limbic activation presents with heightened emotional arousal. Thus, the inhibitory centres in the prefrontal cortex are related to ego and superego functions. [Solms, 2013]

The cortical ego inhibition (corticolimbic inhibition neurobiologically) in psychoanalysis is postulated to reflect a defence mechanism because it involves suppressing or inhibiting emotions, impulses, or behaviours that may be perceived as threatening or anxiety-provoking.

Individuals are not aware that they are suppressing these behaviours. [Schore 2001]

This lack of awareness, according to psychoanalysis, is conceptualised as an ego cortical inhibition – a defence from a neurobiological perspective. [Daskalakis et al., 2007]

An example of corticolimbic inhibition as a defence mechanism is seen in emotional numbing, which can occur in response to trauma or other highly stressful experiences.

The individual may consciously or unconsciously inhibit emotional responses to protect themselves from overwhelming feelings of fear, sadness, or anger.

This inhibition can manifest as a blunted affect, lack of emotional expression, or reactivity. [Daskalakis et al., 2007]

Fenster et al. discussed the emotional overmodulation phenotype of PTSD, as shown below, where the PFC excessively inhibits the limbic circuit, mediating symptoms of depersonalisation, derealisation, emotional numbing and, in extreme forms, dissociation. [Fenster et al., 2018] 

3. THE SUPEREGO

The brain areas associated with the superego are thought to include the prefrontal cortex (PFC), orbitofrontal, ventromedial frontal, cingulate, amygdala, temporal lobe, and insular cortex.

These areas are responsible for moral judgment, reasoning and risk calculation, like an ethical compass guiding decision-making.  

Psychoanalytic theory postulates that the superego develops around 3-5 years of age during the phallic stage of psychosocial development. [Freud, 1923]

The Superego neurodevelopment in a child is a steady process that is completed once the father’s norm (or normative behaviours) is internalised, and the sexual urges toward the mother are repressed, thus leading to the dissolution of the Oedipus complex. [Freud, 1923]

The superego and its associated neural correlates: [Ramezani et al., 2018]

Dietrich and colleagues identified three higher-order cerebral functions of the superego: [Dietrich et al., 2009] 

1. Management of social rules and demands  
2. Ego-ideals or ideal images of the self  
3. Restrictions or impulse controls  

1. Management of Social Rules and Demands:

• The superego is vital in managing social rules and demands within an individual’s psyche. It represents the internalisation of societal norms, values, and moral standards.
• This function involves regulating one’s behaviour by accepted social conventions.
• When functioning correctly, the superego guides individuals in making decisions that align with societal expectations and ethical principles. It acts as an internal moral compass, influencing choices and actions to ensure they adhere to the rules and norms of the surrounding society. 

2. Ego-Ideals or Ideal Images of the Self: 

• Another crucial superego function involves establishing and maintaining ego ideals or idealised self-images.
• These ego ideals represent aspirational self-concepts or the ideal versions of oneself that individuals strive to achieve.
• The superego sets these standards based on societal and cultural influences, personal values, and individual experiences.
• It continuously evaluates an individual’s behaviour and self-concept against these ego ideals, driving efforts to match one’s actions and identity with these idealised images. 

3. Restrictions or Impulse Controls:

• The superego serves as a regulatory mechanism for controlling impulses and instinctual drives originating from the id, another component of Freud’s structural model of the psyche.
• This function involves imposing limitations and restrictions on impulsive and hedonistic desires, promoting self-discipline and self-control.
• The superego counterbalances the id’s immediate gratification tendencies, guiding individuals to consider the long-term consequences of their actions and prioritise societal and moral values over impulsive desires. 

The superego is the faculty that seeks to police what it deems unacceptable in society.

The superego achieves this through feelings of guilt and shame. Therefore, it can be said that the superego represents all moral restrictions and is striving towards perfection. [Kahn, 2002]

Even though the Central midline structures (CMS), DMN and cortical fronto-parietal circuits (CEN) were suggested to be related to the ego, very few neurobiological progressions associated with the superego of structural theory have been made.

Sensory information requires the thalamocortical track to give rise to consciousness. This is similar to how the id is needed to give rise to the ego and superego.   

Some areas of the limbic system were noted to play a role in the concept of the superego (e.g., the amygdala).

This suggests that the superego’s lower-order brain areas share similar neural circuitry as the id. This would be consistent with the idea that the superego largely functions unconsciously, identical to the id. These findings highlight the critical role the vmPFC and superego play in negotiating through moral dilemmas. 

