Primary Process Mobility of Cathexis

Situations in which feelings invested in one object are transferred to others are apparent in the example where the patient conflates a stranger with his long-dead friend. However, a better example comes from another patient, who clearly recognized her husband when he visited her in hospital and treated him as such. Yet, when he was not there, she regularly referred to the man in the bed next to hers as being her husband and behaved accordingly toward him. Again, the wish-fulfilling properties of such conflations are clear. She wanted her husband to be there. When he was, that was fine; but when he wasn't, it was not at all difficult to ignore or modify her conception of reality to fit with her requirements.

In these cases, then, it appears that the false beliefs seen in neurological patients can, at least in part, be explained by an emotion-based model. Additional studies (e.g., Fotopoulou et al., under review; Turnbull et al., in press) that have investigated patients of this sort in a more systematic and quantitative way are entirely consistent with this emotion-based account (though they have revealed a range of issues that merit further investigation). For example, the false beliefs of these patients almost invariably transform their current situation into a more affectively pleasant one, in which family and old friends come to visit, or the hospital ward is perceived as a hotel, or is now directly attached to the living room of their home.

An emotion-based account of confabulation is of direct relevance to issues within psychiatry. For example, such an account offers some interesting insights into the possible neurobiological foundations of false beliefs—especially the suggestion that the excessive influence of core emotion systems over cognition might account for patently incorrect opinions about the world being held in the face of reasoned argument. It is of no small interest to psychiatry that the brain regions implicated in neurological patients with false beliefs are the same medial frontal sites as those implicated in schizophrenia. Indeed, the link between the two conditions becomes even clearer at the pharmacological level because poor regulation of a dopamine-based emotion system may lie at the core of false beliefs in both schizophrenia (e.g., Grace, 1991; Moore et al., 1999; Weinberger and Lipska, 1995) and other classes of false belief phenomena, such as dreams (Solms, 1997, 2000). More extensive discussion of this issue is beyond the scope of this chapter (see Solms and Turnbull, 2002, Chapters 4 and 6 for more detail).

0 0

Post a comment