The Development of Consciousness: An Integrative Model of Child Development, Neuroscience and Psychoanalysis (Book Review)

Author:  Sasso, Giampaolo (Translated by Jennifer Cottam)
Publisher: Karnac
Reviewed By: Sara Casalin, Volume XXIX, No. 4, Fall 2009, pp. 49-52

In The Development of Consciousness Sasso builds bridges between psychoanalytic theories and contemporary scientific accounts of neuropsychology. He states that "knowledge of the neurophysiology of cerebral integration is inevitable and requires attentive investigation because it throws light on important aspects of the psychoanalytical concept of development … (p. 239)".

Sasso is not the first author that illuminates the development of children from a biopsychosocial perspective. Different researchers already accentuated the fact that the development of the psyche is influenced by the interaction between the neurobiological predisposition of the infant and the interpersonal experiences with the social environment (e.g., Fonagy, Gergely, Jurist & Target 2002; Schore, 1994; Siegel, 1999). However, Sasso is the first author that attempted to link the "pure" psychoanalytic Freudian theory, as well as newer psychoanalytical perspectives, to neuroscientific findings.

Although neuroscientic findings may not seem close to what clinicians are doing in their daily practice, neuroscience is a field in which knowledge of child development is growing strongly. For this reason, it should be implemented in the science of child psychologists. Sasso’s book is also valuable for psychoanalysts working with adults because he links neuroscientific findings in the field of child development to important psychotherapeutic concepts. What Sasso clearly underscores in his book, is that psychoanalysis cannot operate isolated from today’s neuropsychological knowledge of the brain. His aim is clearly to delineate a new psychological framework for mental health practitioners.

In ten chapters issues in psychoanalysis, neuroscience and infant development are covered. In the next paragraphs, I will summarize and critically discuss the most important themes conveyed to me.

Neuroscience and Psychoanalysis

Sasso devotes a lot of attention to Freud’s Project for a Scientific Psychology (1895)—which Freud himself referred to as "Psychology for Neurologists"—on the one hand, and to recent progress in the field of neuroscience on the other. He attempts to show that neuroscience confirms and revises many of the theoretical ideas of Freud, for example, his ideas about the imitational function of perception; but contemporary neuroscience also disconfirms a few of his ideas, for example, the concept of dreams as the realization of a desire. He summarizes this beautifully by saying that "neuroscience suggests that the Project is neither completely unrealistic nor erroneous (p. 23)".

Furthermore, Sasso shows the changes since Freud as a result of other theoretical models, especially in the areas of child development and object relations. He measures Freud’s theory against current theories of child development. The behavior of an infant, as revealed by modern studies, is clearly quite different from the way it was conceived in classical psychoanalysis, in which dependence on primary needs and of energy discharge towards intertia are the main notions. Sasso cites important psychoanalytic researchers such as Bowlby, who was the first psychoanalytic researcher that emphasized strongly the innate disposition of the baby towards relations with the object. Freud did acknowledge the importance of the mother in the earliest years of the child, but ignored the relational aspect: the mother "object" was seen as a means through which the baby’s needs could be gratified. Sasso clearly underscores that the goal of the libido is not pleasure, as Freud stated, but the object as such, as Bowbly declared. While Freud focused on the autoerotic function of drives, relational theory assumes that drives correspond to an internal activity that is predisposed towards the object in a relational way. Accordingly, the importance of the early mother–infant interaction for the neurophysiological development is woven throughout the book. Also, the active baby in search for stimuli as opposed to the passive baby that only receives input, as well as the strong self-regulatory ability of the child, are accentuated.

While he obviously refers to important psychoanalytical concepts as "social fittedness," (Emde, 1983), "there is no such thing as a baby" or "good enough mother" (Winnicott, …), "alpha and beta elements and alpha function" (Bion), he unfortunately does not explicitly name them. A clearer discussion of these concepts would be helpful to integrate the different approaches attempted in post-Freudian and newer psychoanalytical models with modern notions concerning child development.

New Model of Brain Development

By formulating a new model of brain development, in which he takes a microlevel viewpoint on infant development and mother–infant interaction, Sasso does the very ambitious, but difficult, task to relate different psychoanalytic theories with new child development models. Because this model forms the core part of this book, I will discuss this in detail.

In his model of reticulum the brain is structural (vertical organization) and dynamic (the cerebral reticulum has its own intrinsic dynamics, capable of interaction with environment). This is what is missing in Freud’s thinking. These dynamic properties, which are not yet present in Freud’s thinking, are the necessary conditions to explain early neural activity from birth. Sasso pinpoints the brainstem as the activator of endogenous dynamics: referred to as subject pole "s" (which, in the Project, Freud called the ego). At birth, the human brain is not fully developed, thus consequently it requires interaction between infant and environment for maturation to take place. Therefore, the basal (endogenous) activation patterns resulting from the brainstem need to be regulated by the mother—referred to as the object pole "o" (the object) —who functions as the external regulator of these internal drives of the child. The brain is defined as a system of "s-o" pathways on a number of different levels, continually integrating the subject pole with the object pole (more on this further on).

