Psyche and Brain: The Biology of Talking Cures

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'There is a sea change afoot in contemporary psychoanalysis and this brilliant volume is a manifesto of it. When brain science and clinical psychoanalysis are put on exactly equal conceptual footing fascinating possibilities emerge with an intoxicating clarity. Fred Levin's remarkable volume makes evident how psychoanalysis is thinking its way into the future. Psychoanalysis has collected a virtual Tower of Babel of facts. Levin artfully rearranges this vast material, offering a glimpse into a theoretical integration only dreamed of a few years ago.'- Arnold Wilson, Ph.D., Professor of Psychology, Seton Hall University, New Jersey; Faculty, Columbia Center for Psychoanalytic Training and Research, New York

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CHAPTER ONE: The philosophical background to Freud: thinking about thinking

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Fred Levin

Let’s begin with an exploration of some of the philosophical issues that are raised by contemporary psychoanalytic theory,1 concentrating on a line of development of philosophy of mind in which the major nodal points are the contributions of Aristotle, Kant, and Freud. Philosophy of mind has an impact on several aspects of psychoanalytic concern.2 One such area is how our philosophical beliefs about such things as knowledge acquisition might influence psychoanalytic theorizing and the way we treat our patients. A second area concerns creativity,3 which I conceptualize as depending foremost upon one’s ability to temporarily suspend personal belief systems in favor of alternative beliefs. In turn, I assume that the ability to suspend belief varies directly with the extent to which such belief systems function as dispensable parts of one’s self.4 I further assume that mental health is associated with a cohesiveness of the self, in the sense of personal belief systems that are relatively independent of each other and not required for thinking generally (see Chapter Three), nor for our self-esteem.

 

CHAPTER TWO: Psychoanalysis and the brain

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Introduction

Having commented upon the philosophical basis of psychoanalysis, we are ready to begin our journey into understanding as much as possible of mind–brain. We are living during a worldwide scientific revolution in which knowledge of the brain and behavior is expanding dramatically, leading to a convergence of psychological and neuroscientific viewpoints. In Edinburgh, Trevarthen (1989, 1995) has illuminated the micro-orchestration of mother–infant communication, while in the United States Demos (1985), D. Stern (1985), Basch (1975, 1976, 1983), Lichtenberg (1983, 1989a,b), and others have clarified details of infant development, which make it apparent that we begin our lives with many surprising abilities that facilitate bonding. The newer work on infant development can be seen as properly following upon the pioneering child research of Anna Freud (1965), Melanie Klein, Winnicott (1960, 1969), Spitz (1945, 1965), and many others.

MacLean (1985) has created a triune brain theory from which Antrobus, Ehrlichman, Werner, and Wollman (1982), Baer (1989), Moore (1988), and others have derived many significant insights. In fact, it was MacLean who coined the term “limbic system” and, along with Papez, mapped out the anatomical details we now take for granted, as if its role in affect had always been understood. Today, MacLean continues his research in Washington on such subjects as the relationship between speech, language, bonding, and the programming of the thalamostriate division of the limbic system.

 

CHAPTER THREE: Learning, transference, and the need to suspend belief

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Fred Levin

We are now ready to return more particularly to the questions raised at the outset regarding the search for a psychoanalytic theory of learning, and also a theory of transference. We could start with the second of the two theories (relating to transference) but cannot fail to rapidly advance to the first theory relating to learning, since transference is at least partially reducible to the mind–brain’s system for acquiring refined, affectively meaningful information about the self and object world (i.e., expanding episodic memory). In what follows I will attempt to settle some issues that help us proceed with the deeper investigation of transference and learning of Chapters Four and Five.

Transference from its inception has been a complex idea. Freud’s major depiction of transference rests on an image of the mind as a form of map, with known territory (the conscious and precon-scious) and terra incognita (the unconscious). This powerful topographic metaphor of knowledge distribution within an imaginary space illustrates Freud’s capacity to excite our imagination while simultaneously arousing our scientific curiosity. Most critical, however, is Freud’s conveyed sense that the fabric of mental life is deeply conflicted as a universal condition, and that only when the mental “pieces” are properly recombined (through analysis) does the entire “puzzle” become intelligible (the so-called dynamic point of view).

