Mourning and melancholia revisited: correspondences between principles of Freudian metapsychology and empirical findings in neuropsychiatry

Abstract

Freud began his career as a neurologist studying the anatomy and physiology of the nervous system, but it was his later work in psychology that would secure his place in history. This paper draws attention to consistencies between physiological processes identified by modern clinical research and psychological processes described by Freud, with a special emphasis on his famous paper on depression entitled 'Mourning and melancholia'. Inspired by neuroimaging findings in depression and deep brain stimulation for treatment resistant depression, some preliminary physiological correlates are proposed for a number of key psychoanalytic processes. Specifically, activation of the subgenual cingulate is discussed in relation to repression and the default mode network is discussed in relation to the ego. If these correlates are found to be reliable, this may have implications for the manner in which psychoanalysis is viewed by the wider psychological and psychiatric communities.

Figure 1

Regions positively correlated with the default mode network (orange), most notably the medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), inferior parietal lobule and medial temporal regions. Activity in these regions has been shown to decrease during the performance of goal-directed cognition. The areas shown in blue are negatively correlated with the default mode network (DMN) and may be described as an object-oriented network (ON). The ON is consistently activated during goal-directed cognitions but is relatively inactive at rest. It is argued in the present work that the DMN is functionally consistent with the Freudian ego. Image reproduced with permission from [289].

Figure 2

Functional connectivity of the subgenual cingulate (Cg25). Yellow/red indicates regions positively correlated with the seed region (i9) and blue indicates regions negatively correlated with the seed region. The seed region, i9, fell within the area of Cg25. This region's network of connectivity incorporated several areas associated with the default mode network (DMN). Although it is not clear in these images, activity in Cg25 was also strongly correlated with activity in the ventral striatum and medial temporal regions. Image reproduced with permission [54].

Figure 3

Single photon emission computed tomography (SPECT) images from a depressed patient showing characteristic hypofrontality relative to a healthy control subject[82].

Figure 4

Positron emission tomography (PET) images of cerebral blood flow changes during transient induced sadness in healthy controls (left); pre deep brain stimulation (DBS) in depressed patients (centre); and 3-month post DBS in treatment responsive patients (right). Hyperactivity in Cg25 and hypoactivity in the dorsolateral prefrontal cortex (DLPFC) is evident during low mood and depression. This situation is reversed during remission of symptoms. ACC, anterior cingulate cortex; ins = insular; PF, prefrontal cortex [51,95].