Two aspects of the body are represented in the brain, and they are represented differently. The most important difference is that the brain regions for the two aspects of the body are associated with different aspects of consciousness. Very broadly speaking, the brainstem mechanisms derived from the autonomic body are associated with affective consciousness, and the cortical mechanisms derived from the sensorimotor body are associated with cognitive consciousness. Moreover, the upper brainstem is intrinsically conscious whereas the cortex is not; it derives its consciousness from the brainstem. These facts have substantial implications for psychoanalytic metapsychology because the upper brainstem (and associated limbic structures) performs the functions that Freud attributed to the id, while the cortex (and associated forebrain structures) performs the functions he attributed to the ego. This means that the id is the fount of consciousness and the ego is unconscious in itself. The basis for these conclusions, and some of their implications, are discussed here in a preliminary fashion.

Mark Solms raises the issue of the neuronal and conceptual characterization of consciousness. He focuses very much on stimulus-induced activity in relation to affective and cognitive functions. This, though, implies a content-based view of consciousness that defines consciousness by its contents—that is, affective and cognitive. Beside content, recent discussions often consider the level of consciousness associated with brainstem/midbrain as a second dimension of consciousness. However recent data about the intrinsic activity of the brain suggest the need to include a third dimension—form (or structure or organization)—in the characterization of consciousness. The commentary spells this out, including the implications for the neural correlates of consciousness and Solms’s view.

We very much value the integrative formulation of the neural basis of the seeking system put forth by Wright & Panksepp, but we have several concerns that might be incorporated or acknowledged in future versions. These revolve around the need for a more rigorous and modern evolutionary backdrop, a greater appreciation for earlier discussions of appetitive and consummatory behavior, more integration with other neural models of learning and reward, questionable terminology, clarification of hierarchical claims, greater attention to genetic polymorphisms and individual differences, and greater acknowledgement of earlier attempts to integrate ethological and psychoanalytic formulations that address neural and motivational systems, conflicts underlying behavior, and implications for treatment.

Early life experiences may have enduring effects on human biological development. Premature infants aged 6 to 12 months cared for in incubators (control group, C) shortly after delivery were compared with premature newborns cared for using the kangaroo method (experimental group, E), characterized by consistent skin-to-skin contact. We found that groups C (n = 15) and E (n = 27) were comparable at birth. Logistic regression analysis showed that Group C infants had higher salivary cortisol concentrations and were shorter as compared with Group E infants. These findings are consistent with experimental findings showing that differences on early maternal presence lead to enduring biological consequences.

Accompanying a male adolescent out of the darkness of being unable to differentiate between inside and outside, between being a boy or a girl—the psychoanalytic journey is described from both a clinical and a theoretical perspective. Based on Sigmund Freud’s metapsychology, psychoanalytic concepts such as regression, defense mechanisms of the ego such as projection and introjection, and features of the primary process are illuminated. Special emphasis is placed on changes in body schema and the role of language in reality testing. The therapeutic process cannot be understood without reference to the psychoanalytic concept of the ego and its early development. Using neuroimaging evidence, results of neuropsychological assessment, and excerpts of the ongoing therapy sessions, the pieces of the boy’s history are put together alongside the reconstruction-surgery of the frontal cranial bones.

Patients suffering from borderline personality disorders are often difficult to treat, and require specific psychotherapeutic techniques. In current neurobiological models of borderline personality disorder, temperamental factors such as increased emotional reactivity and diminished attentional control figure prominently and account for the psychopathology of this disorder. Here, we follow a different approach and ask the question of how a model of this disorder may account for the modifications of psychotherapy technique that have proven effective in this class of patients. The psychotherapy of this disorder emphasizes work on enriching the semantic repertoire of patients in interpreting their own emotion and other people’s motivation for their actions. Based on current psychometric research on distinct factors contributing to individual effectiveness in attentional control (working memory capacity), we propose that the organization of semantic memory may constitute an important and neglected aspect of a neurobiological model of this disorder. Impulsivity and emotional dysregulation resemble the long-term developmental effects of habitual strategies to determine response, which cognitive studies have characterized in terms of the interplay of attentional control capacity, cognitive and emotional load, and semantic organization. Rather than attributing an exclusive causal role to either increased emotional reactivity or diminished attentional control, we propose an account of this disorder as emerging from a self-reinforcing developmental history in which both these factors are intertwined. After mapping these notions onto specific psychotherapeutic interventions, we propose a model through which specific technical strategies result, in the long term, in structural change.

Psychoanalytic and scientific conceptions of unconscious processes are reconverging. This commentary on Heather Berlin’s Target Article, “The Neural Basis of the Dynamic Unconscious,” discusses the current status of the study of the neural substrates of cognitive, affective, and motivational dimensions of unconscious processes. The current research is contextualized with some thoughts on the historical tensions between psychoanalytic and academic models of the mind. Recommendations for advancing both psychoanalytic and neuroscientific investigations of unconscious processes are proposed, with a focus on psychopathology and psychoanalytic treatments and processes in different types of pathological personality structures.