Psychiatry & Psychotherapy Podcast - Consciousness & Emotion with Mark Solms

Episode Date: July 18, 2022

Dr. Mark Solms, author of,  The Hidden Spring, gives us a guided tour of a journey into different aspects of consciousness, how Freud can be updated with the work of Jaak Pankseep and affective neuroscience, as well as some of the more fundamental principles and groundbreaking work in which he comes to the conclusion that the why, how and where of consciousness centers on our "in the moment" experience of emotions and feelings. By listening to this episode, you can earn 1.5 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CME while listening to this podcast. Go to Psychiatrypodcast.com, sign up, sign in, take the test, and the certification is emailed to you in seconds. our welcome to the podcast i am joined with mark solmes and dr gozi i am really excited to have you guys listen to this this interview will go through some of the basics of mark solm's book the hidden spring a journey to the source of consciousness neither are all of us are conflict of

interest free we do not accept any money from pharmaceutical companies we are bringing you this, hopefully for your expansion of your conceptualization of consciousness, emotion, drives, how we should diagnose. As we progress in this talk, we get to kind of where psychotherapy kind of interacts with consciousness and some of the historical underpinnings of things. So I hope you guys enjoy this. I'd kind of like to think about Mark Holmes coming into this session, kind of like Tom Cruise came into Oprah at Winfrey that one time where like the excitement level was so high

that Tom Cruise started like jumping up and down on the couch, right? So I would like to say that like it's a delight to bring in, you know, a child psychiatrist who's deeply in love with your work. And of course I've enjoyed hearing you speak. I've been to a conference where you've spoken and also your book is amazing. So it's good to have you on. Thank you very much. Great to be here.

So I thought we'd start since your book is on consciousness. Can you describe kind of like an elevator pitch for what you think consciousness is and where it is located in the brain? Well, when you say what I think consciousness is, that's part of the brain. the problem is that it doesn't seem as if anybody can agree on what that word refers to. So the best we can do is be explicit about what we mean, what one-one-self means by the term. I mean what the philosophers, Tom Nagel and David Chalmers, are referring to when they say that there is something it is like to be an organism that has consciousness. So the experiential qualitative, there is something it's like to be that thing.

It's not just a blank existence. There's a qualitative, phenomenal feel to it. And I put it that way partly because that seems to be about the closest we're going to get to a consensual definition of what we mean by consciousness. We mean, you know, those things are conscious that possess this quality of something, it is like to be themness, but also because it's a kind of deflationary definition. In other words, it's a, it's not claiming too much. It's speaking about the most elementary form of what we mean by consciousness, which is just experience of any kind. So that's what I mean by consciousness.

And my, the elevator pitch that you're asking for boils down to two points. You know, The one is that I think we've been looking in the wrong place when we've been trying to identify what they call the neural correlates of consciousness. In other words, this qualitative feeling of being an organism, which part of the brain's activity correlates with that sentient being, we've conventionally looked to the cortex. I mean, for more than 100 years, well over 100 years, we've looked to the cortex as being this neural correlate. And I think that's the wrong place.

I think we should be looking to the brain stem, in particular to what's known as the, loosely known as the reticular activating system of the upper brain stem, the basic arousal structures of the brain. They're all sorts of reasons why we have not looked there in the past, but there are all sorts of reasons why we should be looking there in the future. And then secondly and lastly,

what's novel about my approach is that I think that the foundational form, the elemental form, the basic form of consciousness is not this stuff that we are looking at right now. In other words, visual or other extra receptive perceptual consciousness. Visual consciousness has been our model example of what we mean by consciousness. I don't mean that we've ever reduced consciousness to vision, but the basic strategy seems to have been, if we can understand how visual consciousness arises, we can extrapolate from there to the whole of consciousness. I think that we should be focusing on affect, in other words, on raw feeling,

feelings like hunger and thirst and fear and sleepiness, that these are the most basic forms of consciousness. And if you want to understand what it is, then you should start with its most basic form. So there's my pitch in a few sentences. Would you say, I feel, therefore I am? Absolutely. I would say, I feel, therefore, I think, therefore I am. Okay. And specifically, your definition of feelings would be the conscious awareness of, like, emotion, right? And also, you extend it to things like thirst and some of these more bodily desires. Is that how you would frame it? Yes, I don't mean to imply for a moment that something like thirst or other bodily affects

are the totality of consciousness. I mean, of course, consciousness consists in a lot more than those sorts of basic bodily feelings. What I'm claiming is that those best, Basic bodily feelings are the elemental form, the foundational form of consciousness. And what I mean by that is that probably it was the first type of consciousness to emerge evolutionarily. But I also mean it in the functional hierarchical sense that in our brains here and now, all of the other complicated forms of consciousness, including uniquely, human forms of consciousness, all of that stuff is dependent upon that raw affective feel.

So unless you have those basic effects, the basic feeling state of being an organism that's registering its own states, unless you have that, all of the rest of it is not possible. So the rest of our consciousness is contingent upon that basic affective awareness of bodily existence in the world. How important was, I know in the book, you kind of tease apart the differentiation between, you know, this quality of consciousness and historically in terms of, you know, from what we see in the medical world and psychiatry, different aspects of like arousal, you know, whether it's like delirium or whether it's, you know, using the Glasgow comest, comest, you know, scale. How important was that for you to kind of just because a lot of the times, you know, when we're talking about affect and feelings and consciousness, it becomes a semantic battle between the kind of the professions. And so do you want to speak a bit about just how important

was to kind of tease that apart for you? Yes, it's very important. Thank you. It was in the late 1940s that Magoon and Maruti, two American neurophysiologists, discovered to their absolute surprise, it's not as if they were expecting to find anything of the sort. They discovered in the late 1940s that the reticular activating system, this is a deep core brainstem set of nuclei, that they generate consciousness in the sense that I just mentioned a moment ago, that All of these cortical higher forms of consciousness just can't exist without brainstem arousal. And this led to the surprising finding, not only that consciousness is endogenously generated. In other words, it doesn't flow in through the senses.

It comes from the inside, outwards and upwards, from the inside of the brain, outwards towards the extra receptive mechanisms of the brain, not only that, but also that it's a very ancient thing, because those brainstem arousal structures have been with us for over 500 million years. They are shared by all vertebrates. So that was the surprise. And the way that Magoon and Marootsi dealt with that surprise introduced the notion that you've just alluded to, namely that there is such a thing as blank arousal,

that there's a kind of contentless, quantitative dimension called the level of consciousness, which we can divorce from, differentiate from the qualitative contents of consciousness, which they then persevered in claiming was what cortex provided. So upon realizing that the cortex cannot generate anything conscious unless it's activated by the brain stem, they effectively said the brain stem is like a sort of power supply for a television set. And unless you plug your television set in the wall, of course, it's not going to be able to do its televisual thing, but that doesn't mean that the power source is really where it's at when it comes to television. That was the kind of image that they used.

