Recently, I was asked by a colleague what might be the neuroscience base of poor hygiene in persons with mental illness.

I do not fall back on reductionistic explanations, when there are obvious psychodynamic/psychosomatic meanings. Theoretically, even if there was a primary biogenetic 'lesion,' it would be taken up into dynamic meanings which become part of the clinical picture and need to be dealt with. My patients who have neglected themselves often do it for dynamic reasons. Some of which are:

• A repetition of being neglected when young (no one watching out for them)
• Depression secondary to loss of others, one's capabilities, one's own self-esteem etc.
• Self-hate and self-punishment
• A barrier so others do not get close
• Passive-aggressiveness
• Demoralization & learned helplessness
• Social defeat/social isolation
• Other issues overwhelm and paralyze them
• A cry for help, that someone will do it for them
• Preservation of sameness as a way of controlling panic and anxiety
• Body odors as a sign they exist, i.e., they are not dead, something like the sensation seeking of some borderline patients, e.g., cutting as an antidote to inner deadness

One of my patients, I am convinced, hoped that I would inhale his body odor so that I’d 'take him in'--that he would become part of me.

There are many other dynamic reasons for self-neglect and poor self-care without having to attribute them to a "primary deficit syndrome" (negative symptomatology based in reduced dopaminergic neurotransmission in mesocortical pathways). Downregulation or upregulation of DA (gene expression) can be triggered by psychosocial factors and this in itself may become part of a self-sustaining loop contributing to the problem. I think the differentiation between secondary and primary negative symtoms, such as Will Carpenter and others, have proposed, fails to understand the depth of human misery and its impact on CNS structure/function. Today, I read in a medical atlas on bipolar disorder (used by trainees in the field) that stress does not contribute to the inception or course of bipolar disorder (E. Fuller Torrey was used as a reference). Pardon the French, but if the author got off his ass and actually read the many, many research articles (epidemiology, sociocultural, biological, etc.) documenting the significant role of stress (i.e., fear & anxiety) in the inception and relapse of bipolar disorders (rise in cortisol, effects of high EE, psychosocial stressors prior to symptom activation, etc.), he would not have made that misleading comment.

The neurologist/phenomenological psychiatrist Erwin Straus underscored the importance of dynamic meaning in all aspects of human life (e.g., body stance & movements). All aspects of our existence can be infused with dynamic meaning which becomes part of the clinical picture. How could it be otherwise with beings who have such complex relational and cortical/subcortical functioning? Reductionism might be good for securing research funds or getting articles published, but it may be ineffective, or worse, harmful, for actual patient care.

Part 2:
Valerie:

I too am spontaneously responding to your fruitful, creative ideas. Yes, and the odors must become a type of security blanket for the analyst/therapist as well. Searles, in his most creative paper (if one could have the audacity to say that-he had so many creative papers), at least it was his favorite paper (personal communication), "Transitional Phenomena and Therapeutic Symbiosis," pointed out that the patient's symptoms had to become transitional objects for both patient and therapist (this is how he defined therapeutic symbiosis) in order for therapeutic resolution of the symptoms to take place. As a psychobiological psychoanalyst, I see relational contexts in seemingly bizarre symptoms. Perhaps, the self-neglect of some of our patients are unconscious signals to invoke tender care . In psychobiological research with non-human mammals, it is sometimes called licking-grooming & arched-back nursing-LG-ABN-and high levels of this in the mother are correlated with low stress reactivity in offspring. I am including some material from previous postings which go into this more deeply.

Research demonstrates the importance of the role of the somatosensory relationship between mother and infant. Previously, I have written of the relational neurobiology existing between mother and infant (Koehler 2006). In mice, fetal cells migrate into the mother’s brain transforming themselves into neurons, astrocytes, oligodendrocytes, and macrophages. The latter responding to molecular distress signals if the mother’s brain is injured. The mother's brain regulates to a significant degree,e.g., through the maternal- placental-fetal neuroendocrine system, the developing fetal brain, creating long-term predispositions towards stress reactivity (e.g., placental corticotropin releasing hormone/factor). Oxytocin, some have called a “social neuropeptide,” helps mothers overcome an aversion to the odors of neonates. Oxytocin is released in the mother’s olfactory region of the brain at the time of birth, thereby inhibiting the firing of olfactory neurons. This neuropeptide, which is found only in mammals, thereby suggesting its importance in social interaction, serves other functions involved in maternal-infant bonding. Within 2 or 3 days of birth, human infants can discriminate their mother’s voice from the voice of others. Infants are already familiar with their mothers voice since it is one of the most intense acoustic signals measurable in the amniotic environment. Such somatosensory sensitivity is also observed within the visual system. Within hours of birth, infants prefer the shape of the human face to other objects. By 2 weeks, infants prefer gazing at their mothers’ face than the face of others. Wexler in 2006(“Brain and Culture: Neurobiology, Ideology, and Social Change” by Bruce E. Wexler published in 2006 by The MIT Press) concluded:

“These innate social-sensory predilections, the dependence of growth itself upon social-sensory experience, and the intensity of pre- and postnatal social-sensory experience, rapidly link the infant and primary caregiving adults in mutually regulating dyadic systems. The resulting synchronization and mutual contingency of infant-adult behaviors are evident in sleep and electroencephalogram patterns, direction of gaze, facial expressions, vocalization, and cardiac and behavioral rhythms” (p.97).