Sasso links this with the object-relational development of the child. In explaining the developmental evolution of object representation during mother–infant interaction, Sasso contends that drives cannot be considered without the object because they cooperate immediately after birth with the real properties of the object. In the early stage of life, the object has no complete objectual characteristics. Proto-objectual properties refer to the first information from the mother that can be encoded by the infant, namely through tactile and olfactory-taste (subcortical) channels. At first there is tension coming from the object (tactile stimulation) and also caused by internal tension due to somatic excitation in the child. Then, through several "s-o" processes, which Sasso discusses in detail, real and more complex objectual information of the mother becomes encoded (on a cortical level). Put together, the object initially evolves from a configuration of endogenous and exogenous proto-objectual elements to include an increasing number of exogenous objectual elements. Sasso states that this transformation is clearly the most important process of neural maturation.

But what activates these "s-o" pathways? How does the mother regulate the internal states of the child? And thus, how exactly does object representation develop? Sasso explains on a neurological level that, from the prenatal period on, through projective (P) and introjective (I) processes between the subject pole and the object pole, information goes in two directions: from internal to external and reverse (thus, "P-I processes"). The skin (tactile stimulation) acts as the first medium where complex mother–child interaction can occur. Even in this very early stage, it can be observed that these activations alternate with a certain systemicity, namely the synchronization between mother and child. This means that in an optimal interaction maternal introjective modulation manages to counterbalance the projective endogenous modalities of the child. In other words, the maternal "P-I dynamics" modulate the child’s "P-I processes," in such a way that there is an ideal balance between the P and I properties. Gradually, the representational system develops: the external object (mother) becomes internalized and becomes an internal property of the reticulum. In this way, the child becomes increasingly able to intentionally master its own patterns, introjecting the good regulation, which becomes a stable part of the P-I dynamics of the reticulum. Sasso demonstrates for this development to occur, the child has to learn to distinguish his own intentionality from the mother’s, as soon as P-I syntonization begins.

To fully understand the process of object representation, Sasso explains more in detail the vertical organization of the brain. The primary pathways are pathways of sensorimotor integration and tactile and visceral sensitivity. On this level, sensory and perception pathways of external information are still poor in representational elements and there is a certain initial indifferentiation between the subject pole and the object pole in the reticulum (fusional). Gradually, a process of differentiation and integration between subcortical and cortical areas takes place. At first, endogenous proto-object projection is still prominent at the lowest level (main reticulum), then slowly in the upper element (secondary reticulum) the introjection of an object representation occurs. This is called a vertical pathway. Taken together, projective modalities on the lower levels integrate with introjective modalities on the highest level.

Sasso links this vertical integration to unconscious processes that are replicated in the transference in psychotherapy and distinguishes unconscious memories not caused by repression, versus memory contents as a result of a defense that actually represses the content of the memory. In the latter case, he discusses the main defense mechanisms as activity-passivity, ambivalence, reversal, splitting and displacement via the associative complexity of the secondary reticula and their relationship with the main reticulum. He highlights in this regard is "the hard work of the subject pole . . . in keeping stable associative dynamics that form from multiple, potentially contrasting introjections (p. 187)" from different reticula.

Pathogenic Classes

Next to an explanation of an optimal interaction, the author formulates the "generative tree of pathogenic classes," which provides a framework in which he places main psychoanalytical concepts developed over the course of the last century, such as "autistic phase" (Mahler), "paranoid-schizoid position" (Klein), "false self" and "transitional object" (Winnicott), and "bizarre objects" (Bion). On the one hand, he describes in detail what happens if mother is not sufficiently present to regulate the child’s internal states. In this paranoid-schizoid position, there are many projective proto-object properties of endogenous origins and a recursiveness between strong projections and weak introjections. These are not to be considered predispositions of the child, but as a result of the interaction which is characterized by projective identification as a compensation for the lack of the mother (insufficient introjection). Psychopathology like schizophrenia and borderline conditions are related to this type of process. On the other hand, he illustrates what occurs in the relationship if mother has a very active relationship with the child. In this case, the introjective characteristics are added to the endogenous ones, leading to vulnerabilities for respiratory diseases, food disorders, oral addictions, multiple personalities, hysteric and masochistic developments. Also the class of autistic development is discussed in detail, with three possible autistic dynamics evolving in different ways.

Effects of Psychotherapy Relates to Language Development

Many objects (real or imaginary) can be encoded in the secondary reticula. However, all of them depend on the particular object that is introjected, starting from the main reticulum, during the first stages of maturation. Since the brain development depends on the primary patterns that have already become stable in integration, it is difficult to modify the associative structure of the secondary reticula. The language used in psychotherapy modifies these dynamics: verbal interaction can result in an efficient change in the associative structure of the reticula—congruent with what Freud believed. But how can this be explained? Sasso shows how language influences neural maturation in childhood. In this part of "origin of language" Sasso discusses in detail the importance of brain lateralisation, linguistic maturation and associative dynamics and conscious and unconscious mental processes. In short, he states that the language (tertiary) reticulum is driven by the "s-o" dynamics of the secondary reticula and interact with these continually. Also here, the cyclic process between projections and introjections are of central importance. Consciousness evolves through the network of links that the main reticulum has with the redundant reticula. Words provide a more specific contribution to consciousness. Words, even when they have evolved at the cortical level, remain rooted in the initial integration dynamics. Hence, a certain word for example "mother" (p. 206) may represent different meanings for different people, due to the different I-P dynamics as a result of the different relational meanings, established during development, for the person. This is a truly idiosyncratic process. Because words correspond to a whole range of essentially primarily dynamic patterns, it is possible to modify them during verbal communication. This is truly the most interesting part, namely the link between mother–child communication and therapist–patient communication.