And with that came the idea, you mentioned the Glasgow Coma scale there, the idea of measuring the level of consciousness as a kind of quantitative. dimension, the Glasgow Coma scale is a 15-point scale, and you sort of locate the patient on that quantitative dimension of wakefulness. Then contents and qualities are added by the cortex, which creates the theoretical fiction, and I really use this word advisedly, the theoretical fiction, that there is such a thing as blank wakefulness, you know, that you can, that you can be conscious without there being any phenomenal experience. But nobody's ever pointed to such a thing.

Nobody has empirically ever demonstrated what blank wakefulness looks like. And if you take, this is the crucial empirical point that I'm making, because really this is not semantic. I'm saying there is no such thing as brainstem arousal that has no content and quality. And so the critical test is to take patients who have only, an intact brain stem and have no cortex. And I'm referring here, I know you well aware of these cases, a children born with a condition called hydran encephaly,

where they either have no cortex or no forebrain as a whole, but certainly no cortex, and they have a fully intact brain stem. Now, the theory that I've just mentioned, the one that inherits from Magoon and Maruti, and which is still the mainstream view in the whole of behavioral neurology, the whole of cognitive neuroscience. This is the mainstream view that the brainstem is just a power supply. It's got no content and quality.

If that were correct, then these children are a critical test of the theory. They should be in a coma. Or more precisely, they should have blank wakefulness, what is called a vegetative state, which is also defined as non-responsive. of wakefulness. But when you look at these kids and crucially interact with them, they are, first of all, certainly not in a coma.

They go to sleep at night. They wake up in the morning. They lose consciousness when they have seizures, which sadly they're prone to. But much more interestingly and much more importantly, not only theoretically, but also frankly, ethically, they are anything but non-responsive. They are emotionally responsive beings. They show the full range of basic emotional responses, and they show them in situationally appropriate ways.

In other words, they get frustrated when you deprive them of something that they want. They get a fright if you surprise them. They giggle if you tickle them, you know, and so on. So they are, I mean, that's the essence of responsiveness, that they are emotionally responsive And also, very interestingly, they show emotional initiative. They actually try to bring about situations which they like. So the critical test of what you expect to find, if the cortical theory of consciousness were correct, that the contents and qualities of consciousness are entirely attributable to cortex,

then children who have no cortex and never have had any cortex should have no content and quality, and yet, you know, this is what we find. Now, I must tell you, I'm sorry, I'm probably babbling on too long, but it's such a fundamental point. My colleagues are still many, I mean, many of my colleagues, they still make, they say, well, how do you know that those children are conscious? Because, of course, they can't speak. They've got no cortex. And this seems to be the goal. hold standard, reportability. If you can't report your conscious states, then, you know, there's this, this is sort of inexplicable skepticism as to whether or not they really are conscious. And of course, the same applies to pre-verbal infants. On that criterion, pre-verbal infants are

automata, you know, and so is your dog and your cat, you know, not conscious because it can't say, hi there, you know, I'm feeling happy. So, so. So, so. And so, and so, and so, and so, and, and, you know, So, you know, there's lots of other evidence we've gathered to try and get around that objection. But I'm just trying to answer this fundamental point that you've made, which is, you know, how are we to understand this distinction between the level and the contents of consciousness? And I think, to come back to my starting point, I think it's a fiction. I think there is no such thing as a level of consciousness, a blank contentless, qualitativeless. consciousness because consciousness is there is something it is like to be conscious i've never seen

any conscious creature that i don't know what you could possibly mean by a conscious creature that there is not something it is like to to experience its consciousness okay here's here's um is here's a follow up then for that is consciousness a spectrum or is it like an on or off like spectrum meaning like as someone goes into for example a hypoactive delirium or a delirium and they become progressively less conscious of their reality, right, and more, like, reactive. Or, you know, as someone becomes more inebriated with alcohol or fine wine, you know, do people's, is consciousness like a step, is there steps down in consciousness in your perspective? Or is it like a linear on and off? Like, how do you see that?

I think that question has two aspects to it. And so let me address them in turn. The easy part of it is, you know, are there more and less complex varieties of consciousness? And I would say yes, absolutely. For example, I have little hesitation in acknowledging, in fact, gratefully acknowledging that we human beings have a degree of reflective consciousness, of awareness, of our awareness, an ability to abstract ourselves from our first-person perspective and see ourselves from the third-person point of view and so on.

You know, there's no doubt that that is something way beyond what I'm attributing to these hydranencephalic kids. There's no possibility that they could have that sort of experience because they have not only no prefrontal cortex, but no cortex at all. So that is the highest form of consciousness in a, And then there are all sorts of degrees going downwards, not only in terms of species-specific levels of complexity, but also pathological forms. So you refer to delirium, which is a kind of disorganized form of consciousness, and you refer to inebriation, which is a sort of obtunded consciousness.

And, of course, those are degraded forms. and clinically, you know, the Glasgow Kerner scale that we were talking about earlier, you know, it quantifies or it sort of very roughly locates you on the scale of how much consciousness is present. Although I hasten to add the point I made earlier to repeat it, that the how much doesn't mean only a volume control. It also means how much consciousness, in other words, is there a qualitative something it is like to be in that state.

In its most rudimentary form, it is just feeling. It's just, you know, without any, like in other words, feeling hunger or feeling pain. It's just a feeling. You don't have to have a name for it. You don't have to have any theory about where it comes from, whether it's, you know, whether it's internal or external, you know, all of those things. So just a raw, simple, valenced feeling is, is, is enough to my mind to attribute consciousness if that is present.

But the second meaning of your question, on or off, is a little bit more difficult to answer. I would say clearly there can't have been a moment where until that moment, there was no consciousness in the universe. And then on Wednesday, you know, the 13th of August, 500 million BCE, you know, consciousness dawned. I think that there must be precursors. There must be sort of proto-consciousness. And it becomes very difficult to clarify what exactly one means by that.

I'm happy to do that, but it's more difficult is what I'm saying. So I think that there is a kind of a gray area where it becomes question. the rule, whether this, should we attribute the word consciousness to this or to that or to that? And I think that that's a bit of a mug's game. There is no absolutely sharp demarcation. That's the second part of your question. But the first part, which I think is the main thing you were getting at, absolutely. There are grades of consciousness, and that's clearly true.

I think, to be clear, that the mistake. we've made in consciousness studies is to focus our attention on the most complex grades of consciousness. And, you know, looking at these higher corticles, sometimes specifically human forms or visual perception and thinking that this is the appropriate place to start. Why? Well, because we know we are conscious. So let's start with us. But, you know, I think that the, that's placing a little bit too much emphasis

on the problem of other minds because it's very unlikely that consciousness begins with us. And so I think it just makes simple scientific sense to start with its more basic forms if you're wanting to understand what it is, how it works, what it's there for and so on.

Is it fair to say, and a follow-up question to that, is it fair to say that kind of that triangle, those brainstream structures with the erratic system and a couple of others, instead of it being more like an on and off switch, a power supply, it's more like they're modulating.

