Lissa Weinstein

The Neurobiology of Personality Disorders: Implications for Psychoanalysis

As advances in neuroscience have furthered our understanding of the role of brain circuitry, genetics, stress, and neuromodulators in the regulation of normal behavior and in the pathogenesis of psychopathology, an increasing appreciation of the role of neurobiology in individual differences in personality and their pathology in personality disorders has emerged. Individual differences in the regulation and organization of cognitive processes, affective reactivity, impulse/action patterns, and anxiety may in the extreme provide susceptibilities to personality disorders such as borderline and schizotypal personality disorder. A low threshold for impulsive aggression, as observed in borderline and antisocial personality disorders, may be related to excessive amygdala reactivity, reduced prefrontal inhibition, and diminished serotonergic facilitation of prefrontal controls. Affective instability may be mediated by excessive limbic reactivity in gabaminergic/glutamatergic/cholinergic circuits, resulting in an increased sensitivity or reactivity to environmental emotional stimuli as in borderline personality disorder and other cluster B personality disorders. Disturbances in cognitive organization and information processing may contribute to the detachment, desynchrony with the environment, and cognitive/perceptional distortions of cluster A or schizophrenia spectrum personality disorders. A low threshold for anxiety may contribute to the avoidant, dependent, and compulsive behaviors observed in cluster C personality disorders. These alterations in critical regulatory domains will influence how representations of self and others are internalized. Aspects of neurobiological functioning themselves become cognized through the medium of figurative language into an ongoing narrative of the self, one that can be transformed through the analytic process, allowing for the modulation of genetic/biological thresholds.

An Investigation into Some Implications of a Vygotskian Perspective on the Origins of Mind: Psychoanalysis and Vygotskian Psychology, Part I:

The Russian psychologist Lev Vygotsky proposed an analysis of language, thought, and internalization that has direct relevance to the current concerns of psychoanalysts. Striking methodological and conceptual similarities and useful complementarities with psychoanalysis are discovered when one peers beneath the surface of Vygotskian psychology. Our adaptation of Vygotskys views expands upon Freuds assigned role to language in the topographic model. We suggest that the analysands speech offers several windows into the history of the individual, through prosody, tropes, word meaning, and word sense. We particularly emphasize Vygotskys views on the genesis and utilization of word meanings. The acquisition of word meanings will contain key elements of the internal climate present when the word meaning was forged. Bearing this in mind, crucial theoretical questions follow, such as how psychoanalysis is to understand the unconscious fantasies, identifications, anxieties, and defenses associated with the psychodynamics of language acquisition and later language usage. We propose that the clinical situation is an ideal place to test these hypotheses.

Language and the psychoanalytic process : psychoanalysis and Vygotskian psychology. II

This paper follows our previous one, where we described a psychoanalytic conception of language, thought, and internalization that is informed by the thinking of Lev Vygotsky. Here, several aspects of the analytic process which allow for the understanding of ineffable experiences in the analysands history and the analytic situation are investigated: specifically, primal repression, metaphor, and the role of speech in free association. It is suggested that Freuds notion of primal repression be revived and redefined as one aspect of the descriptive unconscious. Some implications of primal repression for transference and resistance are explored. The metaphoric in its broad sense is examined as one example of how early dynamic experiences embedded in the process of language acquisition can be reached within the clinical situation. It is proposed that an understanding of free association is enhanced by awareness of distinctions between inner, egocentric, and social speech. The basic rule can be interpreted as an invitation for the analysand to use inner speech in collaboration with the analyst as best he or she can. Further, the aliveness and degree of superficiality of the analysis can be seen as a function of the analysts ability to appreciate the properties of inner speech and foster the conditions in the analysis that allow for its unfolding.

Coherence, competence, and confusion in narratives of middle childhood.

Middle childhood is a pivotal time in character development during which enduring internal structures are formed. Fiction can offer insights into the cognitive and affective shifts of this developmental phase and how they are transformed in adulthood. While the success of beloved books for latency age children lies in the solutions they offer to the conflict between the pull toward independence and the pull back to the safety of childhood, the enduring stories for adults about children in their middle years can be seen as works of mourning for the relationship with the parents and the childhood self, but more importantly as attempts to transform their experience of middle childhood through the retrospective creation of a coherence that was initially absent. Thematic and structural elements distinguish two groups of stories for adults: the first appears to solve the conflicts of this period by importing adult knowledge and perspective into the narrative of childhood; the second describes the unconscious disorganizing aspects of this period, thereby offering readers a chance to reorganize their own memories, to make a coherent whole out of the fragmented, the confusing, and the unresolved.

