David Garfield

Becoming Aware of Feelings: Integration of Cognitive-Developmental, Neuroscientific, and Psychoanalytic Perspectives

A fundamental ingredient of psychoanalytic treatment is the ability of the analysand to become consciously aware of his or her own emotional responses. We propose that the conscious awareness of emotion is a type of information processing that can be viewed as a separate domain of cognitive function, that the transition from unconscious (implicit) to conscious (explicit) aspects of emotion can be understood developmentally in the manner described by Piaget for cognitive functions generally, and that explicit emotional processes have a modulatory effect on implicit processes. We then present a parallel hierarchical model of the neural substrates of emotional experience supported by recent neuroimaging work. We describe how the neural substrates of implicit and explicit aspects of emotion are dissociable, and we discuss the neural substrates of implicit aspects of emotion, background feelings, focal attention to feelings, and reflective awareness of feelings. This framework constitutes an alternative to traditional psychoanalytic understandings of insight. We conclude by discussing the implications of this model for psychoanalysis, including the nature of clinical change, the psychological processes involved in change with and without insight, and a framework for conceptualizing how to promote emotional change in a variety of clinical settings.

Levels of emotional awareness: A model for conceptualizing and measuring emotion‐centered structural change

The need to establish the efficacy of psychoanalytic long‐term treatments has promoted efforts to operationalize psychic structure and structural change as key elements of psychoanalytic treatments and their outcomes. Current, promising measures of structural change, however, require extensive interviews and rater training. The purpose of this paper is to present the theory and measurement of Levels of Emotional Awareness (LEA) and to illustrate its use based on clinical case vignettes. The LEA model lays out a developmental trajectory of affective processing, akin to Piaget’s theory of sensory–cognitive development, from implicit to explicit processing. Unlike other current assessments of psychic structure (Scales of Psychological Capacities, Reflective Functioning, Operationalized Psychodynamic Diagnostics) requiring intensive rater and interviewer training, it is easily assessed based on a self‐report performance test. The LEA model conceptualizes a basic psychological capacity, affect processing. As we will illustrate using two case vignettes, by operationalizing implicit and explicit modes of affect processing, it provides a clinical measure of emotional awareness that is highly pertinent to the ongoing psychoanalytic debate on the nature and mechanisms of structural change.

Natural language processing in psychiatry : artificial intelligence technology and psychopathology

The potential benefit of artificial intelligence (AI) technology as a tool of psychiatry has not been well defined. In this essay, the technology of natural language processing and its position with regard to the two main schools of AI is clearly outlined. Past experiments utilizing AI techniques in understanding psychopathology are reviewed. Natural language processing can automate the analysis of transcripts and can be used in modeling theories of language comprehension. In these ways, it can serve as a tool in testing psychological theories of psychopathology and can be used as an effective tool in empirical research on verbal behavior in psychopathology.

Open trial of nefazodone for combat veterans with posttraumatic stress disorder

Fourteen combat veterans completed a 9-week open trial of nefazodone for treatment of posttraumatic stress disorder (PTSD). Overall PTSD symptoms as measured by the Clinician-Administered PTSD Scale (CAPS) showed a modest but statistically significant decrease with nefazodone treatment. Decreases in CAPS reexperiencing and avoidance, but not hyperarousal symptoms, approached statistical significance. Anxiety decreased significantly, and there were trends toward decreased depression and anger on structured assessments. This study adds to the clinical evidence that nefazodone may be helpful for the management of PTSD symptoms.

Lupron-induced mania

BACKGROUND Gonadotropins and sex hormones are intimately related to the stability of affective states. Patients with affective disorders may demonstrate abnormal levels of sex hormones and gonadotropins. It is therefore possible that affective disorder patients may experience mood dysregulation by synthetic sex hormones and gonadotropins like lupron. METHODS A case report of a young woman with a history of endometriosis and a past history of irritability and depression is described. Treatment of the endometriosis with lupron induced a manic episode. RESULTS The lupron-induced mania was successfully treated with a mood-stabilizing agent, lithium carbonate. CONCLUSIONS Patients with a history of affective disorder may develop manic episodes when treated with Lupron. Mood-stabilizing agents are helpful in ameliorating this unwanted effect.

Application of artificial intelligence principles to the analysis of crazy speech

Artificial intelligence computer simulation methods can be used to investigate psychotic or “crazy” speech. Here, symbolic reasoning algorithms establish semantic networks that schematize speech. These semantic networks consist of two main structures: case frames and object taxonomies. Node-based reasoning rules apply to object taxonomies and pathwaybased reasoning rules apply to case frames. Normal listeners may recognize speech as “crazy talk” based on violations of node- and pathway-based reasoning rules. In this article, three separate segments of schizophrenic speech illustrate violations of these rules. This artificial intelligence approach is compared and contrasted with other neurolinguistic approaches and is discussed as a conceptual link between neurobiological and psychodynamic understandings of psychopathology.

A comparison of personality characteristics of patients with posttraumatic stress disorders and substance dependence: Preliminary findings

Department of Psychiatry and Behavioral Sciences, Finch University of Health Sciences/The Chicago Medical School, and the Veterans Affairs Medical Center, North Chicago, Illinois. Reprints: Nutan Atre Vaidya, Department of Psychiatry and Behavioral Sciences, FUHS/The Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064. E-mail: vaidyan@finchcms.edu. Copyright

Design of an emotion profiler using SNePS

SNePS is being used to implement an emotion profiler which is based on a new emotion theory. The system is designed to read a transcript of an actual doctor/patient conversation and produce a profile of the patients emotional state. Because conversations are not restricted in topic and patients use words idiosyncratically, the emotion profilers use of knowledge is limited. This paper describes a design and SNePS implementation which uses domain-independent knowledge to effectively parse and process transcripts.

Two Reciprocal Selfobject Variants in Systems of Pathological Accommodation: Illustrations From the Movies Shine and Black Swan

The devastating descent into psychosis is powerfully illustrated in two movies, Shine and Black Swan. Here, two young prodigies, David Helfgott, the pianist, and Nina, the fictional ballerina, portray a vulnerable idealizing selfobject transference between father and son and a crippling merger/twinship selfobject transference between mother and daughter. Furthermore, the films demonstrate how the two young artists serve as potent stabilizing influences for each of their same sex parents. An intrinsic maturational need in each young artist is vividly thwarted by the bound up nexus of each parent and child dyad. After comparing and contrasting the two films and the psychotic fragmentation which evolves, we postulate what environmental supports and what selfobject experiences are necessary for the child caught in this kind of psychological configuration to survive into adulthood.