The NeuroPsychoanalysis of Change International Society for the

The Neuro-Psychoanalysis of Change International Society for the Psychoanalytic Study of Organizations New York October 23, 2010 Richard J. Kessler, D. O.

The Same Different

LATEST NEUROSCIENCE DISCOVERIES Hallucinatory wish fulfillment… In libris graecis appetere mea. At vim odio lorem omnes, pri id iuvaret partiendo. Vivendo menandri et sed. Lorem volumus blandit cu has. Sit cu alia porro fuisset. Primary and secondary process Ea pro natum invidunt repudiandae, his et facilisis vituperatoribus. Mei eu ubique altera senserit, consul eripuit accusata has ne. Ignota verterem te nam, eu cibo causae menandri vim. Sit rebum erant dolorem et, sed odio error ad. Vel molestie corrumpit deterruisset ad, mollis ceteros ad sea. In libris graecis appetere mea. At vim odio lorem omnes, pri id iuvaret partiendo. Vivendo menandri et sed. Lorem volumus blandit cu has. Sit cu vituperatoribus. Mei eu ubique

every perception is in fact actively constructed by the brain from the building blocks of individual sensory cues under the guidance and influence of emotions, motivation and prior experience”. (Gazzaniga, 1995)

“Nothing prevents us from assuming that there was a primitive state of the mental apparatus in which this path was actually traversed, in which wishing ended in hallucinating” Dreams & Consciousness HALLUCINATION

Chapter 7 model “Thy wish was father …. to that thought” n The mind is activated by drives: “nothing but a wish can set our mental apparatus at work” n What is a wish? “Thus the aim of this first psychical activity was to produce a ‘perceptual identity’ a repetition of the perception which was linked with the satisfaction of the need” n “But all the complicated thought-activity which is spun out from the mnemic image to the moment at which the perceptual identity is established by the external world…. . merely constitutes a roundabout path to wish fulfillment which has been made necessary by experience”. Thought is after all nothing but a substitute for hallucinatory wish…. . n “in the end our thoughts are nothing more than movements that have not been actualized “(William Calvin, 1996) This “feedback” process is a model for all mental activity!!

Chapter 7 model Implications The world is discovered through the object The mind is the residue (memories) of experience These experiences are initially “sensorimotor” In dreaming, perception is dissociated from motility (and external stimuli) making it an ideal state in which to develop mental imagery and thought n “External reality” constrains “psychic reality” (as secondary process and the reality principal constrain primary process and the pleasure principal) n The secondary process transforms wish into prediction. The “objectivity” of perception is learned. What is remembered becomes differentiated from what is present n The transition between hallucinated images to memory traces and then from what is remembered to what is present is the transition from the primary to secondary process n n

Dream/Wish/Consciousness Freud: * The dream repeated these reflections unaltered , but it represented them in a situation which was actually present and which could be perceived through the senses like a waking experience”. * “Dreams make use of the present tense”. * “The dream wish … is hallucinated, and as hallucinated, meets with belief in the reality of its fulfillment … [and] counts as undisputed reality” n Opatow: * Hallucinatory wish fulfillment: “. . the mind, through purely internal operations generates an experienced reality” *And what mentally is under consciousness? . . . A striving towards hallucination dynamically intercepted and infused into the flow of awareness, penetrating and interweaving with consciousness to be partially realized in the external world” Hallucination Fantasy Reality n “That is, the ontology of dreams is the ontology of consciousness”. (Revonsuo, 1995)

Neuroscience Bridge n To the functional systems of neuronal activity that construct our experiential world, dreaming of or perceiving something is equivalent to actually perceiving or doing it (La. Berge, 1990)

Why visual hallucinations?

n Man is a visual animal n Vision is the best distance perceptor (light vs sound) n Vision provides the best clues for predicting experiences of pain/pleasure n Mother’s face remains when nursing ceases n The opening and closing of the eyes is a sensorimotior experience par excellence n Anyway, the substrate of auditory image, hallucination and perception are the same (Brown, 1988)

When Vision Goes, the Hallucinations Begin Susan Kruglinski, N. Y. Times 9/14/04 n Charles Bonnet Syndrome occurs in 15 - 20 % of people whose eyesight is worse than 20/60 n Blind spots/low vision caused by cataracts, glaucoma, diabetic retinopathy, macular degeneration n Hallucinations are experienced like movies (especially faces) n V. J. Ramachandran: The visual cortex is responsible for taking in information and forming remembered or imagined images. Normal vision is a fusion of incoming sensory information with internally generated sensory input, the brain filling in the visual field with what it is used to or expects to see.

