Neuropsychoanalysis

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Report on the 19th Congress of the International

Neuropsychoanalysis Society, Mexico City:
“Repression and defense”

Daniela Flores Mosri

To cite this article: Daniela Flores Mosri (2018) Report on the 19th Congress of the International
Neuropsychoanalysis Society, Mexico City: “Repression and defense”, Neuropsychoanalysis, 20:2,
102-117, DOI: 10.1080/15294145.2018.1547659

To link to this article: https://doi.org/10.1080/15294145.2018.1547659

Published online: 22 Nov 2018.

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NEUROPSYCHOANALYSIS
2018, VOL. 20, NO. 2, 102–117
https://doi.org/10.1080/15294145.2018.1547659

SOCIETY PROCEEDINGS

Report on the 19th Congress of the International Neuropsychoanalysis Society,

Mexico City: “Repression and defense”
Daniela Flores Mosri
Psychology, Psychoanalytic Psychotherapy and Neuropsychoanalysis, Universidad Intercontinental, Mexico City, Mexico

ABSTRACT ARTICLE HISTORY

The 19th congress of the International Neuropsychoanalysis Society took place in Mexico City at the Received 22 October 2018
Universidad Intercontinental from August 31 to September 2. The topic was “Repression and Accepted 24 October 2018
Defense.” Delegates from five continents attended. This report summarizes the keynote
KEYWORDS
presentations and plenary symposium. The talks focused mainly on inhibition, suppression, and Repression; suppression;
repression. Experimental, clinical, and theoretical papers were presented and discussed. inhibition; defense; memory

Introduction
cortex. Zellner highlighted that organisms try to predict
The 19th Congress of the International Neuropsychoana- situations in order to survive. The psychotherapeutic
lysis Society took place in Mexico City from August 31st context allows for the exploration of the origins of learn-
to September 2nd, 2018. The Congress was held at the ing and inhibitions. Both behaviors and thoughts must
Universidad Intercontinental and covered the topic of be regulated and they constitute the basis of defenses.
repression and defense. People from five continents She also emphasized the affective quality of conscious-
attended, including Australia, Japan, Israel, Italy, the ness and that anxiety is the feeling that drives defenses.
Netherlands, Peru, Germany, Brazil, Switzerland, the Defense relates to trying to avoid something or to
United States, the United Kingdom, Canada, Colombia, excluding something from awareness. It can also mani-
Belgium, France, Puerto Rico, South Africa, Uruguay, fest as a distortion of contents that the person is still
Finland, and Turkey. In what follows, I summarize the aware of. Zellner cited Vaillant’s hierarchy of defenses
content of the talks given in plenary sessions. As many (Vaillant, 2011) based on their level of maturation.
of these nuanced and complex concepts have necess- There are psychotic, immature, neurotic, and mature
arily been highly condensed, readers are encouraged defenses. The psychotic level refers to the need to actu-
to seek out original publications by the presenters for ally try to change reality to deal with anxiety. The imma-
detail and clarification. ture level includes defenses at the narcissistic level which
relate to ways of managing images (self-image and
images of objects). Devaluation, idealization, and omni-
Day one
potence are examples of those narcissistic defenses.
The Educational Day preceded the Congress with three The second subgroup covers defenses related to dis-
talks. Maggie Zellner spoke about psychodynamic avowal, such as denial, rationalization, and projection.
defenses from a neuropsychoanalytic perspective. She The borderline defense subgroup comprises splitting
began by dividing the brain into two main two sections: and projective identification. The last subgroup of imma-
first, the affective and instinctive subcortical one, and ture defenses is the action group, which includes acting
second, the inhibitory and thinking cortical one. The cor- out, passive aggression and help-rejecting complaining.
tical part of the brain inhibits instinctual hereditary beha- In the neurotic level of defenses, Zellner mentioned iso-
viors described in Panksepp’s seven basic emotion lation of affect, intellectualization, undoing, repression,
circuits: SEEKING, LUST, CARE, PLAY, RAGE, FEAR, and dissociation, reaction formation, and displacement. In
PANIC/GRIEF, which are related to brainstem nuclei, in the high-adaptive level, defenses such as affiliation,
conjunction with other areas like the amygdala, ventral anticipation, altruism, humor, self-assertion, self-obser-
striatum, and hypothalamus. The ability to generate vation, suppression, and sublimation were explained.
thoughts and imagination is attributed to the human Zellner suggested that some of these mature functions

CONTACT Daniela Flores Mosri [email protected]

© 2018 International Neuropsychoanalysis Society
 NEUROPSYCHOANALYSIS 103

probably exist before the proper capacity to defend, Another kind of memory system is the procedural one,
based on evidence from different mammalian species that mediates motor skills acquired through practice.
that show altruism and other prosocial instincts. She HM’s case was used to illustrate the acquisition of new
also detailed that humor can be seen as a manifestation procedural memories despite his deep anterograde
of PLAY and sublimation can express the need to create. amnesia. Turnbull next spoke about emotion memory
Zellner also explained that we can defend against posi- by reminding the audience of Claparede’s case in
tive affects due to pathological attachment experiences. which he hid a pin in his hand and shook the hand of
She concluded that defense is used against things that an amnesic patient who would not shake his hand
cause anxiety and stress. Based on Cramer’s work again after this incident, illustrating the presence of
(Cramer, 2008), she also mentioned that defenses func- emotional memory even if the subject has no access to
tion outside of conscious awareness, that they go episodic memory of the event. He also described exper-
through a developmental chronology and that they are iments using the Iowa gambling task that recruits
present in all personalities, including normal ones. Fur- emotional memory circuits to illustrate the acquisition
thermore, defenses reduce the conscious experience of of emotional memory when subjects are not consciously
negative affects despite the conserved high activation aware of the rewards and punishments.
of the autonomous nervous system (ANS). The excessive In terms of the anatomic basis of the types of memory,
use of defenses is associated with psychopathology. Turnbull related WM and semantic memory to cortical
Zellner finished her presentation by describing some areas, the latter particularly to the anterior parts of the
therapeutic techniques to work with defenses in the con- temporal lobes. In cases of bilateral damage to the
sulting room. limbic system, classical amnesia or axial amnesia can
The second presentation of the Educational Day was be present, especially in lesions associated with the hip-
by Oliver Turnbull, with the title Remembering and pocampus and the parahippocampal gyrus. Axial
feeling. He started his talk by mentioning that the brain amnesic patients live perpetually in the present, the
runs multiple memory systems at the same time. The best known being the case of HM, who experienced pro-
oldest distinction is between semantic and episodic found anterograde amnesia after a surgery to remove
memory systems. Episodic memory is very personal both his hippocampi. Turnbull then addressed four
and subjective, while semantic memory is about con- systems associated with emotional memory or its regu-
cepts that constitute community knowledge. Episodic lation. The first one is related to the amygdala which
memories can be re-experienced and constitute the nar- has been associated with fear and fear conditioning, as
rative of autobiography, but are subject to rapid forget- well as anger. When the amygdala is damaged,
ting. Forgetting is the result of the failure of retrieval. mammals lose the ability to learn by fear as seen in
Attention and rehearsal improve retrieval, and are mech- Urbach-Wiethe disease. SM is a famous case that illus-
anisms related to emotion. Turnbull next explained the trates how the patient did not have normal reactions
relevant work of Michael Anderson on motivated forget- to anxiety-provoking incidents. Turnbull emphasized
ting by describing the think/no-think task, in which there that other emotions were intact in SM. The second
is increased memory recall for the “think” condition and emotional memory system recruits the major output
impaired performance under the “no think” condition. pathway of the amygdala to the bed nucleus of the
Anderson has suggested two mechanisms to explain stria terminalis (BNST), which needs long-time exposure
his findings; the first one is suppression or inhibition of (at least 10 minutes) to activate. Thus it is more linked
the memory, and the second one is thought substitution. to chronic exposure to stress. The third system involves
These mechanisms are underpinned by two subsets of cortical control, particularly by the ventromesial part of
brain regions in the prefrontal cortex. Turnbull then the frontal lobes. This area controls emotion-based learn-
spoke of other kinds of memory, such as working ing, also called intuition. Patients such as Phineas Gage
memory (WM), also called short term memory (STM). show no avoidance of bad outcome choices after their
He explained that long term memory (LTM) can be lesions in this area. The fourth system mentioned by
accessed without recruiting STM. LTM is heavily over- Turnbull is related to the inhibition of the hippocampus
learned, related to a meaning process; it is also rehearsed by the frontal lobes, widely investigated by Michael
regularly. Its contents are highly personal and autobio- Anderson. Turnbull has used Anderson’s think/no-think
graphical. Turnbull described how anterograde amnesia task with neurological patients. Lesions to the dorsolat-
patients cannot remember new declarative information, eral frontal lobes can produce heightened emotional
but their premorbid memories are intact which associ- reactivity and bring repressed memories back.
ates with Ribot’s law. Old materials are the most consoli- Turnbull then illustrated the distinctions between
dated, and the most rehearsed and the hardest to shift. memory systems with several cases. He described the
104 D. FLORES MOSRI

