Neuroscience and Psychoanalysis - Books



Clara Mucci: Borderline Bodies: Affect Regulation Therapy for Personality Disorders
W. W. Norton & Company, New York/London, 2018, p.357

Beginning with the work of four psychodynamic clinicians, Ferenczi, Kernberg, Fonagy and Shore, Clara Mucci proposes a new integration of neuroscience and psychoanalysis. She states that working with borderline personality disorders means facing the traumatized body, as well as problems of identity diffusion, narcissism, suicidal tendencies, hypochondria, antisocial traits, just to mention the content of some chapters. The author, competent in both neuroscience and psychodynamic psychotherapy, offers a way to deal with impulsivity, the internal void, problematic relationships, severe dissociation, perversion, attachment, in accordance with Schore’s developmental model of psychopathology. This model, based on the right brain/mind/body pathogenesis and attachment theory, is illustrated by clinical vignettes and case histories in several chapters which explain the psychotherapeutic work with the somatic self's severe symptomatology and earlier traumatic relationships. Quoting Allan Shore (foreward, p. xiii ) "Thus, for Mucci, the reconstruction of the relational origin of borderline dysregulation, destructive behavior, and negative self– other representations is the starting point for treatment, aiming at a reconstruction of the map of attachment relationships, including early relational traumata, deprivation, loss, and maltreatment."

Borderline Bodies highlights the role of this "first other", the body, in various domains. The starting point is early relational trauma, defined according to the author, on two levels rather than what the DSM-5 (2018) categorizes as “trauma and stress related disorders”.  The etiopathogenesis of early relational trauma and disorganized attachment is strongly connected to dissociative defense mechanisms, which cause the formation of split parts in the functioning of the borderline subject. "Dissociation results from disorganized attachment and derives from intersubjective relational trauma between caregiver and child, strongly affecting the right hemisphere of the child and his or her capacity for future higher- order organization and control". (p. 9)

 The book also reviews the process of "mentalization" (Fonagy,  1995) which is  highly damaged in personality disorders. In these cases, and under the influence of the affective dysregulation, the body acts as a "foreigner", a “not- me”, an alien inauthentic self, sometimes becoming the repository of the "death wish", following a classical psychoanalytical position. According to the author: "The alien self not only is formed through the lack of constant tuning and the lack of congruent and coherent marking of the affects of the child on the part of the caregiver, but also is built and embodied intergenerationally in the future subject through negative affects and feelings translated from the mother to the child". (p. 19)  

Many grids and figures in the book guide the readers towards a better understanding of the many borderline disorder models as well as of the mechanisms by which adverse childhood experiences influence health and well-being throughout the lifespan. While an in depth discussion of the book is beyond the scope of the present review,  certain key questions are noted that may be of particular interest to the reader.  Are personality disorders a peculiar right- brain disorder?  Do the domains of neuroimaging and genetics confirm most of what we know at present? Do right - brain treatment for personality disorders exist? The author provides many clinical vignettes which attempt to illustrate how to best treat significant forms of psychopathology such as severe personality disorders, post-traumatic stress disorder, hypochondria, as well to address problems such as suicidality that frequently arise in the course of treatment.   

Rosa Spagnolo
 





Antonio Damasio: The strange order of things

Pantheon Books, New York, 2018

The journey proposed in the book The strange order of things by A. Damasio starts from primordial life and ends with the more complex forms of social organization linked to the production of culture. How should we read the book? Not as the nth neuroscience publication, but following the indication that the author provides in the introduction: we humans are storytellers and love telling stories about the beginnings. But not only on the beginnings. We continue to produce, create and generate culture in a continuous effort to face human tragedies. And a primary and significant role is played by feelings in this continuous production. 
Starting from the primordial life forms, A. Damasio is taken by surprised by the term “strange”. In fact, “strange” is the word used in reflecting on the complexity of human life that evolved from simple organisms, such as bacteria. Again, it is “strange” that a single word such as “homeostasis” “is sufficient to describe the development of life both in simple and complex terms. If “homeostasis” is perceived as feelings in the organisms with a nervous system, this has created, over millions of years, an unbreakable bond between body and mind, a partnership that spawned culture and civilization. This is the strange order of things. The complexity contained in the simple unfolding of things that make human existence complex. 

