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The Clinical Effectiveness of Psychoanalysis Today: Freud’s Living Legacy, Neuroscience, and the Brain with Dr. Mark Solms #91
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In this episode of Doorknob Comments, Fara and Grant are joined by Professor Mark Solms, a psychoanalyst, neuropsychologist, and pioneering figure in neuropsychoanalysis. Professor Solms discusses his new book, The Only Cure: Freud and the Neuroscience of Mental Healing, and explores what it means to translate Freud from the language of early psychoanalysis into the language of contemporary neuroscience. He brings a critical scientific perspective to psychoanalysis while asking what psychoanalysis can still offer modern psychiatry and brain science.
Listeners will learn about Freud’s pioneering work in neuroscience, and what inspired his shift toward psychological methods for understanding mental and brain function. The conversation explores why subjectivity matters, how feelings and emotional drives shape behavior, and how functionalist approaches to the mind can bridge psychoanalysis, neuropsychiatry, and contemporary neuroscience. They also discuss TMS, deep brain stimulation, neuroplasticity, psychedelic-assisted psychotherapy, and the need for an integrated psychiatry that takes biology, psychology, and lived experience seriously.
We hope you enjoy it.
Resources and Links
Doorknob Comments
https://www.doorknobcomments.com/
Dr. Mark Solms
https://x.com/Mark_Solms
Preorder The Only Cure at https://www.simonandschuster.com/authors/Mark-Solms/253231176
Dr. Fara White
https://www.farawhitemd.com/
Dr. Grant Brenner
https://www.granthbrennermd.com/
https://www.linkedin.com/in/grant-h-brenner-md-dfapa/
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Transcript
Introduction to Freud's Methods
00:00:00
Speaker
Freud, he was a kind of a kid in a toy shop because nobody had done this before. um He called it dissecting the function. And he said, um you know, I know that this method of dissection hasn't been used before, but I can see no harm in it. I'm literally quoting him. He said, I can see no harm in it so long as we do not ah confuse the scaffolding and the building.
Meet the Hosts and Guest
00:00:25
Speaker
Hello, I'm Dr. Farrah White. And I'm Dr. Grant Brenner. We're psychiatrists and therapists in private practice in New York. We started this podcast in 2019 to draw attention to a phenomenon called the doorknob comment.
00:00:38
Speaker
Doorknob comments are important things we all say from time to time, just as we're leaving the office, sometimes literally hand on the doorknob. Your knob comments happen not only during therapy, but also in everyday life.
00:00:49
Speaker
The point is that sometimes we aren't sure how to express the deeply meaningful things we're feeling, thinking, and experiencing. Maybe we're afraid to bring certain things out into the open or are on the fence about wanting to discuss them.
00:01:01
Speaker
Sometimes we know we've got something we're unsure about sharing and are keeping it to ourselves. And sometimes we surprise ourselves by what comes out.
00:01:12
Speaker
Welcome to the Doorknob Comments Podcast. We're joined today by Professor Mark Solms, a world renowned pioneer in mental health and neuroscience, a psychoanalyst and a professor of neuropsychology. He holds the chair of neuropsychology at the University of Cape Town and Grootschers Hospital's Department of Psychology and Neurology and is the training director of the South African Psychoanalytical Association.
00:01:34
Speaker
Professor Solms founded the International Neuropsychoanalysis Society and has published extensively in both neuroscientific and psychoanalytic journals. He's the author of eight books, including The Neuropsychology of Dreams, Clinical Studies in Neuropsychoanalysis, The Brain and the Inner World, and The Hidden Spring.
00:01:52
Speaker
Additionally, he is the editor of the revised standard edition of the complete psychological works of Sigmund Freud, as well as the forthcoming complete neuroscientific works of Sigmund Freud.
Connecting Freud to Modern Neuroscience
00:02:02
Speaker
Most recently, he is author of his newest volume, The Only Cure, Freud and the Neuroscience of Mental Health. Welcome, Professor Salms.
00:02:12
Speaker
So could you tell us, could you start by telling us a little bit how you got the idea for The Only Cure? ah Funnily enough, it was my publisher ah who said that um the appearance of the ah that Freud's complete psychological works, you know, this revised standard edition, they said it's um too good an opportunity to miss. I must write something about Freud.
00:02:41
Speaker
So um what they had in mind was something about translating Freud, which I thought was rather a sort of limited ah topic.
00:02:51
Speaker
and Probably there are five other people in the world in addition to me who interested in that. So I thought I would use the word translation more broadly. And um I would speak about translating Freud from the the the the language of psychoanalysis and the you know the early 20th century to the language of neuroscience in our own century. So that's what it is. It's an attempt to, how how does all of this stand up ah in light of how we think about the the mind today from a neuroscientific point of view?
00:03:27
Speaker
I think that's actually quite fascinating. and you know, I had been an analytic institute in New York for quite some time. And I think it's really, really refreshing to see someone sort of infuse the latest, you know, science and um research into a field like psychoanalysis.
00:03:53
Speaker
Well, thank you. and That's a polite way of putting it. and Another way of thinking about it is, you know, I'm trying to it bring a scientific perspective to psychoanalysis, which means necessarily a critical perspective.
00:04:11
Speaker
um And that's not always welcome. And then conversely, you know, I'm trying to bring what is valuable in psychoanalysis into neuroscience, which is also not always welcome. So
Freud's Legacy and Neuroscience
00:04:23
Speaker
ah although I, ah the you know, the guiding principle,
00:04:27
Speaker
principle of my writing this book was that I want to say what I really think is true. I was mindful of the fact that I might be losing friends on both sides of my interdisciplinary ah ah working life in doing so.
00:04:43
Speaker
It was interesting. i want One thing I i think Farah and I agreed beforehand is not to get too much into psychoanalytic politics. You know, having said that, um you know, because we don't know that listeners are super interested in the internecine bizarre battles, though, if you're a historian, it's very interesting. And you you chronicle very well some of those travails, you know, between Carl Jung and Sigmund Freud. and some others and you you allude, i think, to to others still like ah like Lacan.
00:05:16
Speaker
um And your your discussion of relational psychoanalysis made me smile, having trained in an interpersonal relational tradition. And, you know, I agree with a lot of those.
00:05:28
Speaker
sort of um observations that you made. I think what really comes out for me on the Freudian side and and having read Carl Jung and Sigmund Freud as a preteen interested in becoming a psychoanalyst in the 1980s, never really felt a strong kind of conflict. ah You know, you you helped to clarify that.
