We had a very successful conference this past weekend at NYU entitled "Biology of Mind: An Emerging Dialogue between Neuroscience and Psychoanalysis," in which Eric Marcus and myself participated along with David Silbersweig (whose neuroimaging group at Cornell is integrating psychodynamic theory with neuropsychiatric in psychotic symptomatology) Jack Gorman, Mark Blechner,Marco Iacoboni, Dan Siegel, Clark Sugg, and Tyler Volk. Marco Iacoboni, Director of a brain mapping lab at UCLA, presented his research on mirror neurons. It was fascinating to hear about mirror-neuron systems (MNS) in our brains and in the brains of mammals. Iacoboni, a neurologist by training, defined them a s a way of taking the other into oneself. I thought of Gaetano Benedetti's approach in which the therapist identifies with the catastrophes occuring in the patient and Maurizio Peciccia's progressive mirror drawing technique with persons who are diagnosed with schizophrenia.Below is some material on the MNS, and its potential relevance to schizophrenia, from my book in progress.
Brian Koehler
Mirror Neurons & Schizophrenia
Neuroscientists Gallese (2003a&b) and Rizzolatti and colleagues at the University of Parma, Italy (see Chris Frith and Daniel Wolpert’s edited 2003 volume The Neuroscience of Social Interaction: Decoding, Imitating, and Influencing the Actions of Others published by Oxford University Press) have opened up an important area of research in their discovery of ‘mirror-neurons’ in primates. These neurons, some of which are in the rostral sector of the ventral premotor cortex which have specific histochemical and cytoarchtectonic characteristics and which have been termed area F5, respond when primates see an other performing a specific action as well as when they do the particular action themselves. They are thought to be the neural basis of imitation.
Studies in humans have demonstrated that observing an other’s action facilitates the neural pathways the observer would use to perform the same action (applied to affects, this may be a neural basis for the mutual identificatory processes so necessary to achieve in psychotherapy). Arnold Modell (2003) pointed out that Vittorio Gallese and Giacomo Rizzolatti, co-discoverers of mirror neurons, recently demonstrated that the experience of witnessing pinpricks that an experimenter applied to his own finger stimulates the very same neurons as when an observer receives a pinprick. Modell noted: “The implication is that our brains resonate to the other’s feelings in manner similar to how we resonate with the other’s intentional actions...This research suggests that we use our bodies as a template that enables us to feel our way into the other’s experience. This supports the contention that the roots of empathy are in the body, and as with projective identification, this process occurs unconsciously” (p. 187). This mirroring system could underlie the development of empathic attunement (e.g., Benedetti’s theory of the therapist’s identification with the catastrophes occurring within the patient) and intersubjectivity.
The research of Meltzoff (Frith & Wolpert 2003) has demonstrated perception and action (e.g., identification and countertransference?) are not independent and that the very early capacity of infants to imitate their caregivers may have as a neural base this innate mirroring system. Along with this immersion in the experience of the other is the capacity to distinguish the self from other which neuroimaging studies have suggested is mediated by the right inferior parietal lobe. The integration of representing others as both like me and different from me is fundamental for the establishment of intersubjectivity. This neural viewpoint is similar to Benedetti’s emphasis on the de-integration of separate and symbiotic selves at the core of the psychotic structure. Gallese (2003a) examined three fundamental aspects of interpersonal relationships: imitation, empathy and mentalization (intuiting feelings and intentionality in the minds of others and in one’s own mind) and has suggested that they all share a common basic operative defining a shared interpersonal space: embodied simulation which is pre-reflective, automatic and unconscious. Gallese hypothesizes that this basic level of embodied simulation processes enables the construction of a shared meaningful interpersonal space. Gallese noted:
“The shared intersubjective space in which we live from birth continues to constitute a substantial part of our semantic space. When we observe other acting individuals, and face their full range of expressive power (the way they act, the emotions and feelings they display), a meaningful embodied interpersonal link is automatically established by means of simulation” (p. 177).
Gallese (2003b) has applied his shared manifold hypothesis and the neural base of intersubjectivity to the phenomena of schizophrenia. He noted: “In schizophrenia, self and other are not anymore mutually interrelated, but they tend more and more to diverge and crystallize into segregated, incomprehensible and impenetrable realms. In spite of this lack of interpersonal relatedness, the self can experience dramatic loss of its boundaries...as epitomized by Schneiderian positive symptoms such as thought insertion, auditory hallucinations, and delusion of action control” (pp. 177-178).
