So wrote Professor Steven Rose in a recent book review for the Sunday Times Culture section (7 April 2002: p.41). He continued:

Can this be true? Are not the newly forged investigative tools of cognitive neuroscience, from beautiful colour-saturated brain scans on the one hand to impenetrably complex computer simulations of mental functioning on the other, serving notice on the mythical melodramas of Freudian and Kleinian theatres of the mind? Let us confine ourselves to the facts. And in the opinion of many, it is a fact that the ‘internal world’ is a world composed of neurons, not the dynamic unconscious.

But the modern era of scientific investigation affords an opportunity to think afresh. Perhaps we should heed those voices from the past enjoining us to adopt a truly bio-psychosocial view of the mind and its disorders, encompass a broader sweep of evidence, mobilise our faculties of critical judgement... and be prepared to change our ways of seeing things.

FORMS OF FACT

It is easy to understand how researchers and clinicians committed to particular methods of investigation find it difficult to consider evidence from seemingly alien approaches to studying the mind. It is no wonder that revolutions in the scientific zeitgeist are sporadic and often stuttering: Kuhn's (Reference Kuhn1970) paradigm shifts are messy affairs. In studies of the mind, as in other fields, the forces for change in theoretical orientation are likely to be various and often personal. Yet for all this, it sometimes happens that a particular observation or finding can jolt one's mind into adopting a new frame of reference. A way of thinking that had seemed strange or awkward can suddenly become familiar: phenomena previously beyond the pale of explanation suddenly fit into place. New facts, or new kinds of fact, move to occupy centre stage.

In the domain of conventional science, research on early attachments has led the way in turning minds towards psychoanalysis (Reference FonagyFonagy, 2001). Systematic studies of the origins and developmental implications of separation—reunion reactions in infants have demonstrated the far-reaching significance of early-established patterns of relatedness and relationship in human beings. The advent of the 1985 Adult Attachment Interview (further details available from Professor Mary Main, Psychology Department, University of California, 3210 Tolman Hall #1650, Berkeley, CA 94720-1650, USA) has advanced the analysis of those patterns in terms of strategies that maintain individuals' emotional equilibrium in the context of mentally represented relationships. Here is rich cross-fertilisation between attachment theory and psychoanalysis, and all to the good for developmental psychiatry.

But I want to dwell on another example of mind-stretching, and return to Steven Rose's point about the bridge between contemporary neuroscience and psychoanalysis.

NO MAN IS AN ISLAND

The example concerns very basic psychological processes that occur between people. Over two decades ago, publications by Meltzoff & Moore (Reference Meltzoff and Moore1977) alerted the scientific world to a startling fact about newborn babies: they can imitate the facial and manual actions of other people, actions such as mouth-opening, tongue protrusion and finger movements. It seems that infants have an inborn propensity to ‘match’ their actions and expressions to other people's bodily gestures. A recent neuroscientific gloss on this discovery is that in the premotor cortex of macaque monkeys there exists a type of cell — the mirror neuron — that fires during the execution and observation of mouth and hand actions (Reference Gallese and GoldmanGallese & Goldman, 1998). Functional magnetic resonance imaging with human subjects has provided corroborating evidence for a mechanism directly mapping observed actions onto internal motor representations of those actions (Reference Iacoboni, Woods and BrassIacoboni et al, 1999). In other words, we primates have ways of perceiving others' actions — and, by extension, expressions of subjective states — that recruit our own tendency to enact or experience those actions or states ourselves. Minds mirror one another.

When it comes to prompting people to think creatively about human psychology, a neurofunctional picture can be worth a thousand psychoanalytical words. The ‘mirror neuron’ perspective on social co-action may be simple, but behind it looms another, more-subtle vision of interpersonal coordination: perhaps human beings are in a state of constantly shifting identification with each other, as the forms of one person's own activity and attitude influence those of someone else. Controversial, yes — but implausible, no. Just as our brains are linked with each other through the activity of neurons, so our minds are linked through an interplay of subjective states (Reference Trevarthen and AitkenTrevarthen & Aitken, 2001). In the words of John Donne, ‘No man is an Island, entire of it self’. Set this simple but profound fact in the perspective of early development, and the social transactions that shape children's earliest representations of themselves vis-à-vis other people, and one arrives at a view of mental functioning that gives the interpersonal dimension new prominence.

