Bassat: Linking Immunology with Psychoanalytical Psychotherapy

The groundbreaking metaphor of “the body keeps the score,” found in trauma research, aligns seamlessly with Bassat’s article exploring the profound impact of embryonic experiences on human development. Her work underscores the convergence of modern biological research with earlier theoretical and clinical insights into primitive mental anxieties, explored by pioneers like Tustin in the 1980s.

Bassat emphasizes that from conception, the human embryo faces a biological challenge: overcoming the mother’s immune system to implant in the uterine lining. This process lays the foundation for what Bassat terms a “neuro-immuno-psychoanalytic” discourse, revealing how the formative experiences of embryonic life shape both our psychological and physiological makeup.

Building on this concept, Bassat references authors like Wilfred Bion, who posited a link between autism and immune system dysfunction during early pregnancy. She further explores the idea that adverse environmental factors in the prenatal period can evoke unbearable states of dread within the fetus, disrupting psychological development and leading to the formation of autistic defenses.

Bassat redefines autistic states as psychophysical protective reactions rooted in bodily sensations rather than solely psychodynamic defense mechanisms. The overwhelming sense of vulnerability and threat experienced in the pre-verbal stage can lead to profound anxieties: a dread of annihilation, disintegration, a sense of boundlessness, or the absence of a safe, containing presence. This bodily experienced terror is not susceptible to rationalization.

Consequently, the autistic infant may resort to clinging behaviors, fixating on autistic objects or shapes. They experience a profound terror of separateness, which equates to a fear of death in their perception.

The author describes how the immune system, with its function of recognizing and responding to ‘self’ vs. ‘non-self’, mirrors the mental processes that determine our sense of individuality and connection with others.

As a psychotherapist with a background in biochemistry and microbiology, I find Bassat’s work both fascinating and deeply resonant. Her writings illuminate the profound impact of prenatal development on psychological wellbeing. Clinically, we frequently encounter clients with deep-rooted anxieties, dread, emptiness, irrational fears, and uncontrollable compulsions – states resistant to rationalization or traditional talk therapy.

These psychophysiological states defy cognitive resolution because their origins lie in pre-verbal trauma. Such experiences, occurring before language acquisition, cannot be consciously recalled. Many psychotherapists recognize the importance of physical presence, movement, and aesthetic connection alongside verbal processing. Metaphors and imagery often prove more potent than purely rational problem-solving in talk therapy.

The Podcast

Episode 129: From Immunology to Psychoanalysis: Reflections on Primitive Mental States with Shiri Ben Bassat (Tel Aviv)

MARCH 4, 2023 00:45:21

The Psychoanalytic Case study

This podcast case study @26:42 is compelling for several reasons. Firstly, it documents the author’s initial case as a psychoanalyst, highlighting the challenges and rewards of working with a child diagnosed with autism and psychosis. The dedication of both the analyst and the child’s adoptive mother to persisting through the child’s violent reactions to therapy demonstrates remarkable commitment. Additionally, the therapist’s innovative use of movement as an embodied mode of communication aligns with psychoanalytic theory, showcasing a thoughtful and adaptable approach within this framework.

In her paper, Bassat (2021) writes: “

  1. I created a stable, consistent setting of five sessions a week at a regular hour – a
    concrete action- needed to rebuild a functional container that would hold her, while
    also remaining flexible and changing, allowing her to take objects from the room
    (Quinodoz, 1992).
  2. I cultivated an accepting and total presence – offering the room, my body, and my
    internal objects so that they could be invaded and even destroyed. I thus enabled her
    to destroy my books, scrawl on my walls, bite me, dribble, and leave behind a
    destroyed, chaotic room – only to re-encounter it in a clean, orderly state upon her
    return. My internal objects had similarly been attacked and injured by evoking
    unbearable memories of my own personal traumas. I understood to what extent Yael’s unrepresented traumas were destructive and painful, in need of a mother-analyst womb to be contained in as Klein’s notion that our consulting rooms are equated, in the unconscious, with the maternal body (1961)
  3. An extensive use of a live, active presence and reparation in action (Alvarez, 1992,
    Pollak, 2009) aimed to distinguish and connect bodily functions, inside and outside,
    self and object, and different emotional states. So, by standing behind the wall to
    concretely separate myself from her, darkening the room, remaining silent, averting
    my gaze, and attempting not to breathe, I was trying to prevent the exterior world
    from intruding while she was still unready. Later, I helped her to envelop herself in
    tape so that she would feel less disintegrated.”

