![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Pfinstegg on October 12, 2004, at 13:11:14
Institutes meeting held in New York on October 2 was extremely interesting. It was a whole day of neuroscience and case examples. To try to boil it down to the one most important thing I learned, it was about the primacy of the right hemisphere, in both the development of trauma- induced psychiatric illnesses, and in their treatment. It was a novel sight to see psychoanalysts presenting slide talks!
Dr. Alan Schore, who is both an analyst and a neuroscientist, spoke initially about how neglect and/or abuse in the earliest years of life causes the right hemisphere to develop abnormally. There tend to be less connections from the limbic system to the right orbital frontal cortex, so that self-soothing and calming of fear responses take place less efficiently, or perhaps hardly at all. Dissociation was an accepted concept to these therapists, who located it, too, in the right hemisphere. Times of painful neglect, for example, are visualized as oval groups of neurons containing the implicit memories of that painful experience. These areas, also, have less than the normal number of neurons connecting them to surrounding regions of the right hemisphere, so they cannot be modified. Roughly speaking, the right hemisphere= the unconscious.
Therapy for these kinds of trauma was considered to be almost entirely a matter of the client's right hemisphere connecting up with the therapist's right hemisphere! These parts of the brain will evaluate gaze, facial expression, tone and pacing of the voice, body language, etc. The two brains getting into harmony with one another, as a mother's does with her infant's, result in neuronal growth, so the dissociated areas become more connected with the highest centers in the right hemisphere, which can provide soothing and a calmer view of whether a threat is actually present now, as it was in the past. The very final thing that happens is that the therapist and client deliver as much of this information as possible to their left hemispheres, where it can be reflected upon. They gave fascinating clinical examples of how the two people work together, much of the time non-verbally, to bring about needed changes. To sum it up, when a client and therapist's right hemispheres get into harmony, the patient's right hemisphere grows and changes- that's how we get better!
Posted by Annierose on October 12, 2004, at 13:25:27
In reply to The Association of Independent Psychoanalytic, posted by Pfinstegg on October 12, 2004, at 13:11:14
That is just amazing information! Without getting too personal, what do you do that you were there?
Posted by Pfinstegg on October 12, 2004, at 16:18:17
In reply to Re: The Association of Independent Psychoanalytic, posted by Annierose on October 12, 2004, at 13:25:27
I'm a professor of rehabilitation medicine at a medical school; my research interests are in neuroscience, particularly the emotional effects of various kinds of brain damage. I have to admit that I was amazed and thrilled by what I learned at that conference- for personal reasons, too, as I have csa, dissociative identity disorder and PTSD. I thought it was so encouraging- particularly the evidence that the parts of the brain they mentioned can grow and change throughout life!
Posted by Aphrodite on October 12, 2004, at 16:39:01
In reply to The Association of Independent Psychoanalytic, posted by Pfinstegg on October 12, 2004, at 13:11:14
Oh, Pfinstegg, this is just wonderful and fascinating information. Thanks for sharing! Is there a website you could point us to for more information? Or is a book or a journal? I'd like to know more.
BTW, how have you been? Is your analysis still going well?
Posted by antigua on October 12, 2004, at 17:11:10
In reply to The Association of Independent Psychoanalytic, posted by Pfinstegg on October 12, 2004, at 13:11:14
Wow, that is incredible information. You have given me hope on a day that I really needed it. To know that my brain can be altered therapeutically is a wonder to consider.
Thank you so very much,
antigua
Posted by Pfinstegg on October 12, 2004, at 17:42:02
In reply to Re: The Association of Independent Psychoanalytic » Pfinstegg, posted by Aphrodite on October 12, 2004, at 16:39:01
Hi Aphrodite! I found a lot of information about Dr. Schore here on the web just by googling him. His most recent book is "Affect Regulation and the Repair of the Self" which was published this year. There are also PDF articles and Medline referrals. The book is excellent, but it is rather expensive, and a bit repetitive, as it's a collection of individually published articles. I do think he is very worth knowing about!
The analysis- well- it's very hard right now, as we are dealing so extensively with the dissociated parts. They have so much difficulty feeling attached or trusting. But we do work very hard at it. I know we are doing the right thing, but I do wish it weren't so slow and painful. How about you?
