From Modern Psychoanalysis, Vol. XX, No. 2, 1995 (P. 207 – 212)
A theory is presented that incorporates psychoanalysis as a treatment for disturbances that find manifestation on the level of the body. The actual physiology of the mind/body and body/mind connections are discussed, as well as the biochemical effect of putting all of one’s thoughts and feelings into work.
You can try an interesting little experiment. Ask your friends to point on their bodies to the place where they think their “I” exists. You will see that most will point to the center of their heads. This is an understandable response. Most of us experience our authentic me, or the essence of our self, as having to do with our thoughts and feelings, and we think of them as residing in our psyche or our mind, or our head, home to our mind. If you pose the same question to someone who is steeped in eastern philosophy, you are more likely to find that they point to the area of their stomach, or gut – the solar plexis – which is conceptualized in eastern philosophy as the center of the body.
This little experiment suggests that different cultures define differently the center of one’s being, and that the pervasive thought in our own culture is that the “I” in us has more to do with our minds than our bodies. Given this predilection, it is not surprising that when psychoanalysis was imported into this country, it was imported as a treatment for the mind. The body, as an entity that could be pertinent to this innovative treatment, was only nodded at in passing. The passing glance was, of course, the role of the mind in effecting psychosomatic diseases, diseases which originated in the mind, but found representation in the body. Franz Alexander and Flanders Dunbar were early psychoanalysists, who had interest in the various ways that mind could affect body.
Twenty years ago, as modern psychoanalysis began to be disseminated as a theory and treatment technique based on Freud’s understanding of drives, it was natural that we would focus on the role of aggression in psychosomatic disorders. Spotnitz (1985) had discovered that aggression could be turned against the psychic self in the disease of schizophrenia; it was a natural extension of thought to then hypothesize that aggression turned against the body self could, similarly, result in diseases of the body. Indeed, experimental research confirmed that hypothesis, as the personality profiles of cancer patients and heart disease patients were documented. The suppression of felt aggression, in the case of cancer (Bahnson & Bahnson, 1964), and the excess of felt aggression as well as an inappropriate discharge of aggression, in the case of heart disease (Friedman and Roseman, 1974), were found to be leading variables in the contraction of these diseases.
Technological advances in the last twenty years have given us the ability to make wide extensions and elaborations of these early thoughts. We have the ability today to actually “see” into the brain, and thus document a map of the mind, home to our thoughts and feelings. What this research tells us is that when we, as psychoanalysts, instruct our patients to “say everything,” we are not only talking to the ego, nor just to the unconscious, nor any other representation of the psyche or the mind; we are talking, as well, to the body – the actually biology – of the patient.
Modern research has confirmed that every thought and every feeling has electrochemical representation. The Positron Emission Tomography (PET) is the technological advance that literally gives us a window into the brain, allowing us to take color pictures of electrochemical events generated in the brain by particular thoughts and feelings. For example fear only lights up in a certain part of the brain with a certain color. Happy is a different color, in a different part of the brain. We can “see” anger’ we can “see” the feeling of calmness; we can “see” sexual excitation. (In fact, we can even create sexual excitation by electrically stimulating the pleasure center in the brain, a technique that was begun on rats, but perfected on human schizophrenics in the 1960’s by Dr. Robert Heath at Tulane University Medical Center, New Orleans).
Equally remarkable to the advances allowed us by the PET, we also now know what chemicals are associated with some of our emotions. The chemicals that are particularly interesting to us are the hormones because it is these that are the chemicals of feelings. Any change in feeling is concomitant with a changes in hormone release or inhibition. (In short, emotions are where it’s at.) The hormonal system of the body, like all the systems in the human organism, has a natural homeostatic mechanism. When sufficient hormones have been secreted to meet the needs of the body, the hypothalamus noted there is an under-secretion of hormones, the inhibition is deactivated, and the appropriate glands once again begin pouring out their hormones.
In studying the chemistry of anger, it has been determined that the hormones associated with anger are epinephrine and norepinephrine (also known as adrenalin and non-adrenalin). A surprising finding, however, was that the emotion of anger and the emotion of fear are biochemically identical. In the hormonal system, anger and fear produce essentially the same reactions – an outpouring of epinephrine. The finding is interesting in light of Freud’s postulate that fear (an emotion) is a defense against aggression (a primary drive). In psycho-physiologic terms, the defense against the drive and the drive itself represent the same biochemical picture.
What makes the dance of our biochemistry and our emotions downright cosmic is much more complex than the early psychosomaticists posited. It is not just that mind effects body; it is, as well, that mind and body are so intertwined on the level of hormones that the direction of effect is dual: mind effects body, and body effects mind. It is only, in fact, linguistically that there is a separation at all.