“In a sense we are hallucinating all the time, What we call normal vision is our selecting the hallucination that best fits reality” (Ramachandran) Joan Miro The Hunter

The Hodology of Hallucinations (D. Ffytche, 2008) n “We observe increases in activity in visual brain regions. Increases in visual connection strength and an alteration in relationship between visual relay and receiving stations, together suggesting that hallucinations were caused by a transient form of blindness. ” n The shift of thalamo-cortical activity from tonic to burst mode may have direct relevance to the Charles Bonnet Syndrome.

Altered States, 1980

Sensory Deprivation n Retreats……. Vision Quests n Experimental findings were “unexpected”! n Visual and auditory hallucinations, body image distortions, paranoia, nightmares, sleep/wake confusion, acute desire for stimulation, suggestibility n Produce theta rhythms

Perceptual Isolation Experiments (Goldberger & Holt, 1961) n “The psychic structures underlying the operation of logical, reality oriented thought require continual sensory contact with the order and patterning of the real world…. In the absence of such contact, the psychic structures lose their stability and drive controlling capacity, with the result that regression to the primitive, archaic primary process mode of functioning is facilitated”

Interim Hypothesis n “From this perspective, dreaming can be viewed as the special case of perception without the constraints of external sensory input. Conversely, perception can be viewed as the special case of dreaming constrained by sensory input”. ( La. Berge, 1996)

“Nothing prevents us from assuming there was a primitive state of the mental apparatus in which this state was actually traversed in which wishing ended in hallucinating”

Nascent Body Ego Lehtonen, Partanen, Purhonen et al, (2006) Can we scientifically study that “primitive mental apparatus”?

Nascent Body Ego (the experiment) n EEG of infants at birth, 3 months and 6 months n Pre-feeding, Feeding, Post-feeding n Nursing and bottle fed n Pacifier before feeding as a control

Nascent Body Ego (results…new born) n Breast and bottle feeding produced amplitude changes in the EEG in somatosensory projection areas, especially on the right and particularly at mouth and occipital areas. n Activity in fronto-central leads was barely detectable n No amplitude changes while sucking a pacifier

Nascent Body Ego (results… 3 months) n No significant differences in EEG amplitude between three conditions n This is a time of social smile, improved sensory motor coordination, more organized responses to the environment n Coenesthetic to diacritic (Spitz), Basic core (Weil), Primal matrix configuration (Pacella), Core consciousness (Stern), homeostasis to attachment (Greenspan)

Nascent Body Ego (results… 6 months) n New EEG pattern with variable but robust amounts of theta rhythm during breast and bottle feeding n Theta rhythm in both hemispheres but more in right n Traces of theta rhythm in prefrontal leads

“Hedonic” Theta Rhythm ü Represents a newly acquired neurophysiological organization between cortical and sub-cortical structures. It is also later generated during “psychosocial contingency” or internally controlled attention (speech, peek-a-boo) or changing environmental information (expectation, gazing, handling, crying) and endogenously by the hippocampus. ü Theta rhythm : body ego and right parietal lobe

Physiological responses of 5 month old infants to smiling and blank faces (Bazhenova et al, 2007) n Increases in theta rhythm and vagal activity (respiratory sinus arrhythmia) and positive affect develop in response to smiling faces and “blank faces” n Pre-frontal theta activation might represent internally controlled sustained attention and an attempt at evoking reciprocity n Theta rhythm is generated in hippocampal-neocortical circuitry when information important to the species is to be gathered in the environment (Miller, 1991) In this case an interactive mismatch potentiates mental development

Jan Breughel The Sense of Touch

Are nursing experiences the first day residues? n n If so, wouldn’t theta rhythm be found during REM sleep? Well, it is, but how did it get there?

