Belger and Dichter (2006-"Textbook of Schizophrenia” edited by Jeffrey A.Lieberman, T. Scott Stroup and Diana O. Perkins for American Psychiatric Publishing, Inc.), in their review of current structural and functional neuroanatomical changes in schizophrenia, noted: “In individuals with schizophrenia, the alterations in brain structure may be quite subtle, be difficult to detect, and appear as a variety of small planar, linear, volumetric, and, more recently, shape or geometric changes in brain morphology” (p. 168). They suggest that the evidence is growing that schizophrenia is a disorder of cortical connectivity resulting in more global, systemic alterations in cortical and subcortical structureand function. Belger and Dichter refer to recent diffusion tensor imaging (DTI) research which have reported significant functional impairments infrontotemporal and frontoparietal connections which suggest a structuraldisonnectivity in schizophrenia. More recent studies combining DTI with magnetization transfer imaging (MTR), a technique sensitive to myelin and axonal alterations, suggest that some of the diffusion abnormalities in schizophrenia are likely a result of abnormal coherence, or organization of fiber tracts, while others may correlate with myelin or axonal disruption. Decreased diffusion anisotropy was observed in multiple neural regions in schizophrenia. Belger and Dichter conclded their review with the following observations:

“The implementation of complex cognitive and affective functions in the human brain not only depends on the proper functioning of individual regions but also necessitates the communication between brain regions that facilitates integration of cognitive, motor, and affective domains of function...structural and functional impairments have been identified across multiple brain systems in schizophrenia, particularly along frontolimbic pathways and regions. Much of the current evidence from neuroimaging studies suggests dysfunctions to be prominently manifest in anterior components of the limbic circuitry, including the thalamus, basal ganglia, and hippocampus, as well as their target projection regions in frontal neocortex” (p. 180).

Personally, I interpret this research as underscoring the importance of the emotional and social brain in schizophrenia, the structural/functional dysconnectivity theories remind us of the original meaning of the term “schizophrenia,” i.e., a splitting of mental functions and mental life. For psychoanalysts, this splitting of mental and emotional life, is both based in deficit and conflict. I am reminded of the words of William Shakespeare in his play King Lear:

How stiff is my vile sense
that I stand up
and have ingenuous
feeling of my huge sorrows
Better I would distract[dissociate] so
should my thoughts
be severed from my griefs
and woes
by wrong imaginations[delusions, hallucinations]
loose knowledge of themselves

Brian Koehler PHD
New York University
brian_koehler@psychoanalysis.net