00:05:49
Speaker
um But what I think you really get at and what I want to ask about is you know, what is the essence of what Freud said? And you go through a lot of details where he defined the neuroscience that we use today and somehow his work, you know, has not been cited. So I think it's good that you're bringing light to that.
00:06:10
Speaker
um So I wanted to ask you about that particular piece of it, like the neuroscience that Freud actually discovered that has been unsung or unrecognized.
00:06:22
Speaker
Gosh, well, actually, that's a very big topic. So I will i will not be able to do it justice. I'll just ah mention a few headlines. To begin with, ah something of the the history in the sense of know how Freud transitioned from neuroscience to psychoanalysis.
00:06:39
Speaker
and it's it's not that he's he he became ah It wasn't a radical ah shift. ah He was still studying the same things. He was interested in how the instrument of the mind works. ah you know What makes us tick?
00:06:56
Speaker
ah How are we put together? ah Starting out as a very basic neuroscientist, he moved up the nervous system from from the single cell you know to to the the the cortex and and uniquely human functions, particularly language.
00:07:13
Speaker
And um in in trying to understand how language is organized in the brain, he started to bring psychological topics, ah psychological concepts to bear, because that's simply
Freud's Observations on Neurological Disorders
00:07:30
Speaker
necessary. you know If you study the aphasias, in other words, the disorders of language that arise from focal brain disease, um the way that language breaks down its It can only be described in terms of linguistic concepts.
00:07:45
Speaker
So, you know, he he started to use psychological theory and made a point of it saying, you know, you can't understand mental functions without using mental theories and and mental concepts and making observations about psychological phenomena.
00:08:02
Speaker
And then and around the same time, he was, as any neurologist is, he was seeing a lot of what we now call functional neurological disorders.
00:08:14
Speaker
And ah the the observation that he made, which is kind of like obvious in retrospect, was that the paralysis of the the patients um with functional neurological disorders, and I'll just speak of the paralysis to keep things simple, they don't follow the rules of anatomy. So for example, a person with a functional paralysis of the left arm, the paralysis starts at the shoulder and ends at the tip of the fingers, and it affects the whole arm equally.
00:08:44
Speaker
um in In other words, it's a paralysis of the idea of an arm, rather than the way that the arm is actually represented in the cerebral cortex. And so he started realizing that there too that you need psychological concepts to understand functional neurological disorders. Then came the problem that we had no methods for studying the living brain ah in those days. I'm talking about the eighteen ninety s So if you're interested in what's going on and in in the what I'm calling the instrument of the mind, which is a term he used, he also spoke of the apparatus of the mind, ah and you want to make observations and you want to test your hypotheses against further observations, the only method available was psychological. There were no neurophysiological methods. I mean, even the EEG you know hadn't been developed until the last years of Freud's life.
00:09:44
Speaker
So it was ironically, in order to be a proper scientist, that ah you know he he he made the shift to using psychological methods because he was now interested in studying these aspects of what could equally well be described brain function.
00:09:59
Speaker
mental function, brain function, same thing, as far as Freud was concerned. Ultimately, he wanted to discern the underlying workings, the underlying functional organization um of of these ah of these systems.
00:10:13
Speaker
um so he then You know, I think this was the truly pioneering step, was to try to study, try to discern ah the functional organization of the mental apparatus from a subjective point of view.
00:10:29
Speaker
That is, on the one hand, you know, putting him on very shaky ground methodologically. But on the other hand, my word, that's half of what we know about the brain, you know, is what it's like to be a brain.
00:10:41
Speaker
And there are things that you can only learn about ah from a subjective point of view. In other words, how do you feel? you know, feelings are rather important in terms of what we do.
00:10:54
Speaker
You can't explain ah what what you do. You can't explain behavior without reference to the subjective determinants of behavior. So it really was a very important step to try to incorporate into ah mental science in the broadest sense, neural mental science, um to try to incorporate what we can learn about this part of nature ah from the subjective
Freud's Early Discoveries and Neuroscience Today
00:11:20
Speaker
point of view. It surely must...
00:11:22
Speaker
that exist for a reason. you know why Why does it feel like something to be a brain? It's not just it's not just a nice to have sort of extra bell or whistle. you know it It surely does something.
00:11:34
Speaker
so So it was really important. And then, you know not to over-egg my answer, I will just say that from then onwards, Freud, he was a kind of a kid in a toy shop because nobody had done this before.
00:11:46
Speaker
um He called it dissecting the function. And he said, um you know, I know that this method of dissection hasn't been used before, but I can see no harm in it. I'm literally quoting him. He said, I can see no harm in it so long as we do not ah confuse the scaffolding and the building.
00:12:06
Speaker
you know So so ah he introduced functionalism, the idea that what we're trying to do is understand the function, and you can study it in its in its psychological realization, you can study it in its neurophysiological realization, you're studying the same thing. What we nowadays call memory systems, for example, it's not it's not a piece of tissue, and nor is it a thought or a feeling, it is an abstraction.
00:12:32
Speaker
And so Freud was trying to see what how can we, how how is this thing put together? The memory systems, the the um the drives, as he called them, in other words, the motivational systems, the executive system, what he called the ego, and so on.
00:12:50
Speaker
And so when I say he was a kid in a toy shop, I mean... He couldn't but make discoveries. Nobody had done it before. So, you know, the fact that he, in broad brushstrokes, ended up sketching, you know, how the thing works. I mean, very broad brushstrokes. Let's not overstate it You know, this was 100 years ago. But, you know, he he sketched the territory in a way that we then were able, from the other end of the microscope, as it were, you know to rediscover ah from ah from a neuroscientific point of view. And um the fact that to a large extent, the two um ah the two sets of conclusions in broad brushstrokes coincide with each other is not entirely surprising. I also don't think that there's a secret plot to write Freud out of history. I think we genuinely rediscovered these things, not even knowing that Freud had discovered them before. And the sorts of things I'm talking about, we can go into detail if you want me to, but I mean, you know, the embodied nature of of cognition, ah the the fact that there are these fundamental driving forces that we human beings, you know, whatever else we are, Homo sapiens is a species of animal. There was a shocking thought those days in Victorian times, but, you know, of course we are. And so...
00:14:09
Speaker
you know, this sort of thing. And Freud recognizing that large part of our cognition is unconscious. At the time that he said that, you know, it was considered an oxymoron to speak of unconscious mental functions, mental meant conscious. you mean What do you mean unconscious mental? And so on.
