Book review: Who’s afraid of (neuro) science?

Holmes, Jeremy (2020) The Brain has a Mind of its Own. Attachment, Neurobiology, and the New Science of Psychotherapy. Confer Books, London

Maturana, Humberto R. and Francisco J. Varela (1987) The tree of knowledge: the biological roots of human understanding. Revised Edition. Shambhala, Boston

Many influential psychotherapists are making the case for a ‘new science of psychotherapy’, as Holmes names in his title. In this short book, he sets out a summary of the elements he sees this new science entailing. He is clear that this is a personal attempt to make sense of research in neuroscience and physics while integrating their findings with psychoanalytic concepts, and additionally seeking practical applications for relational psychotherapy. Why accompany him on this path? For my part, I agree with him when he writes towards the end of the book that ‘we need theories and models of how the mind works – its language, relationships, motivations, desires, plans, and their supporting structures – which are both scientifically valid and experience-near’ (p. 115). To me it means being open to multi-disciplinary understandings of the craft of psychotherapy while being curious about how we can be more precise in our assumptions.

In my experience, ‘scientifically valid and experience-near’ are often portrayed as opposing views, impossible to integrate. The practice of therapy means ‘experience near’ is much easier to grasp and ‘scientifically valid’ can seem unrealistic when working with unique relationships. Many therapists hear neuroscience and assume biological determinism, or a reductionism to a medical model that seeks a chemical or genetic basis for what many of us argue are socially-mediated and context-driven definitions of what is pathological. But is it an either or? Could it be both and? This book is valuable because it provides a synthesis of approaches that are often consigned to distant silos. Holmes offers neuroscience and new mathematical models of mental function and communication, and also, embodied affect and cognition, attachment, relational effects; he writes of psychopathology as a continuum of difficulties in making sense of our internal and external experience. This multi-disciplinary approach is gaining fellow travellers but as yet remains the less trodden path.

Holmes is proposing a multi-disciplinary perspective to create better hypotheses for the mechanisms underlying the effects of psychotherapy. To date, the complexity of factors in therapy and the difficulties in creating meaningful randomised trials has meant that we have evidence for the effects of psychotherapy (not all positive) but know little about possible mechanisms. He likens it to Darwin noticing heredity and evolution by observation but our understanding of the mechanism having to wait until we could imagine and then see DNA. As Holmes puts it ‘the book’s project is to argue that advances in neuroscience point to new understandings of how psychotherapy produces psychic change’ (p. 4). Does he succeed? Or is it a fool’s errand?

He begins by considering a new paradigm emerging in neuroscience, the ‘Free Energy Principle’ developed by Karl Friston and colleagues. They propose that energy is not a physical phenomenon but an ‘explanatory category, akin to gravity’. This conception of energy is closely aligned to definitions of ‘energy’ in Freud’s early work, a link that Holmes makes in Chapter 2. Rycroft makes the connections clearer in his Critical Dictionary of Psychoanalysis, where his entry for ‘energy’ reads: ‘Freud’s theory of bound and mobile energy has little to do with the concept of energy as used by the other natural sciences, but it is really a theory of meaning in disguise’ (1995, p. 48). Holmes argues that the principles or framework provided by Free Energy have correlates with Freud’s idea that ‘we seem to recognize that nervous or psychical energy exists in two forms, one freely mobile and the other, by contrast, bound. Mobile energy is characteristic of the id and bound energy characteristic of the ego’ (Freud 1940 in Rycroft 1995, pp. 47-49). The application of the Free Energy Principle to psychic life is similarly that energy is either free or bound. ‘Free energy reflects the ever-changing and potentially chaotic nature of the impact of the environment, [and] unbound, can overwhelm the unprepared nervous system’ (Holmes 2020, p. 7). This implies that the task of the nervous system is to attempt to predict how to interpret signals, finding ways of matching internal states and learnt patterns of experiencing the environment. Holmes underlines how Friston’s mathematical work shows the importance of predictions in dealing with the ‘ever-changing discrepancies between prediction and sensation, between our generative models of the world and reality’ (ibid. p. 6).

Holmes takes it as read that psychotherapy recognises bodily feelings as underpinning affective life. His taken for granted approach to embodiment is welcome and yet does not feel as widely practised as he assumes. He also makes a strong case for relational, attachment-based understandings of the therapeutic relationship, and what he describes, drawing on Bollas, as ‘a plea for the health-giving properties of more equal, ‘democratic’ interchange between the sensual and the representational’ (p. 10) that is, a plea to value embodied knowledge as much as language. It is one of the strengths of Holmes’ multi-disciplinary approach that he sees ‘prediction errors’ arising as much from our internal experience as from external stimuli in physical as well as psychic events. He proposes that it may be the discrepancies between what we want/expect and what we feel in our bodies that is experienced as unpleasant, while we feel good when expectations and experience align (ibid.). He defines ‘the psychological distress that brings people to psychotherapeutic help […] as chronic states of unresolved prediction error. The aim of psychotherapy is to redress these by mobilising the capacity for action and model revision’ (pp. 6-7).

