Book Review: The Only Cure: Freud and the Neuroscience of Mental Healing

Despite its potentially contentious title, Mark Solms’s most recent book is likely to be very widely read among clinicians, researchers, nonclinicians, and nonresearchers alike. And, indeed, it should be! Stylistically appealing (even the most complex scientific notions are rendered truly comprehensible), highly intriguing (one keeps reading to find answers to the most fundamental of heretofore insufficiently answered questions, not to mention the clinical mystery introduced at the outset and resolved only at the finish), and profoundly informative, this book raises stimulating questions and convinces us of the validity of their neuropsychoanalytically grounded answers. A neuropsychologist, Solms has long dealt with neurodegenerative disorders, the markers of which are often losses in cognitive function and thereby of the mind. He also has much experience working with illnesses seemingly neurological but more accurately diagnosed as psychiatric. Whatever the reason for one’s suffering, it is the notion of cure, not that of symptom relief, that consistently interests Solms, propelling his research and clinical treatments and leading to his founding of the relatively young discipline upon which the notion of cure rests. It is neuropsychoanalysis, as we see from his brief overview of the history of psychoanalysis early in the book, that is increasingly coming to the fore as “the fall of the psychoanalytic empire” and the subsequent post-mid-20th-century rise of “biological psychiatry” (pp. 8–9) give way to the conjoining of contemporary neuroscience with Freud’s understanding of the subjectivity of the operational psyche.

Readers familiar with Solms’s previous writings will recognize aspects of this book, whether mind-brain unification, as opposed to its dichotomization, the deep respect for the findings of affective neuroscience as launched by the late Jaak Panksepp, or the belief in “the implications of the fact that conscious psychological processes are caused by unconscious psychological processes (which can also be viewed as physiological processes)” (p. 76). No one is more familiar with psychoanalysis as it grew from Freud’s neuroscientific conceptualizations of the structure and functioning of the MindBrain, or more familiar with the need for what neuropsychology offers those conceptualizations, than the translator and editor of The Revised Standard Edition of the Complete Psychological Works of Sigmund Freud (2024b) and the forthcoming four volumes of previously unpublished neuroscientific writings by Freud. No one is better equipped to account for the veracity of what is espoused by Freud, a neuroanatomist and neurologist before all else. Which is not to say that Solms’s understanding of the cure, “the only cure,” amounts to an acceptance of all Freud the scientist bequeaths us. If Solms’s knowledge of Freud’s work likely surpasses that of anyone else alive today and, coupled with his own practice of neuroscience and neuropsychology, allows him insight into why the cure is curative, into how it goes beyond the alleviation of symptoms, it also allows him to put in high relief one “egregious error” (p. 139) after another made by Freud.

These errors include Freud’s (Freud, 1905/2024c) ideas about gender identity. While Freud believed in a predisposition of all to bisexuality, he was unable to determine at the time what current science has shown; namely, that male- and female-typical brains are not exactly the same. While not equating gender identity with sexual orientation, Solms does note the connection between them as related to the anatomy of the brain and, interestingly, the behavioral differences between masculine and feminine that Freud mistakenly viewed as “‘active’ and ‘passive’” (Freud, 1905/2024c, p. 219), which, Solms asserts, “surely can’t be right” (p. 147). Freud’s errors also include the pleasure principle and its relation to the id. Solms calls this “a metapsychological abstraction” (p. 87) that is not unconscious, as Freud proclaimed it, but the origin of all consciousness, as feeling is the source of consciousness itself. Freud’s errors include the classification of the drives, a grouping that was “hopelessly wrong” (p. 87), though Freud did predict, Solms is quick to remind us, that “the biology of the future would ‘blow away’ his speculations in this regard” (p. 87). Solms convincingly argues that Freud (1920/2024a) was blatantly wrong about the death drive, based on our biologically informed understanding of homeostasis, its relation to what Freud accurately perceived as profoundly motivational, but misperceived as deathly as opposed to satiating. Most egregious of all, however, is the number and interpretation of drives, and here is where Solms owes much to Panksepp (1998) who distinguished between basic emotional and bodily systems generative of affect. Freud’s conceptualization of the drive circuitry, however foundational, errs in three ways: there are not two drives, but seven; their psychological expressions are misattributed; and libidinal development is not sequential (oral, anal, phallic), but concomitant for the very meaning of maturation is “learning how to satisfy all seven of our basic emotional needs in an integrated way” (p. 160).

