In the sections dedicated to the theory of evolution, we have mostly discussed the interaction that constructs itself between behavior and environment. Lamarck had also foreseen, in his syllabus for biology, a study of the interaction between behavior and the internal environment of the organism. This second portion of Lamarck’s project is what I now want to address. It is a pivotal theme for body and somatic psychotherapists, because it describes how the interaction influences not only the psyche but also other regulators of the organism.
To fully understand psychophysiology requires the study of physiology and biology. Even if he has not undertaken such studies, a psychotherapist—especially if he works with the body and the soma—cannot avoid being interested in what is known in these domains. The mixture of a psychological clinical model and physiological models is nonetheless problematic for several reasons:
As Philippe Rochat repeats tirelessly in his presentations and writings:1 even an academic psychologist is unable to find his way in the unbelievably complex mazes in the area of psychophysiological research. There is nothing scientific in wanting to act “as if” one understands. It is more honest and often more rewarding if you are a psychologist to defend a psychological model that corresponds to a practice, a familiar know-how, and to articulate its theory without using data from other fields. The clinician can then present his model to experts in psychophysiology, who may not only find some relationships with what they are doing, but will perhaps be inspired by some aspect of the clinical model. However much psychophysiological models may inspire you, they must not be utilized as a scientific guarantee, but as a source of inspiration that allows you to take up your clinical observations and reformulate your models without using the physiological models that caught your attention to validate your point of view. A psychological model only has value if it is based on the observations and notions of psychologists and psychotherapists.
Being both a psychologist and a psychotherapist, I do not have the education that would allow me to summarize the status of the research in contemporary psychophysiology. In the sections that follow, I highlight psychophysiological models that are often discussed by body psychotherapists and must be known to understand the literature in this domain. These models have been selected, a bit haphazardly, by psychotherapists who often ignored a large part of the literature and who do not always have enough knowledge in psychophysiology to know the implications of their choice of model. This is also true for a number of psychiatrists who have a sound initial foundation in psychophysiology and have sometimes conducted fine research as students (like Freud), but who ended up focusing on a particular clinical dimension in which they were interested. Having said that, these accidental choices are useful, as they allow us to perceive what sort of psychophysiology is compatible to what body psychotherapists imagine when they develop a form of intervention. If scientific rigor is not always present in the choice of physiological theories adopted by psychotherapists, the choice is at least pertinent as a metaphor of what is conceptualized in a practice, just as Plato’s fables are often more relevant than they appear at first glance. Research is in effect not only an attempt to understand but also a stimulus of humanity’s imagination that can conceive of realities it could not previously picture.2 In the Middle Ages, no one could have imagined, even in dreams, the images that we now have of the galaxies and cellular life.
The following sections allow today’s starting psychotherapists to acquire a minimum of basic concepts they may then have to shore up by taking courses designed to introduce them to recent refinements. I hope the notions I discuss will help and encourage everyone to more easily consult recent textbooks in psychophysiology.
One of the implications of Lamarck’s theory is that there probably exists in all of the species common mechanisms susceptible to reconstruction in function of their organismic, social, and geographic context.3 Today, the most obvious example of such modifications is the mutations of the genes. In the nineteenth and beginning of the twentieth century, the common mechanisms between the species was the metabolic functioning of the aqueous milieu contained in each organism and the homeostatic mechanisms, which coordinate the requirements of the internal environment and the exigencies of the social and geographic environment.
Two themes developed by the French physiologist Claude Bernard4 (1813–1878) are still discussed in the literature:
This second theme will permit us to situate the notion of the auto-regulation of the organism. This notion had been taken up by those body psychotherapists6 for whom one of the functions of body psychotherapy is to facilitate an organism’s capacity to self-regulate constructively.
In his evolutionary physiology, Lamarck demonstrates that organisms are, before anything else, membranes containing fluids. A way to describe the evolution of anatomy and physiology is to show how the regulatory mechanisms of the fluids evolved.7 The development of the organs relate to a differentiation of the body fluids (venous and arterial blood, lymph, urine, saliva, sweat, tears, etc.). When the nervous system finally appears, it participates not only in the regulation of the fluids but also in the interaction between body movements and body fluids. Thus, the muscular activity that animates a gesture is structured by the nervous system but must also have a pertinent logistic support from the cardiovascular system.
Little by little the idea that the internal environment was nothing other than a part of the ocean that our distant ancestors had taken with them when they passed from an aquatic to an aerial life established itself within me; but that which needed to be revived above all else was the cell. (Laborit, 1989, La Vie Antérieure, 7.3, p. 102; translated by Marcel Duclos)
Claude Bernard has called the water contained in living organism the “internal environment.” A large percentage of the weight of each organism is made up of fluids in which the cells can live and communicate with each other. These fluids have a certain number of particularities that make it possible to distinguish between biological water and the water from a brook. To be able to sustain the ongoing activity of the cells, these fluids must maintain the stability of a number of properties, such as temperature (between 36°C and 37°C in humans) and a neutral hydrogen potential (or pH8). This fluid must be able to nourish the cells and evacuate their waste, and furnish enough free ions (+ and -) to guarantee various forms of exchanges between the cells and the milieu that surrounds them. These exchanges are at the basis of metabolic activity. The maintenance of the properties of the internal environment is the first and main task of a living organism. Claude Bernard found convincing ways of demonstrating that cellular activity can be entirely described and explained by physical and chemical conditions.9 He is one of the scientists who actively sought to exclude vitalism10 from mainstream biology.
The properties of the internal environment cannot stray from their central values without endangering the survival of the organism. It is mostly the warmblooded species that can sustain changes in the ambient climate, for they have the physiological means to maintain a constant internal temperature in conditions that sometimes vary considerably. Yet even humans have difficulty handling changes of more than 60°F in ambient temperature.
In an amoeba, the fluids are hardly differentiated. Their dynamics regulate the solidification of the membranes in the constriction phase, and the softening of the membranes that allows various forms of mobility. This mechanism is a first kind of passage between a form of protection against aggression and displacement as a predator. The amoeba can modify the consistency of its tissues by oscillating between several states:11
1a. Hardening. The quantity of fluids contained in the organism diminishes and the tissues harden. Perhaps here we have the first version of what will become the chronic tension of the muscles, which leads to the restriction of mobility, respiration, and the pleasure in moving.
1b. Hardening is often associated to a disengagement from peripheral activity.
For many physicians, like Wilhelm Reich, some of these functions are found in the more differentiated functioning of the human vegetative system:12
In the same period, the ethologist Konrad Lorenz proposed a complementary analysis concerning the relationship between the mobility of unicellular organisms and human motricity.13 The pulsation of the amoeba is the basis of the construction of the affects of withdrawal (the 3 Fs: flight, fear, and freeze) and attack. Fight and flight are just two of the many behaviors associated with aggression, anxiety, and fear. If I base myself on the current observations of body psychotherapists who work with anxious individuals, we can distinguish two types of fear:14
Another behavior associated with danger that is often observed in a psychotherapy practice is an abrupt immobilization.15 This reaction is used by some herbivores on the savanna when they can no longer escape a big cat. They become immobile and hold their breath to trick the predator into believing they are dead. If the predator is distracted, the zebra can suddenly stand, run, and escape. In humans, we sometimes observe some variations of this reaction, which would be a variation on the theme under way in the evolution of the species by the amoebic contraction.
This attempt to have everything start from the mechanisms of the amoeba is sometimes useful,16 but a bit too simplistic for the clinician:
This discussion indicates how Bernard’s approach made it possible to coordinate apparently purely physiological mechanisms with global behavioral dynamics that mobilize the organism almost in its entirety.
Walter B. Cannon (1871–1945) completed his medical studies at Harvard University, where he then became a physician, a researcher, and a professor.17 The first body psychotherapists hardly ever quote him,18 but they often propose for mulations that were manifestly influenced, at least indirectly, by his theories. Most of Cannon’s models were taught in the biology classes of secondary schools. In other words, for many, Cannon = Physiology.19 His model of homeostasis is the first medical model that describes the capacity of the organism to auto-regulate. It also became a reference for European psychologists of the 1930s.20
At the end of World War I, Cannon was a military physician in France. In Paris, he discovered the work of Claude Bernard and his idea that every organism has, at its disposal, strategies to regulate its internal environment in a changing environment. Cannon then undertook research on the strategies that permit an organism to regulate the internal environment. He refers to these regulatory systems as homeostasis.21
The concept of homeostasis is a precursor of the systemic and cybernetic theories. Like Lamarck and Bernard, Cannon situates the mind in the mechanisms created to enhance the regulatory systems of the internal environment of the organism. This approach does not prohibit other functions from having grafted themselves to the regulatory mechanisms of the internal environment. This point of view is compatible with Darwin’s hypothesis on the emotions, which, like parasites, latch on to the regulatory systems that were not originally conceived for them. Cannon mentions, for example, the observation of Bernard quoted by Darwin:22 that there exists a spontaneous link between certain emotional expressions and cardiac activity. Having demonstrated, in detailed fashion for certain mechanisms, that the affects are associated to diverse physiological mechanisms, Cannon concluded that the mechanisms of internal homeostatic regulation are composed of physiological, mental, and behavioral mechanisms. Other researchers, like Wilhelm Reich (1940) and Henri Laborit (1971), studied how these mechanisms insert themselves into social and political strategies.
I went from the idea that an oyster can only make an oyster shell; a snail, a snail shell; and that a city is nothing other than a shell constructed by a living organism: a human society. (Laborit, 1989, La vie antérieure, 10.1, p. 187; translated by Marcel Duclos)
In humans, the mechanisms of homeostatic regulation often function in association with the mechanisms of relational and social regulation. The regulation of an infant’s temperature cannot be maintained without the help of the parents.23 In a land as cold as Scandinavia, parents would not be able to help their children maintain an adequate temperature if they did not have the proper clothing, housing, and heating systems. It is therefore possible to think that the homeostatic systems of socialized species, like ants and humans, are carried out in social dynamics.
The homeostatic mechanisms of humans only function if they receive a constant social support. Physicians allow themselves to have social requirements (in the matter of hygiene, of nutrition, etc.), which go far beyond the care dispensed to particular organisms. The interpenetration of all of these mechanisms is of an unheard-of complexity that Cannon could not study with the limited means of a laboratory. He contented himself to study the homeostatic mechanisms situated in an organism, that is, the mechanisms that coordinate behavior and the demands of the internal environment. He analyzes, for example, what motivates an organism to seek out the shade, sweat, and drink when the temperature of the ambient air increases. Like most of the authors I have already mentioned, Cannon situates the affects in the center of what coordinates behavior and physiology. The affects would be one of the tools that permit the organism to coordinate mind, behavior, and physiological needs.
Taking up the language of the System of the Dimensions of the Organism (SDO) that serves as the reference point for this textbook, the affects are propensities organized by the mechanisms of organismic regulation to coordinate the dimensions of the organism in function of a goal structured by one of the dimensions. There are several types of affects.
The homeostatic instincts form at least two types of propensities:24
The instinctive affects have as their first goal the mobilization of the power25 of the organism for a task linked to survival.
Other types of affect, well known to psychiatrists, are the moods, like depression and euphoric mania. Some practitioners have a tendency to place depression and anxiety on the same plane. They consequently use the word mood to designate these two affects. Psychiatric and psychotherapeutic practice often compares and contrasts depression and anxiety on an axis different than the contrast between depressive and manic states.26 For Andre Haynal,27 for example, depression is often the regret for a past that never existed, and anxiety, the fear of a future that will not come about. This formula was often useful to me in my practice.