Posted by Pfinstegg on October 12, 2004, at 17:47:12
In reply to Re: The Association of Independent Psychoanalytic » Pfinstegg, posted by antigua on October 12, 2004, at 17:11:10
Hi Antigua! Isn't it a wonder? And it can happen at any time in life, even when we're older.
Posted by alexandra_k on October 12, 2004, at 18:03:07
In reply to The Association of Independent Psychoanalytic, posted by Pfinstegg on October 12, 2004, at 13:11:14
Thankyou for sharing that, I found it interesting. I have done some research on DID and the neurological basis of dissociation, and am interested in different theories.
>Times of painful neglect, for example, are visualized as oval groups of neurons containing the implicit memories of that painful experience.
I didn't think that memories were localised. I thought that that was one of the morals that could be drawn from Lashley's infamous 'search for the engram'. Memory isn't located in any particular region of the cortex, rather memories are patterns of neural activation that are distributed throughout the cortex which is why we get 'graceful degradation'.
>Roughly speaking, the right hemisphere= the unconscious.
People have tried to find whether the structure of mind as posited by analysts (id, ego, superego) corresponds to neural structures or not. The trouble is that we know that we can remove the whole of the right hemisphere and so long as language production and comprehension is localised in the left hemisphere there can be suprisingly few behavioural changes. If the right hemisphere is the unconscious (roughly) then it would seem that with the right hemisphere removed the person would (roughly) have no unconscious!
I know that there have been lots of studies done on the neurological basis of dissociation. It has been found, for example that there are differences in neural activation when a subject switches to an alter, but not when they do a 'fictional switch' to play-acting an imaginary character (see Adler, New Scientist). These findings are controversial, and the interpretation of the findings are extremely controversial. The notion seems to be that memories are localised and so different alters have access to different memories. But this doesn't work if memories are distributed.
Thankyou for giving me some things to think about...
Posted by daisym on October 12, 2004, at 18:53:09
In reply to The Association of Independent Psychoanalytic, posted by Pfinstegg on October 12, 2004, at 13:11:14
I'm going to a conference in March where Dr. Schore will be speaking. I'm really excited now and hoping my own workshop doesn't cross his. The neat thing is that since I'm on the BOD of this Association, I'll get to have dinner with him. I'll have to be careful to not turn it into a private therapy session!
What you learned about connecting to the therapist's right hemisphere makes total sense to me. I think of it as having huge sensors in the room picking up everything behind the words. My therapist calls it my radar, and says it is probably 90% correct because I needed it to be when I couldn't trust what people where telling me. He checks in a lot around this..."what are you reading from me?"
What else did you learn? And did you find time for some fun? Thanks for sharing.
Posted by fallsfall on October 12, 2004, at 21:22:19
In reply to The Association of Independent Psychoanalytic, posted by Pfinstegg on October 12, 2004, at 13:11:14
>These parts of the brain will evaluate gaze, facial expression, tone and pacing of the voice, body language, etc. The two brains getting into harmony with one another, as a mother's does with her infant's, result in neuronal growth,
*** So, wouldn't this mean that analysis on the couch would hinder progress?
Posted by Pfinstegg on October 12, 2004, at 21:41:33
In reply to Re: The Association of Independent Psychoanalytic » Pfinstegg, posted by alexandra_k on October 12, 2004, at 18:03:07
I don't know enough to comment on the theories of memory you raise versus the ones presented by Dr. Schore - I'm just reporting his view. The thing he particularly emphasized was the lack of neurons connecting the implicit memories of neglect and abuse to higher centers, in the orbital prefrontal cortex especially, which could mitigate the on-going pain which these unconscious memories cause. Whether they are actually *grouped* or not is a good point that you raised. No-one has yet actually *found* a dissociated state on an fMRI or PET scan, although, as you say, there are different patterns of arousal in the brain in dissociated states. It could certaily be true that, as you say, the networks of implicit memory of neglect and abuse are spread widely throughout the brain. I did become convinced that the neurons that should be connecting those implicit unconscious memories to the rest of the brain are reduced or absent.