There's a chapter in the book where it talks about the source where it isn't just this source of kind of like this power supply, this downward to the kind of neocortex kind of impression it kind of gives and functioning. There's also feedback from the neocortex to the reticular activating system. And so it works more like, it seems like it works more. like modulating stuff and obviously like a instead of like a fountain of consciousness it works like an estuary of consciousness there's a

mixing it's probably not the best name for a follow-up book or something but is that is that am I am I on the right track and seeing it like that there is this interplay in those kind of brainstem structures yes so let me answer your question and then I want to say something else which I think is

an important elaboration from what you've just said. So to answer your question, yes, absolutely in the normal brain, the reticular activating system, which is what we've been talking about until now, its role is to modulate the activity of other brain structures, most importantly for present purposes, to modulate the arousal of cortical message passing. So the cortex is an intrinsically unconscious instrument. It's perfectly capable of doing its basic cognitive and perceptual tasks unconsciously. There's tons of evidence for unconscious perception and cognition, including uniquely cortical perception and cognition. So the cortex doesn't have to be conscious

in order to function. But when it becomes conscious, it's modulated by reticular activating system. And then as you say, then there's also feedback to the brain stem. Most importantly, to the perioproductal gray, PAG for short. And the PAG, together with the reticular activating system, is a kind of functional unit for arousal, upward and downward sort of circular motion of arousal. Then there are other structures in the brainstem, particularly the superior caliculi and the midbrain locomotive region,

which are also important in terms of that triangle you're referring to. But the crucial point you are making is it doesn't function by itself, does it? It's what you're asking. You're saying it's modulating the function of the cortex. And I would say, yep, absolutely that's true. But I would add that that system exists in creatures that do not have cortex. So we must also wonder, well, what does it do prior to the evolution? of cortex.

And this is an empirical question also. You know, we can investigate hypotheses. We can make testable predictions as to, you know, is there evidence to suggest that these creatures with no cortex, but only with reticular activated system and the other brainstip machinery we're talking about, is there evidence to suggest that they're conscious notwithstanding absence of cortex? And also, as it happens, the children we were talking about a moment to go, you know, they have no cortex.

So my point is twofold. Yes, normally in us creatures endowed with cortex, normally we speak of the function of the reticular activating system in relation to its modulatory function at the level of cortex. And that's what it does with us. But I'm saying that that is not the basic ingredient of feeling. That's already stage two. Stage one is just, if I may translate it into words which the creature is not capable of,

I feel like this, it's just feeling. Then stage two is, I feel like this about that, to extend conscious feeling onto its sources so that you can monitor not only how you're feeling, but also what's causing those feelings and what effects are changes in my context, having upon my feelings, to have a common currency between these extra receptive representations and my endogenous feeling state is an advance over the most basic form, which is just how I feel.

And you don't have to represent consciously the context. I said that there's evidence that such a thing exists. I'll just mention one of it, apart from the kids who I've already mentioned, in zebrafish, who have the brainstem machine who we're talking about, but no cortex, we put them in a, I say we, this is not an experiment of mine, but we, neuroscientists testing the hypothesis that these fish have feeling states made the falsifiable

prediction that if you place substances in their tank, in the fish tank, which have no nutritional benefit, but which have hedonic, in other words, they feel good. Substances like nicotine, morphine, amphetamine, cocaine, which are actually bad for the little fish, but which feel very good. The prediction was that they will show condition, place, preference, behavior. They'll stay on the side of the tank where those substances are being delivered. And the prediction is confirmed. The fish like to hang out where the cocaine is and the other three substances I mentioned. So, you know, this suggests that raw feeling affects the behavior of a creature that has no cortex.

And I'm emphasizing the word feeling there because that's all that these substances do is that they feel good. And so I'm saying that feeling in and of itself does not require its modulatory function on cortex. I said, I want to add something to my answer. So that's my answer to your question. Yeah, normally there's this loop, but that loop is a. second order of things.

First and foremost, the brainstem just feels. Secondly, comes the stuff we are talking about. Now, when I said there's feedback to the periacidactal ray, it's important to add that that feedback doesn't come only from cortex. In fact, it comes from all of the homeostatic, the weak, complex creatures, in fact, just about all creatures, in fact, all creatures. we have needs. We have to remain within certain physiologically viable or biologically viable bounds. And deviations from those bounds are demands on the organism to do something, otherwise it's going to expire.

And then it performs some work to bring itself back within its homeostatic and viable bounds. And the feedback from all of those homeostatic mechanisms, the sort of error signals, the sort of how How am I doing in terms of my biological viability? All of those signals descend up, I mean, all of those signals descend upon the periacqueductal gray. And so, and there's no structure in the brain, which in humans, we know this from humans because they can declare it, there's no structure in the brain which produces more intense affects and a greater variety of effects when stimulated than periacqueductal.

gray. It's the most concentrated feeling-generating tissue that there is. And it's where all of these homeostatic error signals descend congregate. And so my hypothesis, to come back to, you know, the implicit question, or something implied by your question, is consciousness not in its raw, basic form a modulation of cortex? I'm saying, no, there's something more basic, which is that it is a registering of how well or badly you're doing in terms of remaining within your homeostatic bounds. We, we, all, as I said, all living things function homeostatically. That's what differentiates us from non-living things is that we're working to remain, we're resisting entropy. We're resisting the second law of thermodynamics. We're not dissipating. We're staying within

our expected phenotypically viable states. And the, so I I'm saying that is that the basic mechanism of consciousness is the, the, I mean, when I say all creatures function homeostatically, I mean all living things, I mean even plants. So I'm not saying that all of them are conscious. I'm saying that there's something added to homeostasis. All the evidence suggests it's something to do with the homeostatic error signals. That's what affect is all about. And affect, in my view, in other words, the dawn of consciousness, the first elementary

form of consciousness in the raw feeling sense of the word is the additional capacity, not only for homeostasis, but for the organism to register how well or badly it's doing here and now. Did that work or did that not work what I did now? To be able to register errors not only by dying, but by feeling bad, which predicts death. It means you're heading the wrong direction. and pleasurable feelings tell you you're heading in the right direction, that this is an enormous adaptive advantage,

and it enables creatures so endowed to navigate uncertain environments, environments which are not predicted by their phenotypic reflexive and instinctual capacities. So such a creature doesn't only survive as long as what it does automatically works. If what it does automatically doesn't work, then it's got this sort of additional level of functionality, which is, okay, that didn't work. Now, what about this? Let's try this.

And feeling registers in this valence qualitative form, how well or badly you're doing in terms of meeting your homeostatic imperatives. That is my hypothesis. Okay, so, gosh, there's a lot of questions I could ask, but one, what I was thinking about was that I read that you were psychoanalyzed for nine years, five times a week. And I'm curious of what would you say your observations were of your own ability to be conscious of your emotions, experiences, feelings, reasons for doing things before and after that experience. Yeah. Well, let me say just quickly why I went to the trouble of being psychoanalyzed. It was because I was so frustrated as a neuropsychologist, put the emphasis on the psychologist part of it, you know, I thought that neuropsychology would be about neural mechanisms of mental life.

