On Saturday October 30th 2004, Brian Koehler will present a paper, “The Schizophrenias: Neuropsychoanalytic Perspectives,” to the Psychoanalysis and Psychosis Study Group sponsored by the Independent Track of the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis and the New York Chapter of ISPS-US. The meeting will be held at the New York University Postdoctoral office, 1 Washington Place (corner of Broadway), conference room from 4:30-6:30pm .
The terms used to describe mental illness, e.g. ‘chemical imbalance,’ ‘neurobiological brain disorder,’ etc., are empty signifiers if one does not accept the Cartesian split between brain and mind (including socio-cultural factors). Neither is mental illness the result solely of genes. As Harvard geneticist, Richard Lewontin pointed out: life emerges only from the interaction between genes and environment (and as psychoanalyst Peter Fonagy suggested, the environment as subjectively experienced and perceived by the individual). There are no genetic factors which can be studied separately from environment, nor are there environmental factors independent of the genome. There are classic examples of epigenetic, non-genomic inheritance, in which environmental experience of the mother, e.g., maternal effects on the development of defensive responses to threat, is transmitted to offspring in a manner not dependent on information encoded in the nuclear gene.
The following is an attempt, closely tied to research and clinical experience, to arrive at what I would understand as a less reductionistic model of the schizophrenic disorders. It is grounded in research in the following domains of scientific inquiry: neurogenetics; neurobiology; developmental psychobiology; affective and cognitive neuroscience; neuroplasticity; epidemiology; attachment theory; phenomenology; and most importantly, psychoanalytic and psychotherapeutic experience with many individuals with a diagnosis of schizophrenia.
This systems neuropsychoanalytic model of the schizophrenias holds as untenable the artificial separation of neurogenetics and neural events from the autonomous and social selves of the experiencing individual as well as her/his socio-cultural contexts. Hyman and Nestler (1993) pointed out that it is an error to separate brain from mind and the social surround. These authors privilege a molecular approach to psychiatric neuroscience. However, as pointed out by Leon Eisenberg, the human brain is all biological and all social. Bolton and Hill (1996) noted that intentionality (beliefs, goal-directed plans, fears, etc.) pervades biological systems to the molecular level. They assumed that mental states characterized by intentionality could not be reduced to physico-chemical or neural processes without valuable information and meaning being lost in the process. Bolton and Hill criticized what is known as “biological psychiatry” for reducing biological processes to physics and chemistry, and departing from an intentional-causal analysis which is essential in psychology, psychoanalysis and biology.
Over the past 15 years, there has been a steadily growing dialogue between neuroscience research and contemporary psychoanalysis resulting in the emergence of novel approaches to the understanding and treatment of such clinical phenomena as the repetition compulsion and masochism, posttraumatic stress disorder, obsessive compulsive disorder, etc. In this paper, I address the schizophrenic disorders from a neuropsychoanalytic perspective. In particular, I will focus on two core aspects/symptomatology of the schizophrenias, i.e., auditory hallucinations and the delusion of external control. After presenting the most recent neuroscience research findings on these psychotic symptoms, I will attempt to demonstrate, using case material from my psychoanalytic practice, the relevance and helpfulness of psychoanalytic modes of understanding and therapy for persons with a diagnosis of schizophrenia. In addition, I will summarize the current neuroimaging research on the effects of psychotherapy on neural functioning. Slides will be utilized to illustrate fMRI and PET scan research findings.
New York University