I do know from experience what people are like who have lost a good part of their anterior right hemispheres due to such illnesses as a stroke. It is very striking to me how they say that that they cannot dream or feel deeply. They often say how people tell them that they are fortunate that they have not lost their ability to speak, but that people do not have any idea how much of themselves they have really lost. They often feel like hollow shells, who can speak, but cannot feel. They seem to know, themselves, that they have nothing, really, to say. I have thought for a long time that patients like these have really lost the richness of being and self-experience that comes from having an *unconscious*. Probably not everyone would agree to that way of conceptualizing it, but it is clear for everyone to see on their MRI's that a lot of their right hemispheres are gone.
Posted by Pfinstegg on October 12, 2004, at 21:53:53
In reply to Re: The Association of Independent Psychoanalytic » Pfinstegg, posted by daisym on October 12, 2004, at 18:53:09
Oh Daisy, how exciting! I hope you'll report on the conference when the time comes. And I HOPE you and he aren't scheduled for the same time. At least you know you'll be able to talk to him at dinner-I'm expecting a report on that, also!
It was just a one-day conference, so there weren't too many opportunities for just fun. There was a very positive atmosphere in the auditorium, however, and I did make some interesting new friends during lunch. I was just so pleased with the whole thing, overall!
Now, thanks to Dr. Schore, we are able to put into words a bit better why we have all instinctively felt that you have an extraordinary therapist!
Posted by Pfinstegg on October 12, 2004, at 22:11:04
In reply to Re: The Association of Independent Psychoanalytic » Pfinstegg, posted by fallsfall on October 12, 2004, at 21:22:19
Yes, Falls, it DOES mean that! These are all psychoanalysts who no longer use the couch. They were asked about that during the discussion, and one of the speakers (James Fossage) said that he had recently moved to a new office, and showed it to two friends after work one evening. They praised the office, and mentioned what an attractive couch he had. he told us all that he did not mention that the only person who actually uses the couch is HIM when he needs a nap!
Schore was one of the pioneers in abandonning the couch. He uses a chair system which tries to replicate the positions of mother and infant- they are almost at right angles to one another, with the client on a sort of chaise-longue in which he can either lie or sit- or sort of both at the same time. This arrangement allows for gazing and looking away, as infants and mothers naturally do with one another.
Needless to say, this has been a topic of discussion with my analyst since he came back from vacation! I normally alternate between lying down and sitting up, usually doing both during one session. He's very comfortable with both, and thinks both are important. The seating arrangement is a little more awkward than Schore's, though.
Posted by tabitha on October 12, 2004, at 23:55:18
In reply to Re: The Association of Independent Psychoanalytic » fallsfall, posted by Pfinstegg on October 12, 2004, at 22:11:04
Fascinating stuff! And thanks for sharing it. So you research emotional effects of brain damage, and now you're learning about brain effects of emotional damage. It must really tie things together.
What you wrote about the right hemisphere jives with what my T has told me, and with my history. I had a neglectful, but not otherwise abusive childhood. Inability to self-soothe is one of my main troubles. My T always tells me I have to engage the adult, left-brain thinking to moderate the old programmed reactions. It's very hard for me to do that, so hearing about how it's actually possible to rewire the right brain is encouraging. I'll keep plugging away.
Thanks again.
Posted by alexandra_k on October 13, 2004, at 20:57:53
In reply to Re: The Association of Independent Psychoanalytic » alexandra_k, posted by Pfinstegg on October 12, 2004, at 21:41:33
I don't think anyone really knows the answer, but there are a lot of people trying to find out, and there is a lot of work that has been done on theory construction etc. I do appreciate that you were reporting someones view rather than attempting to think critically about it; it is just that I am sceptical (of everything) by nature and by training.
I know that there has been work done on the role of the hippocampus, and limbic system with respect to memories - and it seems that you were concerned with refiring of intense emotional states to subtle internal or external stimuli rather than the verbal recall of trauma. (is this right?). In that case we are looking at implicit memory rather than verbal memory. Or at experience rather than belief. Beliefs (I reckon anyway) are distributed, whereas experiences may more plausibly be localised.