Thus Holmes sets out to ‘transpose’ the mathematical models of neural functioning into everyday experience and psychoanalytic thinking. He proposes that the methods of psychoanalysis, such as dream interpretation, free association, and the ambiguities of transference, are ways of creating more space to think between the automatic predictions generated by internal states and past experience. Making more space for uncertainty is achieved by creating a type of conversation based on attunement so that the person coming to therapy can make use of the capabilities of the therapist in containing their distress. In terms of the model of information processing provided by the Free Energy Principle, there is a constant ‘conversation’ between ‘top-down generative models with bottom-up sensations from the outside world (exteroception) or the body (interoception). Their interactions reach agreement by minimising the discrepancies’ (p. 43) between them, whereas the therapeutic encounter allows discrepancies to be examined and enables different agreements between top-down explanations and bottom-up sensations to be reached. The aim of psychotherapy then, would be to create a context for bound energy to be freed so that new patterns of binding can be attempted.

Holmes devotes a chapter to the resonances of the process of ‘binding’ free energy into reliable predictions with psychoanalytic concepts and makes a convincing case for the parallels with Bion’s ‘reservoir of priors’ of maternal reverie and alpha function to help the baby process experience. In terms of Free Energy ‘she is providing top-down input which helps bind free energy and resolve prediction error’ (p. 51). Here he brings in his own work on the ‘borrowed brain’, an interpersonal understanding of how parents who are good at mentalising generate security in infants by ‘understanding and resonating with their infant’s affects’ (ibid.). He expands on the parallels he sees between Freudian and Bionian ideas and the free energy paradigm which are too detailed for this summary. There is something delightfully straight-talking about ‘brain borrowing’ as the description of the effects of a close connection with another and the effect this can have on our perceptions and responses, enabling ‘unbound energy associated with loss or violence [to] become containable [by being mutually mentalised]’ (p. 73).

He moves on to consider the state of the art of relational neuroscience, which is more clearly relevant to group analysis, with its emphasis on the ‘hyper-social’ (p. 57). He describes what he names as ‘sensory attenuation’ as part of the pattern underlying turn-taking in communication. He adds an intriguing idea: that in the presence of others, in a conducive environment, a form of synchrony takes place where we ‘share minds’, a notion Holmes likens to the concept of the ‘third’ in psychoanalysis and which parallels the processes of mirroring and resonance in the group analytic matrix. Holmes quotes Friston and Frith’s idea of a ‘collective narrative shared among communicating agents…for example when in conversation or singing, […] our beliefs about the (proprioceptive and auditory) sensations [bottom-up] we experience are based on expectations of the song [top down]. These beliefs transcend agency in the sense that the song does not belong to you or me’ (2015, p.14 in p.58). This description is highly reminiscent of Schlapobersky’s group discourse as the aim of a functioning analytic group (2016). Holmes then draws on the work of Barrett (2017) on emotions to critique ‘Western essentialism’ and say that ‘individuals, their brains, and their emotions are not static entities but nodes in an ever-shifting chain of interconnected processes’ (p. 60), a statement that has Foulksian echoes (although Foulkes does not appear in this book). He quotes Feldman to name these processes as ‘biobehavioural synchrony’, a ‘co-wiring of parents’ and infants’ brains and behaviour into a synchronous unit that supports the infants’ brain growth and buttresses social competencies (Feldman, 2015b, p. 387 in ibid. p. 60).

Chapter 4 conceptualises psychopathology in terms of free and bound energy, with models of how we get stuck in patterns of responses to environmental and perceptual cues. It is worth reading the chapter in detail to see how prediction errors in internal and external perceptions are processed differently and can manifest in maladaptations that we currently diagnose as psychiatric disorders. For example, he takes the work of Ongaro and Kaptchuk to discuss how somatisation disorders could be understood as attributing excessive weighting to interoceptive sensations, that is, ‘bodily sensations are taken as more “precise” than those gathered from an ever-changing environment; they are typically organised as “habits” rather than hypotheses and thus in the manner of a “stubborn scientist” are inaccessible to top-down revision’ (p. 79). In the same way that Ongaro and Kaptchuk write of ‘explained and unexplained symptoms lying on a continuum…’ (ibid. p. 3), this way of thinking about the accuracy of our models and perceptions applies to all of us and enables a less pathologizing view of difficulties or differences in processing information and drawing conclusions from what we perceive.