In psychiatry, the term mood designates all the affective systems that can be easily influenced by medications because their organization depends largely on the physiological mechanisms that are structured around the vegetative, cerebral, and hormonal mechanisms. The positive moods are those that participate in the constructive regulations for the integrity of the organism; the negative moods are linked to the regulations that accelerate the deterioration of the organism. This usage rejoins the meaning the term has when someone says they woke up in a good or bad mood.
Like depression, a mood can be triggered by a specific event; the length of time during which it lasts is greater than the status of a simple response or reaction to a stimulus. A mood often presents a cyclical face, independent of circumstances, that makes one think of a genetic factor. The formula that prevails, since Freud, is that of a genetic predisposition that can be modulated by events. A predominant mood in a patient is often found markedly28 in the family history. In psychotherapy, by default, I propose that the patient learn to live with his moods rather than desire to master the moods.29 The disappearance of a significant tendency toward cyclical depression or anxiety is rare, although it can sometimes be observed. The reason for the stability of these moods becomes apparent as soon as we admit that there is a link between mood and particular forms of homeostatic auto-regulation which engenders a lifestyle and a style of communication. Therefore, to reduce the rhythm and the intensity of the mood swings requires taking into account the coordination between a lifestyle, a way to behave and think, and the modulation of the mechanisms of homeostatic regulation. Sometimes, changes on all these levels are necessary; sometimes a well-localized change modifies the entire system. The prognosis is better when the patient lives in a supportive environment.
All the passing moods have a constructive value for the organism, if we admit that they are a type of homeostatic regulation (anxiety before an exam can be useful) to a situation whose contours are relatively clear. As soon as a mood becomes habitual, it associates with a multitude of regulatory mechanisms of the organism. If this mood inserts itself in a person’s character, it ends up becoming a permanent form of regulation for the organism. By associating itself so profoundly with a particular mood, it makes them less available to other moods. The organism therefore loses its flexibility and diminishes its capacity to adapt.
I take the case of the depressive affect in a person who suffers from obesity30 to detail the deep-rooted nature of a mood in the physiological dynamics of an organism. To do so, I detail a part of the connections between depression and the consumption of carbohydrates:
As we can see in these examples, the link between carbohydrates, serotonin, insulin, depression, and obesity is almost unsolvable without a profound change in the social functioning that participates in the formation of the eating habits. This explains the failure of most of the interventions related to obesity. In the elements I have summarized, we can see that each variable has a series of implications and branch lines that can activate mobilizations with contradictory effects. As it happens, the rapport between a change of diet and depression can be caused (a) by the psychological difficulty to accept a change of habits, and (b) by lowering serotonin production. In this model, there are two distinct causal systems that reinforce a depressive mood.
As soon as a practitioner attends to the respiration of his patients, he notices that some people can be considered “oxygen anorexics.” When he asks his patients to breathe deeply, many feel “dizzy.” They need to reduce the volume of their respiration or reduce the increase of metabolic energy by moving, or by hyperventilating. The reeducation of the metabolism of respiration cannot be accomplished only in the context of psychotherapy, because such a change requires the regular practice of breathing exercises, as this is done in pranayama training, in the Pilates method, in sports, and so on. Thus certain forms of hyperactivity (constant chatter, the need to move incessantly, etc.) can be explained by a physiological incapacity to “digest” an increase of the metabolic activity.
The following is a way to explain “anorexic” respiration, that is presently taught in several body psychotherapy schools (e.g., in Bioenergetics analysis):
I have observed this vicious circle, for example, in patients whose parents needed to be protected from the intensity of their children’s needs.36 Other persons act before having the need to (eat as soon as they are aware of the slightest hunger, masturbate as soon as there is the slightest sexual desire, etc.). In this group, we often find individuals who have little tolerance for frustration and who act impulsively. They prefer many small frustrations to intense ones.
As we can see in these examples, metabolism is a dimension the psychotherapist has not learned to understand in a detailed manner, but which could be useful to him to keep in mind. Reducing the intake of oxygen reduces the metabolic activity and consequently the energetic charge that all the dimensions of the organism need to have available to them. The relationship between the dimensions and metabolism is evidently cybernetic: the influence is asymmetrical (not of the same type) but reciprocal. Thus, the metabolic activity depends on breathing and eating behaviors. The available energy can then be dispensed in many ways: by moving, by thinking, by storing lipids, and so on. This domain is what the biochemists often call “bioenergy.”37 In my point of view, it is mostly these chemical dynamics that make it possible to give an account of the whole of the energetic dynamics of an organism.
In the domain of body psychotherapy, Alexander Lowen proposed the term bioenergy to designate what Wilhelm Reich called the orgone. Charles Kelley followed a similar reasoning when he called Reich’s38 cosmic energy “radix” (root). The use of a scientific term to designate a notion considered unscientific in academia did reveal itself to be lucrative in terms of clients, but it reinforced the rupture that developed between academia and Reichian therapies. Even Reich would probably have objected to a procedure that is manifestly a mystification. To justify this approach, the neo-Reichians discredited the chemistry of the chemists as an inanimate mechanic; on the other hand, their Reichian energy was presented as being full of the vitality that generates the universe. Yet an inverse argument could be directed at these Reichians who reduce the chemical dynamics to something foolishly mechanical. They know so little about chemistry that they fail to grasp the unbelievable creativity that is activated thanks to the chemical and atomic operations. Enhancing the value of theories like that of the orgone often covers up ignorance of the chemical dynamics and their creativity, all the while wanting to give the impression of being omniscient.
The first observations of the vegetative or autonomic nervous system goes back to Claudius Galen of ancient Rome; but John Newport Langley (1899) is generally recognized39 as the first to have proposed a correct vision of the structure and the function of this system. Cannon uses the term autonomic, which prevailed in the Anglo-Saxon literature, whereas Reich follows the Germanic tradition in using the term vegetative:
Cannon’s research on the vegetative system tries to demonstrate that it is one of the central mechanisms of the homeostatic system. An increasing number of researchers indicate that the vegetative system is also associated to the emotions. Levensen (2003), for example, showed that it is possible to associate some emotions to some types of activation of the autonomic nervous system. He is able to associate the basic emotions, as distinguished by Ekman42 to distinct vegetative activities. Thus, happiness reduces the electric activity of the skin, and this activity is elevated when the emotion is negative (anger, fear, sadness, disgust), or the cardiac activity is particularly low when a person feels disgusted.
Cannon was the first to give as much weight to the chemical as well as to the neurological dimension of the vegetative system:
Therefore, there is not only a sympathetic and parasympathetic nervous system but also sympathetic and parasympathetic functions:
Certain organs, like the heart and the digestive system, are influenced by these two systems. Thus, the sympathetic system accelerates the cardiac rhythm and slows down the peristaltic activity of the digestive tract, while the parasympathetic system slows down the heart and accelerates the peristaltic activity. The more active the body, the greater the mobilization of the sympathetic system, which can be qualified as the vegetative support system of the action. The less active the body, the greater the mobilization of the parasympathetic system, which actively contributes to the state of relaxation and sleep.
In certain cases, the nerve and hormone pathways have the same effect on an organ.45 The vegetative regulations coordinate the moods and the overall condition of the organism. The vegetative coordination is mostly nonconscious but sensitive to the impact of the central nervous system (especially on the striated muscles). This explains why individuals can influence these systems by indirect modalities (breathing exercises, relaxation, yoga exercises, etc.). The vegetative system is part of the mechanisms of organismic regulation. It is consequently used in most of the interactions between the dimensions of the psyche and the body.
Recent research shows that vegetative dynamics are more complex than what Cannon’s generation of physiologists thought. For example, there is more chemical vegetative activity than what was previously assumed by Cannon and Reich.46
In the subsequent sections, I illustrate Cannon’s general understanding by quoting more recent works. They show how the affective and vegetative systems insert themselves into both the fundamental physiological functioning, like the peristaltic activity, and the activity of the central nervous system.
ANXIETY INHIBITS THE PERISTALTIC ACTIVITY
At the end of the nineteenth century, while he was still a student, Cannon worked with X-rays, which had recently been made operational, to explore the physiological functioning of the digestive system. He accidentally discovered that an emotional disturbance blocks the motor activity of the stomach, and the return to a more serene state promptly restores the peristaltic movements of the digestive tract.47 This research confirmed the observations that a general practitioner, William Beaumont, had made on one of his patients.48 Edmund Jacob-son, who had been a student of Cannon, undertook research in psychophysiology in Chicago, and he established that anxiety influences not only the stomach but also the motility of the duodenum, the esophagus, and the colon.49
Between the two world wars, most physicians and psychologists thought that the emotions influenced the behavior of the digestive tract.50 Like the rest of Cannon’s work, this theme disappeared from serious discussions during the 1960s without being invalidated.51 It was considered trivial and without influence on the evolution of psychosomatic practice and theory. Trygve Braatoy,52 for example, mentions as if it were self-evident that the releasing of the stretching reflexes and of yawning, as well as peristaltic gurgling, are an evident sign of relaxation that often accompanies—in a spontaneous way—a postural and muscular release.
THE PSYCHOPERISTALISM OF GERDA BOYESEN
In the 1960s, going against the general trend, Gerda Boyesen, a Norwegian clinical psychologist and physical therapist, developed forms of intervention in body psychotherapy that were based on listening to the peristaltic sounds of the sigmoid colon53 with a stethoscope. The basic principle is that any intervention that returns movement to the peristaltic activity is pertinent to the restoration of the organism’s systems of physiological auto-regulation. This work is founded on the hypothesis that the peristaltic process can be activated by digestion or mechanisms linked to the release of stress. In the case where the mobility of the digestive tract is associated to affective dynamics, Boyesen speaks of psychoper-istalism.54
Currently, psychotherapists who practice this method use electric stethoscopes with loud speakers to detect rapid changes in the motility of the colon:
The event associated with the change of peristaltic activity can be a gesture, a mental association of the patient, a smile of the therapist, a particular way to massage, a change of light in the room, and so on. The therapist and the patient therefore inquire together about what happened at the crucial moment and give a particular importance to these events. The method used for this inquiry is free association. Having said that, it is impossible to know with certainty what event is really associated to each change of peristaltic activity. The relevance of a series of thoughts, conceived at a particular moment, can be confirmed by its impact on the therapeutic process, or if its association with a peristaltic change repeats itself. This method is useful to distinguish two types of utterances:
One of Gerda Boyesen’s hypotheses is that any topic accompanied by a return of peristaltic activity is susceptible to being integrated by the patient, whereas any subject that provokes a slowing down of the peristaltic activity can be indigestible for the patient’s psyche. In any case, Boyesen recommends to her students that they consider this method only as a tool whose relevance depends on the context of the therapeutic process. We are in a world where a bodily event can have many causes. The peristaltic motility is, above all, regulated by the sympathetic (reduction in the activity of the intestines) and parasympathetic (increase in the noises), each of which have multiple functions. Anxiety keeps an organism in a sympathetic state even during a relaxation exercise.
An example that demonstrates the danger of thinking that there is a direct link between relaxation, the parasympathetic system, and gastric motility is the observation that during some states of relaxation, peristaltic noises often cease. We can then evoke a number of hypotheses:
When such questions arise, the therapist needs to use other forms of inquiry before he can find the correct interpretation. This approach is useful in that it helps the therapist narrow the range of questions that are relevant at a particular moment in the therapeutic process.
