"Pearls" from Neuroscience
By Cassandra Klyman, M.D.
Attachment theory seems to be the most popular paradigm in the 21st Century for understanding the development of the mind and mental functioning. The internal model of the development of the psyche, as it interfaces with the environment and with different pressures from the id and superego to create an ego, has become a backdrop to a theory that holds that the baby develops a sense of self and mastery of affect through intersubjective experience with its caregiver. This different emphasis was bridged by the self-psychologists in the 70s and 80s and a resurgence of appreciation of the British School of object-relation theorists. What seems so confirming is that recent neuroimaging and neuronal laboratory work offers data regarding brain areas that light up in the subject and the viewer simultaneously to illustrate empathy, and the discovery of individual “mirror” neurons in monkeys that get activated when they are motorically still but are watching a lab worker eat a banana—the identical neurons that would light up if they were eating! "Monkey see, monkey do" now has a much more exciting cachet! Patients who had undetected and untreated sensory problems as children--particularly visual or auditory problems--need as adults special attention paid to the distortions in self-regard and empathy that were consequences of their handicap.
This link between imitation and humanity is the core of evolutionary science. The significant researchers in this field are Drs. V. Ramachandran and M. Arbib at University of California, San Diego, Sarah-Jayne Blakemore in London and G. Rizzolatti in Italy. They are working on the theory that the simple “mirror neurons” for grasping could have advanced to a more sophisticated network allowing for symbolism and syntax of language. Using PET, they showed that Broca’s area was also involved in organizing intentional actions and in allowing people to understand the intentional actions of others. This corresponds with the deaf community’s assertion that language is more than speech, privileging “sign” over primitive utterances (American Psychological Association, Vol.36, No. 9, Oct. 2005).
Empathy also has its neurobiological correlates (Rizzolatti and Arbib, 1998; Wolf, 2001). Harris (2003) and Jackson (2005) used PET studies to demonstrate increased metabolic activity during responsive viewing of another person’s pain in the medial and superior frontal gyrus, the anterior and posterior cingulate, the medial thalamus and the orbital frontal and occipitotemporal cortex. Correspondingly, when patients feel their concerns are taken seriously, their neurochemistry is altered (Kandel, 1998; Gabbard, 2000). Fonagy and his colleagues convincingly assert that the “marked” response of the mother to her infant, which is a similar but not identical empathic response, is essential to the baby’s mentalization and sense of self and other. We have known for a long time that psychotic patients do not do well in “high-intensity, emotional families” and that if and when they reconstitute it is in a benign and hopeful surround. Nurseries serve as a prototype. The quiet of our consulting room is another setting where strong feelings get expressed and become modulated through our metabolizing interventions.
The discovery of neural plasticity has shown us that the brain can produce new neurons, dendrites, synapses and therefore new circuitry throughout life. This means that throughout life one can develop healthier, more adaptive ways of thinking, feeling and acting and can also develop the ability to inhibit unhealthy, less adaptive ways of thinking, feeling and acting. So, one can teach old dogs new tricks.
According to Hebbe’s Law, neurons that fire together wire together. With repetitions the newer circuits become consolidated and strengthened in the brain. As a consequence, therapists should complement their time-honored attention to the development of insight into defense, resistence and transference-countertransference with a more rigorous attention to the process of working through over time. Working through definitely takes work outside the therapy room in our patients’ everyday lives. Patients need to do homework in order to actively change old patterns of thought, feeling and action. In this process therapists can help greatly as mentors, educators and coaches helping patients to consolidate the insights gained in treatment into real, lasting and beneficial changes in their adaptations, health and happiness.
The Neuroscience Study Club at the Michigan Psycho-analytic Society has been meeting for several years. We began with the study of consciousness and memory. We have read various authors and had several visiting guests from philosophy and neuro-radiology. Among our interdisciplinary group we are honored to count Dr. Henry Krystal as one of our charter members. Our enthusiasm is high for new learning and we all have seen changes in our work with patients.
We have presented our ideas at the Michigan State Medical Society Annual Scientific Meeting and were well-received. All physicians appreciated a better understanding of their fatigue at the end of the day, let alone burn-out after decades of having their brains light up in painful areas while witnessing their patients' pain.
List of books read: The Developing Mind ( D. Siegel); Mind Wide Open (S. Johnson); The Brain and the Inner World (Solms and Trumbull); Gene Worship (Kaplan and Rogers); Freedom Evolves (D. Dennett); Looking for Spinoza (A. Damasio); General Theory of Love (T. Lewis); Gender as Soft Assembly (A. Harris); Affect Regulation, Mentalization and the Development of the Self (Fonagy, et al).
Guest presenters: “Kit” Green, M.D.; Mel Bornstein, M.D.; Linda Brakel, M.D.; Richard Hertel, Ph.D.; Michael Shulman, Ph.D.
Rizzolatti, G. and Arbib, M. (2001). The Bridge from Doing to Communi cating. New Scientist, 169 (issue 2275.27), p. 22.
Gallese, V. (2001). The Shared Manifold Hypothesis: From mirror neuron to empathy. J. Consciousness Studies 8(5-7):33-50.