 

CHAPTER FOUR: The special relationship between psychoanalytic transference, similarity judgment, and the priming of memory

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Fred Levin and Ernest W. Kent

Humans create databases from experience that they deepen and enlarge over time. It is the product of this deepening and enlarging process that we call knowledge. Knowledge keeps us safe from danger and enhances our chances of reaching wished-for goals. Of course, some knowledge is wrong in that it leads to faulty conclusions or unsuccessful adaptation. For example, how much of the content of this essay is correct may be difficult to say at this time. This last observation points out the importance of continually testing and therefore updating our knowledge bases.

Within the psychoanalytic situation, the analyst and patient engage the patient’s complexity, experiencing together crucial countertransference and transference states that become a major object of their study. Over the years, psychoanalysts have learned how to tap this vital, conscious and unconscious dialectical stream of information about feeling states, behavior, and cognitive patterning. The resulting self-knowledge and working through of feelings greatly facilitate the mastery of conflict and emotional growth by means of updating and improving the key knowledge bases upon which our adaptive skills depend.

 

CHAPTER FIVE: Integrating some mind and brain views of transference: the phenomena

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Fred Levin

Introduction

This chapter25 builds on the insights of Chapters 1–4 and further examines novel interdisciplinary perspectives on transferential learning phenomena. Extra-analytic information about the more general set of phenomena that constitutes transference enhances both clinical work and psychoanalytic theory construction. As we have seen, making correlations with ideas from cognate fields accelerates the contribution of psychoanalysis to more general scientific theories (Waelder, 1962). At the level of clinical theory, Merton Gill saw interdisciplinary analyses as highly relevant attempts to understand psychoanalytic phenomena from the broadest perspective possible.

Some notable interdisciplinary efforts have appeared on the subject of transference: for example, Fried, Crits-Christoph, and Luborsky (1992) have documented the existence of transference phenomena outside the clinical context of psychoanalysis, thus confirming what psychoanalysts and cognitive psychologists have long inferred, that the transference concept has utility in explaining behavior generally and is not restricted solely to the clinical setting. Also, Forrest (1991a,b) has discussed transference as a brain phenomenon susceptible to derangement in conditions such as the misidentification syndrome. Forrest (1994b, 1997) further warns us against splitting our thinking and clinical approaches to patients into partial domains where biological and psychological approaches are conceptualized as unrelated entities.

 

CHAPTER SIX: Some additional thoughts on attention

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Fred Levin

Introduction

Ayoung driver suddenly comes to a screeching halt as he realizes that his car has entered an intersection against a red light and is perilously close to pedestrians. The surprise on his face makes him look as if he just awoke from a bad dream.

A self employed business man fires his secretary and then gradually discovers that he is unable to stay organized and properly attend to many accounting details which begin to seriously overwhelm him.

A grammar school student with an otherwise nice disposition becomes surly with her parents after realizing that once again she has forgotten to turn in a homework assignment, and will not get academic credit for her efforts.

An analyst listens to a patient freely associate and is surprised to find herself thinking of the very last time she spoke with a dying friend. Returning from this reverie, however, she recalls that at the beginning of this same session the patient had innocently mentioned in passing the name of a particular friend he might visit on an upcoming trip. The analyst knows that this close friend of the patient is suffering from cancer. The analyst comments on her own associations, and with this the patient gets more in touch with his current fears about losing his friend to cancer. He had been aware of these thoughts earlier in the session, but was defending against them.

 

CHAPTER SEVEN: Why consciousness?

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Fred Levin

Introduction

The problem regarding consciousness, simply stated, is that no one has satisfactorily explained why consciousness is necessary (Shallice, 1988, p. 381). Solms (1997) bravely raises a number of questions about consciousness. After commenting on his work, I will survey some interdisciplinary perspectives and then attempt to describe what it is that consciousness might be doing.

For Solms, and for most psychoanalysts, processes within mind which are usually labeled subjective experience are no less real than so-called objective observations of the external world. Solms further argues, and I agree, that all perception involves conjecture about events, localizable either in the universe outside or in the one inside our self (Lassen, 1994a,b; Levin, 1991; Posner & Raichle, 1994).