Echidna n 180, 000 year old primitive mammal n Large neocortex (54% vs 22%) n Slow wave sleep but no REM n Theta rhythm during waking, species-specific adaptive behavior Tachyglossus aculeatus

Jonathan Winson n Theta rhythm represents a form of off-line processing. n Theta rhythm encodes memories during REM sleep n Theta rhythm reflects “a neural process whereby information essential to the survival of a species – gathered during the day- was reprocessed into memory during REM sleep” n Neuroimaging studies in humans show that brain regions that are activated during learning experiences are reactivated during subsequent REM (Maquet et al, 2000) and NREM sleep (Peigneux et al 2004)

Winson concludes, n “Consistent with evolution and evidence from neuroscience and reports of dreams, I suggest that dreams reflect an individual’s strategy for survival” n “Dreams represent the practicing of strategies, aimed perhaps at capturing one’s mother rather than a mouse” (Tauber & Glovinsky, 1987)

Secondary Process Reality & Feedback (Pinchas Noy, 1969) n Feedback is defined as the continuous flow of perceptual information that serves to regulate and monitor a given function n The secondary process develops in relation to external reality and depends for its maintenance on perceptual feedback from that reality n This feedback serves to prevent primary processes from disturbing reality-oriented thinking and behavior or to integrate them into it n The primary processes are mental functions not dependent on feedback for their maintenance

All the primary processes ”(displacement, symbolization, condensation ) are egocentric/subjective “programs They represent the organization of input (perception) and storage (memory) according to: q Relationship to basic drives q Relationship to affective state q Sensory qualities of objects q Functions of objects q The Self

METS MR. METZ

The “Silent” Right Hemisphere?

The Neuroscience of Insight & Creativity n Creativity defined: § Mental impasse § Creation of novel , non-obvious representation (conceptually disparate § § knowledge domains are linked) Solution parsimony “Aha” or “Eureka” moments require not incremental steps (“plug and chug”) but transformative or restructuring processes n Neuroimaging demonstrates that brain regions recruited for spontaneous/creative thought overlap with those recruited during goal directed thought (Christoff, 2004) but spontaneous/creative thought also competes with goal directed thought (Teasdale et al, 1995)…it shares functions and mechanisms not only with other forms of thought but with sleep-related cognition (Christoff, 2010)

Sleep Related Cognition? n "Lying down with my eyes closed, I was trying to reach a state almost like sleep, " Yukawa says. "I was deeply relaxed, almost at the doorway to dreamworld, aware only of sounds that I could hear on headphones. " n The sound of a babbling brook was played constantly during the training, and whenever she began to produce theta waves in the parietal lobe at the back of the brain, she would be "rewarded" with the sound of a musical gong.

“Decisions, particularly important ones have always made me sleepy, perhaps because I know that I will have to make them by instinct, and thinking things out is only what other people tell me to do” Lillian Hellman n Spontaneous thought (off-line processing) recruits the “default network”: medial frontal cortex, ant. & post. cingulate, precuneus, post. parietal lobe and memory processing in temporal lobe (Raichle, 2001, Schulman, 1997) n The “default network” is activated when attentional demands diminish. It is associated with the kind of memory consolidation that occurs during sleep (Ellenbogen, 2007) n Creative thought brings together prefrontal, “default” and memory networks. It is associated with lower pre-frontal arousal (attention) and cognitive control and lower levels of noradrenaline and dopamine n REM sleep compared to NREM sleep is characterized by marked decreases of noradrenalin

Experimental Work (a sample) n Default network regions are more active prior to the presentation of remote associates problems that were subsequently solved by insight (Kuonios, 2006) and when creative stories are generated from lists of unrelated words (Howard-Jones, 2005) n Reductions in beta power (15 -25 Hz) predict transformative insightful solutions (Sheth, 2008) n REM vs quiet rest or NREM improves creativity by promoting the formation of new associations (Cai, 2009)

Remote Associates Test n Elephant-Lapse-Vivid ü Memory n Bass-Complex-Sleep ü Music n Desert-Ice-Spell ü Dry n Base-Show-Dance ü Ball n Inch-Deal-Peg ü Square n Soap-Shoe-Tissue ü Box n Blood-Music- Cheese ü Blue n Skunk-Kings-Boiled ü Cabbage