case of a patient with Alzheimer’s disease who couldn’t fMRI studies reflect a higher level of overall metabolic
remember any new episodes, but he would be warm activity regardless of the net level of excitation and inhi-
to staff members and friends he had interacted with pre- bition, i.e. inhibition can also be associated with a higher
viously, demonstrating how recollection of emotion is level of metabolic activity, we should be cautious of
not dependent on episodic memory because they are interpreting fMRI results as indicating only excitation.
different systems. Executive function seems to be a Axmacher next explained that inhibition conveys a tem-
reliable predictor of the capacity to reimagine the narra- poral structure of activity that may lead to rhythmic and
tive to build things together. Turnbull cited Bartlett oscillatory activity, which can be recorded by electroen-
(1932) to state that memory should not be called so, cephalography (EEG). Individual cells reflect action
but remembering, because it is an active process that potentials while low frequency oscillations are a pure
reconstructs memories. He next clarified that infantile network phenomenon. All oscillations, apart from very
amnesia can be explained by the fact that the hippo- slow ones, require inhibition to maintain rhythmicity.
campus only starts to come on line at 2 or 3 years of Axmacher noted that gamma oscillations are associated
age. There are emotional memories from birth. Turnbull with cognitive processing, whereas alpha oscillations are
also referred to the case of post-traumatic stress disorder a functional network marker of inhibition, because inhi-
(PTSD), in which there is a sudden emotional and unex- bition plays a key role in the oscillations. Alpha oscil-
plained anxiety. One of the hypotheses states that lations can be related to the Berger effect, in which the
patients cannot recognize the object that elicits anxiety occipital cortex is inhibited by alpha oscillations when
due to the release of cortisol during stressful episodes, people close their eyes. Alpha-related inhibition can be
which in turn decreases the functionality of the hippo- controlled by several brain regions, in particular the pre-
campus. On the other hand, the amygdala is enhanced frontal cortex (PFC).
by cortisol. Turnbull mentioned that psychotherapy Axmacher focused on two ways in which inhibition in
with amnesic patients could bring further opportunities the brain is related to the behavioral level: on the one
to do research about memory; he suggested that hand within individual brain areas, and on the other,
emotion memory systems are more important in the top-down executive control by areas like the PFC.
transference than episodic ones. He concluded his pres- According to Axmacher, numerous PFC functions –
entation by emphasizing that there is much knowledge such as selective attention, inhibition of emotions, reap-
about the memory systems separately, but that more praisal, and inhibition of motor responses – can be sum-
studies should focus on their interaction. marized in one name, inhibition. He then described three
The third talk of the Educational day was given by paradigms used to investigate the inhibitory functions of
Nikolai Axmacher with the title Inhibition: erasure or sup- the PFC. The Stroop task, the Flanker task and the go – no
pression? He began by stating that inhibition is an active go task. All of them require the inhibition of a response
process due to the fact that it does not accomplish which results in all three cases an increase in reaction
perfect counterbalances which in turn can lead to the times and a decrease in accuracy. The likelihood of
need for repression. Axmacher explained that there are making errors is an inverse measure of the ability to
two main synapses in the nervous system, the glutama- inhibit responses to these stimuli. Furthermore, Axma-
tergic or excitatory, and the GABAergic or inhibitory. Pyr- cher described the white bear phenomenon in which
amidal cells are the main kind of excitatory neurons and participants are asked not to think of a white bear in
are mostly glutamatergic while interneurons are usually environments in which these animals would not be
inhibitory and related to GABA. Activity in the nervous expected to live. After the inhibition time is over, partici-
system is determined by the net level of excitation or pants report intrusions, i.e. people think of white bears
inhibition. There are two basic canonical circuits that for a long time after the task. This is called a paradoxical
convey inhibition. The first one is feedforward inhibition, rebound phenomenon.
in which both the pyramidal and the interneuron are Axmacher next spoke of the repression of rewarding
activated and the input blocks the activity or counterba- actions which can initially be very unpleasant. It
lances the activation of the glutamatergic cell, so that the depends on the PFC and shows a paradoxical effect.
output is unchanged. The second one is feedback inhi- This kind of inhibition depends on cognitive control
bition, in which the excitatory cell is activated but it and can be rewarding in itself because it leads to the per-
feeds back on the interneuron that then blocks the dis- ception of feelings of self-efficacy, autonomy and self-
charge of the excitatory neuron. These two kinds of inhi- determination. Inhibition thus can have paradoxical
bition avoid excessive activation favoring homeostasis in effects. Axmacher also described extinction as a psycho-
the brain. In a canonical thalamo-cortical circuit, both logical process of inhibition that implies “unlearning”
excitatory and inhibitory cells are activated. Because conditioned responses. Additional learning and
 NEUROPSYCHOANALYSIS 105

unlearning can change the value of a cue. If a value is The first model relies on censoring. Krickel explained
learned to be negative, it can appear to change back that it is a problematic model because the mental state
to neutral again by unlearning the initial association. was unconscious from the beginning; the conflict did
Yet, according to Axmacher, extinction can be deceiving, not happen in reality. The second model relies on repres-
as in most instances, evidence indicates that the initial sion as removal of a conscious mental state to the uncon-
learning is actually preserved. The initial conditioning is scious. This model does not explain how the process
suppressed during the extinction learning and can makes the mental state intentionally unconscious, nor
return by spontaneous recovery, renewal or reinstate- how re-repression works. Krickel introduced four mean-
ment. The neural basis of extinction learning involves ings of unconscious: (1) the unconscious based on the
the ventromedial PFC (vmPFC) which activates GABA- presence or absence of phenomenology of mental
ergic intercalated cells in the amygdala, which then states; (2) the unconscious based on the degree of atten-
inhibit a fear response. The vmPFC conveys a safety tion paid to a mental state; (3) the unconscious based on
signal showing that the original negatively-conditioned deliberative control, impulsive control, or automatic pro-
stimulus is no longer predicting fear. It is also linked to cesses; and (4) the unconscious based on linguistic cat-
memory consolidation and to the representation of egorizations, miscategorizations, or the lack of
schemas and concepts abstracted from a variety of categorization. She then proposed that repression can
experiences. It is related to the cortical midline structures be modeled as a process of six steps: (1) being in
that participate in self-related processing and it is the ter- conflict, a mental state that is felt, attracts attention,
mination zone of the SEEKING mesolimbic dopamine and is categorized; (2) impulsive shift of attention, an
system which maintains interest in the outside world. unconscious process because it is not deliberative; (3)
Axmacher finished his talk by saying that the efficacy repression of the conflict, the feeling does not get atten-
of inhibition relies on the implementation of a homeo- tion and is not categorized anymore but it is still there
static mechanism to counteract excitation, i.e. to avoid and will affect behaviors; (4) repetition, the process
excessive levels of excitation. Furthermore, it can lead repeats at the presence of the stimulus; (5) habituation,
to novel kinds of activity by impelling the rhythmic struc- an automatic connection between the feeling, the
ture on neural activity and different kinds of learning. conflict, and the shift of attention; (6) miscategorization,
After the Educational Day, Mark Solms opened the an optional step if the conflict is realized by the
Congress. The first set of talks began with a plenary sym- subject. Krickel suggested that repression is removal
posium about conceptual and experimental approaches and that re-repression is censoring. Her model solves
to repression from the perspectives of philosophy, both the dynamic and the static paradoxes of repression.
neuroscience and psychoanalysis. Beate Krickel gave a She concluded by mentioning that memory can also be
presentation entitled Repression: impulsive removal from integrated to her model.
consciousness and protective mis-categorization. Krickel The next speaker in the symposium was Simon Boag.
highlighted the conceptual challenge that repression He described repression as the troublesome cornerstone
entails. In her opinion, repression starts with an inner of psychoanalytic theory. Yet, he argued there are no
conflict that triggers the unconscious process of repres- difficulties in Freud’s definition of the essence of repres-
sion, thus leading to an unconscious content. Next, a sion as turning something away and keeping it at a dis-
process of re-repression is needed to keep the uncon- tance from the conscious. However, some authors such
scious content unconscious. The whole process implies as Nesse (1990) have thought that repression is an
a dynamic and a static paradox. The dynamic paradox awkward concept that keeps psychoanalysis apart from
concerns the process and focuses on the fact that repres- the rest of science. Boag next explained some of the pro-
sion and re-repression are intentional but unconscious, blems with the concept of repression; he highlighted its
i.e. knowing that one is repressing but not knowing relationship with other defenses and the problem of
that one is repressing. The static paradox concerns the unconscious mentality. He illustrated repression by refer-
product of repression, which is selective and uncon- ring to one of Kaplan-Solms and Solms’ (2000) cases of
scious, i.e. only problematic mental states are repressed; anosognosia; he emphasized how the patient knew
yet to recognize which states are problematic, the person unconsciously about her physical loss but did not want
needs to be conscious of them but at the same time is to know about it. This constitutes the paradox of
supposed to be unconscious of them. Krickel also ques- knowing and not knowing at the same time and
tioned how a conflict causes an unconscious process, relates to a motivated ignoring. The notion of uncon-
how the mental state is made unconscious, and how scious awareness seems to be a contradiction. Patients
the mental state is kept unconscious. She presented describe having known about the repressed knowledge,
two models of repression to answer those questions. after repression is lifted; they state that they simply did
106 D. FLORES MOSRI