The consciousness debate is muddied, however, when Solms introduces the philosopher Searle (1995a,b), who asserts, among other things, that consciousness is a mystery and that there could be no such thing as an unconscious.39 These untenable assertions of Searle are best answered by the research of psychoanalysis, including especially the research of Shevrin, Bond, Brakel, Hertel, and Williams (1996), which meticulously demonstrates unconscious phenomenology as well as the neurophysiological signature of unconscious process (as distinguished from conscious processing).

 

CHAPTER EIGHT: Subtle is the Lord: the relationship between consciousness, the unconscious, and the executive control network (ECN) of the brain Written with Colwyn Trevarthen

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Fred Levin and Colwyn Trevarthen

“All the life in the body is the life of the individual cells. There are thus millions upon millions of centres of life in each animal body. So what needs to be explained is … unifying control, by reason of which we not only have unified behaviour, which can be observed by others, but also consciousness of a unified experience”

(Alfred North Whitehead, 1929, p. 108)

“The conclusion of the first century of psychoanalytic work that may be of the greatest relevance for a theory of behavior regulation is the realization that a predictable series of regulatory modes succeed each other in the course of ontogenesis. These modes … constitute an epigenetic sequence [such that] each mode persists as a potentiality throughout the life cycle and may be called upon whenever it offers the opportunity for optimal adaptation”

(John E. Gedo, 1993b)

Introduction

Gedo’s developmental hierarchical model, which he and Goldberg originated (Gedo & Goldberg, 1973) and which he has continued to refine (Gedo, 1993a), offers clinicians and researchers alike remarkable assistance in organizing their thinking about the patterns and control mechanisms of mind–brain. Most interesting to this monograph, Gedo has employed his model to explore consciousness, a subject on the boundary between the psychological and the biological (1988, 1991a,b).

 

CHAPTER NINE: The conundrum of conscious and unconscious relations: Part 1-Ito’s evolutionary model of brain and the role of the cerebellum

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Fred Levin, John Gedo, Masao Ito, and Colwyn Trevarthen

Introduction

This chapter addresses the relationship between conscious and unconscious systems from the perspective of Ito’s evolutionary model of the brain and what is known about the role of the cerebellum. The following chapter utilizes earlier discussions of Shevrin’s research on memory tagging and the functions of consciousness, and Posner’s work on the ECN,48 and exploits these for further insights into the conscious–unconscious relationship.

In a recent major contribution, Ito (1998) discusses consciousness from the viewpoint of the evolution of mind–brain, considering psychoanalytic and neuropsychological perspectives without privileging either discipline. In what follows, we elaborate upon Ito’s model, which we find compelling, concentrating primarily on the relationship between the conscious and non-conscious systems (or as Ito expresses it, the neurophysiology of emotional dynamics, cognition and “will”).

Ito’s Evolutionary Model will be described in detail; however, some definitions and disclaimers will help to clarify what we intend to consider, and what is beyond our purview. First, by unconscious we are referring only to the Freudian or so-called dynamic unconscious. For categories other than conscious and unconscious systems we shall use the term non-conscious, by which we refer to all activity in the brain that occurs outside of awareness. The strictly non-conscious is thus a category which includes the dynamic unconscious, but which is obviously larger. In our estimate most brain activity is non-conscious. The extent of the Freudian unconscious is of course unknown, but it probably represents a small yet significant fraction of the non-conscious system. Below, we provide further refinements of the unconscious–non-conscious distinction.

 

CHAPTER TEN: The conundrum of conscious and unconscious relations: Part 2-The tagging of memory, the dynamic unconscious, and the executive control network (ECN)

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Fred Levin, John Gedo, Masao Ito, and Colwyn Trevarthen 68

Introduction

In Part 1 of this essay (Chapter Nine), we introduced our central subject of conscious–unconscious relations; now we wish to build upon what we have already discussed. We made clear the complicated history of research in this area, including some difficulties in defining terms.

