Sapolsky, R., & Balt, S. (1996). Reductionism and Variability in Data: A Meta-Analysis. Perspectives in biology and medicine, 39(2), 193-203.
Sapolsky, R., & Balt, S. (1996). Reductionism and Variability in Data: A Meta-Analysis. Perspectives in biology and medicine, 39(2), 193-203.
Depression is crippling, pervasive, prevalent and worth studying. Depression is also a major cause of disability.
The focus of this article /lecture : What has biology, what has psychology got to do with depression?
Symptoms of major depression: a biological disorder with genetic predisposition with early childhood influences. Sapolsky means this because we can compare people who stay positive
15:30 Neurotransmitters. In depression, implicated are
23.30 Neuroanatomy: Lymbic system, Cortex.
Depression is rumination, and the body responds to it, as if there were a real danger / setback. “What depression is is the body getting too many sad thoughts and the body going along with it. The brain stimulates the body to activate the fright-flight mode.
Sapolsky mentions the Anterior Cingulate Cortex, implying that it is a part responsible for depression. This part, when severed from the rest of the brain, also removes pleasure sensation.
One can see here the balance between the vegetative-somatic controls and cognitive centers of the brain. In depression, the cognitive centers become “depressed” while the active somatic control contribute to the tension felt in the body.
Hormones involved in depressive episodes:
39:00 Freud on melancholia. The difference between mourning and melancholia (Freud , 1922). Mourning allows one to recover. Melancholia is the rumination and wallowing, which is depression. Absence of mourning leads to guilt, followed by aggression turned inward to the self. Depression is described by Sapolsky as such.
42:00 Experimental Psychology
Psychological stress is pathological extremes of learned helplessness, loss, lack of control. One has no possibility to release the stress, by doing something, or talking to someone who is willing to listen.
E.g. loss of parents before 10 yrs of age, there is more tendency of suffering major depression.
Stress is the intersection of the bio and psychological. Depression seem to be genetically linked, but there also other components that are equally relevant.
47:00 Serotonin re-uptake genes? No empirical proof to show that “relevant” genes alone leads to depression. Childhood experiences have as much to do with incidence of major depression (Ogilvie et.al 1996).
Glucacorticoids regulate the function of this gene. Hence stress has an influences (Caspi et al 2003).
In the study of Mayberg et.al. which treated patients with deep brain stimulation, the patients, following treatment, describe their experiences as :
“All patients spontaneously reported acute effects including “sudden calmness or lightness,” “disappearance of the void,” sense of heightened awareness, increased interest, “connectedness,” and sudden brightening of the room, including a description of the sharpening of visual details and intensification of colors in response to electrical stimulation. ” This is similarly described when individuals are effectively treated with psychotherapy (see the student say, “the colors are bright”, to which Perls call it the mini satori in this video of therapy session with Fritz Perls) and also described in psychedelic experiences. Many meditative exercises also provide for this change of experience.
Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., … & Poulton, R. (2003). Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science, 301(5631), 386-389.
Freud, S. (1922). Mourning and melancholia. The Journal of Nervous and Mental Disease, 56(5), 543-545.
Ogilvie, A. D., Battersby, S., Fink, G., Harmar, A. J., Goodwin, G. M., Bubb, V. J., & Smith, C. D. (1996). Polymorphism in serotonin transporter gene associated with susceptibility to major depression. The Lancet, 347(9003), 731-733.
Sapolsky, R. (2009). Stanford’s Sapolsky On Depression in U.S. (Full Lecture). Youtube. url: https://youtu.be/NOAgplgTxfc
Tretter, F., Winterer, G., Gebicke-Haerter, P. J., & Mendoza, E. R. (Eds.). (2010). Systems biology in psychiatric research: from high-throughput data to mathematical modeling. John Wiley & Sons.
This is not an article against the use of psycho-pharmaceuticals. Antidepressants, antipsychotics etc. use save lives and alleviate suffering but have side effects. The individual is left to choose: work through mental suffering by talking to someone, or use a medication but numb out the possibility to feel human empathy. Ultimately the use of these drugs leads us to dependency and destroys our ability to interact with others in a contact-ful way. The result is existential loneliness.
Christopher Bollas, in the Q&A session of this lecture recorded in video below, gave a thought provoking opinion on how psycho-pharmaceuticals like antidepressants, anxiety drugs, and pain killers reduces a persons capacity for empathy.