The primary process …. . n Is an initial form of mentation (phylogenetically and n n ontogenetically) Is a preliminary form of mentation Has no fixed relationship to current external reality Relies significantly on right hemisphere activity Is predominant during childhood, intensified during free association, dominant in sleep, regressed to in psychopathology and altered states of consciousness and indispensible for creative thought

Sea Squirt Larva

Sea Squirt Adult

Rodolfo Llinas The Nature of Movement n William James: the brain is a complex input-output system driven by the momentary demands of the environment. n Graham Brown: movement is generated intrinsically in the absence of sensory input. n Locomotion is produced in the spinal cord by autonomous neural networks which activate muscles of the limb on one side while inhibiting them in the opposite limb. n Sensory information is modulatory

Rodolfo Llinas Thinking as Internalized Movement and its Consequences n “Brains are a prerequisite for purposeful, guided movement which is possible only if you have an internal reckoning, a transient sensorimotor image of what maybe outside” n Prediction is the ultimate function of the brain. n In order to predict the CNS must perform a rapid comparison of sensory referred properties of the external world (context) with a separate sensorimotor internally generated representation (content) of these properties. n The comparison of internally generated images with real time sensory information = perception

But if you generate waking state responsiveness (via intrinsic thalamo-cortical interactions) in the absence of appropriate sensory input hallucinations may be generated!!

This means…. n The brain has two components § Private, closed system…. subjectivity or content (the 40 - Hz thalamo-cortical continuing humming brain) provides significance to sensory input and creates a momentary functional disposition (attention) § Open system…. context (sensorimotor transformations in relations between the private system and the external world)

Therefore v The brain is a reality emulator not a translator. It generates a continuous mental movie of the external environment. “We are basically dreaming machines that construct virtual models of the real world” v Wakefulness is nothing other than a dreamlike state modulated by the constraints produced by specific sensory inputs

Conversely, dreams…. n …. are cognitive states that are not modulated by sensory information…. they are based totally on past experience. In dreams we are released from the tyranny of sensory input. We can create possible worlds. n are characterized by coherent 40 -Hz oscillations that are not reset by sensory input. They are not put into the context of “thalamo-cortical reality”. n from the standpoint of the thalamo-cortical system, are fundamentally equivalent to wakefulness except that the handling of sensory information and cortical inhibition is different in the two states.

Nothing about the primary process? n Premotor aspects of language: …”our ability to vocalize the different aspects of intentionality developed first as the ability to separate the properties of things from the things themselves. This process of abstraction would over time engender …a mental catalogue like an alphabet, that would allow us to generate inside our heads events that would be reentered admixtures of the primary events that went into the generation of language to begin with…. Before language was communicable its genesis must have had as a prerequisite foundation the nervous system’s capacity to generate the premotor imagery required to abstract the properties of things from the things themselves.

So that n We are able to imagine new things because we can perceive pieces of things or properties of the world. We can therefore imagine and then invent things that don’t exist. n Animal bones to television to satellites

Chapter 7 Neuro-psychoanalysis Chapter 6 Lessons Learned n Successful treatments (and relationships) enhance the ability to recognize discrepancies between memory, wish and perception and therefore create opportunities for new perceptions, new memories and new learning. n CAN A GROUP PROCESS PROMOTE THIS TOO? n ARE THERE TECHNIQUES TO ENCOURAGE THIS? ü ü Alter “wish system”. Encourage safe regression Offer novel stimuli Group naps?

Where Good Ideas Come From (Steven Johnson, 2010) v “Innovation thrives when ideas can serendipitously connect and recombine with other ideas” v Environments, networks, physical spaces and cultivated behaviors are needed that compulsively connect and remix information v Spaces are needed that “encompass both order and chaos, the presence of which allows ideas to emerge, collide, recombine and above all be broadly shared”

Gutenberg, Tarnier & Darwin

On Three Forms of Thinking (Thomas Ogden, 2010) n “…dream thinking is our most profound form of thinking. It involves viewing and processing experience from a multiplicity of vantage points simultaneously, including the perspective of primary and secondary process thinking; of the container and the contained; of the paranoid, schizoid, depressive , and autistic-contiguous positions; of the magic and the real; of the infantile self and the mature self…” n While dream thinking may be generated by an individual, there is always a point beyond which it requires two (or more ) people…