00:14:26
Speaker
So all of these things, we've rediscovered them and critical periods, the importance of early development, et cetera, et cetera. And now we're able to add a lot more precision.
00:14:37
Speaker
And and i'll I'll end this long spiel by saying, and let us not forget, there also are many mistakes that Freud made inevitably, as any ah pioneer with such rough and ready tools is is is is inevitably going to make. And so we mustn't overlook the mistakes too and where we have to correct him.
Critiquing Freud's Theories
00:14:56
Speaker
Very good points, I think. um And are there any ah sort of, more salient issues for you in terms of, you know, things that are easier to correct um just in terms of your own research and because, you know, you're such a pioneer in the field?
00:15:19
Speaker
There are two things that, are under the heading of what we've been talking about, there are two things which I think stand out in terms of what needs correcting.
00:15:30
Speaker
um One of them is, i mentioned the drives, in other words, the basic biological motivating forces Freud ah was very unsure as to how to classify, you know, how many are there?
00:15:44
Speaker
um but How many basic ah urges are there that we can call true natural kinds? And um he came up with one theory ah around about 1915. He stated it in its fullest form. Then he changed his mind completely. In 1920, he came up with another theory, a completely different classification. And there he said, look, you know, psychological methods are not best suited to discerning these basic biological forces. The future will, you know, doubtlessly, ah biology biology yeah of the future will doubtlessly, ah you know, correct me on the score. And my word, yes, we need to correct him on that score.
00:16:24
Speaker
So, The most authoritative taxonomy of the basic, what we now call the basic emotions, the natural kinds of emotional need, um is Jörg Panksepp.
00:16:36
Speaker
And if you follow him, ah well, there's seven, not two. Freud thought there were two ah basic ah motivational forces. Panksepp says there's seven.
00:16:47
Speaker
And ah if you accept or even just ah entertain um the the new taxonomy, it's inevitably going to make you look ah at, ah you know, if you think about what's what we are talking about, the basic motivational forces in our minds, it's not it's not a minor detail. You know, if if you change the taxonomy from two to seven, you know, you're going to see things very, very differently.
00:17:12
Speaker
The other thing that I don't know if it'll be obvious to everyone why this is so important, they might just think, you know, this is a detail, but it's not, in my opinion, is that Freud...
00:17:23
Speaker
ah Like everybody else, Freud was a neurologist. He learned you know the standard sort of things. One of the standard things ah is that consciousness is a cortical function.
00:17:35
Speaker
It's bound up with perception and cognition. And Freud followed that ah mainstream view, that consciousness is a top-down function. It's a cortical function. It has to do it's is fundamentally perceptual in nature. He said all of those things. And he also said, I'm just following the mainstream view. This is what we all know.
00:17:55
Speaker
and And I and a few others like Antonio Damasio and the aforementioned Yark Panksepp and others, you know, we strongly of the view that consciousness is not a top-down, cognitive, high-level thing. It is a much more fundamental, basic thing.
00:18:12
Speaker
brain stem, ah um it's it's it's a bottom-up, consciousness bubbles up um and irrigates the otherwise conscious unconscious cognition. if We sort of feel our way into our cognitions. So, um as I say, that that may sound quite arcane to many people, but it has all kinds of consequences.
00:18:34
Speaker
but While you're saying, you know, where we need to correct him, there's one other thing I must mention, when it and it has to do with this taxonomy of the drives. Thank you. And this part, and I hope I can articulate it clearly, but it's really, really important.
00:18:49
Speaker
Freud had a completely different understanding of sexuality from everybody else. you know freud Freud made this observation that there um and that they that there are things that we do sexually which don't seem to be ah in the um service of reproduction.
00:19:12
Speaker
So the the biologically speaking, what's sex for? It's for reproduction. ah And ah that's why such enormous pleasure attaches to it, because it rewards you ah for ah for for doing this funny thing. you know ah which Because if you do this funny thing, it'll produce babies, which is rather important biologically you know for the future, for the survival of the species.
00:19:36
Speaker
ah So Freud observed, but then why do we do so many things which can't possibly result in babies, and like masturbation, like foreplay, you know, like pleasure in in um in in in all all of these weird things that ah are plainly sexual under the headings of of ah perversions, you know, like fetishism and exhibitionism and and so on. mean How's that going to result in a baby? ah So, but it's plainly sexual.
00:20:05
Speaker
So, and and and ah and homosexual intercourse also can't produce a baby. And frankly, you know, why do we use contraception all the time? It's because we're hoping not to reproduce, you know. So his observation was that sex is not about reproduction.
00:20:22
Speaker
It's about pleasure. It's about pleasure for its own sake. And that's all of that sounds perfectly sensible, but then he goes further and he says, therefore, anything that is ah done solely for the purpose of pleasure, it must also be called sexual.
00:20:42
Speaker
And there's an a logical error. I mean, maybe you should maybe you should say it should all be called pleasurable. You know, what what why call it sexual? But he did. And therefore, he says, a baby suckling at the nipple who is no longer in need of nourishment.
00:20:59
Speaker
ah What is motivating it now is sexuality. ah We would say, and this is where it goes back to the taxonomy of drives, no, what's motivating it is attachment. ah that That is rewarding in its own right, being close to your caregiver, and it has all sorts of good biological reasons. But for Freud, it was sexual. For Freud,
00:21:20
Speaker
Eating chocolate because you like it, you like the taste, you know, rather than the the glucose that it gives you. That means eating chocolate for pleasure is sexual. Kids are squealing with delight on swings and roundabouts. That's sexual.
00:21:35
Speaker
And so that is a whopping great, confusing mistake, which I think brought Freud unbelievable problems, which were totally unnecessary. um And so I'll just say, and and this overlaps with my point about the classification of the drives, there are many different pleasures in the brain.
00:21:54
Speaker
One of them is sexual. And then there it when it comes to emotional drives, at least six other forms of pleasure. And there's no scientific reason to to to to conflate those other pleasures with sexual pleasures. they have different Those other ah pleasures have their own chemistries, their own circuitries. They're best seen. But Freud's point that we need to take note of the ah emotional motivations of behavior.
00:22:27
Speaker
In other words, that what drives the subject ah is feelings. You know, you want to do things that feel good and you want to avoid things that feel bad, not because of any underlying biological ah evolutionary determinant. All that motivates us is the feelings. And that is the kind of the the the dividing line between biology and psychology and is the the recognition, as I said at the very beginning, that subjectivity matters, you know, feelings do something. and ah And my word, you know, anybody who works with emotional disorders knows that people are driven by feelings and not always not always in their own best interests. And it's very hard to understand psychopathology without understanding that. So there you have it. Very long answer, sorry.