For instance, the Type A personality, the heart disease patient, is someone who tends to get agitated, is quick to explosive anger and doesn’t consciously experience much fear. The type C personality, the cancer patient, is someone who suppresses anger and, on the conscious level, feels a great deal of fear. Here is where the intersection of mind and body occur in these two disease states: norepinephrine is the chemical of anger. Too much norepinephrine will cause temper outbursts, and temper outbursts will produce a lot of norepinephrine. It is not mere coincidence that an excess of norepinephrine damages coronary vessels. If we feel too much anger, we will produce too much norepinephrine (and vice versa), and we will damage our bodies in a way that makes us more prone to heart disease. Similarly, cortisol is the chemical that suppresses anger. Too much cortisol will cause suppression of anger. Because anger is a defense against fear, the suppression of anger can result in the conscious experience of fear. Too much suppression of anger and too much felt fear produces a lot of cortisol. Not so coincidentally, it turns out that cortisol is a chemical that binds to immune cells and suppresses them, thus rendering the whole immune system less effective. Cancer is, of course, a disease in which the immune system has become sufficiently deactivated that is no longer recognizes the pathogenic cancer cell as a foreign invader.
It is clear that as modern psychoanalysts, we are treating a mind/body entity. The reason why early psychoanalysts instructed their patients to say everything arose out of the idea that people need to have all their thoughts and feeling for psychic balance. We now know that our patients need to have all of their thoughts and feelings to that their chemicals and hormones are appropriately released and inhibited to effect biochemical (physical) balance, as well. If there is too much of one feeling, and not enough of another, then chemical and emotional imbalance will lead to disease states, manifested on either the physical or psychological level. The keen psychoanalyst will, of course, note which emotions a patient has difficulty having, and resolve the resistances to the conscious experience of that feeling. With that resolution comes a biochemical rebalancing.
The basic concept that a change in thoughts and feelings induces change in body chemistry has been experimentally verified in studies on meditation (Green, 1970). The subjects of the experiment merely changed their thought patterns. Researchers found a change in oxygen consumption. There was a decrease in carbon dioxide exhalation and a higher efficiency of oxygen carried to the cells.
Modern psychoanalysis is unique in its ability to speak to both mind and body simultaneously using a strictly verbal medium as the vehicle of treatment. Drug therapy is an attempt to regulate emotional states through intervention on the biological level. Prozac, for instance, increases serotonin, a neurotransmitter associated with the feeling of calmness. Drugs are the standard treatment for diseases that have manifestations specifically in the body. They have the disadvantages of having toxic biological side-effects. One commonly used drug for heart disease induces a high risk of cancer. Most cancer drugs cause secondary cancers, including the often used Tamoxifin which works directly on the hormonal system. Drugs used to make direct changes in the feelings of the patient, as well as causing bodily degeneration, have the further disadvantage of making the patient drug-dependent for the change. Electrical convulsive shock makes an intervention directly to the electrical currents of the brain which in turn release chemicals. ECS has the disadvantage of creating memory loss, since ingrained neural networks are disrupted. Supportive psychotherapy intervenes on the level of psyche, but it attempts to create only a narrow range of feeling (the positive ones, like love and optimism), which, in turn, create only a narrow range of chemicals and hormones. Modern psychoanalysis intervenes on the level of the patient’s psyche to stimulate all thoughts and feelings, broad, effecting both psychic and biochemical balance. As well, psychoanalysis has the advantages of having no toxic biological side-effects, has the power to make permanent change in the chemistry of the patient, and enhances memory, rather than creating memory loss.
Psychoanalysis was used originally for the treatment of nervous disorders. Freud, however, was prescient in that he predicted that the science of psychology would move in the direction of the science of biology. Psychotherapists and psychoanalysts have, in recent years, explained the application of a psychological approach to bodily dysfunctions with some success. One American study of cancer patients (Spiegel et al., 1989) showed that the experimental group who had group psychotherapy, lived longer than the control group of patients who did not have psychotherapy. This was an important finding, made even more significant because the researchers were studying pain tolerance as an effect from group psychotherapy, and the increase in life-span was entirely unexpected. Several German studies have reach the same finding with cancer patients (Grossarth-Maticek, 1982). Equally surprising to the medical community, Ornish (1993) has shown that heart disease can be entirely reversed. He combines the use of diet with group psychotherapy. Individual clinicians, too, have reported a host of cases of regression of bodily disturbances as a result of psychotherapy and psychoanalysis.
Psychoanalysts don’t attempt to directly change the structure of psyche. Rather, we are interested only in freeing the patient’s ability to think and feel and talk (resistance analysis), and it is this freedom which creates change. Left and right hemispheres of the brain become balanced’ old and new portions of the brain are activated appropriately; chemicals and hormones are released or inhibited responsively to the particular circumstances’ electrical currents are neither too strong nor too weak. The successfully analyzed person dies of old age after living a rich, balance and fulfilling life.