Psychoanalysis as a "normal" science

Recent developments in alexithymia theory and research

OBJECTIVE

To review recent developments in alexithymia theory and research that are relevant to the field of psychosomatic medicine.

METHOD

Articles were selected from the alexithymia literature published over the past decade that describe advances in the theoretical understanding of alexithymia or report empirical investigations of the relationships of the construct with emotion regulation and with somatic illness and disease. Empirical investigations of the neural correlates of alexithymia were reviewed also, as were studies that explore therapeutic attempts to modify alexithymic characteristics.

RESULTS

The salient features of the alexithymia construct are now thought to reflect deficits in the cognitive processing and regulation of emotions. This is supported by studies showing that alexithymia is associated with maladaptive styles of emotion regulation, low emotional intelligence, a bidirectional interhemispheric transfer deficit, and reduced rapid eye movement (REM) density (number of eye movements divided by number of REM periods). Although empirical evidence demonstrates that alexithymia is associated with several somatic disorders, more prospective studies are required to establish the direction of causality. Preliminary data suggest that psychotherapies involving specific techniques to enhance emotional awareness and integrate symbolic and subsymbolic elements of emotion schemas may be effective in reducing alexithymic characteristics.

CONCLUSION

Alexithymia is proving to be a heuristically useful construct for exploring the role of personality and emotions in the pathogenesis of certain somatic illnesses and diseases.

A century after Freud's project: is a rapprochement between psychoanalysis and neurobiology at hand?

In his 1895 "Project for a Scientific Psychology" Freud attempted to construct a model of the human mind in terms of its underlying neurobiological mechanisms. In this endeavor "to furnish a psychology which shall be a natural science," Freud introduced the concepts that to this day serve as the theoretical foundation and scaffolding of psychoanalysis. As a result, however, of his ensuing disavowal of the Project, these speculations about the fundamental mechanisms that regulate affect, motivation, attention, and consciousness were relegated to the shadowy realm of "metapsychology." Nonetheless, Freud subsequently predicted that at some future date "we shall have to find a contact point with biology." It is argued that recent advances in the interdisciplinary study of emotion show that the central role played by regulatory structures and functions represents such a contact point, and that the time is right for a rapprochement between psychoanalysis and neuroscience. Current knowledge of the psychobiological mechanisms by which the right hemisphere processes social and emotional information at levels beneath conscious awareness, and by which the orbital prefrontal areas regulate affect, motivation, and bodily state, allows for a deeper understanding of the "psychic structure" described by psychoanalytic metapsychology. The dynamic properties and ontogenetic characteristics of this neurobiological system have important implications for both theoretical and clinical psychoanalysis.