00:23:17
Speaker
now that that's What's important, you know, I think to the point of subjectivity and and studying subjectivity, and i've I've been giving this a lot of thought um for for a few different reasons. One is i I do mainly psychoanalytic work versus medication management. I have a very small medication practice.
00:23:38
Speaker
I do a fair amount of interventional psychiatry with transcranial magnetic stimulation um and consequently have like a different view of neuroscience than than i than I had as we do advanced techniques using functional MRI and specific patient-specific targeting and and then working with people and seeing how someone who's done pretty well in psychoanalysis works for several years within a few days of getting accelerated protocols with TMS completely changes their subjective inner world.
00:24:14
Speaker
And so I've been thinking a lot about how do we operationalize, you know, one's own experience. I think of it almost, and I'm curious what you think about this um in light of where consciousness comes from and and to Freud's point about an apparatus, um that the inner landscape is very much something we can understand through introspection. And psychoanalysis is a powerful tool for doing that.
00:24:40
Speaker
And particularly that we can do things internally when we have more choices. And toward the end of your of your book, you say in the end, only consciousness can free us from the hold of unconscious compulsions. It takes time and patience.
00:24:54
Speaker
Now, I've worked with people who have very strong complexes that are compulsive. You know, for example, feeling like there's a powerful inner critic who's been driving them um to work hard since a young age with a very strong survival flavor.
00:25:09
Speaker
And then after a couple of days of TMS, this personification of an inner bully or critic virtually dissolves overnight.
00:25:21
Speaker
And they're left with sort of more normal seeming anxious thoughts. And it's quite jarring. I would think of it almost as psychological whiplash that something that appeared to be an invariant fixture of the inner world can disappear so so quickly and so thoroughly.
Physiological Interventions and Mental Health
00:25:41
Speaker
Definitely um curious what you think from a neuropsychoanalytic point of view. Because you also have worked a lot and taught and discovered and developed ways of working with people with neurological problems. You talk about a number of interesting cases in The Only Cure.
00:25:58
Speaker
I think of these TMS responses as almost being like anti-lesions. And so all of a sudden, what is almost like a neurological obsession that something that is like a fixture of the inner world and really problematic and taken to be part of one's identity is gone um very quickly.
00:26:19
Speaker
I'm curious what your thoughts are on, number one, the general idea of you know learning to use what I ah kind of weirdly call our inner appendages and you know the motor aspects of that with where we pay attention with our consciousness.
00:26:35
Speaker
and then what you would think about something that seems so fixed um vanishing. you know And I know that Freud wrote about this quite a bit, you alluded to it, and also in analysis, terminable and interminable, he talks about some people being like soft clay and others being like hard stone, but people can work in analysis.
00:26:56
Speaker
And he says some people appear to have like a deficiency of entropy, even though they're younger. So i'm I'm curious what you think about this plasticity and how people can best navigate the subjective space, having you know studied Freud better than than anyone practically.
00:27:16
Speaker
Well, let me say two things to to this. um The first is that you don't need to persuade me ah of the truth of what you've just said. ah in in In other words, you know, that something that seems so ossified and rigid and immovable in its last of decades, you know, can can can be so dramatically changed.
00:27:39
Speaker
ah by way of a physiological intervention. Why I say you don't need to persuade me is because I have worked, I have been fortunate enough to work with ah Helen Mayberg in ah both Canada and the United States, ah and with Volker Kernan in Germany.
00:27:57
Speaker
ah Helen Mayberg is a neurologist, Volker Kernan is a neurosurgeon, and what both of them have done is deep brain stimulation in the treatment of chronic ah ah depression.
00:28:09
Speaker
And these are patients who have been through everything. you know They've had ECT, they've had every kind of antidepressant medication under the sun, they've had psychotherapy, et cetera. And then ah in a seconds, you know you insert an electrode in ah in an appropriate position. Helen Mayberg, it's in the subgenual ah anterior cingulate gyrus. And Volker Kernan puts it into them into the and ah medial forebrain bundle
00:28:41
Speaker
ah So she is getting at those opiodagic sort of panic so so de separation distress circuits and he's getting at the ah what's called the brain reward system or it's but better named a seeking system or a wanting system. And, you know, the patient, remember we're talking about burnt out, you know, really, really bad depression.
00:29:05
Speaker
but The patient suddenly says, Fulker-Kernan's patient says, I think I might go on vacation this summer, you know. Suddenly they've got a forward-looking mind with some optimism and hope and interest in the future.
00:29:17
Speaker
And ah Helen Mayberg's patients, it's like, gosh, I suddenly realized how much, you know, you you care for me. Thank you so much. I'm so grateful, you know, and they just suddenly feel loved and connected and so on. So these things happen.
00:29:30
Speaker
um Now, what's important? And so that's the first thing I wanted to say, you know, that what you're telling us about TMS, I've seen you know even more dramatic versions of it. um And, you know, so this is just a fact that these things happen.
00:29:46
Speaker
ah and And remember, I'm agreeing with you that these are things that have been there for decades and you change them in seconds. So um now's the second thing I wanted to say. It is absolutely essential ah that we have one psychiatry ah which can incorporate these sorts of facts, you know, that you can change somebody's mind literally, you know, with ah with TMS or DBS or or whatever.
00:30:13
Speaker
And you can also change somebody's mind through psychotherapy with nothing other than talking to them. You know, and this is the same mind, you know, that we we we were how things have been in the past. And this is really a pretty much what my working life has been about, is trying to get away from this past where it's like, you know, which football team do you support? Are you on the side of organic psychiatry or psychoanalysis, you know? And and ah our patients are not, you know, that's it's not doing the right, it's not doing what's best for the patient. We need to understand this this territory ah in an integrated way where both sets of observations and a align in us elucidating the the one and only ah mind. You know, in other words, how does this thing work? And it's again, it cries out for a functionalist model
00:31:08
Speaker
you're going to integrate physiological observations and psychological observations, you can't use either language. You need some sort of some sort of common ah currency.
00:31:19
Speaker
And I think that common currency is is the is the language of function. So we need to understand what are we doing to the underlying functional organization of the human mind ah when we when we do these physiological and these psychological interventions, and it has to be one seamless understanding. And I think that what's been sorely lacking ah in psychiatry, and I mean now in what is sort of stupidly called biological psychiatry, as you know as if there's a psychiatry that can By the way, I completely agree with what you're saying.