Empathy is what make a person human. It helps us to have relationships and build bonds of love with others. If one of your loved ones –spouse, children, siblings, etc.– suddenly loses his/her empathy, you have lost that bond with that person, because this person is no longer able to relate to you as another human being. At best, to this person, you are but an object. He/she is not able to feel for you or care for you.
Taking painkillers, according to Bollas, does just that: strips off the empathic nature of a person. He cites an interesting article of a study written byFrom painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain, to illustrate this fact.
Bollas says that taking psycho-pharmecuticals is not the same as taking medicine for physical ailments. If one has a problems related to the mental state, talking to another person is the cure. The challenge is to find someone who would care to listen without judging or controlling you. Such a professional is called a psychotherapist.
People do have the right to take medications to alleviate their suffering. Bollas is, however, concerned by people giving medications to children for psychological disorders. Children have no rights to decide if they want to be incapacitated in a way that they can no longer feel emotions. Not feeling emotions free us from unpleasant feelings, and it also causes us to live in a lonely paranoid world stripped of feelings of being loved. The person may have people loving him, but he cannot feel the love. In turn he will not be able to love back, and end up losing relationships.
When children get diagnosed with ADHD (attention deficit hyperactive disorder), the child is suffering NOT because of the disorder itself. The child is reacting to stressors in his life and environment that causes him suffering. In fact, it is the parents who suffer as a result of the child’s behavior, and many are desperate for the fix… which they can get through diagnosis of ADHD. The drug erases that child’s ability to feel the suffering, and wipes out his ability to feel empathy as well.
Bollas believes that the children are victims of stress put on them by society’s expectation and the educational system.
Military training and work… boot camp turns you into a killer. In combat, you also kill people. If you keep doing it, you’re going to be shattered. It is called ptsd. this is the consequence of sending people to war. When you send people to war, you kill off the the humane parts of the personality. At war, if one is empathic or thinks too much one becomes a danger to one’s unit.
“(W)e need to continue a kind of a political cultural anthropology that consistently deconstructs our social delusions in a way that we as societies continue to cover up our own destructive processes, because most societies have parts that are extremely destructive.”
Bollas, C. (2016). Christopher Bollas: Mental Pain. Video on Youtube. https://www.youtube.com/watch?v=y9Frb4wMifw Townsend Center for the Humanities.
, Volume 11, Issue 9, 1 September 2016, Pages 1345–1353, https://doi.org/10.1093/scan/nsw057 Retrieved from https://academic.oup.com/scan/article/11/9/1345/2224135From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain. Social Cognitive and Affective Neuroscience
Otto Kernberg explains what Projective Identification is:
Projective Identification is one of the primitive defensive operations that goes together with splitting and primitive idealization and omnipotent control.
It is a primitive form of projection of attributing to others what one cannot tolerate in oneself. It is characterized by combination of attributing to somebody else what the person is experiencing but cannot tolerate. While they are still capable of maintaining empathy of what they experience but cannot tolerate. There is also a tendency to induce behavior in the other in effort to control the other person to absolve themselves.
Basically it is an insidious method of inciting emotions, which one cannot come to terms with in oneself, in another person. This as a means to control the other person.
A possible example of such an occurrence is someone who is insecure and envious of another. This person creates situations whereby he/she incites envy and/or competition in the other person.
It could also someone controlling a group. A manager may have a paranoid ideas of the team being disloyal to him, begins to behave in ways to incite feelings of mistrust between the members of the company.
Identification of the aggressor : being a ghost to chase the ghost away, stockholm syndrom (Anna Freud’s). Ferenczi’s idea of identification with the aggressor: The abused child behaves in the way the abuser wants to protect himself from the abuser, by appeasing and complying.
The child introjects the abuser’s feelings: he feels both innocent and guilty. There is a clash of feelings. The abuser, to make himself feel less guilty induces the guilt on the child victim. The parent / abuser projects the impart feelings (also known as projective identification, a term Melanie Klein coined later on) on the child. He induces guilt on the child. The child introjects the shame and feels guilty.
The client should be allowed to express their criticism on the therapist, or they will turn on themselves. These negative feelings are not just negative transference. When the clients can voice their critic in therapy, it is a breakthrough. It is a break from the childhood pattern.
This is an introduction to Psychoanalysis, Self Psychology, Heinz Kohut 1913-1981.