But, you know, the mental life surely first and foremost is subjective experience. And when I trained in the early 80s, subjective experience was. was still a swear word. You know, so if you asked your professors about, yeah, but why does it feel like something to retrieve a memory? Or why are we consciously aware of the wavelength of light that we're registering? Why can't we do that unconsciously?

You know, they're sort of politely advised you not to ask questions like that. These are not, you know, proper scientific questions. They're bad for your career. So I was so dismayed. the neglect of subjectivity in behavioral neuroscience. It's very behavioral. It's like what we can physically see. That's why I turned to psychoanalysis.

I thought, well, for all of its faults, you know, and let's be frank, psychoanalysis has lots of problems, at least it foregrounds subjective, lived life of experience as the stuff that it's stunning. So I just wanted to preface my answer by clarifying. that's why I went to those lengths. Okay, okay, so before we, that's interesting too, because we're talking about there's got to be a problem of homeostasis that leads to us becoming consciously aware to make action, right? So what would be? To make voluntary action.

So the problem that you saw was a dissatisfaction with the intellectual knowledge that you were learning. learning, this is a very advanced consciousness awareness, right? Which led to you, like, seeking behavior, right? So seeking, venturing out of the normal tribe of behavioralists to venture into kind of uncharted territory. Is that a fair description? That's correct. It's because I, you know, I don't want to make it seem as if I'm

some kind of conquistador or something like some kind of hero. It was why I was interested in the field. You know, I was interested, as I said a few minutes ago, in how does it happen that I, my subjective being in the world is also a bodily organ and how do these two things relate to each other? And I thought that's what I'd signed up for, studying that. And when I discovered, no, it wasn't only, I must say it wasn't, this was the early 80s. So it was, I mean, the shadow of behaviorism was still, you know, very much falling on my field.

But it was after the cognitive revolution. It was a decade after the cognitive revolution. So we were allowed to speak about what's going on inside the black box. You know, it wasn't just stimuli and responses. It wasn't just behavior. It was also what is, what kind of processing is going on inside the, between the ears, you know, that generates that behavior. but that processing was all construed in sort of third-person information processing terms. There was no question as to the subjective quality of mental life.

That was still an embarrassment to our science. And I think you can't have, I mean, to have a neuropsychology in which you exclude the subjective is basically, it's like an oxymoron. How can you have a neuropsychology that excludes the psyche? What is the psyche, if not first and foremost, experiential? So that was the problem that I based. And that's why I trained in psychoanalysis because I wanted to bring those, because they had been stunning subjectivity,

they had a whole, and still have, a whole conceptual armamentarium, you know, they have words and theories that pass this part of reality. you know, what is their self? What is, what do we, what do we mean by feelings? How do, how many basic kinds of feelings are there? How do they relate to the organismic needs? And, you know, and what way do they motivate us? And, you know, and all of the dynamics, the interactions between feelings and cognitions, that that's what that discipline is all about. So I wanted to bring all of that theoretical yield of a century of psychoanalysis into neuroscience. And that's what I've done. I mean, and I don't regret it for a moment. I think it was a good idea. But you were

asking me about my own experience of being in psychoanalysis. And, you know, I could obviously go on for a long time about that, but the crucial thing was, first of all, it made me aware in the most direct, immediate, personal way, how much of my cognitive life is unconscious. I know that we now know that in cognitive neuroscience. In fact, more or less at the time that I started to train in psychoanalysis, cognitive neuroscience, the 80s and the 90s caught up with that. You know, that the vast bulk of our cognition carries on unconsciously. And I experienced that directly.

That's probably anybody who submits themselves to a psychoanalysis has the experience the shock of realizing my God, you know, that's why I did all of these things. I mean, like I'll just give you a very apt example. I didn't know that the reason I became a neuropsychologist, it sounds ridiculous when I tell you this. My brother, my older brother suffered a brain injury when we were little. And he was radically changed as a person and it really destroyed, if that's not too strong a word, his life.

It's certainly it's the single worst thing that ever happened to him and perhaps to my family as a whole. So I directly personally witnessed who you are is somehow bound up with your brain. And my brother changed from one, you know, before his accident and after his accident, he was literally two different people. So it's clear that that's why I became a neuropsychologist. And I'll tell you more, it was that I felt bad every time I did well it, school, it was like showing up my brother who couldn't manage school. And so my desire to do well, my own ambition, you know, the only way I could do well academically was in a way that didn't hurt my brother, or for that matter, my parents, you know, all of us having to, having, so the

motivation to become a neuropsychologist was not only I'm interested in how brain and mind relate, but also I can do well in that field and help people like my brother. So it's not so bad to do well in that field. You don't have to feel guilty for it. So these are complicated thoughts, and yet none of it was conscious. So in my analysis, I discover, shit, obviously, yes, that's why, not only why I'm in this field, but why I've taken the particular approach, because you can see also why it wasn't just about cognition. You know, I wanted the, I ended up doing many things which are really frowned upon by my colleagues,

not only training in psychoanalysis, but also I was interested in therapeutic work with my neurological patients. You know, to be a therapist as opposed to a bench scientist, you know, it's kind of like slightly lower class of activity. Therapists, they get their hands dirty. But, you know, I really wanted to do that and needed to do that. So these are the sorts of things that I've personally learned from my own analysis. But if I may add one further thought, not thought, observation, is that anybody who submits themselves to psychoanalysis learns not only what I've just said, but in addition, they learn that they are motivated by feelings.

We, nothing matters more in the life of the mind, in the way that we live our lives, the decisions we make, rationalize them as we may. you know, actually in the end, it's all about feelings. And so I learned that too. And it's quite a shock. It's quite a humbling, humiliating, actually, in many respects also experience, to realize that actually that's all it comes down to. This is what our lives are about.

So those two facts that most of our cognition is unconscious and that what's really driving the show is emotional feelings. Those are the things that I think were the most important lessons I learned by submitting myself to analysis. Yeah, do you think you became more conscious of your feelings, like in your day-to-day sort of interactions in the process? Yeah, now this is a very complicated topic. what does one mean by becoming more conscious of one's feelings? I think that feelings by definition are felt.

I think if you don't feel a feeling, it's not a feeling. So, I mean, it's literally an oxymoron to say, you know, that you have an unconscious feeling. I think that we use that phrase very loosely. What we really mean is something like, you know, that we're acting on the basis of our feelings without connecting our actions with the feelings. So we have feelings and then we do stuff and we don't realize that it's because of these feelings that I'm doing this stuff. And it's not just behaviors. I mean also all sorts of thought processes. Yeah.