not want to know. The unconscious element remains in Waldhauser also contrasted repression and suppression,
consciousness but it is not given attention. Boag next stating that repression does not necessarily have to be
spoke about the permanent expenditure that repression established in an unconscious form and that it was
requires because it is not an event that occurs only once. Anna Freud who said the opposite. In her view, suppres-
He mentioned that repression occurs in the background sion is the conscious counterpart of repression. In Wald-
without awareness. The process entails a wish which is hauser’s opinion, there can be many intermediate forms
evaluated as a threat and thus generates anxiety. The between repression and suppression. He suggested
wish will be repressed in a sort of approach-avoidance studying repression through suppression, which is
conflict. Yet, the wish remains unconsciously pressing directly linked to memory inhibition, and thus linked to
towards the conscious mind, constituting Freud’s propo- inhibitory control mechanisms. The inhibition of
sal of the upward drive of the repressed. An unmet need unwanted thoughts or memories leads to memory
persists and tends to be even more conscious. Boag then impairment that results in forgetting. Waldhauser next
described the interplay of opposing mental forces, i.e. described several paradigms used to study repression
one that wants to express itself consciously and one in the laboratory. He began with Jung’s free-association
that obstructs its becoming conscious. The opposing paradigm in which longer reaction times for word associ-
forces lead to a compromise, as can also be seen in ations indicated conflict and thus repression; the latter
dreams. Boag finds the concept of the censor proble- constituted the explanation for delaying the response.
matic because the censor would have to know itself as Participants were also less able to remember associations
an autonomous and unconscious regulator. To explain to words that generated individual conflict. Modifi-
unconscious knowing, he clarified the difference cations of these methods are still used. Some of them
between knowing and knowing that one knows, which use EEGs which have reported an increase in alpha oscil-
can be illustrated with blind sight phenomena. Boag lations associated with inhibition. Waldhauser also
then described the possible structure of repression, explained that emotional events are remembered
which begins with a target of repression, i.e. a wish better in the long run, regardless of the negative or posi-
that turns attention away from it because it is disturbing tive quality of affects. He described Michael Anderson’s
and intolerable. There is knowledge of the threat, but it is work and inhibitory control which could be related to
denied; thus it cannot be reflected upon, working as an repression. Waldhauser’s research has found that forget-
ongoing trauma. This model entails motivated ignoring ting leads to an increase in alpha oscillatory power in
and relates to neural inhibition, which in turn can help regions such as the dorsolateral prefrontal cortex
to demonstrate repression and to avoid circular expla- (dlPFC) and to a decrease in the trace strength of the
nations. Boag concluded that it is possible to explain encoded memory representation. Using Anderson’s
the theoretical difficulties of repression by using the think/no-think paradigm, Waldhauser found that
knowledge from neural inhibition hypotheses. memory suppression in a no-think condition leads to a
The third speaker in the symposium was Gerd Wald- downregulation of memory, sensory and emotional pro-
hauser, who talked about the cognitive neuroscience of cessing regions; at the same time there is an increase in
repression. His presentation focused on the experimental the activity of cognitive control regions. He proposed
aspects of repression. Waldhauser emphasized the that inhibition in memory recruits the same system as
difficulty of establishing an operational definition of motor inhibition. Suppression has been found to lead
repression. It can be preliminarily conceptualized as the to a reduction of networks operating in the theta fre-
forgetting of mental contents associated to libidinal quency range, usually associated to memory retrieval; it
wishes that lead to psychodynamic conflict. Forgetting also showed an increase of control-related theta power
occurs in association with an inhibitory mechanism in the frontal cortex and a stronger long-range synchro-
that pushes this material into the dynamic unconscious. nization in the alpha band. Waldhauser last spoke of
Unconscious material strives to become conscious again patients with PTSD. He specified that they suffer from
and requires continued effort to remain repressed. Wald- involuntary intrusions of sensory memories of the trau-
hauser explained that drives must attach to affects and matic experience and that the inability to forget trau-
thoughts to become conscious. If they trigger conflict matic experiences is due to deficits in the intentional
and lead to unpleasant affects, the thought is repressed suppression of unwanted memories. Waldhauser con-
but the affect remains conscious. From a cognitive per- cluded that declarative memories can be voluntarily for-
spective, the repressed can be recalled once repression gotten and that this is achieved through the effortful
is lifted. The latter is called hypermnesia. He referred to recruitment of higher order inhibitory control networks.
Erdelyi’s computer model of repression (Erdelyi, 1985) The fourth speaker of the symposium was Ariane
used to formulate predictions for experiments. Bazan, who presented a paper entitled Alpha
 NEUROPSYCHOANALYSIS 107

synchronization as a brain model for unconscious defense: enhanced alpha synchronization. The more there is
evidence from ERP studies. She highlighted the important alpha power in the prime, the more there is alpha
work of Howard Shevrin, who was a clinician, a psycho- power in the target. Thus, only when the subliminal
analyst, and a researcher, and used tachistoscopic sub- unconscious conflict primes were followed by the supra-
liminal priming in his lab. She described three studies. liminal conscious symptom targets did they significantly
The first one covered brain-time frequency as indications enhance conscious symptom target alpha. Bazan
of repression. It combined the one millisecond subliminal explained that these findings suggest that there is
presentation of phobic stimuli with the measure of unconscious meaning of the UC primes which elicits an
evoked related potentials (ERP). The study took 11 inhibition of the conscious symptom targets, which pro-
social phobic participants who were interviewed by vides a cause and effect relationship between the uncon-
four analysts to select two types of words: conscious scious conflict and the conscious symptom target. Bazan
symptom words (CS) and unconscious conflict words concluded that alpha synchronization serves as a general
(UC). These words were presented subliminally and inhibitory brain mechanism of conscious defense and
supraliminally. Shevrin measured time–frequency fea- that it could suggest an inhibitory mechanism of uncon-
tures which allow measuring rapidly changing ERP scious defense. Inhibition is a neocortical process that
signals in dimensions of time, frequency, and power. isolates the signal representation from being integrated
They also used the Osgood negative valence words as into associative networks that could give a subjective
control words. It was seen that UC words were more meaning.
similar subliminally than supraliminally, by forming one
group, while CS words were more similar supraliminally.
Day two
An inhibitory repressive process could be at work when
the UC words are presented supraliminally by inhibiting The second day was opened with a presentation by
the conscious recognition of their unconscious signifi- Michael Anderson about the neuroscience of motivated
cance, because when the UC words are presented supra- forgetting. He began by clarifying that his research is
liminally, they are not recognized as a group. The not directly related to Freud’s characterization of repres-
conscious presentation inhibits the conscious recog- sion but that it is in the same conceptual territory. For
nition of their unconscious significance. Because of Anderson, repression is not a maladaptive process but
differences between conditions, the ERP signal analysis a mechanism of motivated forgetting that helps to regu-
was thought to be an independent objective indicator late emotional states. The ability to stop oneself allows
of conflict and defense. The second study included control over habit and reflex. Its mechanism is inhibitory
alpha synchronization as a brain model for repression control, which regulates motor actions and also memory
in spider phobic participants. Synchronization is a retrieval. Anderson created the think/no-think paradigm
measure for inhibition and suppression, which may be in which people learn associations of words or images.
used for UC words that the person does not want to They are given reminders and asked to think about the
process. The researchers found that only in spider associated memory or not to think about it. When the
phobic participants there was an increased alpha retrieval process is shut down to exclude an unwanted
power for the spider stimulus relative to the control memory from awareness, it facilitates its forgetting, a
stimulus which correlated with an increase of self- process called suppression induced forgetting (SIF),
reported fear. The more alpha synchronization in spider which provides an index of the efficiency with which a
phobic participants, the more they were afraid of person can exclude an unwanted memory from con-
spiders. There was a diminished attention to the sciousness. Using fMRI scanning, Anderson found that
phobic spider stimulus in spider phobic participants when people inhibit the retrieval process, the right dor-
with high alpha power. The third study offered brain evi- solateral prefrontal cortex (dlPFC) is engaged and its acti-
dence for conflict-induced unconscious inhibition. The vation predicted SIF. This mechanism was associated
study attempted to offer a cause–effect relationship with reduced activity in the hippocampus bilaterally.
between alpha synchronization and an effect on con- This circuit was then interpreted as evidence for a
scious symptoms. Shevrin used a priming paradigm in memory control circuit or a retrieval stopping circuit
which the prime was always subliminal and could be a that downregulates the activity of the hippocampus,
UC word or a CS word. He used a target which was interrupting the retrieval process and inducing forget-
always supraliminal and a CS word. The results reported ting. In contrast, activity in the hippocampus increases
that subliminal UC words prime-alpha predicts CS words during the “think” trials. Intrusions of unwanted mem-
target-alpha. Only when the UC prime is given sublimin- ories or thoughts result in a greater downregulation of
ally and when it preceded CS targets did they produce the hippocampal activity. Anderson also asserted that
108 D. FLORES MOSRI