00:31:57
Speaker
yeah what's What's been lacking is any kind of theoretical understanding of how of how the mind works, you know, to have ah to just intervene at the level of molecules or receptors.
00:32:09
Speaker
ah without without any understanding of what you're doing in terms of the the full rich complexity of the mind and its development, I think is to do ah no justice to our field. And the same applies to psychoanalysts.
00:32:24
Speaker
If all that they ever... going to know and understand ah is what they hear sitting behind a couch of somebody saying everything that comes into their head. And don't use all the other knowledge that we've got in order to help us to understand, well, what does this all tell us? How does this thing work? I think that that's the main... For me, what you're saying, it points to the need for an integrated so psychological and physiological psychiatry, ah where we're all working on the same side in order to advance the interests of mental health care, ah in in other words, of our patients. And it's just so much more interesting. you know I don't know why anybody does anything else. It's fascinating. And we're making really great progress ah because we're doing what we should have been doing all along, at at least at at least since the methods became available. You know, I forgive Freud for using only psychological methods because it's all he had. But I i don't think it's forgivable anymore. um You know, and I mean, since the 50s, it's become increasingly unforgivable to stay on only one or the other side of the fence.
00:33:35
Speaker
yeah I find it ah confusing to put it politely and and the types of things I've seen in patients over the years and even people telling me, I wish I had known about this. I've been suffering for 10 years.
00:33:49
Speaker
They're recovered in two days, no wires, no brain surgery required. But understanding that over time is really what I'm interested in. And I wanted to come to the other part of what I asked is,
00:34:00
Speaker
how do you think about people kind of functionalizing or operationalizing their inner subjective world? And how do you how do you tie that to these objective things, right? Like we can see in studies of psychoanalytic therapy that motor changes, the people's behavior seems to be influenced through changes in the putamen.
00:34:22
Speaker
um With TMS, it seems to be related to the anterior medial cingulate cortex. There are these kind of networks of the brain that we can start to understand.
00:34:34
Speaker
But this subjectivity of kind of being in the cockpit of a human a human mind and body, um I'm curious how you speak to that very abstract question.
00:34:46
Speaker
Well, you said earlier, Grant, you know, that ah we we can gain access to what makes us tick through introspection. and And that's a very generous statement to me as a psychoanalyst, because sadly, there are enormous limits to introspection.
00:35:01
Speaker
ah You know, so you can so you can look inwards. It's a jolly good thing. I recommend it. Know thyself. You know, it's ah ah it's good advice to follow. Advice given thousands of years ago. But, you know, there's a limit to how well you can know yourself.
00:35:18
Speaker
ah And ah this is when I said earlier, Freud said there's a lot of mental functions that are unconscious. Well, here's the here's the point. You know, that there are things that motivate you that you don't know what they are.
00:35:31
Speaker
ah They're not accessible to introspection. And so so as much as I'm all for us taking a subjective perspective, I also think we need to recognize the limits. And then you start making guesses about what lies beyond, you know what lies behind. And that's where Freud hit that methodological um in a wall. So from the point of view of physiological methods, ah you mentioned FMRI fleetingly, positron emission tomography, all of these wonderful EEG technologies we have today, EMG, blah, blah, blah, all this stuff. You know you can observe with no resistance, There's nothing opposing you seeing what's there. you know So you can see the whole caboodle, ah the the physiological correlates of what is consciously accessible to the patient and the physiological correlates of what's not consciously accessible to the patient. And so you mentioned the putamen. I mean, that's just...
00:36:28
Speaker
One instance, um the things that we learn, and when I say what we learn, i mean, you know, the things that have influenced us over a lifetime.
Integrating Treatment Methods
00:36:38
Speaker
I don't want to be too cognitive about it I mean, the things that have happened to us, the the problems we've had to resolve, that the solutions we've come up with in the process, and they they they may have been... it ever so conscious at the time when we were little grappling with these things. And, ah you know, when we have traumatic experiences, they're ever so conscious at the time. But eventually, you know, the way in which we ah ah settle these and these troubles, the the way in which we resolve these problems, but they become
00:37:14
Speaker
automatized. In other words, with it's the best I can come up with. There's no point in thinking about this anymore. Let me just put this out of mind. That's what we do. And this is not me sucking something out of my thumb. I mean, it's the basic, you know, it's called consolidation, a systems consolidation. It goes from short-term memory into declarative long-term memory and from declarative long-term memory into non-declarative. In other words, can't be thought anymore.
00:37:41
Speaker
ah that That's what Freud called the unconscious. We now call it non-declarative long-term memory. And so there are things that we've learned, there are ways, there are solutions we've come up with in life, which are automatized, and they're automatized in the structures that that we're talking about. These subcortical memory systems, and the basal ganglia of which the putamen is a part, the The amygdala, which is a big ticket item, but it's a subcortical memory structure. The cerebellum, which the the psychological functions of which you know are only now coming properly into view.
00:38:17
Speaker
All of these structures... ah We have no introspective access to what they're doing, but they're doing a lot. And we can access those structures, not only, as I was saying, physiologically with these methods, we can visualize what's going on, but we can intervene in these structures. And that's what you're talking about.
00:38:36
Speaker
ah You know, you can directly intervene ah in in ah you you you mentioned, i think you mentioned medial ah prefrontal cortex, but But, I mean, TMS sadly has its limits in terms of what it can't get to. But, you know, now with these this new coil, you know, there's there's more that can be done. I think that there's going to be really big advances in in that field. I think you're in the right place at the right time.
00:39:05
Speaker
So, I mean, with TMS, for listeners, we can reach the surface of the brain. But what you can see is that deeper structures are activated through circuits and network changes.
00:39:17
Speaker
And so that area you described, SGACC, SG25, Helen Mayberg's area is hyperconnected. And TMS, when we use targeting, we treat an area of the cortex in the left dorsolateral prefrontal cortex, which has an anti-correlation with it,
00:39:35
Speaker
But a lot of these areas, they're not super deep, but you can't quite reach them with a magnet. There are things like transcranial focal ultrasound where you can stimulate deeper brain areas with with ultrasound, which you can focus it like the sun with a magnifying glass.
00:39:52
Speaker
But that subjective experience of having, you know, it's interesting. someone sees a dramatic change in themselves over the course of a few days, the understanding of that takes place over months.
