Conclusions And Some Psychiatric Implications

During the 20th century, the instinctual apparatus of the mammalian brain was marginalized in psychiatry as well as neuroscience, with only psychoanalysis attempting to grapple with such concepts as the "id" and the "dynamic unconscious." It should again become a foundational issue for all of psychiatry. Although affective consciousness has often been relegated to the unconscious aspects of the human mind, in many psychiatric disorders, this ancient form of consciousness has become so manifest that it overrides the dictates of rationality. Indeed, we must remain open to the possibility that quite often the cognitive aspects of mind are more unconscious than the affective dimensions, as is often demonstrated by conditioning experiments where visceral conditioning proceeds in the absence of any perceptual awareness of the conditional stimuli (e.g., Zald, 2003). Let us briefly consider a couple of examples where the weakness or strength of cognitive and affective coupling—in alexithymia and transference relationships—can cause emotional problems.

Consider the case of alexithymia, the inability to identify and communicate one's feelings. This is not necessarily a deficit in the brain's ability to detect the ancient affective processes elaborated by subcortical systems of the brain, but rather in the inability of higher cognitive-attributional brain regions to connect up well with the ancient autonomic forces of the instinctual emotional apparatus. It may be a partial disconnection syndrome between higher and lower brain functions. Alexithymia may represent a problem in affect regulation, whereby the linkages between subcortical and cortical systems are deviant. In a recent fMRI study that attempted to identify brain regions implicated in this personality trait, it was found that males who scored high on the Toronto Alexithymia Scale exhibited decreased cerebral activation in left mediofrontal-paracingulate cortices in response to highly negative visual images, but they showed more activation in the mediofrontal cortex, middle frontal gyrus, and anterior cingulate in response to highly positive pictures (Berthoz et al., 2002). The tendency of the brain to overrespond to positive emotional stimuli may be partly the cause of these same brains to underrespond to negative emotional provocations. In normal individuals, a tight interplay between cognitions and emotions leads to a balanced mental life. The decoupling of such processes, as in alexithymia, may promote various developmental problems.

Let us also briefly consider the phenomenon of transference whereby the emotional residues of early childhood relationships, especially the unconscious memories linked to disturbing affective interactions, continue to impinge on future interpersonal dynamics. Such emotional-cognitive habits are ubiquitous in human relationships and reflect how the stamp of early patterns of behavior often continues to distort how we respond to others. In extreme cases, emotional systems may have "kindled" so that they become excessive influences in people's lives (Chapter 11). One cardinal aim of psychoanalysis is to allow such transference relationships a psychosocial space to be elaborated in a therapeutic context, and thereby brought back into active cognitive consciousness. Through the refeeling and the redescribing of such affective-cognitive habits, it is hoped that people will derive new insights about their motivations and why they respond to other people in the way they do.

Thus, while the transference relationship starts with poorly understood, almost unconscious emotional habits, the ability of affect and analytic work to bring these dynamics back into a fuller consciousness gives people more options in the way they choose to live their lives. Many psychiatric medicines do the same by regulating the affective "energies" that seem to have a mind of their own. Affective states are so hard to regulate because they ultimately emerge from ancient brain areas that have a spontaneous intentionality of action, which serves as a foundation for our higher cognitive abilities. Clearly, certain popular targets of fine-grained neuroscientific inquiry, such as the amygdala, are only a fraction of the overall story, for that structure, which links certain external events to fear tendencies, is not essential for feelings of anxiety (Damasio et al., 2000; Zald, 2003).

Because of advances in neuroscience, we are now in a better position to understand the extensive neurobiological nature of this neuronal infrastructure—even the dynamic orchestra of genetic transcriptions that help sustain mental life, with potential new concepts in genetic medicine around the corner (Hannon, 2002). To do this effectively, we need to have new evolutionary perspectives concerning mental continuity among species. As Charles Darwin (1874/1917, p. 617) said, "the mental powers of the higher animals do not differ in kind, though greatly in degree, from the powers of man." If we do not seek to understand the emotions of other animals, we can only have a surface understanding of human emotions. The animal research allows us to work out the details of the subcortical sources of human emotional feelings that have now been well highlighted by brain imaging. That type of knowledge will allow us to modify the relevant brain systems with new and more specific pharmacological agents as well as psychotherapeutic interventions.

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