suppression is systemic, i.e. that it temporarily disables Cristina Alberini then gave a presentation about
the functional integrity of the hippocampus and inhibits remembering, forgetting and the neurobiological bases
all retrieval, affecting memory before and after the retrie- of identity. She explained that episodic memory is part
val inhibition, in a process he called the “amnesic of the explicit memory system, which was the focus of
shadow” phenomenon. The latter means that consolida- her talk. In contrast, the implicit memory system includes
tion can be interrupted and that memories are not procedural and emotional responses, which both play a
encoded well, which in turn generates an amnesic tem- role in conditioned responses. Episodic memories can
poral shadow. Anderson next explained that almost all be encoded, stored and recollected. They are processed
long-range projections from the PFC to the rest of the by the medial temporal lobe which includes the hippo-
brain are excitatory and glutamatergic. The PFC then campus, a structure required for the formation and
drives activity in GABAergic interneurons in the hippo- storage of episodic memories. Alberini mentioned that
campus to achieve retrieval suppression, which he was she uses rodents to study molecular and cellular mech-
able to test by using single proton magnetic resonance anisms of memory in her lab, because their anatomy is
spectroscopy (MRS). He showed that the extent of the comparable to that of human beings. She explained
downregulation of the hippocampus was predicted by that new memories are initially labile, and become
a person’s GABA levels, with increased GABA predicting stable and insensitive to interferences over time
better memory suppression. The next feature that through the process of consolidation. The first phase
Anderson described was that memory suppression happens at the molecular or cellular level, followed by
was associated with activity in the right dlPFC and the a transition of memories from being hippocampal-
right ventrolateral PFC (vlPFC). Furthermore, these dependent to being independent of it. The third phase
same regions were found to be involved in motor inhi- implies that memories can become labile again if they
bition, specifically Brodmann areas 46, 10 and 9, and 45 are reactivated, which in turn recruits another gene
and 44. expression-dependent stabilization process known as
Anderson continued his presentation by describing reconsolidation. Episodic memories are not stored
how the PFC can target multiple regions at the same immediately; they take time to be transferred from
time. In the case of an unpleasant scene, there may be STM to LTM. If the process of consolidation is blocked,
activation of the parahippocampal cortex and the amyg- memories will not be formed. Alberini also clarified that
dala. These signals could activate the right middle-frontal the hippocampus is involved in the consolidation
gyrus as inhibitory control center to try to suppress the process but it is afterwards dispensable. She mentioned
retrieval processing. If the person is quick enough, they that other cortical regions store memories. In rodent
can suppress the hippocampus before pattern formation models, episodic learning requires more than 24 hours
completes. If the pattern was completed, then suppres- to stabilize. Reconsolidation is available when memories
sion of the hippocampus and also of the parahippocam- are retrieved.
pus and the amygdala will be necessary to suppress Alberini’s research includes the study of the formation
consciousness of the unwanted memory. In this way, of memories in early development. She defined infantile
re-entrant signals from the hippocampus to the cortex amnesia as the inability as adults to recollect the mem-
trigger cortical inhibition. Robust downregulation of ories of the first few years of life. She posed the question
the amygdala during intrusions resulted in feeling less about how early memories have an influence throughout
upset about the aversive scene and also modulated the life if they are forgotten. The recollection of early mem-
emotional perception of the scene later on. This ories is almost zero at first and starts to increase with
finding is relevant because unlike the Freudian idea age. Children thus forget episodic memories rapidly.
that suppression preserves the emotional state, it is The same happens in rodents. At post-natal day (PN)
now shown that there is a modulation of emotional 18, which corresponds roughly to 7 or 8 years of age in
characteristics of the trace that is being suppressed, human beings, rats have rapid forgetting. By PN 24,
together with memory itself. Anderson also explained they have a better ability to store LTM. Freud attributed
that cortical inhibition reduces unconscious influences infantile amnesia to repression but Alberini highlighted
as a result of the parallel modulation of cortical activity that there is infantile amnesia in rodents which asks for
along with the hippocampus. Suppressing an unwel- a neurobiological explanation for this particular rapid for-
come idea from consciousness later on reduces the getting. She described two hypotheses. On the one
influence of that idea indirectly in thoughts; it can hand, the developmental one emphasizes that the
change the affective perception of traces. Anderson brain is immature for the consolidation of memories, par-
finished his talk by stating that the memory suppression ticularly the hippocampus system. On the other hand,
mechanism can be engaged unconsciously. the retrieval hypothesis suggests that infantile memories
 NEUROPSYCHOANALYSIS 109

are stored but that retrieval is impaired. Alberini early development shapes the maturation of the hippo-
explained an aversive inhibition memory task used campus in an experience-specific manner.
with rodents in which the animals avoid the context in The first parallel research session started with a talk by
which they received mild foot shocks. Inhibition Caitlin Ware about repression and cognitive inhibition in
reflects their memories which involve the hippocampus, dementia, followed by Oliver Turnbull with a talk entitled
the amygdala and cortical regions. If the amygdala and The return of the repressed: impaired cognitive control over
the hippocampus are lesioned, there are problems in unwanted memories after brain injury. Next Efraín Ríos-
memory storage and consolidation. Rats tested in PN Ruiz presented The automatization of implicit memory
17 (approximately one year and a half or two years of processes and its manifestations through symptoms: clini-
age in human beings) lose memories almost completely cal evidence that questions classical repression. Marie
after 30 minutes, namely, they have rapid memory for- Christin Fellner gave a talk by the name of Tracking
getting. In contrast, rats tested in PN 24 expressed item-specific representations and oscillatory correlates of
strong LTM which is comparable to adult memory. The active inhibition during directed forgetting in EEG. The
forgotten memories at PN 17 were hypothesized to be second parallel session was begun by María Isabel Rodrí-
retrievable through a reinstatement protocol and the guez Luna who spoke about the use of neurological diag-
hippocampus, that was believed to be offline, is involved. nosis as a defense against psychodynamic conflict
The hippocampus thus appears to play an important role related to symptoms in adolescence. Next, Diana Buzo
in the formation of infantile memories, i.e. to encode and presented a paper about cannabis use as an artificial
consolidate memories, but it is not involved in the defense to propose neuropsychoanalytic hypotheses in
expression of memory in the reinstatement of memories. borderline female users. She was followed by Tiziano
To explain the role of the hippocampus in the formation Colibazzi who spoke about automated speech analysis
of latent early memories, Alberini described the changes to identify splitting in character disorders. The last
in proteins at the synaptic level after learning and speaker in the session was Davide Tomatis who gave a
memory formation. She specified that learning changes presentation about the use of dreams in psychotherapy
the maturation of the synapsis in the hippocampus. with brain injured patients.
These changes have been found in the critical period During the afternoon’s plenary session, I gave a talk,
for maturation of sensory systems and are mechanisms entitled “Defense at the border: repression or depression
that only happen during development and not in the – it’s always about affect.” I began by distinguishing two
adult hippocampus. One of these changes is the switch meanings of repression. The first one referred to memory
controlled by the NMDA receptor sub-unit from NR2B and trauma; the second one was related to conflict. I
to NR2A. She also mentioned that the brain derived neu- suggested that borderline patients tend to use primary
rotrophic factor (BDNF) modulates the onset and closure defenses that do not recruit repression. I summarized
of the critical period. Alberini reviewed that a critical some of the historical developments about borderline
period is a developmental period in which the brain is pathology. The first relevant records start from the
very sensitive to stimuli and it becomes functionally 1830s, though the symptoms were only considered to
competent. After that period is over, there are other be clinically relevant beginning in the 1930s. Most of
types of plasticity. There are critical periods for sensory the old descriptions included moral insanity, affective
and motor function, followed by one for language. The instability, character pathology, and depression. These
simplest system enables the other systems to come patients can appear to be insane, but at the same time
online when they are ready functionally in sequential clinicians state that they are not psychotic. Thus, one of
critical periods. Their mechanisms are activated by learn- the most predominant views is that borderline patients
ing. Alberini also specified that latent early memories oscillate between a neurotic and a psychotic functioning.
need reminders to express. The dorsal hippocampus is I took a different position and stated that it is only char-
involved to form and store these memories and it has acter functioning that changes according to the defenses
a critical period, just like sensory systems do. One impor- used in different moments. Therefore, borderline
tant implication of these findings is that it does not align patients can appear to be psychotic or neurotic but
with Freud’s explanation of repression. The hippocampus from my view, they are using characterological disguises.
needs stimulation to be activated and it improves with Borderline patients use defense against depression, not
re-exposure to contexts. It requires at least 24 hours to against conflict. Most neurobiological studies work with
consolidate memories and matures for specific experi- the psychiatric criteria of Borderline Personality Disorder.
ences, i.e. it does not generalize its learning to other Yet, their findings can be heterogeneous and contradic-
experiences unless it encounters similar contexts. Alber- tory. Most studies infer impairments in top-down and
ini concluded by saying that episodic learning during bottom-up regulations. They specifically demonstrate
110 D. FLORES MOSRI