THE “SECOND BRAIN” ACCORDING TO GERSHON
Michael D. Gershon’s book (1998), titled The Second Brain, announces a new approach relative to the rapport between the intestines and the brain. He demonstrates that the enteric nervous system, situated around and in the digestive tract, is an immense mass of nerves that function parallel to the brain. Traditionally, this system is considered as the part of the vegetative nervous system which is the most autonomic part with regard to the central nervous system. This immense mass of nerves also supports the production of many neurotransmitters made in the intestines. Notably, three-fourths of the serotonin available in a human organism is produced in the intestines. This substance is used in most of the antidepressant medications. The synthesis of serotonin may depend on the quantity of carbohydrates contained in food.
Gershon’s model55 on the connection between depression and the gastrointestinal system is an example of multiple and indirect links between the psyche and soma. The nerve connections that link the intestinal system and the spinal column are rare, and none of these connections has a direct access to the central nervous system.
This area of research has not verified the link between peristaltic noise and moods because it is probable that the link expresses a weak positive correlation, given the multiplicity of implied variables. For the practitioner who uses methods like those of Gerda Boyesen, this means that when the practitioner hears a definite effect, it is probable that Cannon’s model remains relevant. But as soon as we enter into an attempt to explain difficult clinical complexities, Cannon’s model becomes less pertinent. The studies on the intestinal system allow us to refine two ways to approach psychoperistaltism that clinicians had identified with regard to the diverse forms of relaxation mentioned earlier:
It is altogether possible, from there, to take up a dialogue between the body psychotherapist and the researcher; but this dialogue will necessarily take some directions that the psychotherapists had not necessarily anticipated. The correlation is not, after all, between a behavior of the gastrointestinal system and a mental behavior but between a functioning of the digestive system and a functioning of the affective system. At first, the clinician works with a simple labeling system; as the research progresses, this strategy must often be replaced by one that is more complex.
The basic thesis defended in the subsequent sections is that the mechanisms which lead to stress are useful in situations that spontaneously occur in a natural setting; but that they lose their relevance in situations that have been recently produced by civilization. They can then become dangerous for the survival of the organism.
The survivors wanted to erase from their memory the ten million victims who died uselessly and to forget themselves and their tragically wasted and lost years. (Manes Sperber, 1976, “Malraux and Politics,” p. 201; translated by Marcel Duclos)
World War I was particularly traumatic for Europe for at least three reasons:58
The result of this situation was that a number of soldiers were profoundly and permanently traumatized. Their hospitalization mobilized the resources and research of countless physicians because no theoretical framework existed to understand the disastrous psychophysiological state in which these soldiers found themselves. The theories of stress I summarize in the following sections are based on attempts (often only partially beneficial) to support the soldiers traumatized by the war. The limits of these modes of intervention illustrate that it is not possible to heal all ills with a medical perspective. Other solutions, more political, are certainly necessary.
EROS AND THANATOS
Several military hospitals consulted the psychoanalysts who had built their reputation on the treatment of certain forms of trauma. Because the treatments they developed were useful in certain cases, more and more psychoanalytic psychiatrists were hired by hospitals, where they sometimes assumed important positions.59
Nonetheless, traumatized war veterans responded only moderately well to the psychoanalytic treatment. The psychoanalysts had particular difficulty understanding why certain horrible nightmares regularly invaded the soldiers mind after the war, when the organism was no longer under threat. Freud had grown weary of the incessant slaughter and the lies, of the politicians of the time. He (1915d) viewed humanity with an increasing bitterness. The only way he had to make sense about what was going on was to postulate the existence of a destructive instinct (Thanatos) aimed at self and others that was at least as powerful as the pursuit of pleasure (Eros).60
Freud’s first theory attempts to construct itself, like Wallace’s theory, around a single principle that is almost a “nonlaw.” Therefore, Freud proposed that the psyche structures itself around the pursuit of sexualized pleasure. He advanced in this direction, in spite of the severe critical opposition of psychiatrists like Carl Gustav Jung who were willing, if need be, to admit to a basic life force (élan vital) that was not necessarily sexual. It is difficult for someone who works with individuals who suffer from schizophrenia to admit that their problem reduces itself to a fear of sexuality. In analyzing the descriptions of the behaviors of those traumatized by war with his colleagues, Freud had to admit that the psyche cannot be explained by only one principle. He nevertheless had confidence in his analysis about the relationship between libido and neurosis. He therefore took up, in part, Jung’s argument; he postulated that the impulses of life are differentiated into survival forces through violence and survival forces through sexual pleasure. In these two cases, he notes an autoerotic component (masturbation and self-destruction) and a component directed toward the exterior (copulation and combat).61
THE ORGANISM ACCORDING TO GOLDSTEIN
Kurt Goldstein (1878–1965) was a German neurologist who is known for having studied the lesions that cause aphasia from a perspective influenced by Gestalt psychology (see the Glossary). This influence led him to demonstrate how a local lesion inscribes itself into the global dynamics of the brain and then of the entire organism. This position was original and courageous at a time when most neurologists associated psychological functions to specific areas of the brain. He had been trained by preeminent figures who defended the cerebral localization approach, like Carl Wernicke, who, with Paul Broca, discovered the areas of the brain linked to language.
Goldstein had participated in the medical care of German soldiers traumatized by World War I. He had noticed that it was impossible to find a precise organic locus to be treated by a specific medicine that could alleviate the suffering of these soldiers. Independently of Cannon, he was probably the first neurologist to propose a neurological model that situates the nervous system as a global subsystem in the organism.
Persecuted by the Nazis, he fled first to Amsterdam, where he wrote The Organism (1939). When he immigrated to the United States, this work was published with an introduction by psychologist Karl S. Lashley, who was renowned for his studies on the cortical basis of motor activities. The Organism is the first scientific book that explicitly associates the entity that is a human being to a holistic notion of the organism. Kurt Goldstein’s organism is as coherent as Spinoza’s systems. This vision created such a salutary contrast to the neurological literature of the day that it filled the intellectual world with enthusiasm. The work was read by an entire generation of body psychotherapists like Gerda Boyesen (2001, p. 33) and Malcolm Brown (2001) who called his school Organismic Psychotherapy in honor of Goldstein.62 He also had an important influence on neurology (Lashley, Luria, and more recently Edelman) and philosophy (Ludwig Binswanger, George Canguilhem, Ernst Cassirer, and Maurice Merleau-Ponty).
Kurt Goldstein63 details, in an explicit way, the methodological obstacles that make the analysis of the global organismic system difficult. He supposes that a living organ does not function the same way in its natural environment as it does in a laboratory.64 It is also probable that certain functions of the brain are not highlighted unless we can understand how the brain integrates itself into the organismic system. Forty years later, this methodological remark received the support of specialists in animal behavior. They had noticed that the observations of animals in captivity only partially resemble those of the animals living in their natural environment.65 Today, neurologists who use magnetic resonance imaging (MRI) confirm this analysis when they observe how a brain functions while a person performs a specific psychological task.66
In his studies of traumatized individuals, Goldstein distinguishes the feelings that are associated to an explicit cause from those that do not seem to have a cause. It is mostly the second type of affects which haunts the traumatized persons. Goldstein noticed that the individuals who do not succeed in relating their fears to an identified aggressor also often lose their sense of identity. Many psychotherapists follow this distinction when they distinguish between emotions with or without “an object.” For a great number of psychoanalysts, an emotion without an object, of necessity, has a repressed unconscious object. Today, certain psychotherapists who specialize in the disorders caused by trauma recommend, on the contrary, that the emotions without an associated cause be addressed at the start of therapy. I single out this discussion because it seems important to me to become particularly attentive as soon as a person speaks of affects without objects; however, the status of these affects remain a topic of research for which no satisfactory answers have yet been proposed. When a patient speaks to me of affects without objects, I know I must explore what is going on with him when he has this sort of experience.
FLIGHT AND FIGHT ACCORDING TO CANNON:
THE DANGER OF LOCAL SOLUTIONS THAT GLOBALIZE
A military physician for the U.S. Army during both world wars, Cannon developed other means of support for traumatized soldiers. One of the approaches he proposed (1915) to deal with the organismic dysfunctional state observed in traumatized persons, is to focus on the two basic reactions in the face of aggression: flight and fight. These two forms of reaction mobilize all the resources of the organism for a goal that is relatively clear. This mobilization only ceases once this instinctive reaction is inactivated.
To understand the nature of stress, Cannon takes up the Darwinian idea that certain pertinent adaptive mechanisms of the species can become dangerous for survival when they are inherited by another species. The mechanisms mobilized by traumatized humans would be based on the reactions of flight and fight elaborated by other mammals. This system of adaptation remains relevant for humans when they undergo a manifest aggression of short duration, as when a person is physically threatened by another at the occasion of an attempted robbery. The contour of the aggression is fuzzier during a war, or when one is being harassed by colleagues. In such cases it is difficult to know when the danger begins and ends and how to find a form of flight or fight that is relevant. Often, there is no precise predator, as the danger can come from several sources in unpredictable ways. These forms of aggression are generated by institutions. It is then difficult to know against which predator to direct a flight-or-fight response.67 When the reactions of flight or fight are mobilized to react against an aggression such as war, their activation is often automatic. They instantly mobilize all the resources of the organism. During a war, an individual attacks and is being attacked, but the aims are defined institutionally. A soldier may not only be afraid of enemies. He can also find it difficult to accept that he has to kill others. An individual who is being mobbed often does not know why he is being persecuted or who organizes the mobbing. He just feels disempowered. He cannot prevent the activation of a flight or attack response that automatically activates itself in his organism, even when it is counterproductive.
Once in place, the response mobilizes the affective and intellectual resources to react in a particular fashion. They are monopolized by the need to flee or attack. There is no energy to look for other options. To resolve this difficulty, researchers like Lazarus and Folkman (1984) propose methods that facilitate change in the cognitive behavior of traumatized persons to help them construct other forms of adjustment (coping skills) in the face of a real or imaginary danger. The traumatized person needs external help to cope with the flight-or-attack response that has been activated by their organism. Yet he is often too proud and too ashamed to look for help.
To understand the mobilization of a fight-or-flight response, Cannon focused on the association between the activity of the sympathetic nervous system and the increase in the rate of adrenaline in the blood. This hormone is secreted by the central part of the adrenal glands (the medulla) situated on the top of the kidneys. In a cat, the increase in the rate of adrenaline in the blood, set in motion by the sympathetic nervous system, brings about an increase in respiration, cardiac rhythm, and goose bumps. Adrenaline also creates increased irrigation of the muscles and the brain, enlarges the diameter of the pupils, and facilitates access to the energy resources such as sugar.
Since Cannon’s time, Levine and Frederick (1997) have described how, in the animal that survives an attack, this kind of mobilization is followed by vegetative reactions that permit the organism to recover its strength and energy. The animal trembles and evacuates everything that was accumulated at the occasion of the slowing down of the visceral and renal functioning. Going from a sympathetic functioning to a parasympathetic functioning is only possible once the predator is clearly absent. If the hunted animal is caught, he is killed and eaten. In that case, there is no need for a mechanism to shut down the stress reaction. This is a flaw that humans have inherited. In our case, when there is no clear ending to a stressful situation, the mobilization of stress can be activated until the stressed person dies.
THE GENERAL SYNDROME OF ADAPTATION
Hans Selye (1907–1982) was one of the researchers who pursued the work of Cannon on trauma during World War II.68 This Canadian of Austro-Hungarian origin introduced the term stress in 1946.
One of Selye’s basic hypotheses is that when a person must suddenly accommodate to a particularly shocking situation, he often finds a way to function that allows for survival by developing powerful modes of accommodation in very short time.69 But then something is blocked, and flexibility is lost. As I have often indicated, the organism needs time to structure itself. In traumatizing situations, a sudden reconstruction of certain modes of functioning can save the life of the organism, but then the organism has difficulty getting out of this state. Everything that happens after that is assimilated by the new mode of functioning. The organism thus loses its capacity to reaccommodate itself70 to an environment that no longer has a traumatizing dimension. The frozen accommodation does not include the entire organism but focuses only on some organismic systems.