There are following therapist-client interaction:
Kohut also introduces Disintegration of Selfobject –> leads to emptiness, self aggression, addictions, emptiness depression.
How does Analysis repair disruptive cycle of emptiness…? What has happened that led you to do this? Going to stripclubs, etc… What set you off this time?Make patients addicted to therapist / therapy. That is a way to help patient get rid of the addiction.Some people are also addicted to anger. They use anger to hold them together. What is really valuable in psychotherapy (Interpersonal Schools of Psychotherapy):
“Sustained empathic enquiry.”
Decentering: Look at pattern from patient’s perspective. Try to set aside feeling attacked. Sometimes the patient’s perspective is psychotic. But it is still his/her perspective! So we take it for what it is.
Kohut’s theory of cure: when there is a disruption, try to understand, what happened to the patient. The patient feels ultimately understood. Repairs the disruption.
Transmuting internalization takes place.
Reestablishment in the disruption. The more he is able to be empathic to himself. He is able to build his own selfobject.
Like Kleinian, Self-Psychology works with the internalized selfobject.
Kernberg is opposed to Kohut. He sees Narcissist is suffering from conflict and not deficit like Kohut. Narcissism is seen as manic defence. Profound feelings of emptiness, envy… Helping narcissist become depressed… but this can be lead to client to be very very depressed /suicidal.
The opposing view of Kohut and Kernberg is a reminder that analysis is a way of researching what goes on in the human mind. It is an attitude of seeing, and not a end to understanding “facts”. This makes psychotherapy sciences much more real and dynamic than natural sciences.
In Gestalt therapy, the narcissist is “not able to feel anything”, and thus has found a way to deflect from him/herself any stimuli from the environment. It is a safety mechanism he/she learned as a child. Most oftently the child has good reasons to shield him/herself from perceived or real danger. This deflection mechanism becomes automatic, and the adult is not aware of his/her own situation, because the not feeling is second nature.
The disadvantage such persons have is that he/she does not enjoy relationships and often feel threatened / miss- trusting and always aggressive (active or passive) towards others.
Gestalt therapist realize that when a behavior is not in awareness, it is impossible to talk to the client about it, and expect the client to experience a shift in his/her “nature”. Much of the work has to arise from non-verbal communication and feedback from the therapist.
Shame and guilt are uniquely human emotions. These are emotions that does not exist in infants up to a certain age. In other words, shame and guilt are emotions learnt, and this learning coincides with the infant’s discovery of the self, when the infant becomes self conscious.
In the lecture below, June Tangney explains the results of her research in this area.
According to Tangney, shame comes with the awareness of (or the judgement of) the self as having done (or being) something wrong or unacceptable. Guilt is related to the judgment of the deed (ones behavior) that one has committed.
Shame is also extremely painful relative to guilt. Shame is a feeling of being defective, a sense of being small, exposed, powerless. Shame can last for short or long periods of time. When one feels shame, one tends to want to isolate themselves.
Guilt is different. It comes with remorse, and people who feel guilt are typically drawn to taking reparative action, rather than isolating themselves.
Empathy is a state of feeling the other’s feelings, and it brings us to altruism.
@ 24:00 Guilt and empathy are connected. Tangney’s team of researchers have found correlation between propensity for the feeling of guilt and people’s ability to step into somebody’s shoes (to be empathic). Meanwhile the other more self-absorbed, pseudo-empathic responses are related to shame.
When a person talks about a shame related feeling in a situation, there is less concern for the other and more focus on the self. When the feeling is that of guilt, the concern is for the other’s feelings.
There is therefore correlation with studies of shame in family conflicts and domestic violence.
People prone to guilt are more likely to live a more “moral” life.
On the condition that we do not mis-interpret shame with guilt, the findings show that guilt feelings do not cost the person psychologically (as otherwise thought). This means that so long as we do not judge ourselves, but judge the deeds instead, we are in a better situation to cope with the psychological aspect of having done something deemed as inappropriate.
Proneness to shame, on the other hand has been linked to vulnerabilities to depression, anxiety, eating disorder etc.
This also brings to attention how society treats incarcerated people.
Research showed no real inter-generational link in shame and guilt proneness.
Longitudinal studies show that teenagers that are in the guilt proneness fare overall better than their shame-prone peers.
This is a summary of Otto Kernberg’s lecture on Transference Analysis. Transference is an important term in psychodynamic therapies, and even dialogic therapies like Gestalt therapy.