I am currently doing some work on delusions and it seems that (to a certain extent) a correlation can be found with certain kinds of cerebral trauma and certain kinds of delusions. For example, in cases of the Capgras and Cotard delusion. This raises interesting questions regarding whether a specific delusional belief is 'caused' by, or results directly from the localised head injury. Maybe it is fair to say that the belief that 'my wife has been replaced by an impostor' is a direct result of the cerebral trauma, and is therefore localised to a great extent in those cases. All of that is highly controversial, of course. (Actually I want to maintain that the trauma produces a certain kind of anomalous experience which, when accepted as veridical, or reported on as a subjective experience results understandably and inevitably in utterances characteristic of certain kinds of delusion).
Hope I am not too confusing...
> It is very striking to me how they say that that they cannot dream or feel deeply.
Though is it that they do not dream, or that they do not remember their dreams? This could be tested empirically.
Emotions seem more linked to the right hemisphere than the left, that is true. I am not sure that I would want to say that these people have a diminished unconscious - but then I suppose that I am not a realist about the unconscious. When I did DBT I was told that the structure of mind was that there was 'rational mind', 'emotional mind' and 'wise mind' and a nurse tries to tell me that they were the left, right, and both hemispheres respectively. The psychodynamic theorists similarly speak of the ego, id, superego etc as the structure of mind. I think of these as metaphoric. The structure of mind (in my opinion) is best revealed by cognitive neuro-psychologists who are interested in discovering the mental modules of which the mind is composed.
Posted by Aphrodite on October 15, 2004, at 13:46:53
In reply to The Association of Independent Psychoanalytic, posted by Pfinstegg on October 12, 2004, at 13:11:14
Your post came up on a blog as I searched Alan Schore. See the Wed., Oct. 13 post on . . .
Posted by Pfinstegg on October 15, 2004, at 15:01:08
In reply to Hey Pfinstegg, you're on a blog!, posted by Aphrodite on October 15, 2004, at 13:46:53
Wow.. definitely part of the (excessive) Information Age!
Did you find what you wanted about Schore? About a year ago, I found two excellent articles by him, which I was able to download free. Unfortunately, I didn't bookmark them. Phrases to try might include "Affect Regulation" and "Neuropsychoanalysis and the Right Brain (or Hemisphere)"
When I read these articles, and also the book "Affect Dysregulation and the Repair of the Self" (Norton- 2003), it made me think of those wonderful, so meaningful tuned-in moments with my own analyst, as well as all the ones many others have recorded here. Misattunement with one's therapist seems to be one of the most painful things people post about; it seems that everyone instinctively knows how much emotional "holding" and attunement, even, or especially, of the most painful, inchoate feelings, are needed for us to get better.
Posted by Aphrodite on October 15, 2004, at 19:48:18
In reply to Re: Hey Pfinstegg, you're on a blog! » Aphrodite, posted by Pfinstegg on October 15, 2004, at 15:01:08
I was able to find a lot of information once I realized that his first name has two l's in it! I've printed out a lot of articles and have them by my bed for reading this weekend.
Your point about our "misses" vs. "hits" with our T's was right on the money. My T can hurt me more deeply than anyone, and this research seems to confirm that by stating the reverse in which when we're aligned, it's wonderfully healing. Thanks again.
Posted by Dr. Bob on October 16, 2004, at 1:06:34
In reply to Re: Hey Pfinstegg, you're on a blog! » Aphrodite, posted by Pfinstegg on October 15, 2004, at 15:01:08
> When I read these articles, and also the book "Affect Dysregulation and the Repair of the Self" (Norton- 2003)...
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book, movie, or music without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though, and doesn't *have* to be used. If people *choose* not to use it, I'd be interested why not, but I'd like that redirected to Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
Posted by Pfinstegg on October 16, 2004, at 8:02:01
In reply to Re: double double quotes » Pfinstegg, posted by Dr. Bob on October 16, 2004, at 1:06:34
Thank you! I didn't think of putting it in double quotes, as I didn't think anyone would actually buy that book- but, of course, they might!
This is the end of the thread.
Psycho-Babble Psychology | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.