Different than traumatic situations (such as being arrested and then tortured), stress designates more progressive changes. Selye (1936) then talks about the general adaptation syndrome. This syndrome is unleashed by an accommodation in three phases:
The Activation of the Organism by Stress. Selye isolated an axis of stress that is organized around a reciprocal influence between the hypothalamus in the brain and the median part of the suprarenal endocrine glands, situated at the upper extremity of the kidneys (see figure 8.1). The hypothalamus activates the suprarenal glands through the neurovegetative system. The suprarenal glands secrete catecholamines, like adrenaline and noradrenaline, into the blood. These hormones unleash a classic sympathetic mobilization. This process, shown in figure 8.1, forms a loop of negative retroaction where the excess of Cortisol activates the glucocorticoids receptors of the brain and suppresses the production of CRH. In depressed patients, however, this loop no longer functions, hence an excessive production of CDR and thus of Cortisol. This system is known as the hypothalamic-pituitary-adrenal (HPA) axis.
FIGURE 8.1. The axis of stress (or hypothalamic-pituitary-adrenal [HPA] axis). When someone suffers a stressful event, his rate of glucocorticoids in the blood increases. This brings about, via specific receptors situated in the hippocampus, an activation of the hypothalamus, which then secretes corticotrophin-releasing hormone (CRH). This hormone, in turn, activates the pituitary gland (or hypophysis) to produce ATHC (adrenocorticotropine), which circulates in the blood system and reaches the suprarenal glands, where they provoke the release of cortisol. Source: Retrieved on September 29, 2007, from a site dedicated to Henri Laborit: http://lecerveau.mcgill.ca/flash/a/a_08/a_08_m/a_08_m_dep/a_08_m_dep.html
The activity unleashed by the catecholamines allows all of the reactions produced by the axis of stress to draw from energetic resources of the body by metabolizing lipids and sugars. In activating the hypothalamus, this circuit makes it possible to draw more deeply from the organism’s reserves.
Other layers of the central nervous system, situated underneath the hypothalamus, can also activate the adrenal glands. These regions are situated in the medulla, the marrow, and some reflex pathways. A lack of adrenaline in the blood can also activate the adrenal glands via the mechanisms of homeostatic regulation. The hypothalamus can be influenced by other centers of the brains, especially those that govern perceptive and cognitive analysis or the emotions.
This phase of stress is considered to be constructive because it predisposes the organism to become creative. If a resting phase (a small cup of tea) ensues, the organism restores its forces.
The Stress Reaction. The stress reaction varies in intensity according to (a) the danger and (b) the way the stress is felt by the mechanisms that regulate the reaction. Richard S. Lazarus (1991) analyzed how certain mental reactions could activate or deactivate a stress. He sought to define the means with which to cope with stress. Selye thought that the axis of stress, once it was activated by a mechanism that is still not well understood, reacted in an undifferentiated manner. Since research has shown that the vegetative system is less “autonomous” than was believed, this statement has been marginalized.
THE ORGANIZATION OF THE DEFENSES AGAINST EXHAUSTION. If the Organism is repeatedly placed under stress, the axis of stress runs out of easily available resources. To continue to function, it sets about to draw from those resources that are more difficult to use and activates mechanisms that slow down the reactions of exhaustion. The organism sets itself up in a state of accommodation to the shock. The HPA axis is reinforced by an increase of chemical activity that doubles the activity of the sympathetic nervous system. The activation often begins with the hypothalamus, which recruits the help of the pituitary gland this time. The pituitary then secretes corticoliberin, which will produce a hormone called adrenocorticotrophic hormone (ACTH), also known as corticotropin. ACTH activates yet a greater number of the adrenals, which in turn, among others, will activate the corticoadrenal hormones, which are released by the paraventricular nucleus (PVN) of the hypothalamus. It then activates the adrenal gland, which will release hormones such as the glucocorticoids, like cortisol and cortisone. These hormones mobilize the reserves available in the form of carbohydrates and add “slow” sugars into the blood. They inhibit the antiallergic and antiinflammatory manifestations caused by the damage to the tissues during the stress reaction by diminishing the activity of the immune system (especially eosinophils).
At the moment when this system becomes established and can no longer be curbed, there will be permanent vasodilation in the organs necessary for a reaction of fight or flight and a permanent vasoconstriction in the organs dependent on the parasympathetic circuit. This vasoconstriction is in part noxious to the tissues that depend on it and impedes the disposal of the metabolic waste produced by the muscles in permanent tension:72
We were brought to consider the shock syndromes no longer as an exhaustion of the means of defense; but, to the contrary, as a consequence of their activation and of the persistence of their action in the case of the ineffectiveness of flight or fight. (Laborit, 1994, 2.2.2, p. 236; translated by Marcel Duclos)
THE EXHAUSTION REACTION. The large consumption of carbohydrates reduces the production of other substances that depend on it, like serotonin. As we have seen, a reduction of serotonin can produce depressive and suicidal tendencies. These tendencies sometimes are linked to bulimic crises which seek to compensate for the lack of production of substances like serotonin. Stress can manifest through two distinct mechanisms:
These two mechanisms are activated in parallel fashion. They mutually influence each other, but follow a different causal pathway. The feelings of disempowerment and depression that follow the exhaustion phase are thus accompanied by depressive affects like anger at oneself and one’s powerlessness. The organism has fewer and fewer resources. The waste products in the muscles are not eliminated, breathlessness sets in, the arteries and the heart function poorly.
An excess of Cortisol lowers the immune defenses, but it also attacks tissues of the central nervous system, which it saturates via the bloodstream. At the beginning, this effect is stimulating because it allows the ions of the nerve membranes to circulate more rapidly (it consists especially of the circulation of calcium in the membranes). Once this chemical reaction has been exploited, the neurons are in turn exhausted, and sometimes die, due especially to depolarization. Several studies describe a reduction in the volume of the hippocampus in persons who have lived through this form of sudden accommodation.73 The hippocampus, situated in the limbic system, is especially implied in the management of memory and spatial relations. The attack on this neurological structure causes uncontrollable psychological reactions of disorientation. The glucocorticoids also excite other regions of the brain. They modify the functioning of the frontal lobe, which can explain why persons under stress often make poor decisions. They also excite the amygdala, which increases the feeling of fear. The amygdala reinforces the activity of the pituitary while the hippocampus can inhibit it.74
Certain attacks to the hippocampus can be repaired by taking antidepressants, which is one of the reasons they are prescribed. This implies taking these medications during a prescribed time (at least a year) to restructure zones of the hippocampus that were destroyed by stress.75
Henri-Marie Laborit76 (1914–1995) was also influenced by the study of the shock that unsettles soldiers at war. He was a surgeon in the French navy during World War II and during the last French colonial wars (Indochina and Algeria). In the latter part of his life, he became a kind of Spinoza of biology who shows how each system actively influences the system that contains it. Laborit77 arrives at similar conclusions as Spinoza with regard to human beings when he shows that the mental system cannot be conscious of the nonconscious mechanisms by which it is regulated. One of his principal preoccupations seems to have been to find a way to understand how an individual, entangled in systems of regulations that go through many levels (atoms, cells, organisms, institutions, ecology), can actively and lucidly participate in what animates him. This theme gradually became a form of individual and social engagement.
Laborit’s research observes mechanisms that enrich the models of Bernard, Cannon, and Selye. He describes in greater detail how the regulatory mechanisms of the organism are like a bridge that links the cellular and social dynamics. Like a bridge, the homeostatic mechanisms are rooted in two shores. Thus, the food industry makes it possible for human organisms to feed themselves, but it uses this support to render individuals dependent on a system that exploits them. He describes in a detailed way the chain of mechanisms that connect cellular, organismic and social dynamics. This allows him to provide an enlarged panoramic view of the heterogeneity of the mechanisms involved in the homeostatic regulation of the human species.
THE INDIVIDUAL AND HIS SOCIAL ENVIRONMENT
Henri Laborit78 knew and admired Selye.79 For both of them, one could only alleviate the destruction of the cells by seeing to the equilibrium of the internal environment and by keeping its values as balanced as possible. His first model on the biology of stress is close to the one Selye was developing. They were using different but complementary research strategies to analyze how stress could destroy some of the organism’s tissues. Laborit’s first original contribution to that area of research was based on his observation that an amelioration of the ecology of the cells was only useful if the cell modified its behavior in function of this amelioration. Because of this finding, Laborit and his French colleagues focused on the “pumps” in the cell membrane that facilitate the exit and entry of substances. You will find detailed descriptions in textbooks on physiology that show how the cell membrane polarizes and depolarizes by passing ions from both side of the membrane:
When a cell depolarizes itself, the sodium, whose concentration outside of the cell is greater than in the interior of the cell, penetrates within. Conversely, the potassium, whose intracellular concentration is elevated, in the course of the depolarization, exits the cell toward the extracellular milieu. (Laborit, 1989, 7.3, p. 102; translated by Marcel Duclos)
This exchange requires that there is enough sodium and potassium in the internal environment of the organism. However, Laborit observes, in certain circumstances, the sodium and potassium pumps become inactive. The restoration of equilibrium in the internal environment does not suffice to restore the activity of the pumps.80 Therefore, Laborit sought to find those substances that would restore not only the internal environment but also the activity of cellular pumps. Here, the action is doubled:
Without this dual action, not only do the individual cells waste away but also their participation in the maintenance of the equilibrium of the internal environment becomes defective. A negative vicious circle is then established in which the disequilibrium of the internal environment renders the cells inactive, and the inactivity of the cells destabilizes its immediate environment. At the beginning, this disequilibrium is local; but if it persists, it can invade the organism. Indeed, the exchange of potassium and sodium between the internal environment and the cell adjusts the equilibrium of the substances in the organism’s internal environment. If some cells retain one of these, there is a possible disequilibrium in the internal environment that can create a lack of supply in other well-functioning cells. Moreover, the death of some cells can set toxic wastes like lactic acid in circulation in the internal environment of the organism. This can create a metabolic acidosis. It can also modify the equilibrium of the internal environment.81
Laborit goes from this model between the cell and its immediate milieu when he wants to show how the social environment of an individual and the activity of the individuals who are part of it can become synergistic or destructive. We have already seen that an individual under stress can no longer make sound decisions, and he wastes his metabolic resources. To treat this individual, his environment must also be restabilized, or he must be assisted in finding a more supportive environment. In “L’homme imaginant” (1970) (literally: “man while he imagines”), Laborit’s wording is close to the analysis of Stalin’s regime by Reich.82 Both think that a stressful environment can pollute its subsystems and the systems that contain them. It can go both ways. Thus human societies can pollute nature and the tissues of individual organisms, and this pollution is then maintained by these polluted subsystems. This idea is often developed in systems theory when it assumes that to repair a system one needs to coordinate top-down strategies (working on the globality of the system to repair local damage) with bottom-up strategies (working on a local mechanisms that can influence global dynamics).83
CYBERNETICS AND THE SYSTEM OF REGULATION
Systems thinking was defined when thinkers like Ludwig von Bertalanffy (1950, 1968a, 1968b) and Norbert Wiener (1948) created a rigorous model for the notions of system and of regulation. Laborit is one of those who introduced this way of thinking in France.