My point is not that the developmental or neuroscientific evidence establishes the truth of psychoanalytical propositions about the pervasiveness of identification in the emotional transactions between one person and another. Nor does it justify claims about the role of such processes in the development of personality. Rather, such evidence prompts critical re-evaluation of psychological theories that are predominantly individualistic on the one hand or imperialistically cognitive on the other. It suggests a foundational role for a system of self in relation to other. We may need to recognise that for certain purposes — not least, for explaining how people develop abnormal states of mind, and how they come to reflect upon their own and others' mental states — the appropriate unit of analysis for psychological science may be two or more persons in relation to one another (Reference Vygotsky, Hanfmann and VakarVygotsky, 1962; Reference HobsonHobson, 2002).

PERSONAL MEANINGS

This leads to another important fact about the facts that we are seeking. We should not suppose that, in the genesis of psychopathology, physical causation takes primacy over the role of meaningful connections or that biology always drives psychology. As Michael Rutter (Reference Rutter, Lenzenweger and Haugaard1996, p. 229) has put it, ‘causal arrows run in both directions’. From its inception, psychoanalysis has been intent on tracking the pathogenic reach of personal meanings — a worthy, sometimes heroic, aim. But if we are interested in understanding subjective meanings and their role in the origins and expressions of psychiatric disorder, then in my view we need to measure intersubjective engagement and exchange among people. In particular, if we are pursuing the roots of psychopathology, we shall require a keen eye for those forms of subjective and intersubjective experience (and behaviour) that appear early in development and seem to provide a kind of bedrock for subsequent relations with other people and attitudes to oneself.

There are several ways to uncover facts of these kinds. One route is clinical, by tracking the interplay of subjective states between patient and therapist, and seeing how certain modes of emotional exchange serve defensive functions and contribute to the patient's difficulties. But the status of such evidence is controversial, to say the least. Some years ago, I submitted a clinical paper to this very journal. Much of the evidence for my thesis came from examination of transference and counter-transference phenomena in the supervision of psychotherapy cases. The then Editor's rejection letter contained only one referee's report, the conclusion of which read as follows: ‘Dr Hobson piles hypothesis upon hypothesis, and I cannot see a single fact, nor even the semblance of a fact, to support his assertions’.

So we need other, less contentious ways to determine the facts. It remains the case that intersubjective facts will reveal themselves only if we are searching for them in the right place, and if we are applying appropriate tools of thought.

THE ART OF FACT-FINDING

How, then, can one measure ‘intersubjectivity’? There is only one measuring instrument that can do the job: a human being. We need to study interpersonal transactions with the discipline and rigour required by science, but at the same time with the full range of emotional and intellectual equipment required to make refined judgements about qualities of intersubjective engagement. The problem, of course, is that such judgements can easily become ‘subjective’ in the sense of idiosyncratic and untrustworthy.

Fortunately, science has a technique for distilling objectivity out of subjective appraisals: interrater reliabilities in judgement. Here is a method by which we may transcend polemics that denigrate the psychoanalytical method for ‘rest(ing) on speculation and subjective insights, not on objective examination of public and repeatable phenomena’ (A. C. Grayling, Guardian Review, 22 June 2002: p. 4). A second approach is that of systematic, qualitative analysis of people's accounts of their experiences (Reference Smith, Jarman, Osborn, Murray and ChamberlainSmith et al, 1999). We can even bring these methods to bear on putatively primitive modes of mental organisation and interpersonal experience characterised by Kleinian psychoanalysts — to establish whether or not they are merely fanciful constructions.

This is what my colleagues and I attempted to do by inviting independent raters to make clinical judgements of patterns of relatedness experienced by patients in videotaped assessment interviews (Reference Hobson, Patrick and ValentineHobson et al, 1998); and this is what Lanman, Grier & Evans (Reference Lanman, Grier and Evans2003, this issue) have done in applying the method to the functioning of couples, adding a novel twist by studying the two partners as an interpersonal ‘system’. The evidence is that Kleinian descriptions of nightmarelike (persecutory) and more integrated modes of interpersonal functioning have objective validity, whether these occur between patient and therapist or between the members of a couple in the presence of a therapist.

Now we can assess whether such patterns of relatedness have clinical importance — but only on one condition...

FACING THE FACTS

In Brecht's play, written between 1938 and 1947, Galileo urges his contemporaries to look into a telescope. His exhortations are to no avail, and his listeners turn away. Galileo utters this lament:

Fresh evidence will not speak for itself. It needs our attention. Studies on objective ratings of psychoanalytical phenomena — and a journal like this that makes an unprejudiced evaluation of the science that addresses those phenomena — give us the opportunity to reappraise the status of previously incomprehensible or seemingly fanciful ideas. We have the chance to apprehend facts that open fresh vistas on the mind and its pathology.