00:40:05
Speaker
And it's almost an existential experience for people because I think what you're talking about in a way is the the material reality of the brain as an organ becomes evident in a very positive way, very different from you know if someone has a stroke and they lose function.
00:40:23
Speaker
um And very different from what you're describing if they have a functional neurologic disorder like the the stocking and glove you know paralysis, which doesn't follow the the way the nerve anatomy is.
00:40:35
Speaker
And you you do describe some very interesting experiments in the book around those types of phenomena. They used to be called conversion disorders um or somatoform dissociation where...
00:40:46
Speaker
the lack of awareness can be reversed with quite simple things like putting cold water in someone's ear. um But I'm afraid we're getting too far into the stratosphere with my own kind of desire. Before you move on, Grant, I know that, I mean, sadly, this field is so rich, we we we could carry on ah talking about any one bit of this for many hours. but But you said something there that I don't want to just skip over.
00:41:15
Speaker
ah which is that the, and this speaks to the integration again, you know, that it's not a matter, it's it's why should it be that our patients only get the one or the other ah treatment? So, you know, you're speaking about interventions which open windows of opportunity.
00:41:32
Speaker
TMS is one, deep brain stimulation, which is a radical intervention. I'm not saying everybody should be running off with deep brain stimulation. It's more proof of concept, you know, than a, than a, than ah a, scalable treatment ah know in in terms of real general public health care.
00:41:50
Speaker
But even Helen Mayberg, who's got no axe to grind, she's a neurologist, she discovered, she realized, she learned that her patients after DBS, they need psychotherapy because you've opened a window of opportunity that you then need to capitalize on. And the same applies to psychedelic assisted psychotherapy. I really worry about those who think that you know the future of this is just the psychedelics and skip out the psychotherapy. I think you know it's it's frankly, in some people's cases, it's dangerous ah to to take psychedelics and and not have somebody there to help you integrate what you became aware of, what you gained access to that you had that had previously not been available. So i think that we, again, you know it's not a matter of supporting football teams. We must work together And ah this is just obviously the way forwards. Sorry, I just needed to say that.
00:42:44
Speaker
I completely agree. and You know, that's that's part of what I'm working on in my practice is to put together these frameworks that really serve the patient. I think of it developmentally. um It's a developmentally oriented treatment. And within each patient's sort of optimal developmental trajectory, there's all these different things you can do at different times.
00:43:05
Speaker
And, you know, we just don't understand exactly how to sequence it on a personalized basis, right? It's hard to get an fMRI, right? You can do an EEG in in the office, but the EEG data is hard to understand yet.
00:43:17
Speaker
um And then we have things like functional near-infrared spectroscopy, which we can do in the office and see cortical activity. it's really it's ah It's a great time to be in the field in terms of what is available to help people.
00:43:30
Speaker
um And there's all kinds of terrible economic forces that you mentioned the word scalable. um and And it is interesting that these these neurologically based interventions have virtually no data for longer term therapy.
00:43:44
Speaker
It's only been studied in relation to short term therapies and plasticity windows. The cultural piece, I want to say before we shift gears, with psychedelics, I think is, to me, a source of consternation because people really confuse the the trip with the biological effect.
00:44:04
Speaker
And it's so overdetermined culturally because of the 1960s and LSD. But there's you know research on molecules that are one or two atoms different from LSD in animals that don't cause them to have a psychedelic experience, but still have what appear to be analogs of antidepressant effects. And certainly the commercial, what I will often call the ketamine gold rush, further confuses things and doesn't really serve people.
00:44:36
Speaker
beware magic bullets in general yeah I agree with that and I think what's interesting as I was training a supervisor once said that people sometimes can come to the right treatment at the right time um and I found let's say in my ah brief clinical experience so far, that that happens to be true a lot of the time. And if there's anything that we can do as clinicians, it's to partner with our patients and support that.
Solms' Personal Experience with Psychoanalysis
00:45:12
Speaker
um So they can be quite happy with psychotherapy and their results, um or they can be quite unhappy but attached to their therapist. And it's our job to help them distinguish, yeah, if you want to keep doing this because it feels good, that's fine. If you want to target certain symptoms, um then maybe we take a different path.
00:45:41
Speaker
I'm i'm i'm i'm ah very much aligned with what you're saying. know So shifting gears a little, one of the things I really loved about The Only Cure, and you know it's rare that I read an entire book and nowadays, and I highly recommend it um because it it really goes beyond ah what you're describing about talking about who Freud was.
00:46:04
Speaker
you You really get even more than I think in some of your earlier writings that ah that I've read anyway. it would be hard to read all of your writings, of course, um let alone write them. You talk about your own experience. And i was just blown away by your by your description of free association with with um with Clifford York at the Anna Freud Center. And um I love the idea of free association. I think it's a very compact algorithm.
00:46:31
Speaker
um It's such a simple recipe for psychotherapy and so elegant. And I'm wondering if you could speak to that fundamental rule of psychoanalysis a bit.
00:46:43
Speaker
So and just to explain what Grant is talking about is my own analysis, ah ah which I wrote about in this book ah with my analyst's name was Clifford York. So that that's who he is. Interestingly,
00:46:58
Speaker
as ah So, you know, Sigmund Freud's daughter, Anna Freud, set up this place called the Hampstead Clinic. And when she retired, my analyst took over from her. So I like to see, you see, there's only these three degrees of separation between Freud and me.
00:47:14
Speaker
um So he analyzed me. He was a very old school classical, you know, analyst. And ah so I had that kind of analysis where, you know, I lay on the couch five times a week. And, you know,
00:47:28
Speaker
and And was required, i mean, like absolutely required to say every single thing that came into my head. That's the method of reassociation. You don't select, you don't think what's relevant, you don't you don't try and make... connecting links that are logical or you know following a particular theme. And you also don't exclude thoughts which are impolite and you know and and the sorts of things you wouldn't normally say out loud. ah You're absolutely obliged in psychoanalysis of the classical sort but to say literally everything. Freud said it must be you know like if you're in a train,
00:48:08
Speaker
and you're looking out the window. You just describe everything that passes as ah as you as you look. So that's what you do. You look inwards and you just describe everything that that comes into your head.