Further reading on Immunology and Psychotherapy

This podcast covers the following topics that warrant specialization and inspires further study:

Epigenetic link to Object Relations

Martin, S. (2014) R. Yehuda, N.P. Daskalakis, A. Lehrner, F. Desarnaud, H.N. Bader, I. Makotkine, J.D. Flory, L.M. Bierer, & M.J. Meaney (2014). Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring. American Journal of Psychiatry 171:872-880.

Karla Ramirez , Rosa Fernández , Sarah Collet , Meltem Kiyar Enrique Delgado-Zayas , Esther Gómez-Gil , Tibbert Van Den Eynde , Guy T’Sjoen , Antonio Guillamon , Sven C Mueller , Eduardo Pásaro (2021) Epigenetics Is Implicated in the Basis of Gender Incongruence: An Epigenome-Wide Association Analysis. Front Neurosci Aug 19; 15:701017

Primitive Anxieties

Durban, J. (2019) ““Making a person”: Clinical considerations regarding the interpretation of anxieties in the analyses of children on the autisto-psychotic spectrum” The International Journal of Psychoanalysis 100:5, 921-939.

Prenatal and Postnatal Influence on the Psyche

Meltzer, D. & Williams, M. H. (1988) 2. Aesthetic Conflict: It’s Place in the Developmental Process. The Apprehension of Beauty: The Role of Aesthetic Conflict in Development, Art, and Violence 146:7-33

Bion, W. R. (1976) “On a quotation from Freud.” In Clinical Seminars and Four Papers, Ed. F. Bion. Abingdon: Fleetwood Press, 1987.

Joanna Wilheim (2004) The trauma of conception. Presented at a Meeting of the Brazilian Society of Psychoanalysis of São Paulo (SBPSP) on October 7, 2004.

Trnsformation of the mother’s immune system. Mandelboim, O. et al’ (2006). Decidual NK cells regulate key developmental processes at the human fetal-maternal interface. Nature Medicine 12: 1065 – 1074.

Bibliography

Bassat, S.B. (2021). “War in times of love”- Prenatal cell relations as a prototype of
autistic anxieties, defenses and object relations. Paper that won the 24th Frances Tustin Memorial Prize, 2021. Tel Aviv University, November 5th, 2021. Download pdf.

Psychotherapy is Healing through the Psyche

The full potential of psychotherapy is healing. The healing work enabled through psychotherapy is holistic. This means that psychotherapeutic healing involves the biological, psychological and social aspect of the patient.

Psychotherapy is a complement to medical treatment

Unlike medical professionals who traditionally focus solely on the body while ignoring the social and mental state of the patient — that is now changing in, thankfully– psychotherapists pay attention to the entire person. Particularly true for chronic diseases like cardio-vascular heart disease, medicine and medical procedures only try to remove the symptoms. Psychotherapy helps the patient to work through stress that resulted in the symptoms in the first place, manage behavior to help maintain lifestyle changes, and work through coping with the depression and trauma of having been diagnosed.

Studies have been surfacing about the link between stress and chronic diseases. Read this article featuring a lecture by Gabor Maté : Denial of own emotional needs and its connection to chronic illness.

Psychotherapy is a more intensive form of counseling or psychiatry

Psychotherapy is a profession that is often confused with others, like counseling, psychology and even psychiatry. To really briefly describe the essential focus on each field of mental health I would say that counseling works on problems of daily existence, daily functioning at work and play, or problems created from behaviors that do not support daily function. Psychology is a broad field of work that researches human behavior and responses to situations. Psychiatry considers that which is emotional and behavioral to be biological, and deals with these issues with medicine or medical procedures.

The way to explain the gestalt therapy attitude towards healing is with this Chinese idiom:

斬草不除根,春風吹又生

“When cutting grass, the roots are not pulled out, when spring arrives, the grass grows back.”

Chinese idiom

We can see this in ourselves and in others. Our emotional problems, issues with relationships, problems with work, health problems tend to show repeating patterns. Sometimes we even see these patterns in our parents or in our children. Oftentimes we try to fix the problems. Often another problem of a similar nature surfaces. This is the metaphorical grass mentioned in the above idiom.

If you do go for psychotherapy, your attitude as a patient is to work towards identifying and removing the roots. It is not always painless, but a therapist who is well versed in the work can walk you through it.

