An important new volume containing international research on the effects of stress/fear/anxiety on the brain has just been published: Handbook of Stress and the Brain (2005) edited by T. Steckler, NH Kalin and JMH Reul for Elsevier. It primarily covers the molecular biology of stress including many chapters on neuroplasticity and stress (e.g., effects on neurogenesis). I am in the process of reviewing it (reading all of the abstracts and doing selective reading of topics of particular interest to me) in order to update my knowledge of the relevant research, particularly that which has implications for emotional/cognitive illnesses/disorders such as the psychoses. My early impression that the neurobiology of severe mental illness is in fact primarily the neurobiology/epigenetics of anxiety/fear/stress has been confirmed again and again. The clinical phenomenology, and even etiology, of these disorders, of course, could never be understood at this level of organization. However, it plays a substantive role. Sonia Lupien, Francoise Maheu and Nicole Weekes (2005), in their “Glucocorticoids: effects on human cognition,” reviewed the research literature on the effects of glucocorticoids (e.g., cortisol in humans) on human cognition (contained in Handbook of Stress and the Brain (2005) edited by T. Steckler, NH Kalin and JMH Reul for Elsevier). After 60 years of research, the following points can be made: First, that steroids could access the brain and lead to a ‘steroid psychosis’ (perhaps this is related to the well-known phenomenon called “organismic panic” by Ping Nie-Pao and “organismic distress” by Margaret Mahler); Second, that glucocorticoids can access the hippocampus leading to impairments in learning and memory function; Third, that glucocorticoids access the frontal lobes and the amygdala, leading to possible working memory impairment and emotional/cognitive dysregulation. Is this not exactly what we see in acute and chronic psychotic states?
My long-term clinical experience in psychosis has taught me of the importance of the wider socio-cultural processes (remarkably elaborated on by Martti Siirala in Finland and Francoise Davoine and Jean-Max Gaudilliere in France) and most especially, the role of self-formation within relational contexts, particularly, but by no means only, within the early developmental history of the individual. I find it difficult to articulate the experience of psychosis (although I truly believe we all participate in psychotic processes), but it is significantly involved with annihilation of the self and other (see the work of Marvin Hurvich on annihilation anxieties) and goes something like: to encounter an other I experience the loss of my autonomy, I feel penetrated, taken over, controlled, colonized; and on the other hand, to be alone, either when actually by oneself or in a state of emotional unrelatedness when an other is present, again feels like a panicky loss of self, a loss of a state of personal existence, of continuity and cohesion of self. The latter pole requires drastic measures in order to maintain some sense of personal being/continuity, such as self-referential thinking/delusions and hallucinations. These in effect are ‘back-door’ attempts at self-cure, which often lead to an increasing sense of alienation and isolation in the person partially because of their effect on the interpersonal surround, e.g., which could include responses that are distancing, persecutory, non-comprehending, punishing, etc. The person’s hostility and suspiciousness/guardedness towards others, often self-protective against anticipated unempathic, hostile and controlling responses from others, furthers the sense of isolation and worthlessness. Inevitably, in chronically closing off oneself from the influence of others, one forecloses affective and vital contact with oneself. Professor Gaetano Benedetti and Maurizio Peciccia used the metaphor of the cell and its membrane to illuminate this paradox in which the psychotic person is ensnared. The cell must be able to let in needed nutrients in order to survive, yet it must also, simultaneously maintain continuity and sameness. If it is too walled off it dies and if it is too permeable it also dissolves into nothingness. Human beings, like the countless cells of which we are composed, must perform a similar task: maintaining sameness (autonomy) at the same time that we are adapting and changing in response to our forever changing environments (relatedness).
Other notable volumes on the effects of stress/fear on the brain are:
Levy, A. et al (Eds.) (1998). New Frontiers in Stress Research: Modulation of Brain Function. Australia: Harwood Academic Publishers.
van Praag, HM, de Kloet, R, & van Os, J. (2004). Stress, the Brain and Depression. Cambridge University Press.
Brian Koehler PhD
New York University
80 East 11th Street #339
New York NY 10003
212.533.5687
brian_koehler@psychoanalysis.net
