The New Wounded by Catherine Malabou

The New Wounded: From Neurosis to Brain Damage (Forms of Living) BY Catherine Malabou. Fordham University Press. Paperback, 272 pages. $29.
The cover of The New Wounded: From Neurosis to Brain Damage (Forms of Living)

In the 1600s, French philosopher René Descartes split the world into two kinds of stuff: material stuff subject to the laws of physics and immaterial stuff that operates according to some other set of rules. He argued that the human body is material but the mind is immaterial, relegating it to what the British philosopher Gilbert Ryle famously called “a ghost in the machine.” But even Descartes, years after articulating his theory of the mind-body divide, amended it to suggest that the physical brain might act as an intermediary between the two. In his revised theory, the “spirits” of the mind worked on the tiny, almond-shaped pineal gland, sending messages through the brain, which issued commands to the rest of the body. Modern neuroscience has shown this amendment to be false (we now know the pineal as an endocrine gland that secretes hormones), but Descartes’ dualism is still deeply, some would say perniciously, embedded in the language we use to talk about brain and mind.

Catherine Malabou’s new book, translated from the French by Steven Miller, addresses this old divide by attempting to bring brain and mind together under a conceptual framework that merges the disciplines of neuroscience and psychoanalysis. Malabou is a professor at the Centre for Research in Modern European Philosophy at Kingston University, and she has a reputation for borrowing concepts from both brain science and psychotherapy. In What Should We Do With Our Brain she argued that we have failed to understand ourselves because we have failed to acknowledge recent scientific discoveries, particularly “plasticity,” or the brain’s ability to change (“Our brain is plastic, and we do not know it”). In The New Wounded, she uses the lessons of modern neuroscience, particularly those drawn from soldiers wounded in combat, to redefine “trauma” in a way that forces us to reconsider the concept of “self” and the broader socio-political implications of suffering.

Malabou’s “new wounded” are those who suffer the kinds of wounds that psychoanalysis tends to avoid: ones resulting from brain lesions, battleground trauma, or Alzheimer’s. While Freud disregarded cases of obvious brain damage and focused his considerable attention on wounds he saw as originating from a damaged psyche, Malabou, in contrast, forces an investigation of the mechanisms by which brain and psyche are linked. Since Freud’s time, neurology has proved useful for both understanding and treating brain disorders, but it has not offered a conceptual framework for understanding the everyday workings of the mind. At the same time, many have argued that psychoanalysis is looking a bit rickety in the light of modern neuroscience. In order to move forward, Malabou argues, we need to reconcile these two disciplines: “nothing less would be required today than the complete theoretical reinvention of psychopathology.” While Malabou carefully avoids exploring “new therapeutic possibilities,” this is the rare work of philosophy that may have clinical implications.

To make her case, Malabou offers insightful readings of Freud, then ushers a clique of eclectic voices into conversation—from neuroscientist Antonio D’Amasio to psychoanalyst and philosopher Jaques Lacan to the military psychiatrist Louis Crocq. Her orchestration of sources is impressive, but to say that this book is not an easy read is like saying the Atlantic is not a quick swim. Malabou studied with Derrida (with whom she also co-authored a book), and seems to have taken cues not only from his continental style but from the inscrutability of his prose. Her sentences often descend into a thicket of jargon from which a reader, especially one not versed in Freudian theory, may find herself hard-pressed to extract meaning: “The cloven structure of sexuality, the “screen” of the “libido theory”… enlarges the signification of etiology.” To be fair, this is an English translation of a French philosopher working with a German conceptual framework, but if you’re looking for a lucid explanation of Freud and an engaging contemporary critique of his theories in light of modern neuroscience, I suggest you turn elsewhere. If you’re looking for a meaty slab of philosophy marled with neuroscience, pull up a chair, have a seat, and be sure your knife is sharp.

The book is carefully constructed as a three-tiered argument that is perhaps best understood through two terms: “destructive plasticity” and “cerebrality.” While Freud traced the cause of all mental dysfunction back to what he called “sexuality,” Malabou attributes it to what she calls “cerebrality.” A slippery term of her own invention, “cerebrality” describes the relationship between brain damage and psychological dysfunction. “If the brain designates the set of ‘cerebral functions,’ cerebrality would be the specific word for the causal value of the damage inflicted on these functions...” Malabou is not proposing a one-to-one mapping of brain to mind—the reductionist project Freud decried as hopeless—she is trying to establish a functional relationship between the two.