Ascending and Descending Causal Chains. In the example of the rapport between the membrane’s pump and the internal environment, there is a constant oscillation between the concentration of sodium around the cell and in the cell. These variations are due to three factors at least:84
The environment imposes some conditions on the organism; the organism has its own proper conditions for its existence. These two types of conditions create a vital dialogue between the metabolic demands and what the environment has to offer. Take the example of temperature. If the basal milieu of the human organism is not 36°C (98.6°F), the organism can die. The environment of the planet follows dynamics that do not take this exigency into account.
Temperature activates a “descending” causal chain that has influenced the mechanisms of evolution (only that which can live in an existing geographic system survives), and all of the organism’s levels of organization. This influence is going to be countered by a series of local “ascending” reactions, which regroup themselves to adapt, more or less effectively, to what the planet offers. This ascending chain was constructed, mostly phylogenetically, to protect the exigencies of the internal environment. We now know that these bottom/up demands can influence the planetary system.
Psyche and Organism in Biology. Laborit does not spend much time situating the psyche in his model because it is not a topic that he studied.85 However, he needs to situate psychological dynamics in his general system. He situates them in a particularly complex part of the organizational system of the organism. In the previous section, we have determined the necessity to coordinate two axes:
The psyche is situated somewhere at the intersection of these two axes. It participates in the mechanisms that coordinate the inside and outside of the global organism with the demands the ascending and descending chains impose on behavior.
To negotiate with the environment, the complex organisms create a social milieu as an intermediary between the organism and the environment presented by the planet. The more this social environment becomes complex, the more the propensities of the organism mobilize the dynamics of the psyche. Indeed, even before considering language, socialization requires that the members of the species have come to a certain agreement concerning what is perceived and on the correlation between a stimulus and behaviors. With ants, most of the individuals react to a stimulus just about the same way. A certain variation already exists because the conformity is different for each “caste” (worker, soldier, queen). It would seem that the development of the psyche allowed for the appearance of socialized species that attempt, with more or less success, to combine cohesion and diversity. The more the mind can intervene in a complex way into the regulation of the organism, the more the species is able to develop a capacity to combine cohesion and diversity. The need to develop a wide variety of individual particularities can be included in such a point of view.
The Servomechanisms of Stress. Laborit often takes the thermostat as a simple example of a servomechanism. The thermostat makes it possible for an operator to set a goal for a system. Thus, we use a thermostat to regulate the heating system in a building: to set a target temperature. Take the case of a consumer who regulates his thermostat so that an apartment is always at 20°C. The thermostat activates the heating system for as long as the temperature of the apartment is lower than the temperature set by the consumer, and it brings the activity of the heating system to a stop when the temperature of the space exceeds the set goal. For example, the thermostat is set to engage the heating system as soon as the temperature the apartment falls below 15°C and to shut it off as soon as the temperature in the apartment reaches 25°C. The temperature of the apartment therefore oscillates between those two points. This oscillating regulatory system is characteristic of biological functioning in which a static equilibrium is tantamount to death. Only the inanimate world can follow linear functioning.86 In his discussions with Selye, Laborit distinguished two dimensions:87
In an environment where the axis of stress is activated by a known predator and extinguished by its moving away, the servomechanism of the axis of stress generally functions quite well. We have seen that aggression in humans is often perpetuated by forces that are more difficult to define and localize in time and space. The servomechanism of the axis of stress is too primitive to adapt itself to the details of a situation like mobbing or a tyrannical political regime. For some people, the axis of stress is easily activated, whereas for others it more easily deactivates. Laborit, for example, studied postoperative shock. For certain people, it seems as if the servomechanism of the axis of stress does not detect that the surgery is over and successful. The organism continues to react as if it were still in the operating room.
Even if the mind participates in the dynamics that turn on and shut off the axis of stress, as Lazarus supposed, the connection is manifestly indirect. A relaxation method, psychotherapy, a tranquilizer—all can deactivate an active axis of stress, but none of these strategies work in every case. Laborit assumed that these interventions have an indirect effect. He therefore looked for the specific servomechanism that directly stops the stress reaction. He was convinced that it must be a specific chemical stimulus that can sometimes be activated by one of the interventions I have just mentioned. The relation between deactivation of stress and relaxation, for example, would then be indirect. When relaxation adequately activates the parasympathetic vegetative system, this system puts a certain amount of substances into the circulation of the blood; if the substance is detected by the servomechanism of the axis of stress, it will cut off the systems it controls.
At the time, the available knowledge allowed one to think that such a servomechanism could be situated in the pituitary gland. Laborit looked for a substance that could have such an effect on the pituitary gland. He then analyzed all the hormones produced by the pituitary gland, with the hope that there would be one that deactivates, in a targeted way, the axis of stress. His hunch led him to the discovery of what we today call the neuroleptics. These substances and their derivatives have become one of the principal forms of support that psychiatrists propose to their psychotic patients. This type of intervention permits one to think that one of the mechanisms that activates a psychosis has a particularly low threshold, which puts a more complex version of the axis of stress into play. By inhibiting the substances that activate the physiological dynamics of stress and psychosis, and by raising the values of the servomechanism that activates these states, medication can stop the vicious circle of extremely painful anxiety and hallucinations. This is what neuroleptics do, according to Laborit.
Better to Be a Lout than to Be Resigned. Henri Laborit88 uses a simple controlled experiment to show that in the case of stress, it is better to be aggressive and active than to be resigned. For this research, he uses a theoretical model that has the same structure as the one he used in his research on the necessity to maintain the cells active in a deregulated environment. The basic situation is composed of two rat cages linked by a door. The floor of the cages has a wire mesh on it so that one can pass an electric current through it. Rats receive an electric shock ten minutes a day, but the cages allow Laborit to vary the context in which this is done:
Situation 1. The floor tips when the rat changes cage. The rocking of the floor shuts off the electricity. Every time an electric current passes through the mesh on the floor, the rat feels pain. But the rat quickly discovers that in changing cage, the pain ceases. This is the situation of simple avoidance.
Situation 2. The situation is the same as the preceding one, but a light flickers four seconds before the electric current passes through the mesh on the floor. The rat thus changes cage as soon as he sees the light turn on. This time, there is active avoidance of a painful situation.
Situation 3. The door between the two cages is now closed. The rat can only undergo the pain of the electric shock. The situation is “hopeless.” At first, the rat moves in every direction; then slowly, something will inhibit his will to react, move, and feel. After having lived in this way for a week, the rat has lost weight. He acquires a stable hypertension, which then takes weeks to resolve. The amount of Cortisol in his blood is high. The mucous membranes of the intestines develop ulcers. This state of collapse, contraction, resignation is well known by body psychotherapists who speak of constriction and resignation. Reich,89 for example, describes the reaction of a newborn boy who, after circumcision, can no longer cry and scream, ends up contracting himself and becoming mute. Laborit explains that this pathological state (for the body and mind) can become permanent if the situation remains unbearable. A system of inhibition of action,90 similar to the axis of stress described by Selye, is established.
Situation 4. The situation is the same as the preceding one, except that at the end of a week, the door between the two cages is open. Even though he is now able to change situation, “he will not profit from it and will remain stuck in his inhibition” (Laborit, 1989, X.5, p. 207; translated by Marcel Duclos)
Situation 5. The situation is the same as the preceding one, except that in the electrified cage there are now two rats. In discovering that they cannot flee the pain caused by the electric shock, the will get up on their hind legs, which at least reduces the area of body surface in contact with the electrified floor. They will then fight, up on their hind legs, and attack one other with the upper part of their body. Indirectly, this reaction renders them a service. As each body serves as a support for the other, the rats are able to remain on their back legs much longer. A week later, their bodies are in relatively good shape, and the mechanisms of stress have not been established. This only works if the rats are about of equal strength. This is what often happens in the gang wars of adolescents who live in desperate social situations. In other words, an available aggression makes it possible for them avoid being shut up in a state of resignation.
These experiments suggest a series of measures one can take to help someone who suffers from being in a traumatizing context:
Several recent studies91 confirm that the more a person has an unfavorable position in the social hierarchy, the greater the probability that the axis of stress would be intensely activated. This has been observed in rats, monkeys, and humans. This phenomenon has become sufficiently common for it to become a medical symptom often identified in psychiatry as social anxiety disorder. This body of research demonstrates to what point interactive behaviors can sometimes have a deep impact on affective and metabolic dynamics.
The Methodological Limits of Stress Research. Recent technological developments allow us to gather a considerable amount of information on the functioning of an individual (neurological, metabolic, behavioral, psychiatric, sociological, etc.). However, the statistical methods presently available to organize this data do not allow us to manage as much information as is necessary to understand individuals without generating false results. By “false results,” I mean statistical tests that signal a strong correlation between several sets of data while the research method does not guarantee that this correlation is not due to chance. The crux of the matter is that statistical tests require a large number of subjects to test the impact of only a few variables. The more variables you have, the larger the required number of subjects. Today, technology allows us to gather huge amounts of data on each subject. On the other hand, the expensive machinery used by neurologists only allows them to observe small groups of subjects. Because they are nevertheless understandably eager to explore the information their electronic devices allow them to gather, they collect whatever data they can and then use classical statistics to analyze it. Because they are not always statistically wise, this procedure yields a large number of false results with apparently high statistical significance. There is therefore a lack of adaptation between the current statistical methods and the recent development of technology. The result is that many researchers are showing us that there is probably a great many situations that produce profound stress. We find the same problem with certain research that associates cancer with certain products. The only guarantee against this type of statistical effect is the replication of the experiment by different research groups. The more there is replication, the more the observed result of a particular research study becomes robust.
For example, take the excellent recent research conducted by Karin Roelofs and his team (2009) that observed an intense interaction between the following variables on groups of approximately twenty subjects:
The results indicate that there is probably a strong interaction between these variables. However, the preceding remarks make us cautious. All that we can say about studies of this type is that the researchers would like to show that there is an intimate link between all of the variables that they are able to measure: such is the present-day myth that is in vogue. The whole of body psychotherapy uses an analogous model when it reflects on the functioning of an individual and finds clinical reasons to justify its point of view. The practitioners of body psychotherapy consequently identify this type of research as a proof of the soundness of their point of view. But these research studies prove nothing at the moment. They add one more example that supports the myth of an intimate relationship between the dimensions of the organism and its environment. This example reinforces the body of clinical and experimental data that goes in this direction; but the statistical problems I have indicated do not provide a sufficient basis to allow us to speak of scientific proof. In other words, it is possible that there is actually a convergence between clinical and experimental data. For the moment, this convergence only has the status of an intellectual way of thinking that is relatively robust. I have not, for the time being, found research studies that invalidate this point of view.
The aim of this analysis is to render the psychotherapeutic practitioner attentive to the fact that the press is actually full of alarming articles showing that a particular food, a behavior, or a context considerably increases the probability that the axis of stress will be activated or cancer will develop. Most of these works are interesting but suffer from a lack of adequate replication to become anything more than an observation that presents a question. Above all, I hope this research will motivate mathematicians to develop statistical theories that will permit a more fruitful analysis of the immense pile of data that the new technologies have made possible.92 For the moment, there is such a considerable amount of data that reason often drowns in it all.