Because infancy and childhood last much longer in humans than in other mammals, there is a greater degree of influence of these social interactions on brain development in humans.

The crucial importance of somatosensory and polymodal interactions between mothers and infants has been demonstrated in many studies. When 10-day-old rat pups are separated from their mothers for only 1 hour, growth hormone levels in the blood drop to half of their normal values. Likewise, ornithine decarboxylase (OCD) activity, an enzyme important in protein synthesis and an index of tissue growth and differentiation, also drops to half of its normal levels in the brain and other somatic organ systems. Reunion with mother results in a dramatic reversal of values which gradually are restored to normal levels. If during separation, the mammals are stroked with a brush simulating maternal licking and grooming, growth hormone levels and ODC activity both remain normal. Separation also has been observed to decrease tissue sensitivity to growth hormone. Wexler (2006) noted:

“The effects of maternal separation on growth are also evident in the brain itself. Rat pups separated from their mothers for 24 hours showed a twofold increase in the death rate of neurons and glial cells in the cerebral and cerebellar cortices, and in the white matter tracts that link different brain regions [these findings are also observed in schizophrenia and bipolar disorder]...Neurochemical studies of adult animals have found persistent abnormalities in multiple neurotransmitter systems in animals separated from their mothers during infancy. Expression of the dopamine transporter gene and dopamine-mediated stress responses, expression of serotonin receptor mRNA, expression of benzodiazepine receptors, sensitivity of glucocorticoid receptors related to stress response, and sensitivity to morphine are all altered in adult rats who have been separated from their mothers for varying periods of time as infants. Experimentally induced autoimmune encephalitis is more severe in adult rats that have been separated from their mothers as infants, suggesting an altered immune system function” (pp.90-91).

I have previously reported on the research of Michael Meany and colleagues in Montreal, demonstrating that higher levels of maternal licking and grooming and arched back nursing (LG-ABN) reduces stress reactivity in pups, an effect which can last through adulthood. Genetic factors predisposing rats to greater stress reactivity (LHPA-limbic-hypothalmic-pituitary-adrenal axis) can be reversed through the early maternal environment of increased licking and grooming-a case of phenotype overriding genotypic predispositions. Further research has actually identified the changes in the genes associated with the stress response as a result of maternal licking. Shortly after birth, the surface of DNA is largely covered by small chemical complexes called methyl groups. These methyl groups actually limit biochemical access to the DNA and thereby limit activation or expression of genes. Social experiences after birth can lead to a selective removal of these methyl groups, making some genes more accessible to activation. In the rat, experiential modification of methylation is much greater during the first three weeks of a rat’s sad lab life, than thereafter, remaining relatively unaltered throughout adult life. Meaney and colleagues demonstrated that through maternal licking, which selectively demethylates the genes that produce the glucocorticoid receptors in the hippocampus and frontal lobes, the stress response can be therapeutically ameliorated. Through these processes of early life experience, lasting changes are made in the structure and function of genes that regulate the neural and somatic response to stressors.

In non-human primate studies, peer-raised, as opposed to mother-raised infants, appear chaotic and are characterized by rapid fluctuations between periods of isolation and intense engagement. Peer-raised primates evidence deficient biobehavioral self-regulation Monkeys raised in partial or total isolation, display altered temperature regulation, abnormal eating patterns marked by polydipsia and hyperphagia (this is similar to Harry Guntrip’s psychoanalytic observation that people can relate to food as they relate to other persons-starving themselves or filling up voraciously, and at times vomiting it out, as in anorexia and bulimia), and impaired regulation of body weight. Peer-raised monkeys also showed evidence of decreased neurobiological structure or organization. Correlations between and among the activity of different neurotransmitter systems and behavior is significantly reduced or absent in peer-raised monkeys. A similar loss of neurobiological structure has been reported in human infants continuously raised in the context of social isolation within institutional settings.

The persistent neurochemical and behavioral effects of maternal care of female infants affect the way the infant functions as a mother when she is an adult. Females that have been separated from their mothers when they were infants demonstrated lower than normal gene expression in areas of the brain associated with maternal behaviors. These females as mothers had reduced levels of LG-ABN, attentional difficulties and greater stress reactivity which further compromised their functioning maternally. Environmental factors, such as litter size and the reliable availability of food supplies also play a significant role in the regulation of homeostasis in infants by their caregivers. A variety of environmental factors can influence maternal behaviors and their impact across the generations. This intergenerational effect, which in humans is also significantly impacted upon by fathers and the wider culture, is potentially self-propagating and self-amplifying.

Brian Koehler PhD
Postdoctoral Faculty
New York University
80 East 11th Street #339
New York NY 10003
212.533.5687
brian_koehler@psychoanalysis.net