Sasso helps us to understand how the mental integration through words, between patient and analyst, occurs. Verbal interaction between patient and analyst causes a syntonization (cfr. synchronization) on the introjective–projective dynamics created by the words in the reciprocal cerebral reticula. It is the tonal modulation—via the linguistic-tonal channel—that can modify the identificatory meaning considerably. I is not sure if Sasso refers to what Fonagy has called "affect markedness" (Fonagy et al., 2002), namely the facial, vocal and gestural—"marked" —display that caregivers make when responding to their babies. Nevertheless, Sasso shows beautifully how language can bring about in the therapeutic relationship a new regulation of the most basal cerebral dynamics. As a potential relational object, the analyst spontaneously stimulates the patient’s reticulum to reactivate it in projective–introjective dynamics. Sasso also explains how we can understand the transference–countertransference and the dynamic–identificatory process in this light. Through verbal and nonverbal aspects of communication the analyst tries to understand what a certain word means for the patient and gradually shares this with the patient. In this way he attempts to reconstruct for the patient the real meaning of the patient’s mental processes, which are still strongly influenced by defence processes.

Further differentiation of the self—consistent with the early integration of the self—takes place as the secondary reticula change function and become tertiary linguistic reticula. Put together, in psychotherapy conscious understanding is transformed in a change in the unconscious processes. In this way, changes on the neurological level can take place.

I have some questions about Sasso’s clinical approach. In what way does this view correspond to the theory of "mentalized affectivity" (Fonagy et al., 2002), which has already shown to be very influential in psychoanalytic therapy? He discusses psychotherapeutic concepts in general but does not clarify which pathology would benefit most of such an approach. Maybe a few clinical examples could have illustrated this more clearly.

Final Reflection

The book is very theoretical and difficult to read due to complex schemes and abbreviations, together with a lot of neuropsychological terms not necessarily in general usage. The ninth chapter on "Child Development and the Integration of Psychoanalysis and Neuroscience" gave a clear and welcome summary of important hypothesis in the model of the brain outlined in this book. I was astonished by the very high level of integration and sophistication of the book. The theories of Damasio, Edelman and Tononi form Sasso’s model because they focus on the importance of the brainstem for child development. Additionally, P-I dynamics correspond both with the evolution of Freud’s model and with the theory of Klein and Bion, as well as more current theories of child development. Moreover, Sasso links attachment theory to it, as well as theories of Balint, Rosenfeld and Blatt and Blass. In this way, he clearly want to show how useful careful study of the P-I dynamic can be.

Sasso focuses primarily, however, on neurophysiological processes underlying emotional arousal, but does not discuss important aspects of emotion regulation .such as social feedback mechanisms and affect markedness (e.g., Fonagy et al., 2002), attention processes (e.g., Rothbart, 1989) or positive emotions (e.g., Emde, 1991). Also, as already mentioned, Sasso does not always explicitly mentions the theories or concepts he wants to integrate in his model, which makes the book difficult to read. For example, when he discusses the very important process of "syntonization," he did not cite basic concepts as "affect attunement" (Stern, 1985), "matching" (Tronick, Cohn & Shea, 1985) or "affect markedness" (Fonagy et al., 1992).

Sasso did rightfully cite the importance of transactional models, in which factors of the mother (e.g., psychopathology) and the child (e.g., temperament) interact to predict child outcome. To summarize, this book clearly shows that the child cannot be considered outside the mother–infant dyad, because there is, citing Monica Lanyado and Didier Houzel in the preface of the book, "an inter-subjective interaction, which gradually becomes an intra-subjective experience (p. 6)".


Emde, R. N. (1991). Positive emotions for psychoanalytic theory: Surprises from infancy research and new directions. In T. Shapiro & R. Emde (Eds.), Affect: Psychoanalytic perspectives (pp. 5-44). Madison: International Universities Press.

Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization and the development of the self. New York: Other Press.

Rothbart, M. K. (1989).

Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Mahwah, NJ: Erlbaum.

Siegel, D. J. (1999). The developing mind, towards a neurobiology of interpersonal experience. New York: The Guilford Press.

Stern, D. (1985). The interpersonal world of the infant. A view from psychoanalysis and developmental psychology. Londen: Karnac Books.

Tronick, E., Cohn, J., & Shea, E. (1985). The transfer of affect between mothers and infants. In T. Brazelton & M. Yogman (Eds.), Affective development in infancy: Vol. 5. (pp. 11-25). Westport, CT, US: Ablex Printing


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