The superego’s influence is integral to forming one’s moral and ethical compass and pursuing self-improvement and conformity to societal norms. [Dietrich et al, 2009] 

Exploring the Interplay Between the Id, Ego, and Superego: A Parallel to Contemporary Triple Network Model Correlations and Anticorrelations:

The conflict between id, ego and superego mirrors the contemporary understanding of the correlation and anticorrelation between 3 major circuits based on the triple network model [Menon, 2011]

• The Default mode Network (DMN)
• The Frontoparietal Network (FPN), also known as the Central Executive Network (CEN) or Executive Control Network (ECN)
• The Salience Network (SN)

The Default Mode Network (DMN), Frontoparietal Network (FPN), and Salience Network (SN) are often referred to as “canonical” networks, signifying their fundamental nature, as their interactions are involved in almost all cognitive functions. [Uddin et al., 2022]

• DMN activity is primarily dominant during cognitive leisure and self-monitoring processes.
• The FPN (CEN) peaks during task involvement and cognitive exertion.
• The SN is a dynamic “switch” between the DMN and FPN, in line with salience and cognitive demand.

The SN functions as a dynamic switch between concentration on self and the inner world, mediated by the DMN, and task-related and directed attention on outside stimuli maintained by the FPN.

In response to externally salient events requiring a high level of cognitive effort, the SN is activated, and the DMN is suppressed. In contrast, during internally focused attention, such as self-monitoring or memory retrieval, the DMN is activated.

This pattern results in anti-correlated activity between the SN and DMN during episodes of successful cognitive effort. Similarly, the FPN and DMN are anti-correlated. [Schimmelpfennig et al., 2023]

The most prominent manifestation of this is in ADHD, where negative correlations between the DMN and the frontoparietal control network are weaker in patients with ADHD than in people who do not have the disorder. [Durston et al., 2011]

These aberrations in functional network organisation and dynamic inter-network communication may underlie an array of psychiatric symptoms, aligning with the “triple-network model of psychopathology” [Segal et al., 2023]

This model posits that the involvement of the salience-ventral attention system is transdiagnostic, while other systems are selectively engaged in specific disorders, explaining phenotypic variations among them.

Concept of Aberrant Salience: 

In elucidating the concept of aberrant salience, it is imperative to understand the neural mechanisms underpinning the processing of surprise signals within the human brain, particularly in the context of reward prediction errors (RPEs) generated by the salience network.

Surprises are associated with reward prediction errors generated by the salience network.

Attempts to avoid surprises ensure that the states remain within the physiological bounds and are consistent with the neurophysiological functions of the brain, specifically with the function of the DMN. [See DMN and Ego earlier]

In neurobiological terms, surprise is synonymous with a reward prediction error (RPE), representing a mismatch between a reward’s predicted and actual outcome. Prediction errors signal that current expectations are inaccurate and should be updated.

The surprise signal originates in the amygdala and projects to the dorsal anterior cingulate cortex (dACC), insula, and other structures within the salience network. This signal serves as a gate, regulating the allocation of attention to stimuli.

The magnitude of prediction error (PE) is gauged by how much the outcome deviates from expectations, represented as the “unsigned” or absolute value of the mismatch.

When an unexpected reward is delivered, dopamine neurons respond with a burst, resulting in heightened dopamine release in target regions. This response reinforces preceding behaviours and bolsters motivation for task engagement. Conversely, dopamine neurons shift their response pattern to post-cue presentation when a completely predicted reward is delivered.

This dopamine error signal serves as a teaching mechanism, connecting events (e.g., stimulus-reward or stimulus-stimulus associations) and facilitating learning without endowing events with intrinsic value. [Costa, 2022]

The propagation of the dopamine RPE signal is facilitated through widely divergent dopamine axons, extending to terminal areas within the striatum, frontal cortex, and amygdala. [Schultz, 2016]

Trauma may sensitise the amygdala to surprise, intensifying attention and vigilance toward subtle, unanticipated outcomes. This heightened sensitivity can result in fear, rumination, suspiciousness, or referential thinking. [Millman et al., 2022]

Abnormal encoding of rewarding or aversive outcomes within the salience network care explains the clinical symptoms of psychosis, characterised by a mismatch between prior expectations and incoming sensory information, leading to prediction errors. [Millman et al., 2022]

In addiction, drugs can amplify the dopamine reward signal, inducing exaggerated and uncontrolled dopamine effects on neuronal plasticity. [Schultz, 2016]

In the context of aberrant salience, Volkow et al. used PET scans to show that addicted individuals have reduced dopamine responses to drugs but heightened responses to drug-related cues. This disconnect between expectations and actual rewards underscores the significance of reward prediction errors (RPEs) in sustaining chronic substance use. [Volkow et al., 2011]

Within cognition and affective domains, disturbances in the activity levels of the salience network (SN) are central factors in various clinical disorders.

These disorders span a spectrum, including depression, insomnia, narcissism, and post-traumatic stress disorder (when marked by SN hyperactivity), as well as chronic pain, anxiety, neuroticism, schizophrenia, epilepsy, autism, neurodegenerative conditions, and bipolar disorder (in cases marked by SN hypoactivity).[Schimmelpfennig et al., 2023]

In summary, aberrant salience, rooted in the intricate neural dynamics of the reward prediction error, offers insights into the aetiology and manifestation of various psychiatric and behavioural disorders. Understanding the underlying mechanisms may pave the way for targeted interventions and therapies across a spectrum of clinical conditions.

