9-13 July 2015 in Tijdschrift voor Psychoanalyse (2016), Vol. 22:1 (translated version)
The brain. And the experience of the self. The neurosciences concentrate on the first – the objective part of mental life, the ‘outside’ as it were: that which can be seen and studied, with increasing precision as a result of spectacular technical advances. And the focus of psychoanalysis has been, for more than a century, on the invisible inner world of people, the subjective experience that can only be reported on, not independently measured. Both disciplines have their own specific language, and that can often lead to a confusion of tongues. That neuropsychoanalysis can offer a way out of this thicket was the theme of the autumn 2014 issue of Tijdschrift voor Psychoanalyse. And the following year, the International Neuropsychoanalysis Association held its annual congress in Amsterdam, on the subject of “Plasticity and Repetition”. The concept of plasticity points to the hopeful side of our profession: change is possible. Repetition on the other hand, seems to lie on the other side: it is not for nothing that Freud wrote extensively on ‘compulsion to repeat’.
The way memory works under stress was the subject of a talk given by Cristina Alberini, a biological scientist of the first order (she heads her own laboratory at New York University), but also someone who completed training to become a psychoanalyst. She described her work with rats who were confined to a cage with a light and a dark section. When they would venture into the dark section, they were given an electrical shock to the feet. The experience creates a memory trace: rats will avoid the dark side. The scientific postulation of the past hundred years was that there was a linear process between the original memory trace and the eventual anchoring of it in the long-term memory system. In other words, that every time a memory was retrieved, the brain would reach for the same memory trace. In her work, Alberini demonstrates that things are much more complex and dynamic. When a memory trace is triggered it becomes momentarily susceptible to change. That is to say: the memory is influenced, changed, by the environment in which it becomes activated. The next time the memory is elicited, it is no longer the original memory trace (which nonetheless continues to exist), but rather the most recent one that was stored. This can happen again and again.
This plasticity of the brain has important clinical implications: painful or traumatic memories that are recalled and shared in a safe therapeutic relationship may slowly loss their grip on the self-experience. The repetition compulsion in this perspective offers new chances for a gradual change from maladaptive or neurotic ideas to a greater freedom in making life-choices, and the possibility for individuation. But it also throws light how ‘false memories’ could sneak into the mind when events are recalled in a polarized atmosphere.
Francois Ansermet, a psychiatrist and psychoanalyst at the University of Geneva, talked about the ‘paradox of plasticity’. On the one hand, the brain is conservative: every experience is preserved through repetition; on the other hand, the brain registers every single experience, so everything is always in motion (‘you never use the same brain twice’). Psychoanalysis asks the question: How is change possible if everything repeats itself? Neuroscience research explores: how can a unity be formed (a continuous I) if everything is always in motion? Ansermet explains that a memory trace is always connected with a somatic condition (S) that we experience as emotions, which in turn are connected to a representation (R). Psychoanalytic psychotherapy works on R and S through such techniques as mentalization and affect-regulation. An example from my own practice: Not everyone who is angry will abandon you.
Jaak Panksepp, founder of the discipline ‘affective neuroscience’ presented a passionate entreaty for the importance of understanding the emotions, which are evolutionarily much older than cognitions. He convincingly contended that animals have feelings, which in humans can be thought of as an ‘ancestral memory’, formed by a network of instinctive systems. We experience these in primary process reactions and thinking. His research demonstrates that emotions and also large of our emotional consciousness is rooted in the sub-cortical brain, not the cortex as was commonly thought for more than a century. He used his SEEKING system as an example: its aim is the finding of pleasurable experiences. But in addiction (repetitive behaviour) there is a disruption between wanting and desire. As a result, the addicted animal (including most probably the human animal) only directs its behaviour towards more and more, without ever experiencing any pleasure. Seen in this way, he said, one could look at some instances of the repetition compulsion as a derailing of the pleasure principle, rather than being ‘beyond’ it, as Freud contended.
Again and again, the neurological researchers called for caution and restraint in using their research findings as evidence for psychoanalytic concepts, but instead to the psychoanalytic metapsychology as a source of questions requiring further research. How that can be done was demonstrated by the Belgian psychoanalyst and psychiatrist Marc Hebbrecht in his lecture on the dream theory of Bion. According to Bion, humans create their own reality as follows: daily experiences are absorbed and stored in the unconscious. Emotional experiences become, as it were, ‘dream-able’, and one can see the dream as a subjective highlighting of an experience in order that the dreamer can become conscious of its meaning. Dreaming, in this perspective, is an activity in the service of self-organization that precedes self-development, and as such dreams can be used in psychotherapy as carriers of meaning. His question was if there was neuroscientific evidence for this? And also if there was a continuity in the process of day-dreams and night-dreams? And if there was a neuronal relationship between the implicit memory system and dreaming?
The afternoons offered a bountiful choice of presentations on research findings in parallel sessions. About dreams: how the day residue in dreams almost always contain a high feeling content; and that there is a correlation between people who remember their dreams and those who awaken often during the night. Over the importance of affective touch in the integration of various psychic functions during the development of an infant and child (it reminded me of Anzieu’s skin-ego). And how a good sleep influences the feelings of shame – this last is part of large ongoing research process here in the Netherlands.
One of them moved me to tears. An Italian group of psychoanalysts work with patients who have suffered heavy brain injuries. One man had a ‘minimal state of consciousness’ after a motorcycle accident. At the beginning of treatment we see a rigid man with a fixed stare into the middle distance without any discernible reaction in body or face. Using the Boston Change Process ‘moments of meeting’ method, Davide Tomatis showed how time and again, therapists communicated with the ‘imprisoned self’ of the man, through the responsive mirroring, with empathy and encouragement, of the tiniest of his reactions: a blink, a finger movement. Slowly but surely we see him awaken, he begins to play with the therapist by way of these bodily reactions. By way of establishing a non-verbal but dynamic communication process it became clear that an affective and intersubjective relationship became possible again. Through the process of repetition there turned out to be plasticity in a person who had seemed to be frozen.