00:48:20
Speaker
The and a rationale behind that is that, well, first of all, obviously, you're going to reveal more than you would if you were selecting. you know So you're get you're giving an unselected you know true cross-section of what's really ah on your mind. But also because it's unselected, the the underlying structure, the implicit structure that's organizing this explicit surface slowly emerges. So that's the idea. Because we not we don't have access to those underlying organizing principles that I was speaking about earlier, the things that you know the limits of introspection, and you you just give this random ah sample of of what's on your mind, ah unselected, uncensored, unselected,
00:49:11
Speaker
uninhibited as far as you can bring yourself to do it. And then the analyst's job is to say to you, well, it seems as if these things connect in this way, you know, that, yeah, we seem to have an underlying theme. This seems to be a recurring underlying theme in your thoughts. You know, it seems this thing seems to be a major principle in what puts you, you know, what what what joins the dots for you. in and other words, how you've been put together.
00:49:36
Speaker
And it's an extraordinary, extraordinary revelation. You know, and ah I must say i was not particularly mentally unwell. ah It's ah a very, um you know, it's ah it's ah it's a method that I think has its limits, you know, as ah as a therapy. You know, it's ah it' ah certainly educational. You learn darn side more about yourself than you might want to. You know, so I i really, it's an education. that that ah I i ah greatly value the fact that I was able to literally unpick you know the the the kind of tapestry of of how I'm put together and then slowly put it together again with fewer knots and you know and ah and so on. So so that's what what I did. but
00:50:28
Speaker
you know I don't know what else you're wanting me to say, Grant. I'll just say this, that that um ah the the the the fact that it is so very difficult to actually... i mean, even as I was writing the book, I thought, gosh, you know... I'm not sure I want to tell these readers what came out in my analysis.
00:50:49
Speaker
And and that that says a lot. you know it's It's like one of the basic things about the nature of the mind is that there are things that we don't want to know and we don't want others to know about what really goes on inside of us.
00:51:02
Speaker
And ah so, you know, these are basic, basic Freudian discoveries about things that he called a resistance and defense and, you know, and and the way we disguise things and censor things, even to ourselves.
00:51:15
Speaker
So ah to to have um as best ah a a picture of what it is, as I said, know thyself is a very valuable ah piece of advice. and ah but but But it's not for everyone. you know That's why I'm saying i i wasn't particularly unwell.
00:51:33
Speaker
I think that if I was in dire straits, I don't think I would be able to use that method. And I don't think I'd be able to wait for so long. I would need a more ah urgent and symptomatic sort of intervention. ahead. Sorry. Sorry.
00:51:47
Speaker
go ahead sorry Well, I think it's a bit psychedelic also. free association is a little bit trippy in a way, right? It's a high entropy thing and it's not for everyone. And, you know, certainly some people will discover things about themselves that are destabilizing. They're not ready to know, right? There's the idea of the premature interpretation. um i found it, I found it, uh,
00:52:09
Speaker
some sympathetic cringe kind of reading some of what you wrote, which I think should make people want to pre-order the book also. um And I thought of my own analysis on the couch and I've got five five generations down from Freud, so I can i can relate with that feeling.
00:52:26
Speaker
I find myself wanting one to hear what Farrah thinks and what what you're wanting to learn about and while also wanting to ask who your favorite sort of cases were because the book is rich. just re-associate for us, Farrah.
00:52:40
Speaker
I don't know. i want that tape. Yeah.
00:52:45
Speaker
um But I, yeah, it's, you know, what's interesting and what you didn't mention is that it's a really challenging thing to do. And I think that unless people try to do it, they really don't know um how difficult it can be.
00:53:02
Speaker
ah Whether, it to me, it doesn't matter how much or how little they trust themselves or the other person. um their analyst, it there are, you know, so many barriers, I think, to freely associating.
00:53:18
Speaker
so It's not very free. they talk We talk about it as an accomplishment, not a given. And I don't really, you may know this, um are there any studies of the neuroscience of free association over time, the way people have studied meditation and stuff? Because I think that would be worth doing.
00:53:38
Speaker
You know, it's it's a ah there's um unfortunately, this is a sign of my age. There is a colleague who's busy studying it right now, in fMRI studies of free association, as opposed to general, just mind-wandering in general, and whether it's in a clinical context or not in a clinical, I can't remember his name, ah but, but ah you know,
00:54:02
Speaker
There's so much low hanging fruit. It's kind of extraordinary that that only now is anybody doing proper neurophysiological studies of reassociation.
00:54:13
Speaker
psychoanalysis in general. I mean, I was actually shocked. There aren't many interventional psychoanaly interventional psychiatrists who are psychoanalysts.
Psychotherapy's Effectiveness and Benefits
00:54:21
Speaker
I might, I'm sure I'm not the only one, but what I found speaking at conferences to technologically oriented people is they are fascinated by the psychoanalytic aspect of it and the idea of you know studying things like reflective function after interventions.
00:54:36
Speaker
um But again, um i'm I'm conscious of the time um And I kind of desperately want to know about ah Prince Friedrich III of Psalms Barath. And you talk about him quite a bit in the book, and I'm wondering how he plays in Yes. So um what this ah refers to, you know, in in the book, I go through various ah different um topics. And right at the end, and I look at ah the question of, you know, what are the implications? Given what we've gotten to know about, and let us be aware of ah the arrogance of the present. I don't think we now know how it works. You know, I think that we know a hell of a lot more than we did before
00:55:24
Speaker
So at the end of the book, I said, okay, so if this is how it works, so this is how ah but our current best understanding, you know, of how the human mind is put together in health and disease, ah you know, then what are the implications for society, for culture, for, you know, ah on on the larger scale?
00:55:42
Speaker
So it's in that chapter that I mentioned, this distinguished relative of mine. um He was um very a privileged ah a chap in in Germany. And with the rise of Hitler, he thought that you know he could say what he thought. And and you know he was so he was like the equivalent of a modern oligarch. you know he could just He could get away with with murder What is it that Trump literally said that, that he could stand and fit shoot somebody in Fifth Avenue and he'd get away with it? I think this relative of mine probably felt like that. and know He was so immune because of his so his status. But you know the world and of Germany was rapidly changing. And... um
00:56:27
Speaker
So eventually a number of colleagues of his, um senior military people, um had ah they they got together in his home and and plotted ah ah to assassinate Hitler.
00:56:43
Speaker
And I'm sure many people, because there was a film about it, you know, the Valkyrie plot. I'm sure many people know it it ended up not working. ah they They didn't ah manage to kill Hitler.
00:56:57
Speaker
And in fact, ah most of them ended up being hanged or forced to shoot themselves and so on. So so this relative of mine was a central member of that a plot.