The “motivation systems” are networks of specialized nerve cells that have the capacity to synthesize and to release certain transmitters such as dopamine, endogenous opioids and oxytocin. These transmitters, if acting in common, may create a psychological state that we call motivation, vitality or creativity. Dopamine gives us the feeling of energy; the opioids provide that we feel fine while doing something and oxytocin motivates us to do something for or together with people we like. (Joachim Bauer, 2009, “The Brain Transforms Psychology into Biology,” p. 234)
The axis of stress has sometimes been used as a medical tool. In its simplified version it seems to have clear boundaries, forming a well-differentiated subsystem. This simplification was necessary to support the activity of the practitioners who are not researchers. In reality, the axis of stress is not as coherent as it might seem. It remains a good example of how an affective organization can mobilize all the dimensions of the organism for its own purpose. Thus, the dynamics of consciousness are recruited in such a way that they generate a profusion of pessimistic thoughts. When the organism needs to be motivated to run as fast as it can from danger, this may be a useful mood. When the danger persists, pessimism leads to depression. The stressed person believes that they are his thoughts and defends them. He thus defends the perpetuation of his stress. Yet when the stressed response has been deactivated, the person appreciates having another mood. This model can only be confirmed if there exists other affects that have a similar structure because it is rare that biological evolution sustains a mechanism that has only one function. It would be too costly for the organism. Since the 1960s, researchers have shown that the dynamics isolated around the notions of stress and trauma are also mobilized to construct affective systems that support constructive affects. Having discussed the axis of stress, I am now going to talk about the more recent research studies, and consequently less developed ones, on the vegetative management of positive affiliation.
In the 1950s, psychiatrist Seymour Levine (1960) began his research studies on stress using rats. He employed an experimental device common among the behaviorists, which had also inspired Laborit’s research. In a first series of experiments, he studied three types of rats.
This study was conceived to demonstrate that stress, when inflicted at the beginning of life, has a devastating effect on the development of the rats. Levine was surprised to observe that the group that grew up poorly and exhibited worrisome symptoms when they reached adulthood was the third group: the ones that did not receive daily electric shocks nor were placed in the cage for a time each day. The rats of the third group were noticeably less curious and less active.
Seymour Levine then analyzed more closely the growth and development of the rats who participated in situation 1 and 3 up to adulthood. He observed that the group placed under stress “change gears” more rapidly than the group that stayed in its nest. In this last group, the increase in steroids, in the case of stress, is slower; the activation of the organism is longer lasting and decreases more slowly. In other words, the onset of the axis of stress is less rapid, but once it has been activated it becomes more difficult to deactivate.
Levine and his team changed the focus of their research and started to explore the trauma that could follow from an absence of stress in infancy. The organism needs stimuli that oblige it to mobilize itself and to adjust to its environment. This is yet another example that shows the relevance of one of the themes of this book: propensities come about to structure themselves in function of its interactions with the environment. An environment that does not stress an organism does not allow it to develop adequately.93 Rosenzweig and his team (1972) confirmed this in their study of the neurological development of two groups of rats:
The rats in the second group, having reached adulthood, had a larger and heavier brain. The difference in the nerve mass is especially observable in the neocortex. Other research studies support and clarify this observation: “Rats raised in an enriched environment have larger, more complex brains than those raised without stimulation and challenge. Specifically, they have more neurons, synaptic connections, blood capillaries, and mitochondrial activity” (Cozolino, 2006, III.6, p. 82).
Levine, as does Rosenzweig, concludes that the fact of being hand-carried, being a center of attention, and changing environment suffices to explain the relative well-being of the rats in the first group. Kerstin Uvnäs-Moberg takes this a step further, showing that affection shapes as much as stress does, if not more. But to accommodate to stress is different than to accommodate to an affectionate environment. Uvnäs-Moberg shows that in the second case, another organismic system is activated: one complementary to the axis of stress. It is therefore probable that the two types of experience are stimulating. If one were to add Laborit’s research to this collection of research studies, one would notice that all forms of contact, affectionate or hostile, facilitate stress reduction. The goal of Uvnäs-Moberg’s research is to show the specific impact of a pleasant and affectionate contact.
When Kerstin Uvnäs-Moberg had her first child, she experienced a number of physical and mental changes in herself—changes that she observed in most of the mothers that she encountered. The changes induced by motherhood are well documented but were not explained. At that time, she was conducting studies on the physiology of the intestines.94 She decided to benefit from her research skill to study the psychophysiological causes of these changes.
She began her research with the endocrine factors most commonly associated with childbirth: oxytocin and prolactin. As for the axis of stress, the pituitary plays a central role in the regulation of these two hormones in the organism. The amount increases in function of various external stimulations, of which the most well-known is the one produced by a newborn who nurses at his mother’s breast:
During childbirth, oxytocin links itself to the parasympathetic system to create an inner atmosphere of calm, whereas vasopressin links itself to the sympathetic system to stimulate the circuits of fight or flight, which give the woman the necessary combativeness for the strain of childbirth. This observation is important because it attracts our attention to the fact that the sympathetic and parasympathetic systems can be active at the same time.
Having begun with these two hormones, Uvnäs-Moberg finally discovered a web of influences that include the dynamics of oxytocin and prolactin. As with Selye’s axis of stress, the ramifications of this system mobilize neurological, hormonal, affective, and behavioral circuits; except that, this time, the function of this axis is to support affection and amiability.95 During many years, she and her collaborators in Sweden tried to study the totality of this circuit. One of the reasons this research is interesting is that it is probably the first attempt to understand the entirety of an individual propensity in an integrated research project.
After the birth of an infant, oxytocin spontaneously proliferates in the organism of most mothers. The activation of oxytocin can be inhibited by certain factors. The following three are examples:
Artificial oxytocin (like misoprostol) is nonetheless sometimes necessary to facilitate the delivery of the placenta and prevent a hemorrhage after delivery. The natural oxytocin produced in the neuronal circuits plays an essential role in the attachment between the mammalian female and her newborn. Studies conducted on nonpregnant sheep have showed that an intraventricular (in the brain) injection of oxytocin allows for the artificial production of maternal reflexes. The administration of estrogen and progesterone, plus a vaginocervical (sexual) stimulation produces the same effect. On the other hand, this effect is canceled if the sheep is under an epidural anesthesia.96
Nursing mostly stimulates prolactin and the estrogens. Oxytocin facilitates the ejection of the milk by favoring the contraction of the mammary glands.
If a parent (mother or father) frequently carries the baby belly to belly, Uvnäs-Moberg notes an increase of the amount of oxytocin in the parent and a greater expression of affection toward the newborn. There is a marked difference in behavior relative to length of time and intensity of the contact: the parent spends more time with the infant while giving it thoughtful and attentive care.
When injected into certain parts of the mammalian brain, oxytocin activates a lessening of aggressiveness, an increase in sociability, a greater tolerance to pain, a lowering of arteriole pressure, an increase in appetite, and maternal behavior in women. These effects persist, on average, twice as long in females than in males. The effect of this calm is, first, individual. It easily spreads to other persons in the same group. Experience has showed that this transmission is carried out by olfactory pathways, in all likelihood by the pheromones that touch an archaic part of the olfactory system: the vomeronasal organ.97 These are hormones secreted to have an impact on other organisms, while the classic hormones are secreted to have an impact on the regulation of the organism that secretes them. In other words, there would again be a dual channel of communication:
There are certainly parallel actions here, situated at the behavioral and physiological level and coordinated by an organismic regulator that is activated by oxytocin. Kosfeld and colleagues (2005) set up an experiment that shows that a nasal injection of oxytocin administered to students of the University of Zurich suffices to increase their confidence. This research demonstrated the effect of oxytocin on social relations independently of a relationship with newborns.
Uvnäs-Moberg (1998) has showed that repeated injections of oxytocin lowers blood pressure and Cortisol secretion (produced especially by stress) and provokes weight gain. The beneficial effect of oxytocin establishes itself in the organism only after a series of injections, given regularly for many days. Uvnäs-Moberg (1998) concludes that this shows this effect is not directly induced by oxytocin but that oxytocin sets circuits in motion that gradually form a healing process in the organism. Thus, only after having injected rats for at least five days do we discern, ten days later, a lasting lowering of blood pressure. The effect is not the same for male and female rats. Weight gain, for example, is a characteristic of females taking oxytocin. These repeated injections disinhibit, in a lasting way, the influence of the axis of stress and arrests the excessive secretion of Cortisol.
A similar effect can be obtained by stroking the front of a person’s trunk for five minutes each day, for ten or so days, at a rate of forty caresses per minute. It consists of light strokes (but not to the point of becoming erotic) that go from the top of the thorax to the lower abdomen without going all the way to the genitals.98 This research confirms that a relatively permanent psychosomatic change requires the repeated and regular use of an exercise.
Children who received the kind of attention that activates oxytocin have a lesser chance of developing blood pressure problems as they grow older. Studies on this subject are under way and are worthy of close attention.
Although some circuits organize aspects of conscious awareness, most serve as the background “glue” of our experience, an interwoven network of sensory, motor and affective circuitry. (Louis Cozolino, 2006, The Neuroscience of Human Relationships, II.5, p. 73)
For the moment, I have mostly associated the affects to the vegetative system. In the axis of stress, brain circuits99 are components of a more general physiological circuit that also interacts with mind and behavior. Neurologists who work from such a point of view associate psychological function with circuits that can coordinate several parts of the brain. They are then recruited to fulfill particular functions. Other neurological theories have gathered evidence supporting the view that most psychological dynamics are produced by specific areas of the brain. In the second set of neurological approaches, it is assumed that a part of the brain controls physiological circuits such as those that I have described for the axis of stress. This point of view is close to the top-down notion that already existed when it was thought that the soul (or psyche) could organize somatic dynamics. The first approach is the most compatible with present-day theories of body psychotherapy, as it describes emotional circuits that coordinate physiology, mind, and behavior. However, we shall see (in chapter 9) that consciousness prefers to associate a specific mental dynamic to a specific organismic structure. As this attitude already exists in neurology, many body psychotherapists cannot prevent themselves from adopting neurological models that localize emotions in the limbic system, as proposed already by Lamarck.100 You will notice that I am talking here of a preference for neurological theories that are compatible with some phenomena observed in body psychotherapy and of the comfort of our conscious dynamics. Empirical research often follows a different route. I now describe particular research studies on the brain that illustrate this debate. I begin with Cannon’s thoughts on the matter.
Cannon approached the brain as a structure that can be recruited by homeostatic circuits. This implies that homeostasis and the affects act on what goes on in the brain and what goes on in the brain has an impact on the vegetative dynamics. This strategy allowed for the isolation of the mechanisms that are situated in the brain and have a close link to the affective dynamics. There were two pitfalls to avoid:
Canon, if I understand him correctly, wanted to show that the vegetative system and the brain each have a particular mode of functioning but that there are interfaces (like the pituitary gland) that allow them to communicate. He tried to define the boundaries and the functions of these interfaces and what they coordinate. To try to understand how all of this is organized, Cannon undertook research studies on the hypothalamus and the thalamus, which are situated in the limbic system.101
Cannon explored the emotional circuit with neurologists Gerard J. Britton and Philip Bard.102 They anesthetized the neocortex of cats to study their behavior when the neocortex is offline. They noticed that the cats without a functioning cortex entered into a huge rage that mobilized the entire body. These “sham rages” could be unleashed by almost any kind of stimuli. They no longer had a pertinent function. They had become a standard mode of response of the organism that inhibits other forms of possible responses. This body of research showed that an emotion is calibrated by several nervous structures. Cannon defended a theory of emotions that coordinates three types of mechanisms:
This model makes it possible to account for the impulsive aspect of the emotions and the rich complexity of the real-life experiences they create. The fact that the stimulation of the emotional activity is situated in the limbic system makes this phenomenon more archaic than the ones unleashed by the neocortex. However, the fact that it necessarily recruits the neocortex does make the emotional system more complex than a reflex. This kind of description often gives the impression of a precise function, while in fact the limbic circuits can contain zones that are linked to many affects in a small cerebral region. The thalamus is close to the amygdala; we can find pleasure centers in this region as well as anger and fear. The mix of affects is already complex within the limbic system. A person can experience a form of pleasure and fear when they are angry. This is independent of the systems of guilt or of sadistic fantasies that establish themselves with the introduction of social representations. In similar fashion, many people feel a mixture of pleasure and anxiety during coitus.