It is, however, what Freud got right, coupled with subsequent advances in science, especially in affective neuroscience and in biology, that forms the basis of neuropsychoanalysis: Freud’s most fundamental concepts, including drive theory, repression, conflict, defences, and the principle reason one seeks treatment, “unwanted feelings” (p. 120). It is “unwanted feelings” that tell the clinician which emotional needs are unfulfilled, which of the seven emotional (as opposed to bodily) drive systems are unmet. These unmet needs are what produce the symptoms, as Solms demonstrates in his clinical examples. These unmet needs are what put before the reader the very meaning of subjective experience for feelings are—as Freud himself asserted and Solms, like Panksepp and others, has effectively demonstrated—conscious. (“I’m not hungry unless I know I’m hungry,” Solms often reminds his audiences.)

This brings us to Solms’s articulation of the meaning of experience and the relation between the subjectivity of the mind and the materiality of the brain, what the philosopher David Chalmers (1995) famously coined as “the hard problem.” “That annoying time between naps” is how Chalmers most recently, if ironically, defined “the hard problem.” ¹ His irony aside, Chalmers persists, as does cognitive neuroscience generally, in perpetuating the dualism that affective neuroscience, with its emphasis on feeling, resolves. And if psychoanalysis itself, as Solms makes eminently clear, “starts from the fact that it feels like something to be a brain” (p. 68), it is neuropsychoanalysis, with its focus on the undeniable correlation of the psychological with the neurological inherent within that something, that, simply, must be. It is neuropsychoanalysis that will inevitably be the future of the psychoanalytic field.

Solms refers to some of the discoveries of the scientific and clinical interdisciplinary work, such as

the wishful mechanism of dreams and of confabulatory amnesia, the defensive aspect of anosognosia, the role of separation distress in the brain mechanisms of depression (and in addiction, panic disorder and OCD) and its implications for psychopharmacology, the physical (informational) nature of the ‘functional’ mechanism in functional neurological disorders, the empirical verification of repression, the developmental neurobiology of infantile amnesia, some neural constituents of empathy, the deep connections between drive and consciousness. (p. 228)

And he cites other “puzzles” that “are works in progress”: the “currently ongoing research into the neurophysiology of free association,” for example, and “the biological function of dreaming and the possibility of artificial consciousness” (p. 228). Yet it is the movement from language localization to an understanding of ideation, the movement from dreaming as it relates to various activities of the sleeping brain to the neurophysiology of memory and desire, and the movement of repressed wishes to their symptomatic expression that rid us of the brain-mind dichotomy constituting “the hard problem.” This allows for an appreciation of the dual-aspect monist perspective, the two ways of observing the same MindBrain phenomenon, to which Freud himself subscribed. And it is this that allows us to truly apprehend not only the theoretical value of neuropsychoanalysis, but the therapeutic success of psychoanalytic treatment.

This brings us, moreover, to the following question, the most significant raised by this book: Just what is therapeutic about psychoanalysis? Why is it that, as Solms straightforwardly claims, “nearly every psychiatric disorder listed and defined in the standard diagnostic manuals is best understood and treated, not pharmacologically, but psychologically” (p. 13)? The answer lies in psychoanalysis’s capacity to “actually get to the root of the problem” (p. 14), he tells us as though writing solely for the novice. But here is the point: As noted above, this is a book that succeeds in making everything remarkably clear, while what is made clear is by no means simple. How is the talking cure a cure, and why is it the only real one? The how and why are made comprehensible by the tracing of Freudian theory from its uncertain acceptance to the development of neuropsychology from Freudian thought as a necessity. Solms accounts for the working of the mind by revealing, for instance, how the localizing of linguistic function by the French anatomist Paul Broca required the deeper understanding of that localization as dynamic, as a distribution of interactive mental functions to component functions in various areas of the brain as described by the Soviet neuropsychologist Alexander Luria. Solms accounts for the working of the mind. In so doing, Solms demonstrates the bridging of “the objective and subjective perspectives” (p. 28); he demonstrates that within that very bridging, whence Luria’s significant interest in Freud, resided an authentic understanding of how it was to be achieved. If I attribute brilliance to Solms’s writing, I do so precisely because it is not merely a highly intelligent articulation of what is known but also a vibrant demonstration of why it had to become so.

