Introductory Lectures on Neuropsychoanalysis/Psychotherapy: Lecture Three, Part 1 "How the Mind Develops" Introduction and the "Oral" Stage

In this Lecture I am going to write about my understanding of developmental psychopathology, and especially the influence neuropsychoanalysis has had on my understanding.  Before learning neuropsychoanalysis, I had of course been influenced by the major authors of psychoanalytic developmental psychopathology. These included: Sigmund Freud, Karl Abraham, Anna Freud, Melanie Klein, Margaret Mahler, Otto Kernberg, Peter Fonagy, and Nancy McWilliams. I could not, in these four posts, begin to share the major contributions from this list of psychoanalysts nor the neuropsychoanalyst Mark Solms. What I have written here is my own brief integration of their major contributions.

I am going to write only  briefly about Freud's Psychosexual stages ( oral, anal, and phallic). This is because  in neuropsychoanalysis we believe Freud was mistaken in his belief that the drives develop through these psychosexual stages. Neuropsychoanalysis teaches that the ego is the only part of the mind that develops, and that it does so by learning from experience.  

But we also know that Freud wrote more about development than just  the psychosexual stages. He  also wrote about ego/self development, object relations development, and the resultant psychopathologies that may result when things go awry during development. Freud got it right here!

When Freud began writing about his  psychosexual stages, he believed that all pleasure, broadly speaking, was sexual. He did not know in the early 1900's that there are other pleasure centers in the brain. Neuropsychoanalysis has discovered these additional brain pleasure centers.  Freud further thought that the oral sexual pleasures of the first stage , the anal and phallic pleasures of the next two stages and the final genital pleasures  of adolescence, led to mature heterosexual intercourse culminating in reproduction. Contrary to Freud, we now know that the LUST need does not progress from oral to anal to phallic to genital sexual desires. And,  genital sexuality is not more mature  than oral sexuality, anal sexuality, etc. We also now know that heterosexuality is not a more mature stage than homosexuality.                             

In place of Freud's psychosexual stages, neuropsychoanalysis teaches that the young child's ego compromises consist of inadequate solutions (predictions) to meeting basic emotional needs/drives. The unmet needs lead to unpleasant  feelings. These feelings ARE the psychopathologies that bring most of our patients to treatment. 

Now, the child suffering from these unpleasant  feelings must then utilize defenses against them. And in neuropsychoanalysis as well as psychoanalysis, these levels of  defenses are: psychotic, borderline/narcissistic, and neurotic. These defenses differ in their ability to fend off the feelings. Psychotic defenses are the least likely to work, followed by borderline/narcissist defenses, and then neurotic defenses. Furthermore, the level of defenses chosen reflect how realistic are the predictions causing the unpleasant feelings. Early childhood predictions are less realistic than later ones. 

So, now let's look again at Freud's first psychosexual stage which he named the Oral Stage.  For Freud, the oral stage takes place in the first year or so of the infant's life. Freud believed the focus of this stage was the mouth ( the first erogenous zone ), and the oral pleasures that came from sucking to obtain milk from the Mother's breast, or its equivalency the bottle. He further believed that the pleasures and unpleasures of the mouth and their being met or not met by the Mother/Father, could lead to psychopathology.    

Neuropsychoanalysts today, however, know that much more is going on inside the infant than the pleasures and unpleasures  of the mouth. In the early months, the infant is also beginning to learn how to exist in the world. The  infant is  beginning to experience life beyond itself in its early relationships to others, especially the Mother/Parent.

As stated earlier, Freud first postulated only a sex drive. He later added the agressive drive. Neuropsychoanalysis  adds five additional drives/emotional needs beyond Freud's two. The additional drives/needs beyond Sex ( which neuropsychoanalysis renames LUST), and Aggression (which neuropsychoanalysis renames RAGE) are: PANIC/GRIEF (the Attachment drive/need )FEAR, CARE, SEEKING, and PLAY. The infant's ego  is trying to meet all seven of these basic needs, which is impossible. Though all seven needs are striving to be met, one  need in particular most demands to be met in each stage ( Solms 2021). 

The Attachment need (PANIC/GRIEF) most demands to be met in the first year of life. The need for attachment also correlates to some degree  with Freud's notion that the two greatest fears of this stage are: The loss of the object and the loss of the object's love. 

Many psychoanalysts ( but not all) believe that the psychopathologies that result from problems during this stage are the psychoses and/or borderline conditions. Neuropsychoanalysts, on the other hand, do  not believe that certain  disorders or personality organizations can always be traced to a certain developmental phase.   

I will speak more about the attachment need in the next section, but I will begin that section with early ego/self development in the first year of life.