But I also think it's got to do with our ability to articulate, to name, to differentiate. So you mentioned earlier that I for my sins, I live on a wine estate and I really mean for my sins because that that's in South Africa. There are lots of sins behind land ownership in South Africa, but that's another story. But you know, you mentioned wine. If you drink a glass of wine without knowing a bloody thing about wine, you know, you taste like wine or tastes like some sort of like bitter grape juice,

or I don't know what, you know. And then as you learn more, so you differentiate, you know, you're able to actually register, you know, the mouthfield, and the nose and the body and the complexity and et cetera. And you can identify that's a charade. And this is a cabernet-so-mignon. They've got nothing in common with each other. But only if you've learned how to...

So I think the same applies to emotions that all of those qualities are there in the glass. You know, if you're a naive, let's hope, adolescents having your first glass of wine, you're not going to have the same experiences as you are if you connoisseur 20 years later. I think that we can draw a direct analogy with feeling. But it doesn't mean that those qualities were not there.

It just means you couldn't name them, identify them, differentiate them. Yeah. Okay, so give you kind of like a little bit more nuance and my thoughts on that. So I'd be curious how you would fit in the core emotions, for example, that Darwin and Paul Ekman wrote about the micro-expression. so these very like one-tenth of a second, one-thirtieth of a second flash of emotion, which I actually train people on how to use that in psychotherapy, EmotionConnection.com.

And what I've seen is that someone will flash an emotion, for example, let's say that if they have OCP, obsessive-compulsive personality disorder. So they'll flash an emotion, and then they'll have anxiety about the emotion, maybe classically called like signal anxiety. And then they have a defense. And so you watch the emotion flash on their feet,

face, you watch the defense, which in case of like OCPD will be like intellectualization or rationalization. And their intellectualization, rationalization are very far from the emotion. And it can be even a denial of having the emotion, right? Or you'll get someone who has like a hypomanic defense like to a negative emotion. So then they go a positive and then they or a hypomantic spiritual defense. So it's like they add in twist in some spiritual content into that sort of very positive emotion instead of feeling that negative emotion.

So when I say, did you become more aware of what you were feeling? I imagine before, I mean, before I did psychoanalysis and was analyzed, like I was more intellectualizing things that were probably more present but not felt in the way because it induced shame to feel them or guilt. Maybe you feel differently about emotions that I'd like to hear if you, if you

disagree with any of those points or if you see it differently. No, I don't disagree with any of them. I think that perhaps the most important point to make, before I speak a little bit more about defense mechanisms, which is what you're talking about fundamentally, the most important point to make is that when I use the word feeling, I'm referring to something. feel. And if you don't feel it, then it isn't a feeling, and that's not just a semantic point. It's a functional point. It means that there are things that you can do. Remember, I spoke earlier about the adaptive advantage of feeling. I don't only mean it's in the evolutionary sense. I mean, it's also for each and every one of us. If you feel something, then you possess it. And I said,

that it enables you to make choices, in other words, to have voluntary behavior as opposed to merely automatized responses. That is the crucial functionality that feeling allows, it allows you to feel what the consequences of your actions are and to change your mind accordingly. If you do not have that feeling, then you function automatically. And this is in the realm of a lot of psychopathology, that patients do things. They know not why. And, And that ends in tears every time. And they do it again. So a crucial feature, and by the sound of what you're saying in your own work too,

a crucial feature of what we're trying to achieve in psychotherapeutic work in psychiatry is to bring something to the level of feeling so that the patient is able to have choice over how they live their lives rather than to be compulsively, automatically driven to do things without them being aware, not only that they're doing them, but that they also not the best thing to do, because it always ends badly. So that's the first point I wanted to make, which is that it makes a difference whether you feel something or not. And that thing called a feeling is what I'm studying.

And I want to know how in the brain is that generated? What does it do? and what are the fundamental laws governing it, etc. That's what my work over the last while. That's what's most interested me. But then to come to the matter of defences, yes, certainly I agree that there are things that we do in order to avoid feeling things,

which comes at a cost. In other words, I can take the most simple sort of example. if I were a spider phobic, you know, then every time I go towards where the spiders are, I feel terrified anxiety. And so I avoid those places in the world where there might be spiders. That restricts my life. I now can't go where spiders are. It doesn't mean that when I'm in non-spidery territory, I have unconscious repressed spider fear.

I'm avoiding that place in order not to feel the fear. So now I'm not having a feeling, but it comes with consequences. So that's a very simple way. I mean, you internalize that. There's a place in your mind where you have fearful thoughts. You avoid that place in your mind. It doesn't have to be in the outside world. That's what we mean by a defense mechanism, that there's certain places you won't go.

In other words, there's certain things that you know, that you pretend you don't know, but they're still there. And so, you know, it comes at a cost to the way that we live our life. and more restricted, more stereotypes, you know, and less aware of our optionality, crucially, you know, is what the price is. So yes, certainly I agree there are defences against feeling. And that's not the same thing as an unconscious feeling. It is behaving in restrictive ways in order to avoid experiences

which you can't tolerate, but it comes at a cost. Okay, but what you just described is like you see the spider, you feel the fear, you're aware of the fear, and then you have psychological defense that pop up. Do you think that it's possible to have an emotion, not be aware of the emotion, have a defense against the emotion, deny the emotion ever existed? I think what happens, so, you know, we're beginning to become a little Talmudicier, but I understand why it's important. I think that certainly there are, like you gave the example of a micro-emotion, like a momentary reaction by the patient, a facial expression of a particular emotional response, and then they do something else and they don't seem to be aware that momentarily there was behavioral evidence that they were disgusted or fearful or whatever the case may be.

we have analogous situations in sleep science. You know, we speak of awakenings, which is when the person is awake and they say, hello. And then we have arousals, which are brief awakenings. And then we have microarousals, which are very brief awakenings. And physiologically, you can show the brain has woken up, but the person has no recollection that they were awake. And then there's this Talmudic thing, as I say, do you say? Do you say that they were awake or do you say that they weren't awake? Well, it goes back to the question earlier about, you know, the gray area between no consciousness and consciousness.

I think the same applies in a non-problematical way to feeling. You know, it's like, you know, there's a point at which one becomes aware, I'm scared. And there's a point before that where it's such a brief registration of the scared state that the person doesn't even read, but they respond to it, you know, just as you see on the EEG in the sleep studies, you know, you see that this, that's not only that they're aroused in terms of the EEG, it's also there's a change in their muscle tone,

there's a change in everything, you know, so they physiologically work out very, very briefly, and then they went back to sleep. So that happens. I think that's one variety of what you're talking about. Somebody's fleetingly in an affective state, and then they've got their whole, they've got their whole,

defensive operation that they then rapidly put into motion. And that protects them from having to remain in that state for long enough to even register that they're in that state. And I said to you that has all those consequences, which is why I claim again, I emphasize again, it's important to be able to feel what you're feeling. It's a good thing to be able to feel what you're feeling. But I want to add one quick thing, sorry, which is that it's not always like that. Once you had the experience of if I go there, to use again the silly example of a spider phobia, if I go there, I see a spider so, you know, I run, then in future I don't go there. That second phase, I think, happens in our patients all the time. So they don't have to have

the momentary feeling. They have only the defense so that they never, expose themselves to the negative affect. And you can say, well, that's unconscious emotion. It's that they have learned a way of dealing with emotional situations, which enables them to avoid having those emotional situations. So they don't even fleetingly have to have them at all. But crucially, that learning is the product of feeling. So feeling still drives it.

