The New Wounded: From Neurosis to Brain Damage

Introduction

1 Introduction The distinction between diseases of “brain” and “mind,” between “neurological ” problems and “psychological” or “psychiatric ones,” is an unfortunate cultural inheritance that permeates society and medicine. It reflects a basic ignorance of the relation between brain and mind. — a n t o n i o d a m a s i o , Descartes’ Error: Emotion, Reason, and the Human Brain Cerebrality and Sexuality: Cause and Event I will allow myself to invent one word and only one: cerebrality. My hope is that such a barbarism will come to be accepted as the mark of a concept. Why introduce this word? It is necessary in order to construct the analogy around which my entire discussion will revolve. from sex to sexuality Freud, as we know, distinguishes between two related ways of understanding “sexuality.” The everyday understanding of sexuality supposes that it consists of a set of sexual practices and behaviors. The concept or scienti fic understanding of “sexuality,” however, upholds it as a law—that is, a specific form of causality. Such a concept would thus function as a regulative apparatus designed to organize the phenomenal dispersion implied in the everyday understanding of sexuality. 2 Introduction For Freud, the ability to elucidate how this apparatus works and to establish the causal value of sexuality within the domain of mental illness— especially the neuroses—constitutes a decisive advance and will become one of the bases of psychoanalysis. To elucidate the “sexual etiology of the neuroses ” is not to say that sexual problems, in the first sense, directly impinge upon the psyche—as if the latter were already constituted and incurred such lesions from the outside; it is, on the contrary, to underscore the necessary relation between such problems and the nature of psychic life itself. Psychoanalysis does not only study “noxae that affect the sexual function itself,”1 but also elucidates what destines or predestines these disturbances to become the styluses whereby the internal course of psychic life is inscribed. Psychoanalysis, then, is a matter of aligning the sexual etiology of the neuroses with a theory of events. According to scientific understanding, therefore, sexuality appears as the concept that determines the sense of the event within psychic life. from the brain to cerebrality In the same way that Freud upheld the distinction between “sex” and “sexuality,” it has become necessary today to postulate a distinction between “brain” and “cerebrality.” If the brain designates the set of “cerebral functions ,” cerebrality would be the specific word for the causal value of the damage inflicted upon these functions—that is, upon their capacity to determine the course of psychic life. The recognition of cerebrality, then, implies the elucidation of the specific historicity whereby the cerebral event coincides with the psychic event. Such recognition makes possible a cerebral etiology of psychic disturbances. If it is necessary to elaborate the concept of cerebrality today, it is because, insidiously but unmistakably, cerebrality has usurped the place of sexuality in psychopathological discourse and practice. Accordingly, this substitution is one of the basic reasons for the conflictual relation between psychoanalysis and neurology. The main purpose of my discussion will be to clarify the meaning of this substitution. love and the brain Although there are numerous signs that cerebrality has replaced sexuality, the relation between them has yet to be clearly articulated. All we have is Introduction 3 the vague ideological supposition that the “brain” governs “sex.” This substitution is thus expressed by recourse to the vulgar notion of an “erotic brain” at the root of all our pleasures, emotions, and suffering. Innumerable articles—published both in specialized journals and popular magazines—posit the brain as the organ behind “sexual chemistry.”2 Such developments suggest that the hypothesis of a specific sexual drive endowed with its own psychic representation has been ousted by the idea of cerebral sensibility or sensuality. All affects begin as neuronal or hormonal processes that have different effects but derive from the same source. The libido thus gives way to the vaguer notion of “appetite,” of which it would be merely one species. Accordingly, Mark Solms can declare: “Where Freud used the sexual term ‘libido’ to denote the mental function activated by our bodily needs of all kinds, modern neurobiologists speak of ‘appetites.’”3 The libido—in weak sense of sexual desire or pleasure—would be merely one manifestation among others of a neuronal dynamic...