These studies are often mentioned by researchers who have attempted to confirm a simplified (or simplistic) version of Lamarck’s hypothesis, according to which the limbic system is the emotional brain and the neocortex is the rational brain.104 For them, the limbic system is the neurological center of the emotions. They have presented Cannon as a precursor, while criticizing his conclusions. Today, some neurologists are again getting closer to Cannon’s point of view. Thus, Damasio freely takes up the idea that an emotion is, first, activated in the limbic system. This initial activation must then pass through neocortical circuits to associate with representations and information on what happens outside of the organism. Then he clarifies that the coordination between an evoked affect, representations, and the circumstances necessitate a participation of certain zones of the frontal lobe of the neocortex. The frontal neocortex also makes it possible to relate an affect to forms of expressions and the management of emotions that are specific to a culture.105 This hypothesis remains prevalent: the limbic system and the brainstem activate standardized affective behaviors; the prefrontal cortex allows for the regulation of feelings and affective behaviors. This emotional system is regulated by a web of connections. The complexity of these connections varies from one neurological theory to another. There seems to be few direct routes between the front of the limbic system and the neocortex but, rather, many indirect routes. The theoretical variations seem to be based on how much importance these indirect routes have. Today, there seems to be an agreement that the affects are mostly activated by the centers of the limbic system, and are then regulated by the centers of the neocortex. This view is susceptible to change in the future.
Setting up a dichotomy between the limbic system (= emotions of the mammals) and the neocortex (= the development of intelligence in mammals and humans) became a way to reformulate in a neurological language a debate that opposes the reason of the soul to the diabolic and animal forces of the body. This confusion between metaphor and neurology attained its apex in popularity in 1949 when Antonio Caetano de Abreu Freire Egas Moniz received the Nobel Prize in Medicine for having developed the surgical method for a lobotomy.106 The procedure consisted of a perfunctory operation, often poorly controlled (the insertion of a scalpel via a nostril, sometimes performed by a nurse) to sever the region of the brain that links the front of the limbic system to the frontal lobes of the cortex. The basic model, proposed by Moniz, inspired by Lamarck, and then supported by MacLean’s reformulations, was that the connections between the limbic system and neocortex are rare and are regrouped in the frontal part of the brain. In cutting the connections between the limbic system and the frontal neocortex, Moniz hoped to prevent the limbic system from disorganizing the functioning of the frontal lobe and from having too easy access to the motor system. The lobotomy disorganized a large number of the dynamics of the brain in a nonspecific way, which explains the general dysfunctions that it provoked.
This polarization of the neurological dynamics of the mind is still a current position defended by some neurologists.107 This model is also used by psychiatrists like Bessel Van der Kolk to establish forms of psychophysical interventions that are used to help persons who suffer from post-traumatic stress disorder (PTSD). Thus, Van der Kolk (2006) mentions some observations that show that in the case of stress, an increase of limbic activity and a decrease of neocortical activity has been observed. This observation is certainly correct; however, there are a number of ways to understand it. The therapeutic approaches and techniques proposed by Van der Kolk and his team are respectful of patients, contrary to a lobotomy, but they do not always take into account the complexity of the mechanisms activated by the trauma. Van der Kolk has collaborated with a number of body psychotherapists to establish forms of intervention often useful at times of humanitarian crises.108
This simplistic vision (it dates from Lamarck!) is currently being reformulated by neurologists who propose a more refined version of Cannon’s model109 to show that several brain centers, several physiological mechanisms, and several mental mechanisms coordinate to form a real-life emotional experience. It is impossible for them to reduce such complex phenomena to a few zones of the brain or to a conflict between two zones. Nonetheless, these authors do not abandon Lamarck’s and MacLean’s model of the triune brain because it remains useful, especially for practitioners who only need a rough sketch of certain emotional mechanisms to support certain forms of intervention. Some neurologists110 are presently attempting to show that there exist a great number of nerve and chemical connections between the neocortex and the limbic system. Other researchers show that different emotions can be related to different parts of the neocortex. Thus, Ekman and Davidson (1993) show that different smiles can be associated with different forms of activation in the lateral and medial parts of the frontal lobe and the anterior temporal lobe. Davidson and his colleagues (2002) show that depression can be related to a circuit that passes especially through the amygdala and the hippocampus of the limbic system and the prefrontal region of the neocortex. Sanjay J. Mathew and his team (2004) have also associated anxiety with the activity of the prefrontal region of the neocortex. This analysis conforms to the idea that the prefrontal cortex coordinates information on how an organism autoregulates and how it interacts with its environment.111
The theory of cerebral localization has its point of departure from the observation that when a region of the brain is destroyed, a behavior ceases to exist. Even if no one denies this statement, there have been extensive debates on the ways to explain this observation. Traditionally, neurologists estimated that the region that correlates with the disappearance of a behavior is the site that controls this behavior. In the 1930s, several neurologists criticized this “linear” way of thinking. For example Kurt Goldstein (in Germany) found it more efficient to use a holistic systemic approach, and Alexander Luria (in the Soviet Union) found some advantages in being forced to justify his argumentations in a Marxist dialectical language. For them, observing that a mechanism necessarily passes through a zone of the brain does not mean that this zone of the brain organizes this mechanism.112 For example, the fact that a lesion in Broca’s area (often called the language area of the brain) creates language problems (like aphasia) does not mean that the organization of the ability to speak is situated in this area of the brain.
This critique of the theory of cerebral localization is again found in Cannon’s school. His student, Edmund Jacobson (1967)113 prefers to situate the material foundation of a behavior in the circuits that link several zones: circuits that are situated in the brain (central nervous system) and at the periphery of the body (peripheral nervous system). Even though Jacobson had not studied language, he could have thought that the physiological circuits that make it possible for language to exist pass not only through the regions of Broca and Wernicke but also through the peripheral nerves that allow for the fine motor coordination of the vocal cords. Jacobson was looking for neurological models that could help him explain the impact of relaxation techniques. Closer to Cannon than to Goldstein and Luria, he nevertheless used a systemic model that also criticized linear causal models. He summarized his views on the matter with the following metaphor:
Vignette on the metaphor of the central office that manages the exchange between telephones in a region. You pick up the phone, and dial a friend’s number. The central switchboard answers that it is broken, and consequently, it cannot connect you to your friend. In this example, there is a dysfunction in the switchboard (associated to a region of the brain) that prevents you from speaking to your friend (a behavior associated to a peripheral action of the organism). Are we able to deduce from this analysis that the switchboard decides when your friend picks up the telephone?
We know that thoughts are often activated by the dynamics of our organism, but this does not mean that a particular area of the brain is the only one responsible for what emerges in our consciousness. For Jacobson, the brain is mostly a translator, a transformer that coordinates the dimensions of the organism and knows how to translate a mental operation into an operation that another dimension can activate. Thus, the representation of a gesture is “translated” into sensorimotor instructions that make it possible to activate an appropriate gesture. According to Jacobson, a propensity is organized like an electric circuit. Any device that is connected to the circuit can influence the rest of the circuit or even blow the fuses. The fuse box is a central location with regard to the circuit because I can use it to disconnect the whole circuit. Thus, there are zones in a circuit that can activate it or disconnect it, but that does not mean that these zones control everything that is going on in the other parts of the circuit. These zones have a function close to the notion of a servomechanism used by Laborit. I now describe a few examples of nerve centers that are used as a servomechanism for an affective circuit.
While Selye and Laborit sought to find the chemical servomechanisms of stress, other researchers were looking to localize other servomechanisms situated in the brain. James Old (Montreal), Rudolf Hess (Zurich), and Jose Manual Rodriguez Delgado (United States) are among those. They were exploring ways of using the new technologies that facilitated the implantation of an electrode in a specific zone of the brain to see what would happen when that zone was stimulated. These researchers concentrated on the limbic system, which was then reputed to be the center of emotions.114
OLDS AND THE PLEASURE CIRCUIT
James Olds (1922–1976) completed his doctoral research in psychology with Peter Milner at McGill University in Montreal. Their professor, Donald Olding Hebb (1904–1985),115 asked them to see if they could find, outside of the thalamus and the hypothalamus, limbic zones associated to affective responses. They explored the zone situated around the thalamus, between the pituitary (the bottom of the limbic system) and the septum (the top of the limbic system). These two centers form an axis that passes vertically by the thalamus. By chance, Olds and his collaborators found a zone of the rhinencephalic structures, strongly associated to the sense of smell, that created a sensation of pleasure each time it was stimulated. It became possible to condition rats by activating this zone, as Pavlov and Skinner did by giving food as a reward. For example, Olds activated the electrode every time the rat walked in a corner of its cage. After a while, the rat visited that corner of the cage more and more frequently.
To deepen his understanding of this phenomenon, Olds connected the electrode to a lever that could be activated by the rat. The rat could freely press on this lever at any time. Most of the rats developed an addiction to this behavior. They pressed on the lever more than 500 times per hour. If the experimenter disconnected the electrode, after half an hour, the rat pressed on the lever for a moment and then fell asleep, exhausted. If the experimenter did not disconnect the electrode, the rat ignored his basic needs (hunger and thirst) and pressed on the lever up to 2,000 times per hour for 24 hours. Some rats pressed on the lever until they died.
The same technique was used to help patients who were seriously troubled (schizophrenia, epilepsy). The behaviorist point of view regarding these treatments was to be able to teach patients to execute certain tasks with pleasure. These patients used words like relaxing, joy, or ecstasy to describe what they felt but were unable to explain why they felt the compulsive need to press the button.
These results show several interesting things relative to internal propensities:
1a. A propensity, when it is activated, becomes “imperialistic.” Not only does it mobilize the whole of the resources of the organism, but it also inhibits the other propensities.
1b. The pleasure principle does not by itself ensure the survival of the organism.
At the beginning, Olds was still influenced by the notion of cerebral localization, given that he speaks of the “pleasure center.” But after ten years of research,116 he shows that the septum is part of a circuit of pleasure that connects a center situated in front of the neocortex (prefrontal cortex) to other zones of the limbic system like the amygdala and the ventral tegmental area (VTA). This neurological circuit is also associated to the dopaminergic system. It plays an important role in conditioning.117 The pleasure circuit is also associated to hormones of the catecholamine family, like norepinephrine.118 Olds thus rejoins the point of view concerning the circuits defended by some of Cannon’s students.
THE PLEASURE OF ADDICTION AS THE DRIVING FORCE OF SOCIAL RELATIONS
Once these results are associated to a network composed of neural, hormonal, behavioral, and psychological components, it becomes possible to understand how Olds’s observations correspond quite precisely to what is observed when a servomechanism is activated not by the electrodes but by social phenomena. Thus, certain forms of social manipulation can create important and profitable dependencies. The most notable cases are the following:
These are examples of cases where an intra-organic propensity becomes embedded in a social circuit without the person being aware of what is happening. The whole world of marketing and publicity plays explicitly on such possibilities. In this case, I use the notion of external propensities, which, for me, are different from internal propensities, which are mostly activated by organismic homeostatic dynamics.
Other neurologists have also found centers of “punishment” a bit lower in the same region of the brain. If a rat or a monkey presses on a lever that activates an electrode planted in one of these centers, “it will scream, try to flee, become aggressive, and will not do it again” (Laborit, 1989, X.6, p. 208; translated by Marcel Duclos). Acetylcholine is the principal neurotransmitter of this circuit.