Minkowski (1927), like Eugen Bleuler (1911), was impressed by the nature of schizophrenic autism, the patient’s impaired vital contact with her or his world and incapacity to resonate, to establish meaningful emotional bonds with others. Gallese (2003b) commented on the patient’s difficulties in establishing a precognitive, intuitive interpersonal bond with an other in schizophrenia. Perhaps, this is a defensive reaction to feeling overwhelmed, invaded and colonized by the other.
Gallese views schizophrenia as a ‘lack of resonance,’ as an empathic disorder; the shared manifold of intersubjectivity is disrupted. This approach emphasizes the relational character of the psychopathology of schizophrenia and therefore “has the merit to disclose the possibility to establish a more insightful therapeutic bond with psychotic patients” (p. 178).
I believe that the psychoanalytic approach of Gaetano Benedetti (1987) affords us a relational ‘way-of-being’ with a person with schizophrenia which holds promise in terms of establishing the emergence of self from the dual terrors of the disintegrated self-states constituted at the poles of autistic loneliness and pathological symbiosis/fusion. Benedetti and Peciccia (Koehler 2003; Peciccia & Benedetti 1998), in a series of papers, have been articulating forms of psychotherapy based on their view of the psychotic structure in which the integration of separateness (autonomy, agency) and symbiosis (relatedness in which the patient discovers her or his own boundaries in the relationship with the therapeutic partner outside of the psychotic transference) has an opportunity to take place.
I believe I can now state my thesis: we have within our grasp a potentially fruitful neural basis for the psychotic structure, and its amelioration within psychotherapy and other forms of psychosocial interventions, e.g., involvement in a therapeutic community, identified by Gaetano Benedetti as well as many other psychotherapists working in depth with persons diagnosed with schizophrenia (it is possible to study this utilizing fMRI for both partners of an interaction involving theory of mind, empathy, intersubjectivity, to see the degree of plasticity involved in these neural regions mediating empathy and intersubjectivity). I believe that we have a coherent theory of the psychobiological basis of psychosis if we combine the basic neuroscience research on the brain as primarily a self-activating system, one whose organization is geared toward the generation of intrinsic images (e.g., in dreams), articulated by Rodolfo Llinás (2003), which articulates the pole of autistic protection and withdrawal from invasive control and colonization by an other, with the research on ‘mirror-neurons’ by such neuroscientists as Gallese (2003a&b) and colleagues, depicting the pole of symbiosis and intersubjectivity. Both are essential for interpersonal relatedness, however, the more disintegrated they are (psychically and in terms of co-opting and ‘hijacking’ neural systems), the more difficult it is for the patient to establish continuous and cohesive embodied subjectivity within the realm of interpersonal relations. Our ‘job’ as psychotherapists with psychotic patients is to struggle to achieve this within ourselves as we struggle to achieve this with our therapeutic partners in the countless interactions and enactments taking place within the transitional therapeutic space.
Benedetti, G. (1987). The Psychotherapy of Schizophrenia. NY: New York University Press.
Gallese, V. (2003a). The manifold nature of interpersonal relations: the quest for a common mechanism. In Christopher Frith & Daniel Wolpert (Eds.) The Neuroscience of Social Interaction: Decoding, Imitating, and Influencing the Actions of Others, 159-182. Oxford University Press.
Gallese, V. (2003b). The roots of empathy: the shared manifold hypothesis and the neural basis of intersubjectivity. Psychopathology, 36, 171-180.
Koehler, B. (2003). Interview with Gaetano Benedetti, M.D. The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 31 (1), 87.
Llinás, R. R. (2001). I of the Vortex: From Neurons to Self. Cambridge, MA: The MIT Press.
Modell, A. H. (2003). Imagination and the Meaningful Brain. Cambridge, MA: The MIT Press.
Peciccia, M. & Benedetti, G. (1998). The integration of sensorial channels through progressive mirror drawing in the psychotherapy of schizophrenic patients with disturbances in verbal language. The Journal of the American Academy of Psychoanalysis, 26 (1), 109-122.
Brian Koehler PhD
New York University
80 East 11th Street #339
New York NY 10003
212.533.5687
brian_koehler@psychoanalysis.net
