In light of conference on the "Biology of Mind: An Emerging Dialogue Between Neuroscience and Psychoanalysis" to take place tomorrow and Saturday at NYU, I would like to recommend to interested members of our ISPS community an article which attempts to outline the difficulties involved with, as well as potential benefits in the emerging dialogue between psychoanalysts and neuroscientists: “The emerging dialogue between psychoanalysis and neuroscience: Neuroimaging perspectives”: by Manfred Beutel, Emily Stern & David Silbersweig (from the Functional Neuroimaging Lab at Cornell University) published in JAPA (51/3: pp 773-801). The authors review various studies involving neuroimaging which have demonstrated the beneficial effects of psychotherapy on neural chemistry and function. The authors are currently involved with promising research comparing psychodynamic psychotherapy with dialectical behavior therapy for borderline patients. A single case study of a borderline patient in one year of psychodynamic psychotherapy revealed normalization of serotonergic activity in the prefrontal cortex and thalamus. In summary, there are two avenues in which these results are understood by Beutel et al: prefrontal activation and influence on limbic overarousal (eg, self-reflection, insight, etc) and relational reworking (transferential/countertransferential processing of implicit, unconscious memory-what the Sandlers and Fonagy have termed the present unconscious) of traumatic and pathogenic adverse early childhood experiences. They noted:

“Thus, the curative factor is seen not primarily in the somewhat ambiguous historical reconstruction by removal of repression, but rather in the elaboration of preconscious and unconscious relationship representations in the transference. According to this view, psychoanalysis thus deals with the present unconscious shaped by childhood experiences that it does not represent directly” (p. 791).

Beutel et al comment on the artificial distinction between mind & brain:

“Based on the studies reviewed here and in the context of an emerging view of brain plasticity, the distinction between somatic therapies that impact on the brain and psychological therapies with elusive, purely subjective effects is no longer tenable. It must rather be assumed that psychotherapies that successfully ameliorate symptoms and complaints (or more profoundly change object relationship patterns, affect regulation capacities, and the like) are likely to have a measurable impact on the brain, even though we know little about the [processes]involved” (p.794).

A new volume on the neurobiology of fear and anxiety, Fear & Anxiety: The Benefits of Translational Research edited by Jack Gorman in 2004 for the American Psychiatric Publishing, Inc., demonstrates the widespread effects of these affects on CNS structure and function. The word “translational” refers to an integration of basic neuroscience research with clinical practice. There are chapters on direct effects of stress on the brain by Bruce McEwen & Ana Maria Magarinos (McEwen is a neuroendocrinologist at The Rockefeller University in NYC specializing in the study of stress. In a talk with him, he seemed favorable to my theory suggesting the large overlap between the neuroscience of schizophrenia and the neuroscience of separation/isolation, profound and chronic stress/ anxiety),developmental adversity and later anxiety, effects of terrorism and disasters, an excellent article by Michael De Bellis on the neurotoxic effects of childhood maltreatment and trauma, the scientific basis of psychological therapies in anxiety disorders by David Barlow & Laura Allen, LeDoux on the amygdala in fear conditioning, Amaral on the amygdala and social behavior, etc. Jack Gorman and Justine Kent in their chapter “New molecular targets for antianxiety interventions” have this to say about psychotherapy:

”...These findings also suggest that interventions aimed at increasing prefrontal governance over limbic activity might be successful in reducing anxiety and fear in humans. Psychotherapy is presently the best candidate for such an intervention... [also] several studies suggest that response to cognitive-behavioral therapy is more durable than response to medication” (p. 205). See also Fisher, S. & Greenberg, R. P. (Eds.) (1989). The Limits of Biological Treatments for Psychological Distress: Comparisons with Psychotherapy and Placebo. Hillsdale, NJ: Lawrence Erlbaum Associates ( Bert Karon has an excellent article on schizophrenia in this volume).

Brian Koehler