Perennial Problem Distinguishing Affective And Cognitive Processes

Let us now briefly return to the key psychiatric issues of affect and thought: Brain imaging has finally given us an objective glimmer of the brain emotional systems in humans (Chapter 2), and the general neurogeography is that of the limbic system that Paul MacLean (1990) first brought to our attention 50 years ago. It is an everyday fact that during intense affective states, humans dwell obsessively on mood-congruent thoughts and strategies that readily flood their minds. One rotates these naturally aroused ideas persistently in the mind's eye as long as the affective states "insist," and if the ruminations (i.e., the "repetition compulsions"?) persist for too long, the resulting symptoms can become psychiatrically significant.

Although it is obvious that our thoughts can influence our feelings, for understanding psychopathology it may be more critical to fathom how our feelings channel and energize our thoughts. The prevailing assumption in cognitive science that cognitions trigger emotions, is the more obvious part of the interaction. The more psychiatrically relevant aspects may be the other way around—when perceptions enter the nervous system, they automatically get coded for affective significance, which normally coaxes the neocortical apparatus to cogitate, but which, in its more intense forms, also sets up the potential for life-long transference relationships. In psychiatry, it may be unwise to put the more recently evolved cortico-cognitive "cart" in front of the ancient evolved "horses" that create emotional and motivational urges. Thus there is as much need for an "affective neuroscience of cognitions" as a "cognitive neuroscience of emotions" (Lane and Nadel, 2000).

The classical distinction between rational and emotional processes, however actively the two may interconnect, must be recognized in order to understand how affective states emerge within the brain/mind. Thus, investigators should begin tackling the fundamental nature of affective processes more directly than has been common in neuroscience. It presently seems unlikely that the major sources of our basic affective capacities—to be happy, angry, sad, and fearful—will be found in the neocortex. Although our ignorance about such matters remains enormous, we can only provoke strong emotional feelings by manipulating brain areas below the cortex, in that extensive neural territory traditionally known as the limbic system.

It remains possible that affects fundamentally reflect the neurodynamics of instinctual emotional urges in action. In advancing such a position, it is worth recalling that much of Freud's thought about the mind was based on the then "unknowable" nature of the instincts. In this regard, we should consider that affective consciousness and cognitive consciousness are quite differently organized within the brain. While their interactions provide fascinating examples of the diversity of socially derived emotional experiences—such as shame, guilt, embarrassment, and empathy—it is from our understanding of the basic, evolutionarily derived affects rather than of experien-tially derived cognitions that major new insights into psychiatric therapies will emerge. World events are not as critical for the elaboration of the mind's basic affective potentials as they are for its cognitive ones. Affective functions appear to be genetically disposed in the underlying action systems of the brain, almost as if our basic pleasures and pains are the "affective voices of the genes."

In considering the affect-cognition distinction, we may be wise to consider Mesu-lam's (2000) perspective that major brain processes can be divided into "channel" and "state" functions, with the channel functions corresponding to the discrete, computable forms of information processing that have traditionally been recognized as cognitive capacities. On the other hand, state functions correspond to the noncomputable mass-action organic processes that are broadcast more widely and diffusely throughout the brain. The basic affects are examples of such global brain states, and most should be capable of being regulated quite well, and perhaps eventually quite precisely, neuro-chemically. This is not to deny that cognitive readjustments may also promote desired homeostatic changes, albeit more indirectly.

Although no credible working hypothesis has been advanced on how the affects penetrate (cathect) cognitive activities, this remains one of the foremost scientific problems for psychiatry. In general, we can advance three general frameworks: (1) Affects are read-outs of higher forms of cognitive consciousness that use activities of primitive emotional systems as tokens of information in their cognitive deliberations. (2) Affects are intrinsic aspects of the instinctual emotional systems in action. (3) Affects represent dynamic influences on quite primitive self-representational capacities that allow organisms a spontaneously active presence in the world (e.g., as developed in Panksepp, 1998). Although it is probably some complex combination of all three, I suspect we will eventually find that affects arise substantially from a very widespread paracrine broadcasting of neurochemical messages in the brain, as can be achieved by various neuropeptides (see Chapter 21).

To the extent that psychopathologies reflect such global state changes, the need for cognitive interventions may diminish and the need for organic, neuroemotional adjustments may increase. We should recognize that our neurobiological sciences are currently extremely well positioned to inform us about the nature of the general state principles that operate within the brain/mind continuum. Abundant pharmacological maneuvers already exist and will certainly improve for modulating these background state processes that provide a context for cognitive activities. This should be a clarion call for a new form of neuropsychoanalytic research that tries to systematically evaluate ongoing affective changes in individuals under a variety of conditions (Solms and Turnbull, 2002). Such strategies may give us a better image of the primal structure of the mental apparatus than preconceived paper-and-pencil questionnaires.