00:57:09
Speaker
And so why I write about him is to, is to ah i mean, amongst other things, it is to ah use him as a kind of a ah um ah point of entry into questions like, why do people, if we are you know animals, ah species of animal, which ultimately you know what's designed us is natural selection and you know whatever is necessary for survival and so on, why do people do things like that? you know to Take such a risk.
00:57:41
Speaker
ah you know to to do this noble thing of trying to assassinate Hitler, putting themselves literally in the… you know it it was It was called the Wolf's Lair, was Hitler's headquarters, you know going into the lion's den you know in order to do this thing which was for the greater good.
00:58:03
Speaker
um And ah then the other way in which I used that story was to think about ah what ah what happened afterwards, because most of his friends were hanged ah ah or forced to shoot themselves.
00:58:21
Speaker
He, because he had such a valuable property, um the Himmler, the head of the SS said, if he signs over his properties ah to to Himmler, you know, then he will let him go and as long as he leaves Germany in 24 hours, which he which he did.
00:58:39
Speaker
Signed over his property and left within 24 hours and came here ah to South Africa, where I'm speaking to you from. And ah then he developed prostate cancer and he refused treatment and he was dead within 18 months. And so it's it's about survivor's guilt and and all of that. and you know yeah i was also ah wanting to, ah you know ah why do people ah take these do these altruistic things? Why, if we are biologically motivated animals, you know why do we do things like kill ourselves? In effect, that's what he did out of out of guilt and shame of having survived when all of his friends didn't.
00:59:23
Speaker
So and these are the kinds of things that i deal with right at the end of the book. And again, you can see why we need a psychological psychiatry alongside ah a biological one. mean you know how How does one begin to approach these things without psychological concepts? um And so there you have it. Wow. I mean, such a fascinating story. and um I think, you know, this book is a huge contribution to the field as it stands now and also to the future.
01:00:00
Speaker
Really, hopefully we'll forge a new path for people in training. And I know for a fact that it's available because i just pre-ordered two copies this morning before we ah got on onto the call. So, yeah, any sort of final thoughts from either of you?
01:00:21
Speaker
Well, I would like to mention a part ah ah i around the middle of the book where I look into the evidence ah for the efficacy of psychotherapies in general and and psychoanalytical psychotherapies in particular, because i need to just restate, you know we need to integrate all of these. We're all in the same boat. you know So I don't think only one form of psychotherapy works. We have to and understand how do they, of so many different forms work and what works for whom and why and so on. But leaving aside all of those complexities for now, I just want to make ah ah known that a central part of the book is going through the randomized, you know controlled, double-blind trials, with rigorous tests of the effectiveness and efficacy you know of these treatments. And they really do a hell of a lot better than most people will imagine. Psychotherapy is an extremely effective form of treatment.
01:01:27
Speaker
And um then it's also a matter of, you know, what is symptomatic treatment as opposed to what is causal treatment? I mean, is that symptomatic relief, ah anybody who suffers knows symptom relief is great. You know, let's not let's not um underestimate the value of symptomatic treatments. And sometimes they're lifesaving, even in psychiatry.
01:01:51
Speaker
um You know, so so it's it's terribly important that we have a full armamentarium of treatments. But ah psychotherapy, and in follow-up studies, so after the treatment is is finished, you know, the fact that especially in psychoanalytical psychotherapies, we have this thing called the sleeper effect, where the patient not only maintains their symptomatic gain, but they actually get more better after the treatment, which shows that something has...
01:02:21
Speaker
being triggered in the by the process of the treatment, which carries on being efficacious after the end of the treatment. And I really, I think it's one of the best kept secrets in in in in in public healthcare, you know, that psychotherapy is a very effective form of treatment. Now it's time consuming and it's expensive,
01:02:41
Speaker
So, you know, this is these are strokes against it. I don't think that we can ah deny that a treatment that is shorter and cheaper has a certain appeal as opposed to a treatment that's longer and more expensive.
01:02:57
Speaker
But I don't think that we should conflate the two issues, you know, in terms of what is the most cost effective is not the same question as what is the most effective. And I think even from a purely scientific point of view, leaving aside the public health aspects, we really do need to know what is most effective and why. Then we can start looking at, well, how can we deliver that particular ingredient you know you know in more in a more um scalable fashion? So so the results...
01:03:29
Speaker
ah of and And while I'm on this particular hobby horse, I need to also say, let us not forget that psychoanalysts resisted measuring the effectiveness of their treatment for years. They said, you can't measure these things and blah, blah, blah. you know And they got egg on their faces because then the word evidence-based meant not psychoanalysis. you know But finally, we have an evidence base for psychoanalytical therapies. And it's really something to be pretty darn proud of. So I want to draw attention to that part of the book too. Thank you.
01:04:00
Speaker
Yeah, yeah the the research review is really good. Farah, I know you're pressed for time a little bit. The effect of longer-term therapy, psychodynamic and psychoanalysis, carries on after the therapy ends, which leads me to believe that it is a developmental experience, right? It alters developmental trajectory. It's not just sort of therapy therapy.
01:04:23
Speaker
It's almost like a different class of experience because it has a developmental impact. And the economics, by the way, and everyone, I think, can can look at this data, is actually more favorable for longer-term therapies because they save vast amounts of money in the future because there's reduced psychological and medical morbidity.
Conclusion and Contact Information
01:04:44
Speaker
And so there was a study in Lancet, I think in even 2016, I want to say, where they found for every dollar spent on mental health care, it saved three to six dollars down the road. um But, you know, people think about the next quarter um profit margins only, which, you know, maybe for another time, I don't know if Freud...
01:05:08
Speaker
had much to say about the short-term versus long-term thinking, except that we all seem to be perpetually stuck in survival mode. Very good. Yeah, such a wonderful conversation. And again, thank you so much. It's always delightful to to talk with you. um Where can people find you? ah What's the best way for them to learn about your work? And um So, well, you can find me personally. I don't have a website, but I am on X Twitter, at Mark underscore Solms. And the Neuropsychoanalysis Association ah has a website ah where all of the you know latest events and and and educational things that are available are are are accessible there.
01:06:00
Speaker
ah But if anybody wants to get in touch with me directly, either follow me on Twitter, on X Twitter, or, you know, these days I've discovered you can get email addresses at the push of a button. So I don't mind being emailed. Great. Well, that's very good. Thank you, Professor.
01:06:22
Speaker
here Thank you so much. Thank you. Remember, the Doorknob Comments podcast is not medical advice. If you may be in need of professional assistance, please seek consultation without delay.