evidence of lower PFC regulation, which is hypothesized borderline symptomatology and behaviors can be
to lead to emotion dysregulation and cognitive control explained by the use of multiple defenses against a
impairments. In addition, the amygdala is frequently chronic and latent depression that is thus frequently
hyperactive. The borderline patient appears to have not seen by some clinicians and researchers. Borderline
low abilities for theory of mind and mentalization, patients feel a subjective pain that they are unable to
which are suggested to be related to the subgenual understand because their causes remain dissociated
anterior cingulate cortex (ACC), the superior temporal from the patient’s conscious experience.
sulcus and the temporo-parietal junction. Most studies Ariane Bazan was the next speaker with a talk entitled
indicate hypoactivation but some others suggest hyper- Repressive border control by sensorimotor inhibition and
activation in these structures. Borderline patients also return of the repressed as phoneme phantoms. She differ-
experience problems in social cognition, which have entiated perceptions from imaginations and defined this
been associated with the dorsal ACC and the insula. distinction as one of the first challenges of the mental
The most common combination found in several apparatus. She mentioned Freud’s concept in the
studies is down-regulation of the PFC and hyperactivity Project (Freud, 1895) of indications of reality. Bazan pro-
in the amygdala. A chronic activation of the hypothala- posed that indications of reality are equivalent to
mic–pituitary–adrenal axis has also been recorded efference copies. She stated that Freud took inspiration
which in turn increases the release of GABA. There is in the work of Hermann von Helmholtz and his clarifica-
also a dopaminergic hypothesis that proposes a high- tion related to the initiation of movement as something
regulation of this neurotransmitter, yet some studies that becomes immediately perceptible. Bazan clarified
suggest a down-regulation. I also spoke of the opioid that this is proprioceptive feedback information. When
hypothesis, which states that there is an endogenous the motor command is given, an efference copy allows
opioid system dysregulation, explaining feelings of emp- computing what the state of the body should be. This
tiness and anhedonia due to low activity in mu receptors becomes a prediction that will be compared against
and high activation of kappa receptors. Borderline the actual state of the body. Bazan suggested that
patients thus may be trying to regulate their opioid Freud’s ω neurons are motor neurons and that they are
receptors. important to make the difference between a perception
I next suggested using the contribution of psychoana- and an imagination because they discharge and give an
lytic clinical experience to try to understand the apparent indication of reality to ψ neurons. In her view, active
neurobiological contradictions. The common denomi- apperception can be seen as a model for consciousness
nator seems to be affect, which can best be explored in which efference copies are characteristic. Laying the
through the transference situation. The problem these groundwork for a model of repression, she noted that
patients have with affect appears to be related to early stimuli with active apperception can be submitted to
trauma, which impacts in secondary process learnings an inhibition process. Efference copies also attenuate
and conditionings, i.e. there are dysregulated automa- the predicted feedback of a movement and make an
tized patterns. I proposed that the main problem in bor- inhibition beforehand of what the proprioceptive infor-
derline patients is that they were exposed to an mation will be; this is called efference-copy-based sen-
unpredictable environment which resulted in an sorimotor attenuation. Bazan related the latter with
affective uncertainty that impedes the formation of Freud’s 1895 statement that the ego matures to increas-
reliable prediction patterns. I also suggested a lack of ingly inhibit mental processes by the use of indications of
synchronization of different memory systems. Episodic reality. She argues that sensorimotor inhibition can con-
memories seem to be dissociated from emotional mem- stitute a model for repression. In Bazan’s opinion, the
ories. Therefore, borderline patients show a chronic efference copy-mediated attenuation mechanism could
affective dysregulation, dissociated memory systems, be a neurophysiological principle for repression.
chronic vague anxiety and scarce reliable predictive pat- She explained that there is an absence of secondary
terns to efficiently solve their needs. They frequently feel repression in psychosis when compared against the neu-
frustrated which in turn seems to have an impact on the roses. The prediction efference copy model can be
mesocortico-mesolimbic dopamine system. Patients applied to speaking. In psychosis, there could be a
start to feel demotivated and hopeless also reinforced deficient efference copy that results in an auditory
by their original separation distress associated to reafference proprioceptive feedback that was not orig-
opioid regulation. In conclusion, bottom-up regulation inally predicted. This feedback then sounds like coming
appears to be compromised, from the secondary from the outside, voices that are interpreted as coming
process to the cognitive level and therefore, top-down from the external world because the person does not
regulation is also impaired. The apparent oscillations of recognize having given the command to articulate
 NEUROPSYCHOANALYSIS 111

