Medium 9781855758858

Presence of Mind in Neurophysiological Processes

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This book is a study of the simultaneous physiological recordings and psychoanalytic observations when emotional/psychological responses to external stimuli occur pari passu with observed physiological changes. It is the culmination of the author's psychiatric and psychoanalytic work with patients over fifty years, and is based on the simple premise that physiological measurements cannot describe the mind and the mind cannot describe physiological processes. In order for us to have a significant knowledge of the object the author argues that we need both, and that medical specialists and health professionals (doctors, nurses, psychoanalysts, psychotherapists, psychiatrists, etc.) need to be trained to adopt a Complementary approach to patients. The complex relationship between mind and body offers vital clues to the individual's condition, and only by considering patients both physically and mentally can doctors and psychoanalysts make precise and competent judgements.

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Chapter One: Attention and Inattention

ePub

CHAPTER ONE

Attention and inattention

But what is light really? Is it a wave or a shower of photons? There seems no likelihood for forming a consistent description of the phenomena of light by a choice of only one of the two languages. It seems as though we must use sometimes the one theory and sometimes the other, while at times we may use either. We are faced with a new kind of difficulty. We have two contradictory pictures of reality; separately neither of them fully explains the phenomena of light, but together they do.

—Albert Einstein and Leopold Infeld,
The Evolution of Physics, 1938

In order to understand certain electrical events in the human brain, it is necessary to relate them to experience. Two descriptions are possible, one in psychological terms and the other in physical terms, but this poses the problem of compatibility. The problem of considering both together can be avoided by considering, as Ivan Pavlov (1849–1936) did, that there was only one possible description, brain physiology being a sufficient explanation of the mind. Alternatively, we can assume that the problem is insoluble and leave one or other sort of information out of consideration. In an analogous situation in physics, Niels Bohr did neither if these things. Having developed the Rutherford-Bohr model of the atom by a combination of classical mechanics and an extension of quantum theory, he proceeded, in 1927, to propound the principle of complementarity. A hiatus in physics arose when some phenomena associated with the movement of small particles like electrons could only be interpreted by ascribing to them the properties of waves, whilst other phenomena connected with the propagation of light waves could only be understood by assuming that light is concentrated in a sort of particle, the photon. The philosophical consequences of both matter and light behaving as both particles and waves were grave.

 

Chapter Two: Epilepsy and the Unconscious

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CHAPTER TWO

Epilepsy and the unconscious

He was thinking, incidentally, that there was a moment or two in his epileptic condition almost before the fit itself (if it occurred in waking hours) when suddenly amid the sadness, spiritual darkness and depression, his brain seemed to catch fire at brief moments…. His sensation of being alive and his awareness increased tenfold at those moments which flashed by like lightning. His mind and heart were flooded by a dazzling light. All his agitation, doubts and worries, seemed composed in twinkling, culminating in a great calm, full of understanding…but these moments, these glimmerings were still but a premonition of that final second (never more than a second) with which the seizure itself began. That second was, of course, unbearable.

—Fyodor Dostoevsky, The Idiot, 1868–9

In 1954 I moved down to London and became a registrar in the Maudsley Hospital, which was also the home of the Institute of Psychiatry. This was to work as a house officer and, at the same time, to train for an academic diploma in psychiatry. Having completed the Diploma in Psychiatric Medicine, I was appointed by Sir Denis Hill as research fellow of the Ford Foundation. Hill was a consultant in psychiatry with a special interest in epilepsy and the electroencephalograph (EEG), but he was also interested in neurology and had specific links with the department of neurosurgery. Being associated with him, Hill alerted me, was likely to take me out of the mainstream of clinical psychiatry and might jeopardise my chances of rapid promotion. But this did not deter me. My work was already outside the conventional boundaries and so I set to work researching the psychological component of the stimulus that produced an epileptic fit. I adapted an EEG machine to record the brain waves and other physiological variables, with the aim of revealing the complex relationship between the mind and body, to show how various forms of thinking could trigger neurophysiological changes, which could then be recorded. My approach was, of course, complementary.

 

Chapter Three: Hypnosis and Trauma

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CHAPTER THREE

Hypnosis and trauma

Svengali told her to sit down on the divan, and sat opposite to her, and bade her to look him well in the white of the eyes.

“Recartez-moi pien tans le planc tes yeux.”

Then he made little passes and counterpasses on her forehead and temples and down her cheek and neck. Soon her eyes closed and her face grew placid. After a while, a quarter of an hour perhaps, he asked her if she suffered still.

“‘Oh! presque plus du tout, monsieur—c'est le ciel.”

—George du Maurier, Trilby, 1894

Hypnotism and its applications

The practice of hypnosis developed out of mesmerism in the 1840s with the work of James Braid (1795–1860), a Scottish surgeon, who was keen to challenge certain aspects of mesmerism. The mesmerist craze derived from “animal mesmerism” created by the Austrian physician, Franz Anton Mesmer (1734–1815). He believed that an intangible vital force emanated from human beings as well as from inanimate objects, especially magnets. At séances in Paris and at other centres across Europe the mesmerist would pass magnets over the body in an elaborate ritual inducing trance-like states during which operations were performed and a variety of conditions were apparently cured. Mesmerism was hugely popular, providing spectacular urban social entertainment and drawing large crowds. It reflected the nineteenth-century preoccupation with finding out answers to questions about nature and society and permitted the public contact with what they regarded as the “spirit of the age”. After witnessing a demonstration of mesmerism at the Athenaeum in Manchester in 1843, Braid came to the conclusion that some sort of natural physiological change occurred in the subject and that an individual voluntarily suspended his or her will and produced the trance by a combination of imagination and attention. He described the phenomena as “neuro-hypnology” and he later abbreviated this term to hypnosis. Braid's experiments in hypnosis challenged mesmerist practices and attracted much hostile attention. His contribution was to rid mesmerism of some of its controversial aspects—the magnetic fluids, the sexual associations that attended the “passes”, and the personal relationship between mesmerist and subject—and to submit the notions of trance and volition and their formerly inexplicable manifestations to careful scientific study.