Universal fantasy in latency: Separation, attachment and sexuality in Julio Cortázar's Bestiary

This paper joins recent efforts to build a conceptual bridge between psychoanalysis and attachment theory. A psychoanalytic reading of Julio Cortázar’s Bestiary, a story about a young girl sent away for a summer vacation, is used to conceptualize the relationship between attachment and sexuality during latency. Middle childhood is seen as a pivotal period when cognitive maturation, internalization of parental figures, increasing independence and importance of those outside the family make fantasy the central adaptive mode of functioning. As such, the literature on attachment, which focuses on observed events, has to be supplemented with investigations of the actively created fantasies of that age period.

Personality Disorders, Attachment and Psychodynamic Psychotherapy

While attachment has been a fruitful and critical concept in understanding enduring individual templates for interpersonal relationships, it does not have a well-understood relationship to personality disorders, where impairment of interpersonal functioning is paramount. Despite the recognition that attachment disturbances do not simply reflect nonoptimal caretaking environments, the relationship of underlying temperamental factors to these environmental insults has not been fully explored. In this paper we provide an alternate model for the role of neurobiological temperamental factors, including brain circuitry and neuropeptide modulation, in mediating social cognition and the internalization and maintenance of attachment patterns. The implications of these altered attachment patterns on personality disorders and their neurobiological and environmental roots for psychoanalytically based treatment models designed to ameliorate difficulties in interpersonal functioning through the medium of increased access to mature forms of mentalization is discussed.

Contents Vol. 47, 2014

Founded 1897 as ‘Monatsschrift für Psychiatrie und Neurologie’, continued 1957–1967 as ‘Psychiatria et Neurologia’, continued 1968–1983 as ‘Psychiatria Clinica’ Founders: C. Wernicke and Th . Ziehen Successors: K. Bonhoeff er (1912–1938), J. Klaesi (1939–1967), E. Grünthal (1953–1973), N. Petrilowitsch (1968–1970), Th . Spoerri (1971–1973), P. Berner (1974–1999), E. Gabriel (1974–2004), Ch. Mundt (2000–2011) Official Journal of the World Psychiatric Association (WPA),

Sustaining the object through the erotic imagination: Karoly Makk’s Szerelem [Love]

Pity poor Eros. Once defined by Freud as an abstract life force which holds together everything in the world (Freud, 1921, p. 92) and revealed by mythology to be the messenger who traversed the distance between the gods of Olympus and man, today we find Eros shorn of complexity, ripped from its fraternal twin, hatred, reduced to its bodily referent of sexuality or, worse, to combinations of neural circuitry that fail to differentiate cherished infant from desired beloved. We are told that attachment and sexuality are separate systems with different evolutionary aims (Eagle, 2007; Holmes, 2007); too often Eros is demoted to a mere cover for earlier, ‘deeper’ needs. Yet, as Green (2001) notes, the scope of Eros includes sexuality and love, both generators of representations which form associative chains of ever-evolving complexity. Where desire is initially purely subjective, with the object’s existence experienced as little more than a conduit to a longed for pleasure, following the separation of self and object borne of desire’s frustration, and the accompanying genesis of fantasy, desire, comes to encompass more muted variations as internalized object relations with different valences are integrated. The love between lovers, the love of political ideals, the love of parents for their children and fraternal love all fall within the rubric of Eros. Through the subliminatory channels, desire will touch social and cultural life, informing our perceptions of beauty (Plato, 2006). Yet the range of Eros has rarely been the subject of psychoanalytic scrutiny, and although all of human development takes place at the behest of Eros, as Jonathan Lear (1966, p. 673) notes: ‘‘We lack an understanding of what Eros is.’’ We must conclude, along with such disparate thinkers as Andr Green and Harry Harlow, that psychology may have little to teach us about love beyond what we can learn from our greatest artists.