If it is what Freud got right that accounts for “cure,” it is the continuation of improvement, the getting “more better” (p. 128) posttreatment, that explains the meaning of “cure” and substantiates the claim of “only” in the title. And it is this that allows us to grasp the workings of the brain in relation to prediction, learning, consolidation, and the reconsolidation offered by psychoanalysis. These combine and afford a rich understanding of the mental apparatus in accordance with the minimization of uncertainty, with the physics of self-managing organisms as developed from Bayesian mechanics by Karl Friston’s (2010) free-energy principle. Just as creativity is about imagining, subjectivity is about predicting, about the minimizing of surprise, the correction of prediction error, and “the ‘free energy’ that drives Freud’s mental apparatus is not fundamentally different from the uncertainty-reducing processes that govern the Free Energy Principle as we understand it today” (p. 137). It is memory, moreover, that proves the point:

The point of memory is to tell us what the world is like. Memories guide us through recurring places and situations. They record what seem like the structural features of reality, and also where we last saw our keys. They are, in effect, predictions. Memories are about the past but they are for the future. It is only when “prediction error” occurs that we need to bring the faulty memory back to consciousness, to be revised in light of the event that caught us out. Once we have fixed it, it can be “reconsolidated” back into declarative long-term memory. (p. 115)

And psychoanalysis is curative in rendering unconscious or automatic and natural what was previously “deliberate and artificial” (p. 128). “A patient who has gained insight into their repressed predictions gradually consolidates their new ones more deeply into nondeclarative memory, without needing the help of an analyst to do so,” Solms explains. “This is what it means to be cured” (p. 128).

Solms the clinician meets Solms the scientist head on by offering clinical material at the start of each chapter and exploring it in a way that adds literary-like narrative with the purpose of drawing the reader into the experience. And it is in so doing that Solms provides direct and compelling evidence of his central belief that psychopharmacological medication, electroconvulsive therapy, and other such treatments overpower symptoms rather than uncovering their meaning and resolving the matter at hand: unmet emotional needs. Therapy that is focused on cause rather than symptomatic relief is a cure, “the only cure,” and however brazen such a title may at first glance appear to be, it is by virtue of the tone of the writing, the empathic use of clinical material, and the intimacy of the author’s revelations of his own experience of analysis, that this book succeeds not in convincing, but in teaching the reader.

An example is how Solms covers the history of psychoanalysis, both its periods of greatest acceptance and those of its rejection. From Sigmund and Anna Freud through Jung, Klein, Lacan, and the relationalists of today, Solms frames this history both socio-politically and theoretically, reminding us of the relational foundation of classical psychoanalysis. Drive theory, as put forward by Freud and advanced by affective neuroscience today, is in its essence object relational: “the FEAR drive implies a threatening object; the RAGE drive implies a frustrating object; the PANIC/GRIEF drive implies a caregiving object; etc. The individualized way in which we learn to satisfy these drives is therefore intrinsically object related” (p. 224).

In sum, this is a thought-provoking book that supports Freud’s belief as expressed in a letter dated March 26, 1929, to Albert Einstein that “There is no greater, richer, more mysterious subject, worthy of every effort of the human intellect, than the life of the mind” (Grubrich-Simitis, 1995, p. 262). It is a compelling book that puts forth the evidence that psychoanalysis alleviates symptoms, diminishes emotional discomfort, by way of the interactive. In its unique way of accounting for the success of psychoanalytic treatment, the book brings me back to the point with which I began: The Only Cure is a provocative title. But it is a title rendered incontestable by demonstration, as opposed to argumentation, by display as opposed to description, of its legitimacy. If Solms truly succeeds in convincing those who are at all doubtful of his claims, it is that he does not defend these assertions so much as expose their validity. It is in his presentation of the subjectively experienced, both in the early years of the individual and in the analytic dyad, that he demonstrates how the experiential constitutes the core of the cure to render it the “only” one.