Malabou first marshals scientific evidence demonstrating that the brain has self-regulating circuits involved with emotion. Freud argued that because the brain cannot self-regulate, there must be some “extra-neuronal” system to help it deal with trauma. But scientists such as Joseph LeDoux and Antonio D’Amasio have shown that the limbic system, a series of interconnected brain areas that engage in emotional processing, can self-regulate its activity in ways that might have surprised Freud. Damage to this system impairs patients’ ability to feel emotion and make decisions tempered with emotional insight. Malabou points out that all trauma—whether it includes a direct injury to these brain areas or not—results in dysfunction of the limbic system. Patients display “coolness,” disaffection, and indifference. She uses this observation to argue for “an emergent, globalized psychic pathology that is identical in all cases and all contexts.” In other words, people traumatized by political violence all around the world share the symptoms of limbic system dysfunction. According to Malabou, our new understanding of the brain both renders Freud’s idea of “sexuality” as the cause of psychological dysfunction unnecessary and blurs the boundaries between politics and biology.

In order to shift traumatic etiology from “sexuality” to “cerebrality,” Malabou turns to the traumas inflicted by war. At the start of the 20th century, “war neuroses” manifested in symptoms such as memory loss, confusion, tics, and paralysis were considered “neurotic” responses to psychological stress. Modern medicine, however, has come to understand war wounds such as PTSD and traumatic brain injuries as originating from the traumatic event itself, not from an individual’s particular psyche. For Malabou, the association of psychological problems and physical wounds demonstrates “the impossibility of confusing traumatic factors and psychoneurotic factors.” This conclusion is meant to be applicable to all “wounds” of “traumatic accident,” including diseases that senselessly attack the mind, such as Alzheimers.

The second crucial term elucidated in this book is “destructive plasticity”—the creation of a new identity through destruction of the old one. It is almost as hard to pin down as “cerebrality.” How can we say that a person’s identity is totally erased by trauma? In anticipation this very question, Malabou reaches for wounds on the farthest end of the severity spectrum. Here, she quotes Crocq:

If we ask patients about their experiences of these changes of personality, we observe that this is no metaphor. The patients find themselves equally changed; they no longer recognize themselves as they were before. And this is not simply due to the fact that they are sad about having undergone a difficult event; it is, more profoundly, on the level of their entire way of living, that they come to realize that a new being is within them, a being whom they do not recognize.

The idea is that the dysfunction that follows trauma cannot arise from meaning buried in that old, obliterated self. The old onion of the psyche, with its layers upon layers of meaning, is simply not there to peel apart in analysis; rather, it has been replaced by a new self, which requires a different clinical approach. Malabou seeks to redefine not only traumatic etiology but also to radically revise our understanding of the injured subject.

Although the project of uniting psychoanalysis and neuroscience under a single conceptual banner is promising and perhaps even necessary in light of what we now know about the brain, Malabou’s new framework raises more questions than it answers. For instance, while patients with brain injuries often talk about an “old me” and a “new me,” they generally experience some sort of continuity between the two. Childhood memories may remain unaltered, and if those memories belong to the “old me,” what does it mean that the “new me” still lays claim to them? And how might “destructive plasticity” help us understand what happens in cases where the traumatic event is more subtle? Is identity destroyed and a new one created in cases of concussion, also known as minor traumatic brain injury? And what about damage that occurs over time, as in Alzheimer’s? When can we say the old self is gone and a new one present? It seems one might argue for a difference in degree, not kind.

While modern neuroscience has shown that a group of neurons firing in a particular pattern can also be described as a certain feeling, is still far from articulating the relationship between the brain and the subjective experience of the mind. Within the discipline, this falls into the category of what is known as a levels problem. Scientists can describe, in great detail, what happens on a number of different levels—the molecular, the neuronal, the behavioral, etc.—but they often can’t connect the activity on one level to the activity on another.

An act of translation from brain to mind is the holy grail of much scientific research, particularly in the nascent fields of neuropsychology and neuropsychoanalysis that Malabou so admires. In most scientific circles, it is now understood that Descartes was wrong: the brain somehow is the mind. But how this happens remains a mystery. With her new terms, Malabou is trying to offer a bridge from one level to another, but in the end, it seems she is stuffing theory into the old gap rather than actually building a bridge, or better yet, shining light into the chasm to show us that it’s simply a shadow created by our own limited imaginations.

Meehan Crist is Resident Writer in Biological Sciences at Columbia University. Previously, she was reviews editor at The Believer and her work has appeared in publications such as The Los Angeles Times, Lapham’s Quarterly, The Believer, N+1BR, Bookforum, Scientific American, and Science. She is currently at work on a nonfiction book about traumatic brain injury.