To the extent that channel functions are involved in mental disturbances, cognitive interventions will continue to be important. To readjust specific thoughts, there is no reasonable alternative but to continue to work with the details of individual lives. To understand the existential meanings of individual lives, we must become conversant with the patients' life stories and coping styles and identify the affectively charged associations that serve as impediments to growth. It may also be worth considering the degree to which critical aspects of individuality are lost, and any clear scientific analysis becomes problematic, when we group people into diagnostic categories that may not match brain/mind dynamics very well.

Despite the impressive advances and achievement in brain imaging (Chapters 2, 6, and 7), we should recognize and worry about how much neural complexity and individuality these pseudo-color clouds of arousal may contain. The distinct thoughts and schemes that can filter through these areas are enormous. Typically most individual-specific brain changes are discarded in generating group statistics. This brings us, again, to the managed-care issue of how important is it really for psychiatrists to understand and deal with the nuances of individual experiences? For mild depressions, the answer may be "very little," and neurochemical adjustments will tone down persistent and intrusive cognitions (Kramer, 1993). For specific phobias, obsessive-compulsive problems and perhaps panics, where cognitive behavioral and short-term psychoanalytic treatments are effective (Chapters 12 and 18), the proper answer must surely be "quite a bit."

Scientific psychiatry will need conceptualizations at various levels, ranging from "low-level" cellular and molecular models, to "middle-level" theories that focus on major functional systems of the brain, to "high-level" conceptualizations where the detailed mental events of individuals are considered. Because of the scientific successes of low-level molecular and cellular approaches, much of the field has shifted allegiances and forged commitments only to low-level theories, and hence major texts spend abundant time on the details of neuroanatomy, neurochemistry, neurophysiology, and molecular biology and comparatively little on the human mind.

The goal of the present text is not to compete with those archival treatments of the relevant biological substrates that are now detailed in several recent compendia (Charney et al., 1999; Yudofsky and Hales, 1997; D'Haenen et al., 2002). The aim is to provide a coverage closer to the middle level of analysis (also see Bittar and Bittar, 2000), where mental faculties can be related credibly to objective brain systems in ways that may be clinically productive. Unfortunately, there has been a widespread tendency in biological psychiatry to neglect evolutionary and emotional systems in considering how the brain/mind is organized (Chapter 20), and this may now be retarding new drug development (Chapter 21).

Without a clear understanding of emotional systems (e.g., Table 1.1), we can easily lose focus if we try to leap between molecular and global diagnostic issues. Might this be one reason that advances in the discovery of new types of drugs for psychiatric illness have been so modest? We should remember that most of the psychiatrically useful drugs—the antipsychotics, antidepressants, antianxiety, anticompulsive and antimanic agents—were discovered before the advent of modern neuroscience, often through little more than trial-and-error initiatives. At best, the neuroscience of the past quarter century has largely yielded variations on previously established themes. Practically no new and effective drugs, nor insightful brain organizational concepts, have emerged from the tsunami of research that has been conducted at the molecular level. Many of us have confidence that investments in the fine-grained molecular approaches will yield strikingly new concepts (e.g., the use of neuropeptide and neurotrophin modulators as discussed in Chapter 21). At the same time, some of us suspect that the implementation of middle-level affective and emotional systems concepts will help enormously in better framing our molecular inquiries (Chapters 2 and 16).

Middle-level analyses presently provide excellent opportunities for docking mind and brain issues meaningfully and help generate new ways to look at psychopathologies and pathophysiologies and to generate new ideas for therapeutics. For instance, the existence of a generalized mesolimbic dopamine-centered SEEKING system in the brain has only been recently recognized in biological approaches to the mind (Panksepp, 1998). The system was long misconceptualized as a simple pleasure, reward, or reinforcement system because of the pervasive failure to consider all the behavioral and psychological evidence (Panksepp and Moskal, 2003). However, even Aristotle recognized that the appetitive function of the "soul" permeated all other parts of the mental apparatus, and it may be quite informative to conceptualize the organization of affective processes in terms of distinct, albeit highly interactive, neuromental faculties once more. As already noted, this appetitive motivational SEEKING system contributes heavily to drug addictions and the psychic excesses of schizophrenia and other psychiatric problems.

In sum, we currently know a great deal about limbic system neuroanatomies and neurochemistries, but all too little about the functional subsystems of which the "emotional-visceral brain" is composed. However, animal research, especially if we are willing to accept the affective nature of animal life, should allow us to work out the general evolutionary principles, yielding useful concepts that should also apply to humans (Panksepp et al., 2002). Among such core neural processes, cross-species homologies do prevail. Of course, this work has no chance of clarifying the massive cognitive complexities that arise when these ancient systems interact with our expansive cortico-cognitive apparatus. To understand those interactions, a new psychoethological type of human mind research is needed (Panksepp, 1999). Still, a judicious blend of animal and human brain/mind research should eventually yield a new and coherent psychobiological view that is bound to be of penetrating psychiatric significance.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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