those words. This constitutes a compromised efference second one repression proper. The one for primary
copy-mediated attenuation mechanism. Bazan illus- repression is based on alpha synchronization and the
trated these concepts by telling the case of a psychotic one for proper repression on efference-copy mediated
patient that lacked from indications of reality and thus attenuation. They share the motive of preventing the
could not go into the secondary process. When this activation of internal conflict. Psychosis may only have
happens, psychotic patients stay in the primary process alpha synchronization available. Repression proper
and have associative thoughts that work in a phantas- recruits a mature ego and thus an organization that
matic mode. Bazan hypothesized a psychodynamic resembles a border control or a protective shield.
failure of repression, together with the sensorimotor Mark Solms was the next speaker and he gave a talk
failure of attenuation, the latter becoming constitutive entitled Repression, defense, and the cognitive uncon-
of repression. She next explained that there are speech scious. He referred to the two types of unconscious in
fragments that are invested more because the person the mental sciences: the Freudian and the cognitive
wants to speak about them a lot. If spoken about, they unconscious. The latter refers to automatized programs
lead to emotionally threatening situations that result in to solve life’s problems; it does not need deliberation.
high arousal that would in turn need to be inhibited. The psychodynamic unconscious, on the other hand, is
Repression is a special instance of inhibition while sen- full of conflict and can give rise to psychopathology
sorimotor inhibition happens online all the time. Repres- and suffering. The reconciliation of these two points of
sion would then be a type of sensorimotor inhibition for view constitutes an essential task of neuropsychoanaly-
emotionally threatening stimuli. According to Jeannerod sis. To set the stage for discussing his model of repres-
(1994) if the goal of an action plan is not accomplished, sion, Solms reviewed some key principles. First, Freud
then the sustained discharge is interpreted as a rep- thought that memories are transcribed many times in
resentational activity that would give rise to mental different memory systems, and Solms stated that this
imagery. Bazan emphasized that it is the incomplete or view strikingly resembles the one in cognitive neuro-
total lack of execution of a planned action that leads to science. He then summarized his own model of the “con-
phantoms. She reviewed what happens with phantom scious id,” based on work by Panksepp and others, that
limbs in which the motor investment does not cease in posits that consciousness is not a fundamental property
spite of the loss of a limb. The motor investment can of the cortex. The cortex relates to cognitive processes
increase and be sustained because there is no response. that are not intrinsically conscious, while multiple lines
Activation in motor regions of the brain can be sufficient of evidence indicate that consciousness is generated in
to cause somatic phantom perceptions. Bazan next high- the upper brainstem and activates the cortex. Conscious-
lighted the importance of phonemic phantoms which ness is endogenously generated and does not depend
can be induced after the structural inhibition of some upon exteroception. The brainstem does not only
highly invested words. Bazan proposed that repression provide levels or a quantity of consciousness but also a
shares functional principles of efference-copy-mediated quality. Solms emphasized that the endogenous state
attenuation with non-defensive cognitive mechanisms of consciousness that is generated in the upper brain-
such as suppression. She clarified how alpha synchroni- stem feels like something; it has a quality called affect.
zation is not specific for unconscious defense since it The upper brainstem structures represent the needs of
also serves other cognitive, conscious purposes. Thus, the body which are felt in relation to the biological
neither alpha synchronization nor efference-copy- tasks of survival and reproductive success. These needs
induced attenuation is characteristic for unconscious make demands upon the mind to work by means of
defense as they both serve other purposes. Still they unpleasant feelings that only disappear when those
are different and the distinction lies in their psychody- needs are met, which is how Freud defined “drive.” Cog-
namics. On the one hand, the alpha synchronization is nition is used in the final instance in the service of
used flexibly when it is needed to consciously inhibit irre- meeting those demands; its ideal state is unconscious,
levant and interference processes. If it were used for an aspiring to predict and address needs through ever
unconscious defensive process, it would require a per- more automatized programs. Solms proposed that the
manent state of alertness. On the other hand, id gives rise to the feelings associated with emotional
efference-copy mediated inhibition is used flexibly for needs and that the ego performs the work to meet
the selection of action alternatives. When it subserves their satisfaction. In Solms’ hypothesis, the id is therefore
repression, it would also need a more permanent effect fundamentally conscious and the ego aspires to automa-
on certain representations. Bazan concluded that there tize, i.e. to be unconscious. If a solution stops working, it
are two brain mechanisms for unconscious defense. becomes conscious again to allow thinking and feeling
The first one subserves primary repression and the once more until it can be solved and then rendered
112 D. FLORES MOSRI

unconscious again. Solms also said that the fabric of the view, defenses more broadly speaking are not necess-
ego takes the form of predictions. When they are suc- arily non-declarative while repression is. He proposed
cessful, they allow us to navigate the world and devote that the fundamental mechanism of psychoanalysis is
cognitive resources to new problems; if predictions are transference analysis because patients are going to
unsuccessful, they continue to generate “surprise” or pre- repeat the maladaptive predictions that give rise to
diction error, and recruit conscious awareness, namely their symptoms. The aim of transference analysis is to
the working memory to be thought through. Once the make patients aware of what they are doing; they can
problem is solved it is synaptically consolidated into LTM. then think about it. Reconstruction can help to under-
In this view, since declarative memories (such as epi- stand why they are doing what they are doing in the
sodic memory) can be brought back into consciousness; present. But reconstruction is not remembering. The
this corresponds with Freud’s concept of the precon- aim of reconstruction is to understand the present to
scious. The unconscious, in contrast, is related to the comprehend what patients are repeating. Solms con-
non-declarative memory systems whose memories cluded that transference interpretation entails four
cannot be pictured in images. There are some emotional things: (1) Making patients aware that they are repeating
problems that can never be solved, which mean endless a pattern. (2) Making patients aware that they repeat the
conscious thinking to attempt to solve them. According pattern to try to meet an emotional need. (3) Showing
to Solms, that’s when repression helps by “making the the patient that the pattern does not work. (4) Thinking
best of a bad job.” A bad solution is prematurely automa- about the problem once more. But even after the trans-
tized and constitutes the content of the unconscious. ference interpretation the patient keeps repeating the
The contents of repression do not come back to pattern. It happens because the memory trace cannot
working memory and then the same behavior is be brought back into consciousness which will require
repeated in spite of it not working. Solms stated that the interpretation to be made again repeatedly. The
this view fits into Freud’s proposal of the four character- latter explains why psychoanalytic treatments take
istics of the system unconscious: exemption from mutual time. Solms finished by stating that non-declarative
contradiction, mobility of cathexes, timelessness and memory is hard to learn and hard to forget.
replacement of external by psychical reality. He next pro- As in previous congresses, an Oxford-style debate
posed the repetition compulsion as a fifth feature of the took place. It was moderated by Oliver Turnbull and
unconscious characterized by endless repetition of beha- the motion was This house believes that overcoming
viors that do not solve problems. repression depends on the recollection of real past events.
Solms then mentioned two implications that derive For the motion were Cristina Alberini and Nikolai Axma-
from his model. In the first one, he proposed that cher. Against the motion were Simon Boag and Ariane
Freud’s thing-presentations do not constitute the con- Bazan. The initial voting had 40 people in favor, 110
tents of the unconscious, but of the preconscious due against and one person abstained. The first round
to the fact that they are concrete images related to cor- began with Cristina Alberini who emphasized that over-
tical functions. The unconscious is related to non- coming repression depends on the recollection of real
declarative memory systems. The second implication is past events because the repressed happened, i.e.
that the repressed cannot be brought back to conscious- because something real took place. Even if the memory
ness again because basal ganglionic associations cannot is re-elaborated, the old representation that is repressed
take the properties of a cortical memory image. What can is real and made of biology, synapses, cells and circuitry.
come to consciousness, however, are the feelings Overcoming repression requires a recollection or reacti-
derived from a prediction error. This is why patients vation of the past events. She also specified that it is
suffer from feelings. Thus, the psychoanalytic treatment possible to talk about recollection of declarative mem-
should not aim at bringing the repressed back to con- ories but not of memory traces; the latter must be reac-
sciousness, but at understanding what the patient tivated and cannot themselves be recollected. Next,
needs and finding new ways to meet those needs. Nikolai Axmacher said that recollection of real past
Only preconscious contents can be brought back to con- events is a crucial therapeutic factor in overcoming
sciousness. Solms mentioned that repression is different repression because the latter is characterized by dis-
from other defenses. He referred to the German word torted and thus unrealistic accounts of a person’s life.
Verdrängung as repression and Nachdrängung as after- Thus, overcoming repression involves linking those dis-
pressure which is the ongoing process that keeps the tortions back with reality. Axmacher clarified that recol-
repressed unconscious, namely keeping the unpleasant lecting an event does not mean to re-live it which
feeling unconscious by means of various defenses that would be more related to flashbacks and PTSD. Repres-
give shape to the personality of the ego. In Solms’ sion entails repetition of psychological states that are
 NEUROPSYCHOANALYSIS 113