Transference is defined by Kernberg as: the unconscious repetition in the here-and-now of a dominant pathogenic conflict of the past.
In Psychopathology this pathogenic conflict plays out in the individuals’ present style of relating with others. Kernberg explains the origins of this mode of relating to be from the attachment of an individual to his mother at infancy. Early relationships, environment and the psychosocial world affect the neuro-biological make-up of the individual.
The experiences of the past, good and bad, thus get activated in the here-and-now, and affect how the individual perceives current situations and how he/she reacts to this situations. How he/she perceives his/her role is also affected by these early experiences.
Negative affects that do not reflect current reality is seen as pathological. These get reinforced through misunderstandings and reaction to and of the environment. These fixated negative reactions become the character and reflect the personality of the individual.
11:00 Kernberg explains that a combination of past experiences (and these are distorted and play out together in the present, not just one event at a time. Although we all transfer our experience of the past to our present, it becomes noteworthy as a personality disorder when this experience was overwhelming to the person, and becomes distorted.
To resolve the pathological conflicts of the past as they get activated in the present.
14:25 By setting up a “normal” situation in the treatment situation. To sit with the patient face to face, and allowing him/her to say whatever comes to mind without feeling in danger of being judged, and to listen attentively to the patient.
Therapist exhibits technical neutrality. This interaction activates a transference relationship. The therapist can then help the patient interpret this transference reaction to past experience. This is called transference analysis. The adult mind of the patient can then be supported in integrating his/her past experiences with the present situation, leading to normalization of affect in the present.
Paying attention to transference situation, or what we can understand as the relational events that occur between therapist and client in the therapeutic setting in the here-and-now is very important to working with clients because it works directly with the personality of the patient. This is usually the armor that stands in the way of the psychotherapeutic work. Kernberg’s lecture featured here is detailed, and he explains how relationship experiences of an individual in infancy has a role in the wiring of the brain. He also explains how with psychotherapy that works with transference, his/her affect incongruence can be “mentalized”, and integrated within the patient.
46:00 Kernberg cites a case study of a patient with borderline personality disorder.
22 years old female, suicidal attempts, overdose of medications and street drugs, frequent hospitalization. 3 previous therapies, unsuccessful. sexual promiscuity, antisocial and manipulative behavior, violent affect storms, attacking people emotionally.
Treatment started haltingly due to multiple suicidal attempts. Kernberg describes how he experienced her behavior towards him, which were violent and un-compromising. Kernberg explains how he reacted to her firmly, and in my opinion, authentically. He specified what he could tolerate and what he did not. He however kept focussed on the transference without trying to fix or analyze or advice.
The behavior towards the therapist in this case is what Kernberg describes as the transference. It is how the patient has learnt to behave towards others in a relationship.
What we can take from this, is that patients who have had severe trauma as children do play out their pathological relationships with the therapist. It is up to the therapist to be aware of this patterns of relation of the patient. Sticking to the focus of the transference, and reacting authentically (if you are angry, say so, if you do not accept the abuse, say so, and set limits while being firm and sympathetic).
Kernberg also says that therapist have to look at the treatment in the long term, and although we may be impatient to see change in the patient, we have to be patient.
Gestalt therapists do not use the term transference. This is because of the traditional link this word has to traditional psychoanalysis that Kernberg speaks about. But the concept of using the interaction of the here-and-now is very much Gestalt therapy. Dialogical Gestalt therapist work with what we call the intersubjective or the in-between. This in-between is the transference. Gestalt Therapist who adopt the strict theory of the method, work with the following processes that is also present in transference analysis:
The dawn of Gestalt therapy was initiated by psychoanalysts like Wilhelm Reich’s “Character Analysis“ and Sándor Ferenczi. The writings of these men, have already addressed the issue of working with transference as a means of working through character.
Kernberg, O. (2016). 29 Otto Kernberg. Youtube.com. Accessed on 05/2017. https://youtu.be/-H9qZBIfjHM
Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., … & Buchheim, P. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. The British Journal of Psychiatry, 196(5), 389-395.
Yeomans, F. E., Levy, K. N., & Caligor, E. (2013). Transference-focused psychotherapy. Psychotherapy, 50(3), 449.
Basic Reichen Therapy. A short lecture and personal notes overview on the life and work Wilhelm Reich.