In chapter 5 he examines how psychotherapy can make use of these insights, from a starting point that ‘if mental illnesses are diseases of social brains, then it is likely that evolution will have produced both natural and culturally-mediated repair systems to reverse or mitigate them’ (p. 85). This assumption of social brains is tantalising in that it is not fully explicitly developed anywhere in the book. In short, he argues that psychotherapy uncouples the automatic locking of bottom-up perceptions and top-down inferences by the therapist providing an ‘auxiliary’ mind where uncertainty and not knowing can be contained and other interpretations can be considered. He proposes that many psychoanalytic techniques, from dream interpretation to the ambiguities of transference are all geared towards increasing the space between the pre-conceptions brought into therapy and the possibility of revising models and/or perceptions. The point of the therapist is to provide ‘the presence of a trusted other whose brain [sic^[1]] is temporarily on loan and releases the sufferer from chronic prediction error’ (p. 59). In chapter 6 he considers the common ground between neuroscience and attachment theory, observing how problems in attachment patterns affect our ability to make accurate predictions and deal with change. He proposes that the ‘purpose of therapy is to generate, tolerate, bind and metabolise novelty and surprise’ (p. 159) and illustrates the most productive balance between familiarity and novelty with babies’ attention responses – ‘they ignore chaos and the predictable and instead show interest in manageable novelty, and the presence of a trusted other enhances the novelty-seeking and exploration’ (p. 44). He refers to work that connects styles of communication to experiences of attachment and offers that the free energy model allows us to see how providing a secure base alters the possibilities for dialogue and ‘therapeutic skill depend on being able to turn the impasse of insecure dialogic patterns into a conversational focus and enjoin clients to “mentalise” what is happening between them’ (p. 134).

It is only in Chapter 7, Therapeutic Conversations, that the focus of the free energy principle is more clearly described as referring to communication and how our nervous systems process information. Although Holmes’ focus are conversations in therapeutic dyads, it is striking how often Friston’s original work refers to groups: ‘the Friston and Frith model (2015), where listeners’ and speakers’ brain/minds overlap, creating a temporary “group mind” [and] thoughts and sensations are, for a moment, jointly owned’ (p. 151). Holmes assumes a rich multi-level communication in therapeutic conversations, which are as much about the therapist (or group members in our case) as internal to the patient, and which also include non-verbal communication. He reflects on the etymology of ‘conversation’, ‘con’ with others, and ‘versa’ against, a being with and being challenged as well by others. Although he writes with a dyad in mind, his points are equally applicable in groups, as when he writes that the ‘psychotherapist’s task is to find an interpersonal, often unconscious, and warded-off contextual relevance for their clients’ utterances’ (p. 141). He also touches on the effects of joint attention for co-regulation, the importance of context and Wilson and Sperber’s relevance theory (2002), all useful updates to Foulkes’ thinking on communication in groups.

On balance, The Brain has a Mind of its Own is an accessible introduction to a range of perspectives that together have the potential to make clearer what it is about all forms of psychotherapy that we can all benefit from. By finding the common ground between disciplines and seeing the comparable observations of relational neuroscience and psychoanalysis, as well as bringing embodied feeling and perception into the heart of psychic life, the book opens up new ways of thinking about psychotherapeutic work. So does the book show that ‘advances in neuroscience point to new understandings of how psychotherapy produces psychic change’ (p. 4)? In my estimation he does succeed in showing that the narratives created by psychoanalysis over a century can have a productive dialogue with the scientific narrative that is being developed in neuroscience with the free energy principle. Although at the outset of the book it seems the hope is that neuroscience can provide ‘scientific’ backing for psychoanalytic methods, by the end of the book a more complex interplay emerges. As Karl Friston himself has stated^[2], his free energy principle is not falsifiable, but a formal attempt to express how living systems remain in non-equilibrium steady states by regulating their state within certain parameters (what we commonly think of as homeostasis, although neuroscientist Antonio Damasio argues for a more dynamic term to express this process (Damasio, 2019), as it is more about managing change than ‘stasis’). Friston developed the free energy principle from attempts to understand embodied perceptions and how they are processed neurologically as a model rather than a testable theory.

