METAPHOR MAKING IN THE RELATIONAL BRAIN Dr Sue

METAPHOR MAKING IN THE RELATIONAL BRAIN Dr Sue Mizen Exeter

RISK Personality disorder, CHARACTERISTI CS OF SEVERE AND COMPLEX PD Eating disorder, Somatisation, Autistic spectrum disorder Substance misuse

SYMBOLISATION IN THE BRAIN

JAAK PANKSEPP • Basic Emotion Command Systems • SEEKING • PANIC • FEAR • RAGE • PLAY

BASIC EMOTION COMMAND SYSTEMS

AFFECT: THE PANIC AND SEEKING SYSTEMS • SEEKING (Dopamine) • • Exploration Foraging MANIA and PSYCHOSIS Stimulants • PANIC (Opiates and Oxytocin) • • Separation distress Proximity seeking Depression Opiates

RELATING AND TRIANGULATION • Year 1 • Face to Face interaction with mother • (Primary intersubjectivity) • At 1 year • Triangulation • (Secondary intersubjectivity) • Autistic Spectrum Disorder • Hobson (2002)

TRIANGULATION IN PSYCHOANALYSIS • Ron Britton • The collapse of triangular space in narcissistic disorder.

SUMMARY OF FAILURES OF SYMBOLISATION • Symbolisation requires: • Affective engagement • Relating • First and third person position taking (Triangulation) • Triangulation fails because of: • Inadequate affective engagement • Relational failures • Psychodynamic defences

NARCISSISM AND TERRITORY

NARCISSISM: A DISORDERED SENSE OF WHAT BELONGS TO WHOM. • A bodily sense of territory. • That which is within my control belongs to the myself and is loved. • That which is outside my control is defined as other and hated. • The boundary of the psychic and somatic self is drawn along the line between this definition of self and other • This boundary is fluid, but in normal conditions coincides with the skin.

SOLMS AND KAPLAN-SOLMS: RIGHT HEMISPHERE DAMAGE • Unaware of loss of function (Anosognosia) • Believe the Paralysed limb belongs to someone else (Somatoparaphrenia) • Feel disgusted by the paralysed limb and may attack it. (Misoplegia)

MR C • Mr C presented as aloof, egocentric and imperious, oblivious to the world around him except insofar as it affected his own wellbeing. He appeared unable to see things from the other person’s point of view, eschewing social convention. He only took the initiative to address a complaint. He took nothing in and never expressed gratitude, seeming to have withdrawn into a cocoon of self-sufficiency, and yet, he was simultaneously very needy and demanding. He was hypochondriacal and intolerant of frustration of any kind, expressed mostly to the nursing staff, whom he treated as though they were combined into one big mother, whose function was to meet his personal needs immediately. His intolerance of frustration was also expressed towards his arm and his rehabilitation regime. He expected and demanded to make a total and complete recovery. He seemed to harbour an intense need to regress, to be looked after and cared for, and yet consciously abhorred dependence and vulnerability of any kind. He closely resembled ‘his majesty the baby’, in a word he was narcissistic. • He treated the left side of his body in the same way he did the nursing staff, as though it was another piece of external reality which refused to do his bidding. It was therefore an annoyance, but otherwise of no interest to him. It was as though he had redrawn the boundary of his physical self, so that only his torso and right limb really belonged to him. His left arm was treated like a disobedient servant. • (Solms and Kaplan Solms, 2000, p 162 -3)

MORIN ET AL (2014) DT

XENOPHOBIA AND PSYCHIC ATOPIA • Ramachandran: Apotemnophilia and Acrotomania

NARCISSISTIC DEFENCES AGAINST LOSS AND SEPARATION

SEPARATION AND LOSS SEL F Need OTHE R

BRITTON: ACQUISITIVE PROJECTIVE IDENTIFICATION (THIN SKINNED NARCISSISM) B M Hyper-subjectivity

MR Z

BRITTON: ATTRIBUTIVE PROJECTIVE IDENTIFICATION (THICK SKINNED NARCISSISM) M B Hyper-objectivity

MISS X

THE RELATIONAL AFFECTIVE FORMULATION

CLINICAL IMPLICATIONS

‘TRAPPED’ AND ‘DROPPED’ IN THE MENTAL HEALTH SYSTEM

THE MODEL: A GRADUATED PATHWAY Tier 4 Inpatient Tier 3 E Day Programme Tier 3 Specialist outpatient

A THERAPEUTIC TEAM WORKING TO A FORMULATION The Team • Consultant Medical Psychotherapists • Contain the team • Prescribing • Physical health • MHA • Psychotherapists • Individual • Group • Family • Psychosocial Practice The RA Formulation

THERAPEUTIC IMPLICATIONS • Prosody and affective availability • States of identity • Relating to the body and relating to other • Eating disorders • Psychosomatic disorders • The boundary of the body and the self and battles for control • Triangulating interpretations • Claustro-agoraphobic crises and containment

RELATIONAL AFFECTIVE MODEL • References: • Mizen, C. S. (2014 a) Narcissistic disorder and the failure of symbolisation- A Relational Affective Hypothesis. Medical Hypotheses: Volume 83, Issue 3, Pages 254 -262 • Mizen, C. S. (2014 b) Towards a Relational Affective Theory of Personality Disorder Psychoanalytic Psychotherapy 28: 4. 357 -378 • Mizen, C. S. (2015) Neuroscience, mind and meaning: an attempt at synthesis in a Relational Affective Hypothesis. Psychoanalytic Psychotherapy 29: 4. 363 -381 • Mizen, C. S. (2017) Preliminary thoughts on the neurobiology of innate unconscious structures and the psychodynamics of language acquisition. The Journal of Analytical Psychology (November edition)