Media:  TV appearances include Channel 2 - Emily Rooney (under-anaesthesia detox), Channel 25 - Margie Reedy (legalization of marijuana), Channel 7 - Lester Strong (addictive drugs available at pharmacies).  Quoted in US News and World Report, May 7, 2001, “Alcohol and the Brain” p.56

Psychic equivalence mode – internal reality is external reality

Pretend mode – internal reality is marked and different from external reality

Integration of these modes leads to the capacity to mentalize, a reflexive mode of thought.

 An example of psychic equivalence: An obsessional person “knows” the door is locked, but checks because the internal image of an unsecured house has more meaning and power than external images provided by the senses. 

 Theory of Mind – ability of children to attribute intentional mental states – goals, desires and beliefs – to oneself and others.

 E.g., In play, children can be developmentally advanced.  A 3-year-old child shown a candy box, and believes it is full of candy until shown that it is filled with pencils.  He then believes that he always thought it was full of pencils, and believes that another child shown the candy box will believe it to be full of pencils.  But a 3-year-old child told to pretend that an adult drinks an imaginary glass of chocolate milk, and then to pretend that the glass is now full of lemonade, will remember that at first it was “filled” with chocolate milk.

 This capacity to mentalize has the following advantages:

 a.  The child can have a sense of continuity of the self as the world changes.  The world changes do not change the child.

b.  The child sees others’ actions as meaningful through attribution of thoughts and feelings.  It makes people predictable.

c.  The child acquires a distinction between inner and outer truth, distinguishing between bad people and bad behavior (valuable in the case of abusive parents).

d.  It enables communication between people with two points of view.  Conversation becomes a collaboration.

e.  It allows higher intersubjectivity, deeper experience with others.

             Play with parents and other children reflects the child and reality, while breaking away from psychic equivalence.

             Fonagy describes the psychoanalysis of Rebecca, 4 and without a father.  Rebecca could not play through not having a father with her 22 year old mother because the mother reacted too severely.  Rebecca had pretended that her grandfather was her father, and his death and her mother’s grief precipitated the depression which brought her to treatment.  Her fantasies were forced into a mode of psychic equivalence.  Her feelings of hurt and shame about being fatherless could not be discussed with anyone.  Mother’s reflection of Rebecca included the feeling that Rebecca had “pirated” her independence.

            Fonagy tolerates her feelings and plays this all through in typical analytic style.

             The adult adopts the child’s mental stance and represents it to him as a “third object,” the scaffolding of the child’s sense of self.  If the adult cannot think about a piece of reality, neither child nor adult can “metabolize” the thoughts.  The development of the child’s perceptions of mental states depends on the psychic reality of the caregiver.

            This shifts our language/thinking from “internalization of the object” to “internalization of the thinking self from the object’s thinking.”
 

Notes on:   Schore, A.  (2003).   Affect dysregulation and disorders of the self.  NY: W.W. Norton.

Temperamental attunement with a good caregiver is the result of ventral tegmental development via positive interactions.  The opiate system is originally sculpted by infant/mother interactions.  The eventual result is the ability to gain pleasure (endorphins) from being related.  Insecure avoidance may be the result of selective pruning of this system, coupled with expansion of the lateral tegmental inhibitory system.

 The right brain relational regulation system is formed or deformed by early experiences.