Having provided background for our initial discussion, most of our effort was to introduce the original ideas of Ito (1998) by way of his evolutionary model of brain, and his efforts to bridge to the Freud of the structural model. We elaborated upon the role of the cerebellum because this area of Ito’s work is particularly refined, and because it appears to us to lend itself to making some better approaches to understanding our central subject.

We believe that we can now provide a suitable synthesis of Parts 1 and 2 (the previous and current Chapters) in which we identify what conscious, non-conscious, and unconscious modules seem designed to provide to the overall system. However, to accomplish this we first need to consider the research of Shevrin and of Posner, which follows immediately.

 

CHAPTER ELEVEN: The paradigm of bifurcation: Priel and Schreiber on chaos theory

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Fred Levin

As noted in Chapter Five, it is possible to significantly expand our understanding of subjects such as the psychoanalytic transference if one considers it from both analytic and extrapsychoanalytic perspectives. Priel and Schreiber’s work was mentioned, but a discussion of chaos theory was deferred until now. Chapters Eleven and Twelve elaborate the exciting possibilities that derive from bridging psychoanalysis and chaos theory.

Priel and Schreiber’s (1994) article is a good place to begin because their concise article invites one to consider several complex psychological variables in relation to non-linear dynamics (catastrophe theory, chaos theory, bifurcation theory), a branch of mathematics that covers phenomena that appear random but are actually deterministic. When the equations which describe behavior can be discovered, the behavior can be modeled. This kind of modeling “… has been made possible only recently, thanks to the high computational power of today’s computers” (Ekeberg, 1995).

 

CHAPTER TWELVE: Learning, development, and psychopathology: applying chaos theory to psychoanalysis

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Fred Levin

“Nothing in nature is random … A thing appears random only through the incompleteness of our knowledge”

(Baruch Spinoza, cited in Gray & Davisson, 2004)

“Our job is not to penetrate … the essence of things, the meaning of which we … [cannot perfectly] know anyway, but rather to develop concepts which allow us to talk in a productive way about phenomena in nature”

(Niels Bohr, cited in Nielsen, 1977)

Introduction

This chapter assumes the reader’s knowledge of Priel and Schreiber’s work (as covered in Chapter Eleven). It begins with a review of the pioneering contributions regarding how best to apply chaos theory to psychoanalysis. However, in spite of the increasing number of publications on the subject, there remains an urgent need to make this difficult subject more readily understandable by individuals (read here, psychoanalysts) not trained specifically in mathematics.

A lone American reviewer (Levenson, 1994), and both of the British reviewers mentioned in Chapter Eleven, Gardner and Denman, are quite skeptical that anything useful for psychoanalysis will ever come from chaos theory. However, the majority of the authors covered strongly disagrees and sees great potential for chaos theory benefiting our field: In the United States Galatzer-Levy (1978, 1995, 1997) and Moran (1991) describe the utility of chaos theory in explicating development, quantitative to qualitative shifts, and the importance of recognizing fractal-like signatures in psychoanalytic clinical material; Levin (1996a, 1997a,b) believes chaos theory offers a unique vocabulary and perspective which can further our understanding of learning, development, and psycho-pathology; Forrest (1991a,b, 1995, 1996a) explores the vast domain of artificial intelligence and chaos theory, finding much that can be positively applied to developmental psychology and psycho-pathology; Gleick (1987), Moran (1991), and Spruiell (1993) explain nonlinear dynamics (another name for chaos theory), raising a broad range of theoretical issues; Sashin (1985) and Sashin and Callahan (1990) demonstrate stunning but generally as yet unappreciated results86 employing unique affective response models, and these need amplification; and Moran (1991) and Galatzer-Levy (1995, 1997) have each made thoughtful integrations, the most important of which appears to be the idea that psychoanalytic process reduces psychopathology by adding complexity to mental functioning. In this regard, Palombo (1998), writing about coevolution,87 sees dreaming as “the edge of chaos” (p. 261), resulting in nothing less than the adaptive reorganization of memory (i.e., learning), just as we have indicated seems a reasonable conclusion from the experimental literature.