It's still driven by what I call the law of affect. But you can have all kinds of stereotypes. unconscious ways of thinking and behaving, which then take on a life of their own, and you no longer have to have any felt affect accompanying them. Okay. And basically, I understand, obviously, the podcast is called psychiatry and psychoanalysis. I'm trying to come in it, like, come at it, like, if I was, like, a third year or fourth year kind of medical student, I was just starting my residency.

And so I really like the fact that the book itself, you're kind of taking things that we, I think, I Google it. I think we're still learning about defense mechanisms when we're doing our board exams, like the step one board exams for medicine. Right. And then it seems as though unless you have a, you know, unless you have like a supervisor who is an analyst or you go to a residency that is that way inclined, it kind of kind of drops off. And that was kind of a little bit about my experience, especially the later on in my career. Where does Freud kind of land for you, just in terms of that. You do a great job bridging Freud to PangSip to obviously another paradigm shift to Friston. So what would you tell, you know, a medical student learning about defense mechanisms or even part of a psychiatry residency, you know, learning about Freud?

like how does this really link into how we see our patients? And is this something that we can use in a more formal day-to-day kind of manner, which I obviously do, I've mentioned before? Yeah. I think that it's an unfortunate situation when it comes to Freud. And I don't know who's to blame for it, whether it's the Freudians or the anti-Froidians, perhaps they're both to blame for it.

You know, that it's, we can't seem to blame to, to treat Freud as the pioneer of a discipline, like Darwin is the pioneer of evolutionary biology and everything that goes under that banner, like molecular genetics. Darwin had absolutely known inkling, I mean, even of the structure of DNA, didn't even know the laws of inheritance. He knew nothing about, I mean, genetics literally didn't exist. we don't say, well, therefore we mustn't teach Darwin, you know. But by the same token, you know, we can't teach Darwin as if he were the be-all and end-all of evolutionary biology.

Likewise, Newton in physics, we don't, you know, attack Newton as some kind of, you know, a terribly damaging figure in the history of physics because he didn't recognize the quantum nature of the universe. we teach Newtonian physics and then we go on, move on, and then we teach everything else. And it's not about a sort of hagiography about Newton the man or Darwin the hero. So that's why I say, I'm not sure who's to blame. But clearly what Freud sketched out is that Freud tried to bring the subjective experience, the lived life of the mind, part of nature. He tried to bring an international science.

But of course he was the first one to do that. And so, you know, he only had the most rough and ready initial sort of sketch, leaving out a hell of a lot that he didn't even realize existed, and getting some basic things wrong. What else do you expect? But he was an absolute pioneer of a very important branch of science, the science of what it is like to be and what can we learn about being, in other words, about the living organism,

in the case of psychoanalysis, particularly the human organism, what can we learn about how it works by studying it from the perspective of what it's like to be one, that there are certain things you can observe from the subjective perspective, not least of the feelings, you know, that you can't observe any other way. And so you won't know what impact these things have on the organism if you don't take them into account. And so I think psychoanalysis is a terribly important part of the mental sciences, terribly important, terribly important part of psychiatry, terribly important part of

neuropsychology. But it's just part, you know. And so, so that's what I would say. I would say any psychiatry program that leaves that area out, you know, the serious study of what it is like to be a patient, the role of the feelings, what are they for, what do they mean, why, and how does the patient's behavior relate to their subjective state, and everything that we've learned the most obvious facts about how the way that you behave relates to your developmental emotional history. You know, all of those things. To have a psychiatry program that doesn't have those things center stage is just, you know, it's just appalling. It's just appalling. To have a psychiatry that's only about neurotransmitism and receptor types,

you know, is a tragedy. But at the same time, to have a psychiatrist. country that's just about teaching Freud the whole Freud and nothing but the Freud, as it was in the early decades of the 20th century, you know, it's equally appalling. So I hope that's not too obvious an answer, but that's certainly what I feel. Yeah, it's hard, it's hard to imagine what it was like in Freud's age when he was doing this because we don't have that viewpoint of like what it was like to be a patient back then or like there, you know, there was no. treatment like therapy like what would it be like without that i sometimes think about that or like you know historically if you were ill you would end up in an asylum of sorts and some of them were very horrific um you know induced vomiting bloodletting uh you know chains at times so into that world you have you have to like read Freud and think about like, okay, he's trying this out, patient one, patient two, patient three, you know.

Yeah, I don't know. Any other thoughts on the kind of like... That's what I mean by a pioneer. I mean, you know, what you mentioning things going all the way back to the middle ages, but, you know, they were, in psychiatry in the late 19th century, it was little more than quackery, you know, hydrotherapy and electrotherapy and rest cures and, you know, going into the mountains. And it's like, compared to that, and what Freud introduced, the idea, you know, I don't need to tell you what the talking, the basic ideas behind the talk of cure, which we now absolutely take for granted. Psychotherapy is an enormous advance.

And all of the insights that lie behind that all forms, almost all forms of psychotherapy derived from, you know, those observations that Freud and Breuer and those pioneers of psychoanalysis made. And we owe them, you know, that's, it's a massive leap forward for medicine and, and for, you know, for mental health care. You know, I just, I just think that's, that's so obviously true. And I, I don't know why it's so hard for people to see that. You know, it's a, I wrote a paper in the British Journal of Psychiatry in 2018, the international edition. the title of which was the scientific standing of psychoanalysis, where I tried to address that, these things, directly for a psychiatric audience,

and saying, look, let's just not lose sight of the wood for the trees here. This is what psychoanalysis is about. This is why it's important. This is what it claims. How can we deny that? Isn't that important? And I was very pleased to receive a little certainty, from Cambridge University Press

at the end of that year saying it was the most highly cited paper of the year. So it seems somebody in psychiatry is still listening if we address it in a kind of sensible, sober, scientific way. For me personally, it was like, I think

I was maybe not totally disillusioned, but, you know, I was in a world where it was very kind of DSM-centric, but that when, I think I grabbed you on kind of YouTube, but then I kind of read your paper on the conscious id, when you trying to flip things around, that for me, that was like a game changer in terms of, and maybe it was like I was, I didn't want to waste

all those, all those kind of years, like, you know, looking up Freud and kind of studying it. It was like, I needed to make it practical. And what you did was made me feel as if that wasn't a waste. It wasn't looking at kind of tea leaves, as it were. And I don't know, you know, not to minimize that, but it was, it was very, very profound. And it seems, is that, is that how you felt with that shift and that kind of then kind of connects to, you know, the rest of the book, as it were? Yeah. So that was, that paper that you're referring to, I published that in 2013. And that really was a turning point in my own scientific thinking. When you introduced me earlier, David, you said that I was the discoverer of the four-brain mechanisms of dreaming.