Reward Prediction Errors, Defence Mechanisms and Learning: 

The id’s influence can become more pronounced or dysregulated in psychiatric illness. [Dietrich et al, 2009]

Patients may experience heightened impulses and desires, leading to impulsive and potentially self-destructive behaviours.

For example, individuals with conditions like borderline personality disorder or addiction may struggle with intense cravings and impulsive actions as the id’s control over desires becomes more pronounced.

In addiction, to circumvent the superego’s moral prohibitions, the id often operates in the unconscious realm, avoiding conflicts with the superego. [Freud, 1923]

This interplay between the id, ego, and superego mirrors the neural shift from goal-directed to habitual behaviour.

Addiction’s hallmark, compulsive drug seeking, stems from diminished prefrontal control over striatal mechanisms, where habitual behaviours override goal-directed actions—a ventral-to-dorsal shift.

Recent evidence highlights addiction’s association with a bias toward habitual behaviour, predominantly involving the dorsolateral striatum (DLS), while goal-directed behaviour engages the dorsomedial striatum (DMS) and ventral striatum.  [Lüscher et al., 2020]

Ego and DMN Dysfunction in Psychiatric Illness: 

The ego acts as the rational decision-making component of the psyche, mediating between the id’s impulses and the superego’s moral and societal standards.

In psychiatric illness, the ego’s functioning may become compromised.

Patients might find it challenging to make rational decisions or cope with conflicting desires and societal expectations.  

Conditions such as schizophrenia or bipolar disorder can disrupt the ego’s ability to maintain a stable sense of self and navigate reality effectively, leading to symptoms like delusions, hallucinations, or mood swings.

Conditions like obsessive-compulsive disorder (OCD) or depression can involve a hyperactive or overly punitive superego, where individuals may constantly berate themselves for perceived moral failings or engage in ritualistic behaviours to alleviate guilt.

Is DMN Dysfunction the Ego Overwhelm (Uberwältigung) Freud Described?:

In individuals with a history of depression, heightened connectivity from the DMN to the SN is associated with decreased overall network activity and diminished performance on tasks involving exposure to positive words.

These results suggest that intensified network activity, particularly the influence of DMN on SN, reinforces a predisposition toward negative thinking in individuals and may contribute to the onset and maintenance of depression, mirroring Freud’s concept of ego overwhelm (Uberwältigung).[Guha et al., 2021]

Neurotransmitter Systems and Psychoanalysis: 

Furthermore, the brain’s dopaminergic (DA) and acetylcholinergic (ACh) systems have relevance to the Freudian structural theory of psychoanalysis.

DA systems appear excitatory in motivating the id and benefit the ego in processes like procedural memory (implicit automatised predictions).

At the same time, they are selective in engaging the superego through attentional mechanisms. [Cai, 2021]

Conversely, ACh systems appear to depress the Id’s motivation, restrict the ego, and excite the superego. This intricate interplay between neurotransmitter systems aligns with Freud’s notions of inner conflict and regulation within the psyche. [Cai, 2021]

Aim of Psychoanalysis: 

Translation: 

In this article, we explored Freud’s psychoanalytic theories with a focus on the id, the ego and the superego (Freud, 1923) and their neurobiological underpinnings, including a brief overview of innate relational drivers, prediction errors, and aberrant networks noted within different mental health conditions and states of mind.

Freud’s concepts of primary and secondary processes, along with the id, ego, and superego, provide a rich framework for understanding human behaviour and mental processes, and contemporary neuroscience offers novel insights into the neural mechanisms that underpin these psychoanalytic constructs. 

So, when thinking about Pinel’s moral therapy, Anna Freud’s ego psychology, Klein’s object relations theory, Lacanian language and symbolism, and the core psychoanalytic principles of Solms, it is clear that the mind, body and brain are inextricably linked [Novick and Ross, 2020], and should not be separated.

So, whether we are driven by pleasure (Freud), by social attachments (Klein, Bowlby), or both, it is essential that clinicians consider the neurological basis of these theories and processes and that they use this new knowledge to deliver consistently high-quality care and treatment.   

Coming Up next… 

In the second article in this series, we investigate the evolution of affective neuroscience – The interdisciplinary field which explores the neural basis of emotions and feelings and seeks to understand how the brain processes, generates, and regulates emotional experiences.

Panksepp’s 7 emotion systems:

1. SEEKING
2. CARE
3. PLAY
4. LUST
5. FEAR
6. SADNESS
7. ANGER

We then explore Harry Harlow’s seminal experiments with monkeys (Harlow, 1958), Martin Seligman’s positive psychology, and his theory of learned helplessness and optimism. [Seligman, 1991]

This uncovers new insights into how patients and clinicians are impacted by emotion and seeks to unite some of these schools of thought to form a more comprehensive treatment approach available to all clinicians, wherever they work in the world.