Psychoanalysis and the Mind–Body Relation: Psychosomatic Perspectives

"Symptoms associated with environmental factors" (SAEF) - Towards a paradigm shift regarding "idiopathic environmental intolerance" and related phenomena

Health conditions characterized by symptoms associated with chemical, physical and biological environmental factors unrelated to objectifiable pathophysiological mechanisms are often labelled by the general term "idiopathic environmental intolerances". More specific, exposure-related terms are also used, e.g. "multiple chemical sensitivities", "electromagnetic hypersensitivity" and "candidiasis hypersensitivity". The prevalence of the conditions varies from a few up to more than 50%, depending on definitions and populations. Based on evolving knowledge within this field, we provide arguments for a paradigm shift from terms focusing on exposure and intolerance/(hyper-)sensitivity towards a term more in line with the perceptual elements that seem to underlie these phenomena. Symptoms caused by established pathophysiologic mechanisms should not be included, e.g. allergic or toxicological conditions, lactose intolerance or infections. We discuss different alternatives for a new term/concept and end up proposing an open and descriptive term, "symptoms associated with environmental factors" (SAEF), including a definition. "Symptoms associated with environmental factors" both is in line with the current knowledge and acknowledge the experiences of the afflicted persons. Thus, the proposed concept is likely to facilitate therapy and communication between health professionals and afflicted persons, and to provide a base for better understanding of such phenomena in healthcare, society and science.

New Methods in Exploring Old Topics: Case Studying Brittle Diabetes in the Family Context

BACKGROUND

In questing for a more refined quantitative research approach, we revisited vector autoregressive (VAR) modeling for the analysis of time series data in the context of the so far poorly explored concept of family dynamics surrounding instable diabetes type 1 (or brittle diabetes).

METHOD

We adopted a new approach to VAR analysis from econometrics referred to as the optimized multivariate lag selection process and applied it to a set of raw data previously analyzed through standard approaches.

RESULTS

We illustrated recurring psychosomatic circles of cause and effect relationships between emotional and somatic parameters surrounding glycemic control of the child's diabetes and the affective states of all family members.

CONCLUSION

The optimized multivariate lag selection process allowed for more specific, dynamic, and statistically reliable results (increasing R(2) tenfold in explaining glycemic variability), which were derived from a larger window of past explanatory variables (lags). Such highly quantitative versus historic more qualitative approaches to case study analysis of psychosomatics surrounding diabetes in adolescents were reflected critically.

A Review of the Construct of Demoralization

Demoralization has been the subject of discussion in relation to end-of-life care. It is characterized by hopelessness and helplessness due to a loss of purpose and meaning. The purpose of this review was to consolidate the conceptual understanding of demoralization and argue for its existence as a psychiatric syndrome. The history of the construct is explored, including the nature of existential distress and related psychological conditions that precipitate demoralization. Recent definitions of demoralization are described and differentiated from similar constructs. Future directions are highlighted, specifically in relation to the assessment, diagnosis, and treatment of demoralization in palliative care. Overall, demoralization is a clinically useful construct for those facing existential threat, guiding the clinician toward efforts to restore morale, meaning, and purpose.

The effects of mind-body training on stress reduction, positive affect, and plasma catecholamines

This study was designed to assess the association between stress, positive affect and catecholamine levels in meditation and control groups. The meditation group consisted of 67 subjects who regularly engaged in mind-body training of "Brain-Wave Vibration" and the control group consisted of 57 healthy subjects. Plasma catecholamine (norepinephrine (NE), epinephrine (E), and dopamine (DA)) levels were measured, and a modified form of the Stress Response Inventory (SRI-MF) and the Positive Affect and Negative Affect Scale (PANAS) were administered. The meditation group showed higher scores on positive affect (p=.019) and lower scores on stress (p<.001) compared with the control group. Plasma DA levels were also higher in the meditation (p=.031) than in the control group. The control group demonstrated a negative correlation between stress and positive affects (r=-.408, p=.002), whereas this correlation was not observed in the meditation group. The control group showed positive correlations between somatization and NE/E (r=.267, p=.045) and DA/E (r=.271, p=.042) ratios, whereas these correlations did not emerge in the meditation group. In conclusion, these results suggest that meditation as mind-body training is associated with lower stress, higher positive affect and higher plasma DA levels when comparing the meditation group with the control group. Thus, mind-body training may influence stress, positive affect and the sympathetic nervous system including DA activity.

An accumulation of negative life events and the construction of alexithymia: a longitudinal and clinical approach

We began the study with a theoretical comparison of the concepts of alexithymia and operative thought in terms of etiology as well as with a specific approach to comparing the concepts using the Rorschach Inkblot Method (Rorschach, 1921) with both Exner's (1986) Comprehensive System and the Parisian School (Chabert, 1983, 1987; Rausch de Traubenburg, 2000) methods of coding and interpretation. We then present a longitudinal clinical study of a woman suffering perinatal depression starting at 8 months gestation until 34 months postpartum. The case shows how an accumulation of stressful and traumatic life events in the early perinatal period generates a reactive, structured alexithymia. This psychic process transforms an initial acceptance of therapy into a refusal to engage in a therapeutic alliance along with persistent depressive symptoms, impaired quality of life, and maladaptive coping strategies.

The question of drive vs. motive in psychoanalysis: a modest proposal

This essay explores the possibility of an alternative hypothesis to the prevailing psychoanalytic instinctual drive theory whose theoretical and clinical validity has been variously critiqued and challenged. Arguments are suggested in support of the concept of motive as a viable alternative theory to the drive theory and as a replacement for the traditional instinctual drive model. Issues discussed include the understanding of the mind-body relation, the meaning of psychic determinism and overdetermination, the opposition of drive vs. motive (and the related distinction of cause vs. motive), the meaning of psychic energy, and the difference between the concept of drives as the source of all mental energy and the concept of personal agency. The discussion concludes with some observations on the clinical implications of these concepts.

Mind-brain and consciousness in psychoanalysis

Understanding how the brain produces conscious mentation is vital to the prospective integration of psychoanalytic and neuroscientific study of the mind-brain relation. This essay explores some of the current opinions, based on recent neuroscientific research, regarding origins of consciousness in the brain. Areas explored include levels of consciousness, waking versus dream consciousness, and issues of consciousness and self-organization in split-brain studies. Some tentative suggestions are made regarding clinical implications of this perspective.

Self and time

This article explores the meaning of subjective time and its implications for the understanding of the nature of the self in psychoanalytic terms. Subjective time, the time experience of intrapsychic life, is distinguished from objective time. Its development and evolution in the course of the life cycle are examined, and various aspects of its phenomenology explored. Implications for the understanding of the structure and functioning of the self, especially the combined influence of physiological and environmental processes reflecting the integration of body-mind in the time experience and self-organization are discussed. Some implications for the engagement of the self in the analytic process are suggested, particularly the focusing of therapeutic interaction in the present moment and the implications of the meaning of structural change in reference to the modification of the self-concept through the revision and integration of memory systems in the present interaction between analyst and analysand.