The tool of Psychotherapy is dialogue

The term “talking cure” was coined by a patient of Breuer, Anna O, the first recognized patient of psychotherapy. Talking is not the right word. Rather I would used the word, dialogue. Gestalt psychotherapists like myself work with verbal and non-verbal communication. We can work with persons who do not talk or are not able to.

Psychotherapy works through affects and unconscious activity through dialogue and expression of these thoughts and emotions. The goal is to relief stress from painful emotions, by working through traumatic memories, painful thoughts, and difficult emotional experiences. Through working with the unconscious, awareness is formed and stress is relieved.

Relief of stress from psychotherapeutic treatment and health consequences

The relief of stress creates a change in the neuro-chemical balance in the brain. In turn, the hormonal system is readjusted. This changes and strengthens the immune system and cardio-vascular system. Balance in the immune system reduces risk of cancer and even aids in healing cancer, while reduced stress to the cardio-vascular system reduces blood pressure and heart attack & stroke risk.

Psychotherapy heals the body by causing a readjustment of the neuro-chemicals and hormones in the organs. Patients can feel this effect after an effective session of psychotherapy.

What one gets from Psychotherapy is a holistic benefit: empowerment to build relationships, energy for work, study and play, and inner peace.

Read also: The Neuroscience of Language Explains How and Why Psychotherapy Cures 

What is the consequence of this relief of stress? Relief of stress as a result of dealing with the unconscious leads to physical healing and prevention of serious diseases. Medical problems are influenced by epigenetics rather than genetics. Unlike genetics, which we cannot change, epigenetics describe the expression of genes. Expression of genes is determined by environmental and situational factors that we face in our daily lives.

Healing in the psychotherapeutic session

I focus on the emotions and the connected thoughts that arise. The opposite is also important: memories and even fantasies are investigated to examine the underlying emotions. The integration of the person with his/her emotions and thoughts through dialogue and behavioral experimentation in the psychotherapeutic session leads to chemical change in the neurological system of the patient.

Case study:

This is a case study of a patient who came to therapy because of experiencing stress at his workplace. He was often on sick leave for chronic migraine, hemorrhoids and even un-explainable occasional hearing loss. Close to losing his job, he attends therapy. Only after weeks of treatment, did he realize how he, as a young child, was affected by traumatic situations at kindergarten and later elementary school. His home country was governed by a communist regime during the time of his childhood in the 80s. He had survived his childhood years by forgetting how frightening and lonely the situation was, while secretly hoping that he would be sick so that he could skip school.

This client’s psychotherapy treatment was about working through the trauma. With time, we worked together integrating his memories with awareness of which emotions belonged to the past, and what is no longer needed in the present. One of these was the realization that he no longer needed to “get sick” to skip work. He took breaks, sometimes weeks of non-paid vacation. He learned to regulate his spending, so that he could breathe easy when he took those breaks. Talking about and expressing painful emotions allowed him to release energy that he had bottled up and forgotten all his young life. He became more aware of tension in his body, and started doing yoga. Soon after, he stopped taking medication for migraine. The patient realizes that his path to healing is life-long. Along the way, he was able to find love as well.

The Lasting Effect of Psychotherapy

Unlike taking a pill to regulate emotions, neurological changes brought about by psychotherapy are subtle and lasts the lifetime. With regular sessions, these changes snowball into observable physical improvement. Unlike medication, treatment with psychotherapy does not leave behind negative physical side-effects, as can be seen with antidepressants.

For reasons that Psychotherapy is chemical-free, it is a treatment much needed for children, teens, young adults, and people hoping to be parents.

Through working with the psyche, psychotherapy enables the patient to better function in work, play, sex and relationships. As the patient becomes more self aware, he/she also becomes more aware of his/her relationships. He/she ultimately functions better in life. The effect of psychotherapy achieves what one looks for in counseling, with the added benefit somatic healing.

Just as there exists many schools of psychotherapists, there are, of course, different opinions on this subject of healing. The article written reflects my own work.

What does “healing” mean in Psychotherapy?

Humanistic schools of psychotherapy in particular understand the process of healing through the integration of the psyche and body. My belief is that when these two parts of a person are working in sync, the individual can experience a deep and profound change. The body-mind connection is a vital part of the healing process because it allows us to work from our felt experience; that is, we begin from where we (emotionally) are in the moment. When we have the courage to unearth those emotions and feelings, we are able to move them through our body in the form of emotion and become fully integrated again. Essentially, the body becomes an instrument for emotional release and healing.