 

CHAPTER THIRTEEN: Psychoanalytic operating principles: how they derive from understanding knowledge acquisition

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Fred Levin

Introduction

This chapter109 addresses knowledge acquisition in relationship to two closely connected topics: the workings of mind– brain, and the clinical situation of psychoanalysis. If we understand how knowledge is acquired I believe it is then possible to outline a series of operating principles which can effectively guide our analytic work.

Let us start with a discussion of the problems inherent in conceptualizing mind–brain theoretically in terms of so-called “internal representations”. In its place I propose what I consider the more useful perspective of “expert systems”. Human learning is the result of brain plasticity and depends upon neural systems that change in relation to experience and the build-up of expertise. Any psychoanalytic theory of learning or personality must be consonant with what is known about learning, memory, and knowledge formation from neuroscience (Cloninger, 1991; also see Chapter Four).

Of course, any comprehensive psychoanalytic theory of learning must also take into account what is known about the psychoanalytic transference (reviewed in Chapter Five). In what follows I therefore aim at further clarifying specific clinical recommendations that facilitate learning in general by both creating and exploiting learning readiness. The psychoanalyst reader will especially appreciate the attempt to connect specific clinical recommendations with the neurophysiological principles upon which they rest.

 

CHAPTER FOURTEEN: What the amygdala, hippocampus, and ECN teach clinical psychoanalysis

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Fred Levin

It seems appropriate, before delving into further psychoanalytical clinical recommendations, to review some recent research on the limbic system, particularly the amygdala and the hippocampus (and some closely related structures) since these appear to contribute decisively to our processing of emotions, a subject near and dear to psychoanalysis. One issue to be aware of, however, is that neuroscience scholars currently differ on what is properly included in the limbic system anatomically (Ledoux, 1996). Therefore many will wish to learn more about such details, as follows.

Let me begin with a fascinating article on Phineas Gage (Damasio, Grabowski, Frank, Galaburda, & Damasio, 1994), the colorful railroad worker of the last century who was unlucky enough to have a explosion blow a hole in his head and yet to survive! Since Gage’s damaged skull was donated posthumously to Harvard Medical School, Damasio and colleagues used various means to study Gage’s brain, and confirmed that Gage’s injury most certainly involved damage to the ventral medial frontal lobe of his brain. This supports the view that it was ventral medial frontal lobe damage that played a role in Gage’s post injury personality changes, including his trouble attending and his tendency towards socially inappropriate behavior. Such behavioral–anatomical correlations can prove decisive in verifying hypotheses regarding neurological functional units.

 

CHAPTER FIFTEEN: What working with the neuropsychiatric patient teaches clinical psychoanalysis

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Fred Levin and Meyer S. Gunther

Introduction

What we have to say grows out of our work as clinicians, teachers, and researchers. Specifically, each of us has had the pleasure of working as a member of an interdisciplinary rehabilitation team, one (FML) with the MENDAC119 Program for the Deaf, the other (MSG) with the Rehabilitation Institute of Chicago. What we have to say in this chapter, however, should complement previous discussions elsewhere in this monograph on specific approaches to psychoanalytic treatment based upon understanding the workings of mind–brain.

Kinds of illness

The literature on analytic approaches to neuropsychiatric cases is highly varied (Christensen, 1992; Forrest, 1994b; Kallert, 1993; Kaplan-DeNour & Bauman, 1980; Morozov, 1989a,b; Persinger, 1993; Sandin, Cifu, & Noll, 1994; Soderstrom, Fogelsjoo, Fujl-Meyer, & Stensson, 1988; Stablum, Leonardi, Massoldi, Umiltà, & Morra, 1994). Most rehabilitation cases requiring psychiatric consultation involve patients suffering from acute brain or spinal cord injury from accidents; the next largest group of patients suffers from strokes, malignancies, or neurodegenerative disorders (amyotro-phic lateral sclerosis, multiple sclerosis, and the like). A third or miscellaneous group involves brain complications associated with burns or massive soft-tissue and bone trauma, and children and adults with congenital or developmental problems (including such things as deafness, blindness, autism, language or developmental delay, epilepsy, Tourette’s Syndrome, etc.).

 

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