 

Chapter Four: Hypnosis and Dynamic Psychology

ePub

CHAPTER FOUR

Hypnosis and dynamic psychology

The mental and physiological experience that comprises hypnosis has morphed in ways that reflect changing social expectations and mores. Eighteenth-century patients of Anton Mesmer, for example, felt animal magnetism racing through their bodies. Patients of Amand-Marie-Jacques de Chastenet, on the other hand, replaced these symptoms by providing evidence of having access to heightened, even supernatural, mental abilities. Furthermore, by the second half of the nineteenth century, these occult-like characteristics disappeared, and, instead, hypnosis became a quasi-pathological phenomenon, with specific physiological profiles such as catalepsy, lethargy, and somnambulism. Thus, the collective construction of our mental processes seems to have a history.

—Amir Raz & Joanna Woolfson, 2010

Hypnosis and spontaneous traumatic reactions

Few people have used hypnosis and not witnessed associated anxiety reactions. In 1779 Mesmer gave an excellent account of such a reaction which, indeed, he considered a prerequisite of cure, and subsequent reports have been limited to their occurrence in a clinical setting. They have received little attention otherwise although hypnosis has been widely used in the laboratory (Gorton, 1949; Weitzenhoffer, 1953). This may be the result of a false distinction between the clinical and the laboratory situation, workers in the latter failing to report reactions which they feel are not their concern. What I relate here are my observations made during a pilot study in 1959 of the effects, physiological and psychological, of using hypnosis. The object of this research was to indicate those measures and experimental designs most likely to make possible a physiological definition of emotional changes occurring in the hypnotic state.

 

Chapter Five: Complementary Approaches in the General Hospital

ePub

CHAPTER FIVE

Complementary approaches in the general hospital

Psychoanalysis gives us access to inner workings of the mental apparatus that cannot be studied—literally cannot be seen—from the “objective” point of view. Feelings are a perfect example. Feelings cannot be seen, but they most certainly exist. They are part of nature. And as such they exert effects on the other parts of nature, including those parts that can readily be seen. Hence all the agony of the mind-body problem. How can something immaterial affect something material, unless it is real? The answer is obvious: of course it is real! Reality is not synonymous with visibility. Feelings are real. They exist. They have effects. And for that reason, science ignores them at their peril.

—Mark Solms & Oliver Turnbull,
The Brain and the Inner World, 2002

No-fee psychoanalysis

The practice of psychoanalytic psychotherapy in a NHS general hospital is unusual and special because psychoanalysis as traditionally practised is private and expensive. Each analyst is paid a fee directly by the patient, and in many cases, this fee is paid whether or not the patient attends the session. The session is typically fifty minutes in duration, and during that time the patient is seen only by the analyst. Whatever the patient says is retained by the analyst in strictest confidence. This practice has always harboured a serious inequity in that only patients with the ability to pay can have psychoanalytic treatment and it excluded NHS patients because one doctor for one patient was deemed impossible. In the work I describe here, the opposite obtained, for there was never any selection of patients based on the ability to pay. The National Health Service is a unique operation, subscribed to by every working person and affording free medical treatment to all. As an employee of the NHS, selected and vetted by the Institute of Psychiatry to be a consultant, I was able to treat patients without payment to me of fees per session.

 

Chapter Six: Complementary Cancer Care

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CHAPTER SIX

Complementary cancer care

The art of living well and dying well are one.

—Epicurus

 

Cancer and the psychotherapeutic endeavour

Cancer engenders intense social fear and this has an impact on patients in hospital, where the majority of doctors and nurses are untrained in dealing with psychological trauma. In this final chapter I begin by comparing the approaches of physicians and psychotherapists and argue that by applying the principles of psychoanalysis to psychotherapeutic care, it is possible to relieve some of the mental pain, and indeed in some cases, some of the physical pain of the cancer. Without going into the historical background and theoretical details of psychoanalytic psychotherapy, I outline the ways in which key features of its complementary approach may be adapted to treating patients in hospital.

The specialist hospital

A specialist hospital that focuses upon a particular disease, like cancer, has features that distinguish it from a general hospital. The general hospital admits all types of patient with no restrictions placed on the particular illness from which they suffer. The specialist hospital is exclusive, and it provides a facility specifically for patients with diseases, like cancer, and it is usually attached to a research institute. It contains, almost without exception, very ill patients. With regard to cancer, the treatment also makes the sufferer feel ill. Chemotherapy and radiotherapy, for example, are toxic and destructive processes, intended to “take out” malignant cells and leave others intact. Even though these treatments may not destroy normal healthy cells, the toxic effects can damage some normal cells, or considerably reduce their health, and this can temporarily affect the patient and produce a general debilitating effect. As fast-growing normal cells are vulnerable to the chemicals used to kill cancer cells there may also be a change in personal appearance; most often there is a temporary loss of hair due to chemotherapy. Ablative surgery for cancer of the head and neck may leave its mark on the face and head and even affect speech function and eating. Unlike the general-hospital patient who leaves feeling well, the patient leaving the cancer hospital, however successful the treatment may have been, may feel much worse than when he arrived.

 

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