accompanied by feelings and thoughts that gradually conscious. Bazan thus highlighted that even when
become more inappropriate. Memory recollection there is recovery of real past events, what alleviates the
means to reconstruct and it serves three aims: (1) to symptoms is rendering the reasoning conscious, not
guide present actions based on previous experiences, simply the event itself. Based on Freud, Bazan affirmed
(2) to build and maintain object relationships and (3) to that there is no recollection but reconstruction. She
support a coherent and positive image of the person. exemplified with three clinical cases that reconstruction
Therefore, recollections imply the transformation of the without real past events can lead to alleviation of symp-
initial experience. Axmacher also mentioned that recon- toms. Memories may not come back and a suggested
struction has to be grounded in reality. Recollection reasoning by an interpretation can still help to alleviate
depends on the past to allow new experiences to be the symptoms. Bazan concluded that in the three cases
built. He illustrated his points by mentioning a film in that she described, either the logic was not remembered,
which the memory of infantile sexual abuse had been the events were not remembered either but that they
repressed. The acceptance of the truth meant freedom were easily assumed, or the events were not remem-
and change in the characters’ interactions. He empha- bered, not recognized and were even refuted, but in all
sized that only recollecting what actually happened cases there still was a recovering of the logic that led
helped against the oppressive and false image of the to symptom alleviation, showing that recovering real
past and allows for real emotions and novel experiences. past events is not mandatory to overcome repression.
The third speaker was Simon Boag, against the The second round started with Cristina Alberini who
motion. He stated that lifting repression does not clarified that alleviation of symptoms and overcoming
require the historical recall of past events. He revised repression are two different things. She described that
the concept of repression by mentioning that Freud if memories are reactivated, they can undergo reconsoli-
did not refer to memory in 1915 when he wrote about dation; but if there is a disruption of the process within a
repression. Instead, he referred to wishes and fantasy. certain time window, the memory goes away. The same
Boag considered that those two aspects had not been outcome can be achieved with extinction. Yet, there will
discussed in the Congress and that they are important be spontaneous recovery at some point through the
from the psychodynamic approach. Lifting repression reactivation of memories. Alberini defined memory as
then does not necessarily imply learning about past trau- retention of learned information. The self is constituted
matic events, but also about the wishful structures that by memories and they are dynamic processes that
might be entailed with them. Recollecting events is an change with time. It is a real event what creates the
opportunity for a new reinterpretation and reinvestiga- memory. Reactivation and reconsolidation refer to the
tion of the actual past situation. Recollection then original trace. Nikolai Axmacher responded next and he
means to re-elaborate or reinterpret. The therapeutic stated that regenerative memory implies two crucial
situation means that an infantile memory will be reinter- factors. The first one is the engram which is in relation
preted by an adult mind and it cannot be seen through to the real past event. The second one is constituted of
the eyes of the infant anymore; it is a reconstructive factors such as reasoning, integration with the self, or
event. Boag also cited the Blum-Fonagy debate in the semantic knowledge amongst others. He emphasized
early 2000s in which Blum stated that memory is very that these two factors need to be present in order to
important but that it does not have to be accurate to lead to recollection. Axmacher considers that a coherent
help in the psychoanalytic treatment. Boag clarified story that is not grounded in reality is not sufficient;
that what is needed to lift repression is to be able to reconstruction necessarily involves knowing that the
develop a narrative based on imagined events, wishful story actually happened and that is crucial to overcome
structures, and the transference. Next Ariane Bazan also repression because it is linked to insoluble problems
spoke against the motion. She operationalized the over- related to the psychodynamic conflict which cannot be
coming of repression as the attenuation or disappear- accessed anymore.
ance of the symptoms or even making sense of one’s Simon Boag then expressed particular interest in the
life. She highlighted that the recollection of real past dynamic process of memory previously characterized
events is not mandatory for overcoming repression. by Alberini and Axmacher. Whatever the original event
Her view is that overcoming repression always depends is, there is a potential and constant elaboration upon
on past logical reasoning even if there is recollection of each elaboration. The past can be beneficial but not
real past events. She illustrated her statement with necessary for overcoming repression. Boag also stated
Freud’s treatment of Katharina, a patient who had that the work in therapy is perhaps mainly based on
repressed an abuse by her uncle and whose symptoms making sense of a confusing situation of unknown
alleviated after she made her unconscious reasoning sources in which overcoming repression may be
114 D. FLORES MOSRI

achieved by a reconstruction. He concluded that the and automatic, and it leads to the formulation of symp-
recollection of real past events is not necessary for over- toms. In the investigation of intentional memory sup-
coming repression in any case. Last, Ariane Bazan said pression, the think/no-think paradigm is used, and
that she agreed with Axmacher about the grounding in shows voluntary control mechanisms of inhibition that
reality of the reasoning or interpretation used in analysis. involve the dlPFC which leads to suppression during
Still, she disagreed that the recollection of the engram is retrieval by inactivation of the hippocampus. In this
mandatory. If an interpretation had no ground in reality, case, memory for the no-think items is below the base-
it would have no analytic effectivity. But it does not mean line. Another important paradigm is “directed forget-
that the interpretation is only helpful if there is a recollec- ting,” which involves suppression during memory
tion of that grounding. Bazan recalled the Freudian idea encoding. The results are robust, indicating that items
that the repressed may be forgotten but then it will be that are to be forgotten are remembered less well than
acted out. She gave another clinical illustration of her the items which are to be remembered. The neural cor-
point and concluded that the hypotheses originated relates are again a recruitment of the dlPFC and a
from the analysis alleviated some symptoms without reduction in the activity of the hippocampus. Axmacher
the recollection of the real past events, even when also described the findings of a study using invasive
interpretations should be grounded on real past intracranial EEG in epileptic patients using the think/
events. The audience voted again. There were 45 votes no-think paradigm and the item-method think/no-think
for the motion, 80 against and 4 people abstained. Turn- paradigm. The participants showed a very robust effect
bull declared Alberini and Axmacher winners. of directed forgetting. When the to-be-forgotten items
were contrasted to the to-be-remembered items, there
was a significant increase in low frequency oscillations
Day three
in the theta frequency range in the dlPFC. This finding
The sessions on Sunday began with Nikolai Axmacher’s reflects the recruitment of voluntary inhibitory control
talk about experimental approaches to repression. He processes. Increased alpha activity was found in the hip-
spoke of two in particular, the free association and the pocampus which is related to inhibition. Whenever the
voluntary memory suppression studies. He defined theta power was higher in the PFC, the alpha power in
repression as the main mechanism for the generation the hippocampus was higher. The increase in the theta
of the psychodynamic unconscious. The conflict is power in the dlPFC predicted that at a later moment in
repressed, yet emotions remain and symptoms appear, time the hippocampus would increase the alpha
indicating the existence of a pathological memory power. There is a dlPFC to hippocampal phase synchro-
trace. Axmacher asserted that repression and suppres- nization. These results suggest a communication
sion strongly overlap. The differences, in his view, lie in between the dlPFC to the hippocampus.
that suppression recruits executive controls, i.e. the Axmacher next spoke of the free association para-
PFC. Repression implies strong emotional conflicts that digm, which is based on the idea that free association
reduce the ability to recruit executive control; it is may make repressed contents more accessible. Delays
believed to occur unconsciously, whereas suppression in response are taken to indicate resistance, which is
most often occurs voluntarily and consciously. Suppres- associated with reduced accessibility to contents or
sion appears to erase the memory trace and is hypoth- worse memory to associations related to repressed con-
esized to work as an adaptive functional process that is tents. This paradigm was developed by Jung, who
successful at deleting what is being inhibited. Repres- measured skin conductance responses (SCR) while he
sion, on the other hand, is dysfunctional and leads to showed lists of words to his patients and asked them
symptoms. In terms of the content, suppression can be to say the first words that came into their minds as fast
applied to any sort of material, including negative, as possible. Reaction times were recorded, and the
neutral or even positive items. In contrast, repression results showed increased reaction times and increases
occurs in relation to wishes, desires and psychodynamic in SCR when participants faced conflict. In a different
conflicts. Axmacher proposed that repression could task, they were asked to remember the associations
consist of two consecutive phases. The first one would they originally gave, and longer reaction times as well
be the voluntary employment of inhibitory mechanisms as higher SCRs were observed in association with the
early on, when the psychodynamic conflict occurs. If this conflictual material, indicating repression or resistance.
initial phase is successful, then there is deletion of the Axmacher then described four studies that he and his
suppressed contents, and subsequent emotion regu- colleagues have been conducting. In a study using the
lation. If unsuccessful, a second phase could occur in free association to word list paradigm with fMRI, they
which the intention to repress becomes unconscious found an increase in the activity of the ACC which is
 NEUROPSYCHOANALYSIS 115

