Grounding clinical and cognitive scientists in an interdisciplinary discussion

Re-enacting the Bodily Self on Stage: Embodied Cognition Meets Psychoanalysis

The embodied approach to cognition consists in a range of theoretical proposals sharing the idea that our concepts are constitutively shaped by the physical and social constraints of our body and environment. Still far from a mutually enriching interplay, in recent years embodied and psychoanalytic approaches are converging on similar constructs as the ones of intersubjectivity, bodily self, and affective quality of verbal communication. Some efforts to cope with the sentient subject were already present in classical cognitivism: having expunged desires and conflicts from the cognitive harmony, bodily emotions re-emerged but only as a noisy dynamic friction. In contrast, the new, neural, embodied cognitive science with its focus on bodily effects/affects has enabled a dialogue between neuro-cognitive perspectives and clinic-psychological ones, through shared conceptual frameworks. I will address crucial issues that should be faced on this reconciling path. With reference to two kinds of contemporary addictions - internet addiction disorder and eating disorders - I will introduce a possible therapeutic approach that is built upon the core role of the acting-sentient bodily self in a dynamic-social and affective environment. In Psychoanalytic Psychodrama, the spontaneous re-enactment of a past (socially and physically constrained) experience is actualized by means of the other, the Auxiliary Ego. This allows homeostatic and social-emotional affects, i.e., drives and instincts, to be re-experienced by the agent, the Protagonist, in a safe scenario. The director-psychoanalyst smoothly traces back this simulation to the motivated, and constrained, early proximal embodied interactions with significant others, and to the related instinctual conflicting aims. The psychoanalytic reframing of classical psychodrama does not merely exploit its original cathartic function, rather stands out for exploring the interpersonal constitution of the self, through an actual "re-somatization" of psychoanalytic therapy. Unspoken/unspeakable feelings pop up on stage: the strength of this treatment mainly rests on re-establishing the priority of the embodied Self over the narrative Self. By pointing out the possible conflicts between these two selves, this method can broaden the embodied cognition perspective. The psychodramatic approach will be briefly discussed in light of connectionist models, to finally address linguistic and methodological pivotal issues.

Management of stuttering using cognitive behavior therapy and mindfulness meditation

Stuttering is a speech fluency disorder with varied etiological explanations. It is important to identify symptoms early so that adequate and timely intervention can be delivered with focus on management and recovery. Stuttering, besides affecting speech fluency, might have a number of negative psychosocial consequences for the sufferer that may lead to immense anxiety, besides other symptoms. Therefore, it is thus imperative to include multiple dimensions in the holistic treatment of stuttering. Cognitive behavior therapy and mindfulness equip the client with the skills to manage the problems that occur as a result of stuttering. Since the rate of relapse in this condition is high, the chosen therapeutic paradigm must involve booster sessions over a long term. Periodic, detailed assessment would update the therapist about the barriers in treatment and would help in devising appropriate methods to get rid of these hindrances.

Embodied Cognition and the Direct Induction of Affect as a Compliment to Cognitive Behavioural Therapy

We make the case for the possible integration of affect experience induced via embodiment techniques with CBT for the treatment of emotional disorders in clinical settings. Theoretically we propose a possible integration of cognitive behavioural theory, neuroscience, embodied cognition and important processes of client change outcomes such as the therapeutic alliance to enhance client outcomes. We draw from evidence of bidirectional effects between embodiment modes of bottom-up (sensory-motor simulations giving rise to important basis of knowledge) and top-down (abstract mental representations of knowledge) processes such as CBT in psychotherapy. The paper first describes the dominance and success of CBT for the treatment of a wide range of clinical disorders. Some limitations of CBT, particularly for depression are also outlined. There is a growing body of evidence for the added value of experiential affect-focused interventions combined with CBT. Evidence for the embodied model of cognition and emotion is reviewed. Advantages of embodiment is highlighted as a complimentary process model to deepen the intensity and valence of affective experience. It is suggested that an integrated embodiment approach with CBT enhances outcomes across a wide range of emotional disorders. A description of our embodiment method integrated with CBT for inducing affective experience, emotional regulation, acceptance of unwanted emotions and emotional mastery is given. Finally, the paper highlights the importance of the therapeutic alliance as a critical component of the change process. The paper ends with a case study highlighting some clinical strategies that may aid the therapist to integrate embodiment techniques in CBT that can further explore in future research on affective experience in CBT for a wider range of clinical disorders.