• The orbitofrontal cortex forms internal working models of interactions
• CRF is excessive, and results in excessive catecholamine states, in D infants
• In D infants, parasympathetic “unseen” states are upregulated, results in “dazed” dissociation
• The brain areas which mediate stress and fear are: orbitofrontal cortex (receives input from body and combines it with perception), prefrontal cortex (sorts out complex interaction, does planning), anterior cingulate cortex (alerts brain to incoming data, orders data), amygdala (reads fearful interpersonal situations/faces), hippocampus (memory of past interactions), brain stem (supplies “energy” to brain via cholinergic, serotoninergic, noradrenergic and dopaminergic tonic stimulation), periaqueductal grey (switching zone for mode of interaction: consummatory, drive, panic, play, etc), hypothalmus (“headganglion of ANS”, source of regulatory hormones and neurotransmitters: thyroid, cortisol, hunger, thirst, etc), pituitary and adrenals (endorgans regulated by hypothalmus), vagus (parasympathetic regulation of heart).
• Hyperactivation of dopaminergic and noradrenergic systems in infants results in excessive parcellation via NMDA/glutamate excitotoxicity.  Thus amygdala inputs are relatively strengthened, orbitofrontal weakened, “emotional perseveration” and lack of flexibility and complex cognition.
• Lack of orbitofrontal input to hypothalamic aggression sites leads to unmodulated aggression.
• Orbitofrontal (head of this system) deficits may predispose to: autism, mania, depression, schizophrenia, obsessive-compulsive, alcoholism, drug addiction.
• Dissociation/PTSD may be result of non-functioning of memory-integrating parts of this system, in part because of hypercortisolism/smaller hippocampal volume
• The mammalian “smart” vagal system uses the nucleus ambiguous, the reptilian “vegetative” parasympathetic system the dorsal motor nucleus.  The first can incorporate facial expression, vocalization and gestures vial contingent social interactions, the latter only immobilization, death feigning or hiding behaviors

Amygdala inhibition of hippocampal function at high levels of arousal mediates diminution of conscious explicit memory in traumatic events, yet implicit memory is retained

Summary Notes of Presentations at the International Neuro-Psychoanalysis Meeting,  Rome September 2004.  By Brian Johnson

Howard Shevrin

·          Administered the Hysterical-Obsessional Scale

·          Obsessionals saw spiders, not snakes

·          Hysterics didn’t see

·          Results very statistically significant

 Panksepp

                Panksepp-Shevrin bet on unconscious affect, tested with the tachistoscope.  10 positive or 10 negative words.  Subject marks intensity of feeling: happy/sad, power.  Power shifted significantly (larger) after positive words.  (Panksepp feels sad reflects endorphin lack.)

                Affect not read out of the cortex, is one component (with cognition) of emotion.

                Intense feeling suppresses cortical functioning.

                Conscious affects of distress with unconscious cognitive correlates drive people to treatment.

 Guido Gainotti

                Denial as it relates to right hemisphere lesions:

Amytal in left carotid causes depression

Amytal in right carotid causes euphoria

Left lesions cause anxiety and bursts of tears (appropriate)

Right lesions cause joking and lack of attention to results of injury

Emotional system – rapid and mostly ucs responses

Cognitive system – slow and mostly cs

                Leventhal’s categories of emotions

Sensorimotor – innate

Schematic – stored in memories

Conceptual – thinking about experiences

Patients with right hemisphere injuries decode emotional experiences poorly

Largest galvanic skin response when stimuli presented to right hemisphere

Upsetting films – Normal and left brain damaged patients turned away, right damaged patients tolerated/watched. Gainotti (2002) –

·          Right brain processes schematic emotions

·           Left – conceptual, left brain damaged patients

·          Masked (ucs) stimuli decoded in right amygdala

·          Conscious stimuli decoded in left amygdala

·          Thalmus input transmitted to right amygdala, procedural ucs

·          Thalmus input transmitted to visual cortex, then left amygdala, dynamic unconscious.

For Gainotti and Panksepp, take home message was that only cortical material can be repressed.

 Maggie Zellner, “Neonatal isolation reduces food-rewarded operant responding in rats”

 DEPRESSION                                      causes                                                   EARLY STRESS

 Depression/dec dopamine                REDUCED MOTIVATION                   dec dopamine

 Animals with maternal deprivation administer more drugs

No decrease in consummatory behavior, but decreased locomotion and anticipatory behavior

Blunted response to change in sucrose concentration

No difference in sucrose-maintained lever pressing

No difference in total acquisition of learning how to press lever

BUT

Difference in rate of acquisition of learning

Non-isolated rats had a higher break point – how hard they will work to get the next pellet

Gokce Ozkarar

                 Left frontal hypoactivation in schizophrenia: words presented to left and right ear.  Loose associations (lack of relatedness to original word) occurred only when word registered in the wild right hemisphere, (Freud: id not monitored by ego).  Left frontal lesions also lead to schizophrenia-like symptoms.

Bottom line: find ways to empirically test psychoanalytic ideas.