The End of Evolution.

Charles Darwin's theory of evolution was founded on the core belief that natural history is one of slow, incremental change, a concept he called "speciation." A hundred years later Eldredge and Gould challenged Darwin's theory, arguing that the data of paleontology reveals something quite different: long periods of stasis followed by bursts of change, a concept they called "punctuated equilibria." This article will follow that progression and then describe the three punctuated equilibria that I believe led to Homo sapiens. I argue that two of the three transitions are revealed in the hard data of the fossil record. The third is in the soft tissue of the brain. This third punctuated equilibrium placed Homo sapiens outside of evolution. Its arrival, 50,000 years ago, marked the beginning of the end of evolution.

Safety: From the Paris Morgue to Oxytocin.

On Tuesday April 21, 1896, Freud gave a lecture to the Viennese medical community arguing that "hysteria," as it was then known, was caused by memories of actual physical and sexual abuse suffered in childhood. Freud rightly felt that he had made a major discovery about the science of hysteria, of psychotherapy, and of the mind. However, his idea was ridiculed. Freud's reaction to his detractors was swift: "They can go to hell." Freud withdrew "into a cocoon." When he emerged a year later, he brought with him a new science-the "science" of psychoanalysis, which for all its creativity and imagination, was devoid of science. One of the core concepts that would be sacrificed was safety itself. The "reality" of safety (and thus the reality of danger) was replaced by the "phantasy" of safety (and thus the phantasy of danger). This article reexamines some of the science that psychoanalysis took out. In particular the article looks at early attachment, safety, oxytocin, and the role of the autonomic nervous system. The reintroduction of science to psychotherapy is critical if psychotherapy is to be a science of the mind.

Evolution, Shame, and Psychotherapy.

Medea, the title character in Euripides' play, murdered her two sons in response to her husband Jason's abandonment. If her behavior can be understood, it is best understood in the context of shame. In an evolutionary context, shame is the affective response to the loss of one's place in the group. This response is related to the neurobiology of pain-not the acute pain experienced through the post-central gyrus, but the chronic, lingering pain that is experienced through the insular and cingulate cortices where homeostasis is regulated "from above." Shame is thus a fall in self-esteem, but shame is also a crisis of homeostasis, a crisis that can lead to drastic and, as in the case of Medea, violent attempts to "repair" the imbalance. Shame is a primitive, evolutionarily preserved response to the loss of one's place in the group.

Aspects of psychodynamic neuropsychiatry IV: love, ripe fruit, and other addictions.

Passionate love is a powerful emotional/biological force. So too is heart-break a powerful emotional/biological force. This article studies the neurobiological underpinnings of the two. The argument is that passionate love is best understood not as an affective dysregulation but rather as an addiction. And similarly that heart-break is best understood, and treated, not as an affective dysregulation but as an addiction. Clinical examples are given.

Aspects of psychodynamic neuropsychiatry III: magic spells, the placebo effect, and neurobiology.

Through a case study, the importance of supporting the positive transference is stressed-from both a psychological and neurobiological perspective. The article argues that the neurobiology of expectation underlies transference. This neurobiology has been investigated particularly over the past several decades in work concerning the placebo effect. By understanding the neurobiology of expectation, one gains a better understanding of the neurobiology of the transference. This enables clinical predictions-and decisions-that are informed not just by the teachings of psychology but also by the science of biology.

Aspects of psychodynamic neuropsychiatry II: psychical locality and biology: toward the neurobiology of psychotherapy.

Throughout his career, Freud believed that psychiatry in general and psychoanalysis in particular would one day be rooted in anatomical/biological ground. He felt confidant that such ground would replace the psychological understanding on which he had been forced to base most of his clinical theory and practice. He felt confidant that one day psychotherapy would be more "scientific." This article seeks to demonstrate that this day is arriving. A clinical case is presented where assessment and formulation are largely based on neurobiology, where treatment was conducted less in accord with psychodynamic theory than neurodynamic data of anatomy and biology.

Aspects of psychodynamic neuropsychiatry I: episodic memory, transference, and the oddball paradigm.

Psychotherapy has, since the time of Freud, focused on the unconscious and dynamically repressed memory. This article explores a therapy where the focus is on what is known, on episodic memory. Episodic memory, along with semantic memory, is part of the declarative memory system. Episodic memory depends on frontal, parietal, as well as temporal lobe function. It is the system related to the encoding and recall of context-rich memory. While memory usually decays with time, powerfully encoded episodic memory may augment. This article explores the hypothesis that such augmentation is the result of conditioning and kindling. Augmented memory could lead to a powerful "top-down" focus of attention-such that one would perceive only what one had set out to perceive. The "oddball paradigm" is suggested as a route out of such a self-perpetuating system. A clinical example (a disguised composite of several clinical histories) is used to demonstrate how such an intensification of memory and attention came about as a result of the transference, and how the "oddball paradigm" was used as a way out of what had become a treatment stalemate.

The slippery slope: touch in dynamic psychiatry.

This article is a telescoped narrative of a seven year psychodynamic therapy with a chronically depressed, chronically suicidal, often paranoid woman who presented with a classic Borderline Personality Disorder. An unexpected and powerful moment of physical contact in an otherwise austere therapeutic relationship marked a turning point in a treatment that was blocked. After the patient and clinician integrated this experience, there was a subtle but significant change in the transference reflecting a change in her core paranoid structure.

Freud, Darwin, and the holding environment.

Freud's hypothesis of the neonate, derived from the data of adult psychoneurotic patients, was of a supremely narcissistic being who lived in a dreamlike state of hallucinatory satisfaction. A corollary hypothesis was that the neonate's drive to attach was learned and emerged only after the failure of wish fulfillment. These hypotheses provided the ground for Freud's theories of regression, dream, primary process, and pleasure principle. Darwin's data of the neonate, collected from his observations of a variety of mammals, led him to the conclusion that attachment in mammals is innate. Until 1969 and the work of John Bowlby, psychoanalytic thinking faithfully followed Freud. If psychoanalysis is to survive, then it must attach itself to data and discard any theories that are based on unproveable hypotheses, even if those hypotheses are Freud's.