The Task before Psychiatry Today Redux: STSPIR*

This paper outlines six important tasks for psychiatry today, which can be put in short as:

Spread and scale up services;

Talk;

Science,

Psychotherapy;

Integrate; and

Research excellence.

As an acronym, STSPIR.

Spread and scale up services: Spreading mental health services to uncovered areas, and increasing facilities in covered areas:

Mental disorders are leading cause of ill health but bottom of health agenda;

Patients face widespread discrimination, human rights violations and lack of facilities;

Need to stem the brain drain from developing countries;

At any given point, 10% of the adult population report having some mental or behavioural disorder;

In India, serious mental disorders affect nearly 80 million people, i.e. combined population of the northern top of India, including Punjab, Haryana, Jammu and Kashmir, Uttarakhand and Himachal Pradesh;

Combating imbalance between burden of demand and supply of efficient psychiatric services in all countries, especially in developing ones like India, is the first task before psychiatry today. If ever a greater role for activism were needed, this is the field;

The need is to scale up effective and cost-effective treatments and preventive interventions for mental disorders.

Talk: Speaking to a wider audience about positive contributions of psychiatry:

Being aware of, understanding, and countering, the massive anti-psychiatry propaganda online and elsewhere;

Giving a firm answer to anti-psychiatry even while understanding its transformation into mental health consumerism and opposition to reckless medicalisation;

Defining normality and abnormality;

Bringing about greater precision in diagnosis and care;

Motivating those helped by psychiatry to speak up;

Setting up informative websites and organising programmes to reduce stigma and spread mental health awareness;

Setting up regular columns in psychiatry journals around the globe, called ‘Patients Speak’, or something similar, wherein those who have been helped get a chance to voice their stories.

Science: Shrugging ambivalence and disagreement and searching for commonalities in psychiatric phenomena;

An idiographic orientation which stresses individuality cannot, and should not, preclude the nomothetic or norm laying thrust that is the crux of scientific progress.

The major contribution of science has been to recognize such commonalities so they can be researched, categorized and used for human welfare.

It is a mistake to stress individuality so much that commonalities are obliterated.

While the purpose and approach of psychiatry, as of all medicine, has to be humane and caring, therapeutic advancements and aetiologic understandings are going to result only from a scientific methodology.

Just caring is not enough, if you have not mastered the methods of care, which only science can supply.

Psychotherapy: Psychiatrists continuing to do psychotherapy:

Psychotherapy must be clearly defined, its parameters and methods firmly delineated, its proof of effectiveness convincingly demonstrated by evidence based and controlled trials;

Psychotherapy research suffers from neglect by the mainstream at present, because of the ascendancy of biological psychiatry;

It suffers resource constraints as major sponsors like pharma not interested;

Needs funding from some sincere researcher organisations and altruistic sponsors, as also professional societies and governments;

Psychotherapy research will have to provide enough irrefutable evidence that it works, with replicable studies that prove it across geographical areas;

It will not do for psychiatrists to hand over psychotherapy to clinical psychologists and others.

Integrate approaches: Welcoming biological breakthroughs, while supplying psychosocial insights:

Experimental breakthroughs, both in aetiology and therapeutics, will come mainly from biology, but the insights and leads can hopefully come from many other fields, especially the psychosocial and philosophical;

The biological and the psychological are not exclusive but complementary approaches;

Both integration and reductionism are valid. Integration is necessary as an attitude, reductionism is necessary as an approach. Both the biological and the psychosocial must co-exist in the individual psychiatrist, as much as the branch itself.

Research excellence: Promoting genuine research alone, and working towards an Indian Nobel Laureate in psychiatry by 2020:

To stop promoting poor quality research and researchers, and to stop encouraging sycophants and ladder climbers. To pick up and hone genuine research talent from among faculty and students;

Developing consistent quality environs in departments and having Heads of Units who recognize, hone and nurture talent. And who never give in to pessimism and cynicism;

Stop being satisfied with the money, power and prestige that comes by wheeling-dealing, groupism and politicking;

Infinite vistas of opportunity wait in the wings to unfold and offer opportunities for unravelling the mysteries of the ‘mind’ to the earnest seeker. Provided he is ready to seek the valuable. Provided he stops holding on to the artificial and the superfluous.