Homeostasis, feelings, consciousness and subjectivity were already found in his last book: Self comes to mind (2012); so, what is the perspective presented in this new endeavour? First of all, and perhaps above all, the homeostasis, feelings, consciousness and subjectivity sequence is described as an increasing degree of complexity and generativity of culture and sociality society . Feelings contribute to this by providing a motivation to the cultural process, by monitoring the success and failure of the instruments used and by participating in negotiating over the eons.

The book opens with two fundamental questions that are thoroughly analysed in the third part devoted to the cultural mind at work. Is this sequence the prerogative of the human mind or does it also involve other living beings in different ways? And why would feelings push the mind to act in an advantageous way? 

We may also start from the answer to the second question: if they did not do it, life would be a continuous indifferent mental flow; instead, by pushing the mind, they give it the positive and negative qualities we ascribe to it. Going back to the starting point, we may ask, ”Was this always the case for any life form or not?” The author’s unmistakable answer is: “probably not”. Only the appearance of the nervous system, organized in a continuous neural network contiguous to the body was able to generate the human mind by giving it consciousness and subjectivity. Even primitive life forms are able to recognize and repel one another through surface molecules; they can aggregate and cooperate in dealing with adverse situations. But is this enough to bring the development of sophisticated human behavioural rules back to such a simple primitive mechanism? Without the development of feelings linked to the perception of what is good and what is bad, that is, what is beneficial and what is detrimental, the development of the human mind would not have proceeded evolved . A small percentage of invertebrates (bees, wasps, ants and termites) shows organized social behaviours. They cooperate by following genetic rules that entail very stringent routines which have allowed them to survive for hundreds of millions of years. But no other living organism has ever been investigated on with respect to its origins, on the meaning of group belonging or on its death; so, these social cooperative organizations cannot be compared at all to the cultural and social development produced by the human mind. 

The element in common to all living beings is homeostasis. That is, on a primary/physiological level, we share the regulation of life by maintaining it in a specific homeostatic range which not only makes survival possible, but which has paved the way to the differentiated flowering of life. The differentiated flowering towards the human mind was made possible by the birth and the subsequent organization of the neural network. Only the organisms with a nervous system can feel impairments in the homoeostatic regulation as negative, as negative feelings, while its readjustment to appropriate levels can be perceived as positive, as positive feelings. Therefore, life is certainly possible in the systems with a homeostatic regulation, but it evolved in a different way with the appearance of feelings:  - that is, with the perception of the quality of homeostasis. But this is still not enough to think of living organisms as having a mind. A new ingredient is necessary, i.e. consciousness. It is only through consciousness that it is possible to monitor, regulate and change, that is interfere with, the homeostatic automatisms. Changing the homoeostatic regulation and representing this variation, can be considered as a first form of cultural production. 

In other terms, fighting against the regular tendency to proceed from order to the lack of order calls for accepting the genetic imperative of maintaining the hereditary homeostatic range;  and at the same time, the creation of always new forms of homeostatic control (and this concept can be applied not only to the physiology of organisms but also to maintaining group/social homeostasis).  How was this possible? Through the creation of images that map the inner/external state of the body moment by moment. In sum, this is the differentiating line with other non-human life forms. The possibility to create maps/images is given by the complex organization of the nervous system, a capability that is missing in simpler organisms. Why is the production of images so important and differentiating?  Because the lack of this ability results not only in the absence of feelings (maps/images of the quality of homeostasis), but also in the absence of consciousness and ultimately of subjectivity. In fact, it is only by creating images that an organism is able to represent its inner and external state and hence adjust the response according to the images stored and transmitted both horizontally in the social organization and vertically, generation after generation. The addition of our more recent acquisition, i.e. verbal language, to the stage linked to the production of images completes the journey proposed in the book. The development of the nervous system, its cortical organization and the development of verbal language have facilitated the transfer of acquired advantages; and by promoting a different social set up (for example with respect to other primates), all this has created new and unparalleled forms of culture with respect to other non-human living species: art, construction skills, music, faith and much more that we gather under the term: human mind. 

Rosa Spagnolo