related to conflict processing. In the second study, free of psychoanalysis as a “gozología” (the study of jouis-
association to conflict sentences, Axmacher now sance); he used this neologism to locate jouissance as a
included sentences instead of words, based on typical central concept in the theory and practice of psychoana-
conflicts derived from the OPD manual (Operationalized lysis. Enjoyment can be concisely defined as the set of
Psychodynamic Diagnosis). This study confirmed the pre- modes in which the body of a living subject is impacted
vious findings, and added that psychodynamic therapists by language. The brain deals with two worlds, the inner
analyzed the materials and found that participants were and the exterior. Memory is the origins of jouissance,
aware of conflict-related topics. Because the sentences which is predominantly unconscious. Braunstein stated
were not autobiographically derived, Axmacher’s that jouissance has an essential relationship with
group conducted a third study, this time using free memory. He expressed that episodic memory is the
association to autobiographical conflict sentences, in one that psychoanalysts can be interested in. He then
which they used the OPD interview to detect the partici- distinguished correlations from correlates, mentioning
pant’s main conflict categories. The most common were that correlations can be found between the mind and
wish for dependency vs autonomy, desire for care vs the brain. A correlate would rather mean that it is a
autarchy, and conflicts of self-value. They also extracted story shared by two or more people. Braunstein men-
sentences derived from autobiographical data. All pre- tioned that the correlation between mind and brain
vious findings were confirmed, but the subjective seems to work according to the Möbius band, i.e.
ratings of feelings and their arousal could not explain one does not exist without the other, but they never
the conflict effect, i.e. negative sentences were evalu- meet. The encounter of two minds happens through
ated as negatively as the conflict sentences. Axmacher words, which is the essence of psychoanalysis. In
then designed a fourth study, free association to Braunstein’s opinion, the neurosciences do not contrib-
conflict sentences in patients, in which he recruited a ute to the clinical level of the transference. He used
group of 70 patients and interviewed them using the addiction to illustrate how addicted people try to get
OPD. Patients showed various conflicts simultaneously. something that can help them to diminish or finish
The participants were asked to associate to sentences the discomfort derived from not having a satisfying
that were not autobiographically derived. The only object. The medicine that cures them is the same
highly significant effect found was reduction in reaction one that has hurt them. He stated that correlations
times. They did not use fMRI recordings and they could can only go in one way: from speech to the neuro-
not replicate effects in reaction times and on SCRs. The sciences. Yet, the brain is indispensable for there to
memory was reduced for associations to conflict vs be wishes, jouissance, believes, dreams and speech.
negative sentences. Axmacher last summarized the Braunstein suggested that memory should not be
data obtained from his studies mentioning that they studied, but its brain processes without overlapping
found reliable general effects but less pronounced the mental aspects with the neuroscientific ones. He
effects of personal relevance. Psychodynamic conflict specified that a direct reference of what lies between
activated the ACC leading to repression and also the neurosciences and psychoanalysis has not been
down-regulating the hippocampus. Yet some affects given. In his opinion, if it existed, it would only
and contents may remain implicitly. They compared provide a more precise localization of the processes of
their findings to the think/no-think paradigm showing consciousness and would not contribute anything to
no correlation, indicating that inhibition and repression their psychic understanding. Braunstein said that Laca-
seem to be different processes. Voluntary memory sup- nian topology does not mean to objectivize mental
pression seems to be related to an adaptive process functioning, but to propose relationship models of the
with a specific neural basis whereas repression seems jouissance that happens between the body and the
to be related to a maladaptive process that needs world in the symbolic, the imaginary, and the real. Con-
further studying. sciousness is jouissance. The brain allows for memory,
The last plenary presentation of the Congress was intelligence, and emotion to exist, but it does not
entitled Memory’s jouissance (enjoyment) and memory of know itself how it works. It is indispensable for adap-
jouissance by Néstor Braunstein. He spoke of four types tation between the body and the world. It is a connec-
of memory: episodic, semantic, implicit, and working tor, but each field, psychoanalysis and the
memory. He exemplified each of them and mentioned neurosciences should continue individually and then
that what remains of experiences is jouissance. He learn from each other without deleting their boundaries.
spoke of an encounter of minds and not of brains. In Their correlates are advantageous even without
his view, neuropsychoanalysis put all four types of knowing what their correlation is; the latter should not
memory together. Braunstein proposed a redefinition be forced to happen.
116 D. FLORES MOSRI

The third parallel session included a symposium about of the Congress, repression and defense, Solms con-
fallen and re-engineered defenses, presenting psychody- sidered that progress has been made, but that there is
namic insights from neuropsychiatry and addiction. The still a lot of work to be done. He spoke of the variety of
first speaker was José Fernando Muñoz Zúñiga, who methods used to investigate the processes of defense.
focused on fallen defenses to give introductory notes Amongst them he mentioned the electrophysiogical,
to regression in neuropsychiatry. Next spoke Carmen lesion, and neuroimaging methods, which can lead to
Ojeda López who gave a presentation entitled Pathologi- converging evidence. Given that the skepticism about
cal rewards: perspectives from addiction and neurodegen- the validity of psychoanalytic concepts, third-party evi-
eration. The third speaker was Brian Johnson who dence in these other domains is important. In this
talked about addiction and the engineering of neurobio- regard, it is a substantial achievement to have this
logical systems. I gave the last presentations about psy- body of evidence now that repression exists; that it
chotoxic defenses and the addicted patient as a special cannot be denied. It has become demonstrable that
case of neurological patient. The fourth parallel session there is an involvement of executive, inhibiting, modulat-
included a presentation by Jesús Mario Serna entitled ing parts of the brain, which are actively involved in the
Repression in the light of self-similarity and neuroepistemol- keeping out of awareness of difficult mental materials,
ogy: Are phonemic phantoms fractal? Next was Hans particularly via influence on the hippocampus and the
Olvera who spoke about intrauterine neuro-stimulation medial temporal lobes. Solms emphasized that these
at the origin of psychic function and its role in the preven- findings are a contribution in both directions. He high-
tion of psychosis. He was followed by Iftah Biran whose lighted that several talks provided evidence that things
presentation was entitled Parietal dysfuction in complex that a person does not want to remember can be forgot-
regional pain syndrome (CRPS): from body schema deficits ten, but not deleted. The forgotten appears to remain as
to limb-genital symbolic representations. The last presen- an unconscious active force in the mind. Solms also
tation of the session was given by Danièle Lapointe who clarified that repression included a variety of processes,
talked about the qualitative results of mentalization including suppression and inhibition, as well as traumatic
among 33 female victims of incest. forgetting. He called repression a broad concept which
The fifth parallel session began with a presentation by has clinical implications. Solms emphasized that Freud’s
Elena Panagiotopoulou about beauty and self/other theory of repression evolved over 44 years. This fact
boundaries, followed by Mariana Von Mohr who spoke explains why the concept has been given different
about the social buffering of pain by affective touch meanings, as seen during the presentations of the Con-
and attachment style. Next was Margarete Schött, with gress. Freud’s initial concept of repression referred to for-
a presentation entitled Developmental neuroscience of gotten memories; in later years he spoke of the Oedipus
attachment: fMRI correlates of processing social separation complex and infantile sexuality, gradually giving more
in 9–11 year old children. The last presentation was given importance to fantasy and the supposition that the
by Christina Peters who spoke about being outside our repressed can never be brought back to mind. Thus,
comfort zone to describe the tensions and benefits of reconstruction became more important than remember-
collaboration with other disciplines in psychoanalytic ing. This position coincides with Solms’ current model,
treatment. The sixth parallel session included Paula which considers that the repressed is related to non-
María Corte Gonzáles, who spoke about infantile declarative, basal-ganglionic, non-cortical types of
amnesia from a neuropsychoanalytic perspective. Fabio memory, therefore they cannot be made conscious.
Tha presented a paper about the hysterical symptom Solms mentioned that these mechanisms correspond
and a proposal of articulation between Freudian theory to what Freud called the unconscious and that the
and the Bayesian account. Maria Susana Koreck next declarative memory mechanisms are preconscious. He
spoke about the development of the ego structure and used dreams as an example by reminding the audience
the secondary process revising the default mode that they are not the scene of the unconscious but that
network. The last speaker of the session was Giulia they have a manifest and a latent content; they are
Olyff with a presentation by the title A saw and a trunk based on a broad transference that requires interpret-
or a trunk and a saw: order doesn’t matter for the ation. If the unconscious were possible to be seen
primary process. directly, then psychoanalysis would not need an inter-
To close the Congress, Mark Solms gave his traditional pretative methodology. The unconscious can only be
closing remarks. He began by highlighting the progress inferred. Solms also stated that identifying the brain
that neuropsychoanalysis has made. He thinks that it is mechanisms related to repression and defense gives
about a genuine dialogue that allows learning in both the opportunity of learning new things about the uncon-
directions, in an organic fashion. Referring to the topic scious, adding new insights and lines of inquiry to the
 NEUROPSYCHOANALYSIS 117

concept of the unconscious. Solms then declared the Erdelyi, M. H. (1985). Psychoanalysis: Freud’s cognitive psychol-
Congress closed, inviting everyone to attend the 20th ogy. New York, NY: W.H. Freeman.
Freud, S. (1895). Project for a scientific psychology. Standard
Neuropsychoanalysis Congress in Brussels, July 18-20th,
Edition, 1, 281–397.
2019. Jeannerod, M. (1994). The representing brain: Neural correlates
of motor intention and imagery. Behavioral and Brain
Sciences, 17, 187–245.
Disclosure statement Kaplan-Solms, K., & Solms, M. (2000). Clinical studies in neuro-
No potential conflict of interest was reported by the author. psychoanalysis: Introduction to a depth psychology. London:
Karnac.
Nesse, R. M. (1990). The evolutionary functions of repression
and the ego defenses. Journal of the American Academy of
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