And that phrase is crept into my bio because when I did that work, which was in the 1990s and early 2000s, I was wanting to emphasize that dreaming is driven by four-brain mechanisms. It was that pivotal moment that you're referring to 2013 was when I realized, hang on a minute, you know, there's things going on in the brainstem which are fundamental to the life of the mind. And so that was shifting down to these much more primitive mechanisms and crucially recognizing that this is the, that these brain regions are where consciousness has its source. And the major evolution in my own thinking there was for Freud, the id, in other words, the drives, these fundamental demands made upon the mind to perform work by virtue of us being embodied,

the drives for Freud were unconscious, that his id was unconscious. And as I understood those brainstem mechanisms, which are the mechanisms of drive, you know, they perform exactly the work that Freud was referring to, the demands made upon the mind for work by virtue of our embodied nature. those mechanisms are brainstem mechanisms, and the mechanisms in question are the ones that give rise to the most fundamental form of consciousness, namely affect, may have to recognize that actually drives our felt. To use a silly example, we're constantly burning up glucose, you know, we have a need for energy supplies. And so in our other post tissues, there are these nutrients are stored and we burn them up. But we don't call that a drive.

We don't call that hunger. It's only when you feel hungry that you're driven to seek food. That's what we mean by a drive. And so as simple as it may sound to our audience, that for me was like a major revelation that a drive only has the quality. is of a motivational force once you feel it. And that when we speak of demands made upon the mind for work, those demands are felt.

So that was, you know, and I was expecting, because psychoanalysts are extremely conservative. You know, it's not, it's not, you don't expect to be welcomed with open arms when you say the id is conscious. But that's what I had to say in that paper. And happily,

it has been for the most part, for the most part, very well received. How do you, I want to make sure we touch on your relationship and kind of your thoughts that Yank Panksept came up with. He was an Estonian American neuroscientist, psycho biologist who authored a book, Affective Neuroscience. And in it, and you kind of talk about this quite a bit, actually. And it's, sounds like you had a friendship with him. He was a part of your group. And so he talked about seven biologically inherited primary effective systems.

Seeking, fear, lust, care, panic, grief, and play. How did his work shift your view on, you know, neuropsychiatry, neuropsychoanalysis? Well, yeah. So Yacht-Pank-Sep was a very dear friend of mine, and probably my closest scientific collaborator. I mean, over my scientific lifetime, I think I have collaborated more closely with him than with anyone else for a sustained period of time. Sadly, he died five years ago, but his worker had a profound influence on me. You speak of his seven emotional drives. I want to emphasize that those are not the totality of our drives.

Those are what we loosely call the emotional ones. I say loosely because, again, who's to draw the dividing line? Is lust a bodily or an emotional feeling? Is disgust of bodily or an emotional feeling? But Paxib draws the line somewhere and says, well, these seven, for which there's really solid evidence that these bribes certainly exist in the mammalian brain, the human brain included, let's call those emotional ones. And then, you know, hunger, thirst, sleepiness, the need to defecate and so on, those are not emotional.

So the seven emotional ones, just looking at those, well, first of all, it is from the psychoanalytic point of view, an enormous advance again. I said that we had to recognize that Freud was wrong to say that the end and its drives are unconscious. Likewise, we have to recognize that Freud was wrong to think that there are two emotional drives, as he always did, although tentatively, he always said, well, biology will eventually decide the question. So to say there's seven rather than two is a big step in psychoanalysis. And I don't only mean a big step because it means Freud was wrong. I mean, if there's seven emotional drives at work in the life of the mind,

this has massive clinical implications to recognize those forces at work in our patients. But you used the word neuropsychiatry, and so I would like to add to what I've just said about the implications, the importance, the relevance for the, the clinical practice of psychoanalysis, the same applies to biological psychiatry. I think that with all of our frustrations with the DSM approach, everybody, even the authors of the DSM are saying, this is not the way to go. They're groping for a more viable, a more biologically, grounded basis for carving up the mind at its joints. And I think that this is these endophenotypes, as they're called,

these natural kinds of emotional motivation and emotional feeling and emotional chemistry, let us not forget, when we speak about the development of psychopharmacological agents, which seems to have ground to a sorry. Holt recently. Here is an opportunity for grounding psychiatry on the basis of natural kinds of emotion, which certainly have very direct manifestations in psychopathology, these natural kinds of emotion. Recognizing them enables us to recognize things about psychopathological conditions that

we hadn't previously seen. And also, as I said, it's a bridge between the subjective experience of our patients and the neurochemistry of what's going on. And therefore, also, there are all sorts of opportunities there for drug development. So I think that PANCF's work is crucially important for the future of psychiatry. And do you personally use, like that, a lot of times the things that you kind of are talking about, like, I just see it as like extra frameworks, really very

intuitive frameworks, but you know, using, do you use these kind of primary effective systems when you look at patients? For me personally, like, I, you know, I'm always prescribing wrestling to, I work with kids. So,

you know, moms, whether they're, you know, a family system that's been disrupted by divorce or whatever, you know, I'm like saying, do you do rough and tumble with your kids? And then, oh, no, that's, you know, that's dad does that sometimes, or maybe they do a baseball. But the fact that the work that I read from Hanks, in terms of the role that play is so intrinsic to brain development,

ADHD diagnosis is, I just, it's profound to me. So I don't know, do you use that as well? Yeah, so that's an example when I say that it's not just important, to recognize the much more viable taxonomy of the drives that Panksip has introduced over the one that Freud adhered to. It's not only important for historical reasons, but also for practical reasons. You've alluded to an outstanding example. People just don't think that never occurs to them, that there's a need, a drive to play,

that we mammals need to play. And it's just as much as we need to stay safe, just as much as we need to be able to get rid of frustrating obstacles. If you can't do that, you know, in the long run, you're not going to survive. Certainly you're not going to survive emotionally. You know, if you can't depend your place in the sun. And play is a need, a drive every bit as biologically necessary

for our well-being as all of the other. ones. And Banksyp, you know, saw that and to bring that into psychotherapy, child psychoanalysis generally, because it's not only children that need to play, we all need to play, but we're using the word play colloquially here. You know, it's just a word for a very, very complicated, you know, a thing, properly, scientifically described. But you ask,

do I take these, do I use these things in my clinical work? Absolutely, I do. And I have done ever since that fateful paper

in 2013, and I've, and I've progressively been doing so more and more. And over the last, well, since just about

the beginning of lockdown, so, you know, perhaps three, three years or so, I've been, I've been running I have clinical seminar groups all over the, in many major cities, now online, of course. That's why I say since the beginning of lockdown, where I and groups of colleagues in these

various various ongoing clinical seminars, where that's the whole point of those seminars, is that members of the group in rotation present their cases, ordinary, psychiatrotherapy, and psychoanalysis cases, and we discuss them directly in relation to the Panksepian drive theory. What light does this cast in our understanding of what's going on here? What feeling is this patient suffering from? How do we classify that feeling within the panccipian taxonomy? So that's the emotional need that's not being met.