This book is important because it brings psychoanalysis into dialogue with other disciplines and explores what it might contribute to inter-disciplinary thinking. As I highlighted above, in a few cases, the ‘group mind’ that emerges from a communicative approach to understanding varieties of emotional distress seems also to call out for group analysis to bring its own insights into the conversation. What Holmes describes as the new possibilities for minimising prediction error created by a patient ‘borrowing’ the therapist’s mind, is an insight that could be richly developed in relation to how analytic groups develop individual and collective capacities for bearing uncertainty and facilitating learning. It puts me in mind of Thomas H. Ogden’s comment that ‘psychoanalysis is a paradoxical affair: someone who is supposed to know teaches someone who wants to know what it means not to know.’^[3]

The social importance of arguing for complexity and finding ways of bearing uncertainty together cannot be understated in our current context. In an age of memes and online click-bait that reward simple lies over complex discourse and where the difficulties in maintaining dialogue are collapsing into violence around us, being purveyors of space to not know could be a public service, more clearly for group analysis than individual therapy, as we seek to enable uncertainty to be held collectively in groups. Perhaps we could go as far as being confident enough in our practice that we can bring uncertainty into scientific discourse and allow the creativity and exploration of what is not known to be foregrounded again, instead of thinking of science as certainty, which is one of the ways in which it is understood in everyday life.

My main criticism of the book centres on the use of the ‘brain’ in the title and as shorthand for all our embodied information processing. From my earlier life as a publisher I know that titles are there to attract buyers and not necessarily to reflect book contents, but it is problematic that it is used throughout the text to stand in for nuanced descriptions of embodied responses of the nervous system to how we relate to our context, without explanation. Even where Holmes speaks of seeking to dismantle ‘Western essentialism’, he doesn’t apply it to the brain, a word now imbued with specific cultural meanings – an arbitrarily separate organ in our skulls that is the epitome of our reductionist, individualistic ideas of how we relate to our environment – and an imagined cultural object.

The unconscious use of the reductive ‘brain’ term underlies the fears of psychotherapeutic practitioners when appeals to neuroscience and biology are made in relation to mind and emotions. In some ways the book is concerned mainly with how we use our embodied perception to relate to our social and material environment, and yet, it fails to make an explicit case for linking up the implications of attachment and information processing to our indivisible nature as part of social and natural systems. Perhaps this is something that group analysts could also bring to the conversation: ways of thinking about the social and relational effects of being more precise about our biological ways of making sense, without losing sight of the culturally-mediated ways in which we understand our physical constraints.

It was these questions that made me think of Maturana and Varela’s book, The Tree of Knowledge (1987), in which these two Chilean biologists, mathematicians and philosophers put forward a theory that took the biological roots of understanding to both re-connect human beings with their place in nature and propose that cognition was not a ‘representation’ but an ‘ongoing bringing forth of the world through the process of living’ (p. 11). The power of their model was to acknowledge both the reality of our physical bodies and the infinite creativity of our imaginations in making sense of living. Being reminded of their work brought to my mind how much that seems ‘new’ has often been thought of elsewhere and not found a way to be heard and considered by European institutions and scholars; and how important it is therefore, in any discipline, to invite voices that speak other languages, were socialised in other cultures, and stand in different social positions.

The possibility of ‘both and’ thinking about neuroscience seems to me to be part of what Holmes is doing in practice and it is a valuable contribution to psychotherapeutic thinking. To lose our fear and become curious about scientific models that might speak to our practice and learn with other disciplines; and to see it also as a process, where we can offer our observations and cumulative experience which allows for new thoughts to emerge, also perhaps for the evolution of scientific thinking. Science is the most reliable cultural narrative we have for reality testing and it seems odd that psychotherapies are more prone to splitting into diverse approaches than in seeking common understandings. It is paradoxical but perhaps not surprising that much therapeutic work is concerned with modifying others’ sense of reality, while we psychotherapists seem to resist testing the reality of our approaches and assumptions. We may be justified in being wary of over-simplified reductionist frames that are functional to prevailing power dynamics: ‘scientific approval’ comes with funding, and recognition. But what is the cost in terms of relevance of not having ways to bring our discipline to wider conversations?

Notes

[1] An instance of the way ‘brain’ in used as unacknowledged shorthand for the whole embodied nervous system throughout the book.

[2] Friston, Karl (2018). “Of woodlice and men: A Bayesian account of cognition, life and consciousness. An interview with Karl Friston (by Martin Fortier & Daniel Friedman)”. ALIUS Bulletin. 2: 17–43. Accessed April 26 2021.

[3] Ogden, T. H. (2006). On teaching psychoanalysis. The International Journal of Psychoanalysis, 87(4), 1069–1085. doi:10.1516/d6d1-tgvx-a4f0-jecb

Marcela López Levy
Psychosocial researcher and group analysis trainee at the IGA.