The basic neurobiology
of psychoanalytic therapy
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I have studied, written, and taught material that is based on a non-dualistic (no separation between body and mind) view of the human mind. It's based on the neurobiologically confirmed presumption that no animal with a brain is totally open to its physical and social outer world without intervening nerve-cell processes that represent the outer world on an internal map that I, like most psychoanalysts, call our inner world. These internal maps are evolved through Darwinian natural selection to provide us as biological animals with the predictive neural representations that are most likely to promote personal and genomic survival for the individual. Our capacity to form these inner maps has been naturally selected for probably billions of years. The genes that code for those inner maps are not subject to environmental influence. However, the particularities of our inner worlds are vitally contingent on our experiences in the physical and social environments. New neural connections are made as we become sentient during gestation, and even more so after birth. As we unconsciously struggle to survive in infancy, the nature of our attachment experiences, positive and negative, shape our anticipations of new experiences in later childhood and beyond. Survival is completely dependent on how well the neural circuits of our inner world predict events to come in our personal lives. Freud, schooled in neuropathology, understood this as the neural basis of transference, the reflections of our inner worlds, the baggage we carry into each interpersonal encounter we have throughout the life span - and he considered this aspect of subjective experience to be the main focus of the psychoanalytic process. Neurobiologically, the processes of mental development, psychopathology, and psychotherapy are largely subsumed within the category of cognitive neuroscience called Learning and Memory (L&M). This is probably best reflected in the researches of the Columbia Nobelist Eric Kandel. But Kandel will agree that psychoanalysis provides the best source of psychological understanding of human subjective experience. Our brain-based survival tool kits, then, are products both of our genetic heritage and of cultural influences. Cultural influences are mediated primarily by parental figures, and later by peers, companions, co-workers, mass media, and so on. We psychoanalysts explore our patients' inner worlds, but prior to current reconciliations with neurobiology have tended to scant innate nature in favor of an over-emphasis on cultural nurture. Since the actual "isness" of reality is maddeningly ungraspable to us all, we often use metaphors to describe our life experiences. You will easily identify my metaphors as you read on and see how I almost instinctively use them. One instance, important to me, is that each clinical session with a patient is an opportunity for both of us to learn something new - in a real sense an adventure in conjoint exploration. This attitude seems to resonate with the clinical approach recommended by one of my past mentors, Wilfred Bion, who recommended entering each analytic session "without memory or desire". In less poetic language, the analytic therapist should not prefigure or pre-plan the session to allow maximum freedom for spontaneity. At the beginning of my career as a UCLA psychiatry professor, I had the privilege of frequent conversations with a newly-minted Harvard sociology Ph.D., Harold Garfinkel, who joined our department and introduced me to the teachings of his mentor, Talcott Parsons, widely considered to be the intellectual father of modern sociology. Hal and I started the first ongoing interdisciplinary faculty seminar at UCLA Psychiatry. That seminar was a great education for me: it taught me many of the ways in which cultural nurture influences biological nature. After leaving my full-time teaching and clinic administration and taking on the job of creating a new LA County community mental health program, I applied Parsonian - and Garfinklian - perspectives in building a program aimed at mobilizing community caregivers to abate the sick-role aspects of psychiatric illness. With the invaluable help of our assistant director-brilliant, clinically sharp, witty and steadfast Donald Schwartz, former UCLA chief psychiatry resident, we designed a public community health program which sought impact on the County's underprivileged emotionally troubled residents by having our mental health professionals "ride on the shoulders" of existing caregivers such as welfare caseworkers, classroom teachers, public health nurses, and probation officers. Rather than encourage referrals to our clinics and hospitals, we consulted with caregiving clients to help them in turn to tune into the needs of their own clients more effectively within their own scope of skills and training. Hal Garfinkel set sail for broader horizons later, became Chair of UCLA Sociology, and made several notable contributions of his own. Don Schwartz returned to UCLA as a talented clinical teacher after nine years of smoothing out my rough edges and lending his personal touch to enrich the Department's spirits and effectiveness. Don and I fell into a "good cop/bad cop" routine at times when negotiations with private agencies for contract services became unwieldy. Guess who was the bad cop? I always had tried to keep a steady hand on the helm, but at times had felt we had to repel boarders. 
Stand by to repel boarders! As an amateur, though serious, sea captain now bereft of a vessel, I feel somewhat like a beached porpoise. I have entered many safe harbors, but like the classical sea voyagers of yore, continue to embark on further (virtual) passages, writing of my discoveries (I hope all this sea-talk does not provoke mal de mer in the reader!). As I mentioned above, many of these passages are in my consulting room with patients as co-meditating shipmates. Also, I explore the possibilities of studying and transcending the boundaries between psychoanalysis and neighboring disciplines. A recent paper of mine, now in press, is entitled "Living within the cellular envelope: subjectivity and self from an evolutionary neuropsychoanalytic perspective". At the time of this writing, I am putting together a paper on what is unique about the human mind in contrast to the minds of other primates, to be presented at an interdisciplinary conference in August of 2007 at the University of Aarhus in Denmark. Maybe it's metaphor making that's unique to human minds? An abstract of the paper will be available on this website. Most of my past writings have been on mental health planning and consultation, and two articles have featured philosophical commentaries on the hippy movement of the 60's and on psychoanalysis and Zen Buddhism. Titles, some abstracts, and some full texts are available under my name on Google Scholar. |