And now let's ask ourselves why. How is the patient going about dealing with that need? because clearly the way they're going about dealing with it isn't working, otherwise they wouldn't suffer that feeling, which is the homeostatic and negative affect means you're not where you need to be. And so we then look at the transference in the broadest sense of the word. I don't believe transference just means what the patient does with the therapist or the analyst. Transference is what the patient does with their present-day object relationships.

It's transferring from primary object relationships to present-day. object relationship. So we look to the transfer, how is the patient going about meeting that need? What do they do? And it really, it is of very direct, concrete, clinical relevance. And I find it extremely useful to think about, I know you are saying more than that. You're also saying, well, then what is it? What are the implications for what we do? It has direct implications for what we do as as you know. So yes, I think it's something something of a quiet revolution going on, just beginning to go on in exactly this area that we speak about. The importance of Pankseps, understanding of the multiplicity of emotional drives, and what exactly are those basic categories

of emotional motivation and the implications of all of that for our clinical work, both in psychotherapy and I say again, also in psychiatry generally and even in psychopharmacology, I think that it's a very important new paradigm for all of those fields. For me, as well as the importance of that, it's like when I'm talking to my patient's parents, it kind of normalizes things when a kid is dysregulated and upset, raging, against, you know, getting their iPad turned off five minutes before bedtime. You know, the parent is like, you know, they must have ODD or bipolar. You know, it's kind of very DSM-centric.

And it's kind of like, no, they are having normal mammalian feelings. I know you describe it very, very well, just in terms of rage, you know, something, you know, my mum is getting in the way of me playing my computer games. And I'm having this normal feeling. but then how do we get through that? And obviously things get in the way ADHD, autism, the kid is like a child. It just makes me, I'm able to talk to the parents

without being so pathological. Your child is having a normal mammalian feeling. We just got to figure out how to deal with it. And I feel, I think the parents really value that, I feel. Everything you've just said, I agree with. And that's, and it tallies with my own experience. Rather than this finitious thing, which has been around for a long time, you know, if I may say, so forgive me, perhaps particularly in American psychiatry, your kids got this, you know, as opposed to a kind of an explanation of that means something.

You know, this is why your child's doing that. And I don't mean it's in the kind of hocus, pocus, you know, it's mean something. There's some symbol. I mean, just, you know, feelings are there for a reason. They can be understood. If your child's, you know, behaving in this way and displaying that kind of emotion, it's because something's causing that. So, you know, let's have a look.

And it's, because it's in a biological framework, which kind of fits with the zeitgeist of the general public, educated public, perhaps in particular, you know, they don't, they want to hear things that sound, you know, scientifically, biologically, plausible. And so, you know, this is the great value also in just in terms of public relations. You can convey really pretty psychodynamic things in a way that is entirely comprehensible and palatable to, you know, to anybody. It's kind of commonsensical. And we really need that corrective because the tendency has been this other one, you know, your child's got this.

And it's like, and by the way, all you need to do is take that and, you know, then it will, then it will be better. And a very important part of this paradigm, and I want to emphasize this, is that psychopharmacological agents, for the most, for the very great most part, are symptomatic treatments. So it's, you know, if you want a causal therapy, you know, then you need to get to the level of, well, understanding why is the child behaving like that rather than just, you know, quashing the feeling. You need to know what the feeling is there for. What does it mean? What does it tell us about what's going on? So I think that for all of those reasons, it's terribly important that

we move in this direction. And luckily, as I said earlier, it seems as if pretty nearly everybody recognizes that our current way of thinking is not really working. So, I mean, in Britain, the Royal College of Psychiatrists is beginning to rethink their neuroscience curriculum. And I'm part of a group of people who are trying very hard to get exactly what we are talking about. In other words, affective neuroscience to be the core of the neuroscientific curriculum for the training of psychiatrists in Britain. I think to start and practically end with receptors and molecules. and it's just far too far removed from the real level of the kinds of variables that actually govern from a neuroscientific point of view, govern the kinds of things that psychiatrists are dealing

with. So let's hope that we'll make progress on that front. Well, if you want to make progress with my audience, we can we can have you back and do a deep dive on those seven. And I actually like, I think this is, like what gets me excited. You're in good company. You know, I teach the, the psychiatry residence psychotherapy. I've been doing that with my mentor, Dr. Tar, who's like a 90-plus-year-old psychoanalyst. And he's very big on Yacup Pankzap. So back when I was a resident, he like got me the book, you know? And so for me, it's like I was raised in a nice department where that was kind of like, something we looked at. We looked at. We talked about emotion, subjectivity, inner subjectivity.

You know, the cloud of unknowing was a book I read which talked about like how different psychoanalysts maybe ventured into their particular interests due to their own developmental subjectivity, which is true for you as well, which is nice and true for me as well, of course. And so I think this has been a delight to talk about. And I'm just, I almost feel like an hour and a half. has brought us to like just the tip of the iceberg. I'm like just feeling like all these questions. Like we've we've like we've we haven't there's so much we could get to. But I yeah, before we kind of wrap things up and I want to, you know, honor your time as well, are there any things that you would like to sort of put out there to, you know, my group of therapists and psychiatrists who

listen to this and budding future therapists and psychiatrists? No, well, perhaps if there's one, I mean, first of all, let me say, I agree with you. We've only scratched the surface, and I'd be very happy to come back for a follow-up discussion with you guys. I've enjoyed this very much. If there's anything that your audience could do in the interim, perhaps they could read a paper, which is really available online, that I, I'm published in, I think it's Frontiers of Human Neuroscience, it's called, the journal.

But in any event, the paper is 2018. It's called the neurobiological underpinnings of psychoanalytic theory and therapy. The neurobiological underpinnings of psychoanalytic theory and therapy. If you just Google neurobiological underpinnings and my name, the paper will come up. I think that that's a good kind of summary of the way I'm thinking about these issues. And it also provides in the references, you know, something of the literature upon which it's all based. So people who want to read, that would be a good starting point into the literature, good entry point. And I would also recommend definitely get Mark Selms' book, The Hidden Spring, a journey to

the source of consciousness. We will also link some YouTube's and different audio lectures we found online, which we think are helpful. And for my audience, I think they'll enjoy this content. The book is, it's rich. It's not something that's like, like a thrilling novel that you, you know, it's like more meaty. It's like every sentence you're like, oh gosh, I need to digest that. So it's a good book.

And my audience, I think, will really enjoy that. Thank you very much. I hope I'm not at the end of my scientific life, let alone my life as a whole. As things currently stand, I would say that book is the culmination of my life's work. It's really, it's sort of a summing up of everything that I've done in the last, gosh, what is it now, 40 years, 50 years.

That's awesome. Yeah. All right. Hey, thank you so much for coming on. I really appreciate it. Thanks very much. Good to meet you both. And I mean it when I say I'm glad to come back. Thank you.