While it is not obvious in our therapeutic conversation, this integration is the focus of my work. Within the therapeutic encounter, there is an underlying therapeutic process.

Subtle is the therapeutic process not?

When we go for therapy, we may experience change from the beginning, or no big change for weeks or months. We may talk about the same things in circles before something happens: an insight, an understanding, a gush of emotions, a relief from tension.  When and how we get to this point in the therapy is usually not foreseeable. The process can be described as to be like titration. We make small steps. There is no explosion, but natural, holistic change. But then, something clicks.

Case Studies of healing process in psychotherapy

Case 1, Mary: I recount a case study of a journalist named Mary (not her real name), who came to therapy because of stress due to conflict with her colleagues. Her goal of therapy was to reduce the stress and panic feelings when she is at work. She feared that she may become too emotionally unstable to go to work because of this. For months, Mary talked about her work environment, the colleagues and tried to understand the incidents that triggered in her deep emotions. She also talked about her work, which she calls “her passion”; to remind women of their rights through feminist writings and stories. More weeks went by, and I began to wonder myself if her process was heading anywhere. I stuck to the process of her work, which with time, saw Mary more comfortable with expressing more difficult emotions, especially feelings of vulnerability. Baby steps. One day, she revealed that she had been sexually assaulted by a group of college mates and that she had kept this incident a secret for 20 years. She was able, after 14 months of therapy, to talk about it in session.  Along with this revelation came a flood of feelings: resentment, shame, guilt, vulnerability, frustration, anger, grief, and also thankfulness. At one point, she was even angry at me for having initiated her emotional unravelling. For a couple of weeks, she said that she could not work. She then emerged from this. Mary transformed. She had been afraid of coming to terms with a painful past. In so doing, she re-lived her inner feelings of resentment, frustration and anger towards others and herself in her workplace and even in her writings. While these feelings helped her to write powerful articles, it also caused her to build walls between herself and the society in which she is in contact with. The conflicts left her stressed out and panicky at work. She was helpless against the emotional turmoil. Working through her traumatic experience, she unleashed the source of these painful feelings.  Through this process, Mary was awarded choice. She could tap on these feelings as motivation to write and guide others. She is, however, not bounded to these feelings anymore. She finds inner-calm — which she said “had always been there”, but she did not realize it– in her social context. With time, she was able to build more allies.  Panic feelings were soon of the past. Mary’s healing came about in little steps.

Case 2, Sunil: Sunil (not his real name), was a foreign student from India. He has chronic pain and problems with his digestive system, which doctors have diagnosed as Irritable Bowel Syndrome. He knows that his physical symptoms are related to “stress”(actually compulsive intrusive thoughts and actions) and sleeplessness. Sunil grew up experiencing family violence. With therapy, Sunil learned to notice his emotions and how past memories of childhood affects him today. He learned to observe the triggers in his everyday environment. He learned how to notice and accept his triggered self. Sunil learned to engage the support of his loved ones by explaining to them what was going on in him, and what he needed. With time and help from others, Sunil’s episodes reduced in duration and intensity. Sunil learned in therapy to be conscious of changes in his body when he got triggered. He was guided to find out what his body needed to calm down from its hyper-aroused state. Sunil’s healing process involved dealing with somatic reactions to triggers, and working through past hurts. Within months, Sunil’s digestive system stabilized. He also slept better. Sunil’s healing process was a holistic one.

So what is healing to me in the psychotherapeutic sense?

Mary and Sunil’s healing was a journey towards self-awareness and growth. The time, energy (and, not to forget, money)  spent in therapy rewarded them with freedom from unconsciously re-living traumatic pasts.

Healing in psychotherapy takes place when the patient is able to grow and transform through insight and experiencing (and sharing) feelings.

Psychotherapeutic healing provides the individual with choice. The patient’s awareness of self provides the patient with a broader bandwidth of emotions and behaviours from which to respond to life, rather than reacting out of old, harmful patterns. Therefore, therapeutic healing results in a change in the person’s ability to better engage with and experience the world around them.

This concept of healing is unlike that of conventional thought of “healing diseases”, which strives to remove the disease. In psychotherapy, mental and emotional issues are not to be judged as bad and removed; but understood. Depression, anxiety, PTSD and personality disorders aren’t “diseases to be cured”. These are opportunities for personal growth.