Impaired Mind-Body Connections in Psychosomatic Patients: A Contemporary Neuropsychodynamic Model

Incorporating Brain Explanations in Psychoanalysis: Tennessee Williams as a Case Study

Despite Tennessee Williams's genius as a playwright who could represent his inner emotional struggles in his art, psychoanalysis was unable to free him from the powerful "blue devils" within him. Williams's inability to engage with psychoanalysis presents an opportunity to discuss ways that contemporary thinking about brain structure and function might guide our understanding and treatment of patients such as Williams. One of the core defensive behaviors that made analysis difficult for Williams was his avoidance of painful emotions through compulsive writing, sex, alcohol, and drug-addictive behaviors. These pre-mentalized reactions became Williams's habitual procedural body response, which occurs below the level of the self-reflective brain. Within a relatively traditional ego psychological frame, Lawrence Kubie, Williams's analyst in 1957, attempted to prohibit the compulsive behaviors to be able to process the underlying painful affects in the analysis. However, given that this level of mind and brain functions was Williams's chief means of regulation, Williams could not engage in the psychoanalytic process and left the treatment after one year. I propose that Williams was operating in brain circuits below the level of "higher" reflection or interpretation-receptive circuits and therefore he was unable to make use of a traditional ego psychological model. A review of these brain circuits seeks to encourage therapists to utilize simplified brain explanations for patients, which can destigmatize the pathologic behaviors and enhance engagement in the treatment process.

Increased Alexithymia But No Profound Emotion Processing Disorder in Burnout Syndrome

Our objectives were to investigate alexithymia in burnout patients while controlling for depression and anxiety, as well as to evaluate whether alexithymia may be part of a profound emotional processing disorder or of a mentalization deficit. Alexithymia, depressive, and anxious feelings were compared in patients with burnout, depression, and healthy controls using an age-, sex-, and education-matched cross-sectional design (n = 60). A facial emotion recognition task and an emotional mentalizing performance test as well as physical and emotional violation experiences were conducted. Alexithymia was significantly increased in burnout patients, mediated by negative affect in this group. No impairment of facial emotion recognition or mental attribution could be shown. Burnout patients demonstrated slightly increased emotional abuse experiences in early childhood. The present results corroborate the supposition that alexithymia in burnout primarily depends on affect and may rise due to current strain and overload experience, rather than based on a profound developmental disorder in emotion processing.