For Norwegian philosopher Jon Elster (1999), the mechanisms that regulate the affects also participate in establishing the addiction to drugs, alcohol, cosmetic surgery, and so on. Joachim Bauer (2009, 2010) explains this intimate interconnection between affective organizations and the environment as being due to the need of an organism to socialize. This need would be so profound that it is associated already to the regulators of the genes, which calibrate their dynamics in function of the particularities of the environment.120 The genes exist to organize the way the dynamics of the organism adapt to the environment. A human organism would not be able to survive without its social environment; and this social environment would not even exist if the human organism had no need of it. Environment and organisms mutually influence each other to such a point that one could nearly say that they are addicted to each other:
That is why Thomas Insel, director of the NIMH [National Institute of Mental Health in Bethesda, Maryland], asked with an ironic smile, ‘whether it was an addiction to be socially attached to someone?’ The answer is yes. However, it is not a problem; for that is why nature has made us (Joachim Bauer, 2009, “The Brain Transforms Psychology into Biology,” p. 235)
Every propensity creates a form of dependence by becoming an obsessive habit. It is because they are based on mechanisms necessary for the affective life that the addictions become installed so easily and lastingly in the dynamics of the organism. The principal difference between an instinct and an addiction is that in the case of an addiction the object is socially constructed (e.g., a photograph) and reinforced by cultural and intellectual constructions. Sexuality and hunger are at the periphery of all these categories of intimate interactions between organismic and social dynamics. In these cases, a way of perceiving is the functional goal of an instinct that may transform need into an addiction. As in all forms of perversion, one notices a reversal of function: now the object creates the intensity of a need. This effect acquires even more intensity when it also allows one to participate in social rituals. Thus, for many people, in becoming dependent on erotic sites, they became computer literate. We see in this example the power of these cases that are at the border between satisfying a need and becoming dependent: the fuzziness of this border often allows organisms to rapidly acquire forms of social skills that have a deep impact on the development of new cultural rituals. These mechanisms have probably had a deep influence on how devices such as computers and mobile phones have so rapidly become embedded in the cogwheels of our cultural habits. The time spent in front of a monitor to satisfy one’s fantasies or to facilitate the meeting of sexual and intimate partners develops a way to integrate the affects into institutionally constructed channels (Mafia-like, ideological, commercial, etc.). As Hume’s model foreshadows,121 easily accessible images give greater intensity to some fantasies, which are reinforced by becoming a motoric practice (typing on a keyboard and using a mouse to choose certain pictures on the screen).
Once the user spends most of his time in front of a screen, he has less time to learn how to interact with others in the here and now. He does not have the time to develop or maintain the skills that allow him to live with other persons in an intimate way. Thus, interactions that last for months through the intermediary of a computer monitor can disappear in ten minutes when direct behavioral interactive contingencies are activated. These behavioral contingencies are particularly intense among lovers. When they do not have enough time to co-construct themselves, intimate forms of communication cannot find a space in which they can exist.
Like many other thinkers discussed in this volume, Jon Elster situates the affects between physiology and psyche and shows how addictive behaviors influence conscious thoughts unbeknownst to them. The partners of addicted persons have a difficult time understanding that such a person does not explicitly understand his or her conditioning to a drug, to gaming, and so on. They often think that the dependent person lies—denies the evidence. When I explain to a psychotherapist in supervision or to a partner of an addicted person in psychotherapy that an alcoholic person cannot perceive his or her addiction, something changes in them. Here we are no longer at the level of the defenses described by Freud but at the level of nonconscious connections, woven in the vegetative system and in the brain, which the thoughts of the person concerned are unable to grasp. There can be some denial and insincerity, but mostly there is a sort of internal psychological blind spot that prevents the person from perceiving what drives him or her to act in such a manner. When one talks with an addicted person, one quickly notices that the dependence cannot be discussed in a rational manner. One gradually realizes that the individual cannot really grasp what is happening to him—something that can be incredibly frustrating for those who try to help. He must be helped, supported, deconditioned until he can take hold of himself, with a continuous support like the kind proposed by Weight Watchers or Alcoholics Anonymous. If this analysis permits a dependent person’s circle of family and friends to better understand the communication problems induced by the addiction, it also shows the violence of the social mechanisms that sustain setting up these problems.
In this section, I give an account of a series of works that describe the existence of servomechanisms that connect social structure, behavior, and individual biochemical dynamics.
DOMINANCE AMONG MONKEYS: THE ONE AT THE BOTTOM
In the 1960s at Yale University, neurophysiologist Jose Manuel Rodriguez Delgado122 studied the way that certain nerve centers participated in the hierarchical organization in a tribe of baboons. At the time, the hierarchy among baboons was perceived in a relatively caricatured fashion. The rigidity of the mechanisms observed can be partially explained by the fact that numerous studies were based on the observation of animals in captivity. A tribe of monkeys is seen as having a dominant male when he has all of the rights to the food and the available females, whereas at the other extreme, some males content themselves with leftovers and masturbation.123 The other males find themselves between these extremes. The hierarchical position is determined by one’s ability to win a fight against other members. In this game, the chief is the strongest. The females were rarely studied.
Delgado benefited from the use of wireless electrodes, which could be controlled from afar. Delgado placed a painless electrode in an area of the brain of a male that allows for the regulation of the amount of aggression.124 The lever that controls this electrode was placed in the cage in which this baboon lives. One of the females who also lives in this cage learned to use the lever to reduce the aggression and dominance of this male. Certain behavioral signs associated with dominance (or lack of dominance) in this male are stereotypical (always the same). For example, when he can use all of his aggression, he threatens and often bites those around him. When the female presses down on the lever, the male accosts her in a friendlier manner.
Delgado also placed electrodes in dominated monkeys. When their aggression had been stimulated, they used more dominating behaviors, gained respect more often, but they did not become the leaders of the tribe. In these observations, two facts indicate that it does not consist of a simple direct relationship between nerve centers, aggression and social dominance:
DOMINANCE AMONG HUMANS
The first studies conducted in human ethology shows that there exists hierarchical structures in offices that are relatively similar to those observed among monkeys. A dominant person easily places his feet on the office furniture (table, chair, etc.), easily touches what belongs to others, leaves his belongings everywhere as a way to mark his territory, and ostensibly occupies a colleague’s space (the other’s chair, for example).125 Hubert Montagner (1978) shows that there exist two extreme types of connection between aggression and dominance among the children he observed in a child-care center and in school:
This distinction is already evident in a day care center:
Vignette on aggression and dominance in a day care center. The leaders express relational and appeasing behaviors much more often than the dominant-aggressive ones. In that way, they stir up closeness and the giving of gifts to others in such a way that it is not possible to conclude that their behavior is displayed with the intention of attracting and leading them along. A child of two to three years of age is all the more attractive, imitated, and followed if the frequency of the child’s appeasing behaviors are more numerous than the frequency of his aggression. (Montagner, 1978, p. 161; translated by Marcel Duclos)
Nadel-Brulfert, Baudonnière, and Fontaine (1983) show that the aggression among children can be regulated by situational factors, almost as easily as Delgado did with his electrodes. In the situations studied by Montagner, there were few toys for many children. He then observes a large amount of aggressive behaviors linked to manifest behaviors of dominance. On the other hand, if the researchers place as many toys as there are children in the room, the amount of aggression and the use of dominance are spectacularly lowered. Even if there were an innate predisposition to include some effects of dominance in the human social interactions, this predisposition would not necessarily be activated in all situations. In other words, certain social configurations are part of the circuit that activates the propensity to situate oneself on the dominance scale. It seems that the more that the goods are unequally distributed, the more the behaviors are related to the notion of dominance.
Another type of research shows that the serotonin that circulates in the cerebrospinal fluids126 makes it possible to contain aggression. Certain studies, insufficiently replicated to be considered robust, suggest that the amount varies, especially in function of the quantity of respectful behaviors directed toward a person.
To present this point of view, Buck summarizes an experiment by McGuire, Raleigh, and Brammer (1994) in his textbook on the psychophysiology of affects:
Vignette on dominance and serotonin. [This study] demonstrated an interesting similarity in the levels of serotonin in dominant male monkeys and dominant male humans. They found that the level of serotonin in the blood of dominant male rhesus monkeys is twice as high as the level in other male members of the group. When the dominant male is removed from the group, his level of serotonin falls to normal, whereas the level of serotonin in the newly dominant male rises. According to the evidence, the rise of the leader’s serotonin level is induced by the submissive behavior he receives from the followers. A similar phenomenon was found in the blood serotonin levels of members of a fraternity at the University of California at Los Angeles: the fraternity officers had higher levels than other members. Whether shifts in leadership status affect the serotonin levels of male humans remains to be investigates. (Buck, 1988, p. 213)
SUICIDE AND SEROTONIN
The psychiatrists of the 1990s, especially those inspired by Freud,127 think that suicide and depression are a form of aggression turned against oneself. A considerable amount of research studies have showed that depression is linked to a lowering of the amount of serotonin in the cerebrospinal fluids and that suicide is associated to an even lower amount.128 Research has also showed that there is a connection between depression and the circulation of serotonin in the brain, but this link is more complex.129 It is nonetheless on this second network that the antidepressants act, because it is more difficult to act on the cerebrospinal fluids which can only be analyzed after a painful lumbar puncture. Psychiatrists also observed a connection between the lowering of serotonin and the increase in aggression.130 For example, a very low amount of serotonin in the cerebrospinal fluids can be observed in persons who, all of a sudden, shoot at the inhabitants of a village or become violent toward friends and family, without any of this being predictable. These observations confirm the idea that there is a circuit that connects (a) the amount of serotonin, (b) the containment of aggression, and (c) the need to be respected. This connection is not linear because, as we have seen, the amount of serotonin also depends on other factors like eating habits.
But no one, to my knowledge, has determined the nature and powers of the affects, nor what, on the other hand, the mind can do to moderate them. . . . The affects, therefore, of hate, anger, envy, and the like, considered in themselves, follow the same necessity and force of nature as the other singular things. And therefore they acknowledge certain causes, through which they are understood, and have certain properties, as worthy of our knowledge as the properties of any other thing, by the mere contemplation of which we are pleased. (Spinoza, 1677a, Ethics, III. Preface, p. 69)
Frenchman Jacques Fradin (2008, I),131 who worked with Laborit,132 developed certain aspects of Laborit’s neurological model to create an interesting form of coaching inspired by cognitive therapy. It is true that this neurological metaphor eliminates the social and hormonal dimensions that are part of the model of homeostasis for Laborit, but it has been very useful to me with some patients.
THE COMPLEX NONCONSCIOUS OPERATIONS OF THE BRAIN
Fradin takes up MacLean’s framework but also takes into account recent neurological formulations.133 In a document for the general public, he develops the following points:
This analysis shows that the limbic system is as cognitive as it is affective, while the neocortex is as affective as it is cognitive. Here we have yet another example of an author who cannot reduce the dichotomy of affective and cognitive procedures to the particularities of these two regions of the brain. Damasio (1999), for example, clearly shows that the different forms of consciousness are constructed from the associations of the neurological dynamics situated in almost all of the parts of the brain. Different combinations permit different forms of conscious thoughts. He also confirms, as do Edelman and Tononi (2000), that certain dynamics of the brain manage a network of information of greater complexity than consciousness could manage and that they regulate the dynamics that end up being a conscious perception. The particularly complex forms of data management that become possible once the brain has a well-developed neocortex is not due to a particular function of a zone but to the fact that the more complex circuits (or networks) can be constructed when there is a greater quantity of structurally and functionally varied zones. Thus, the onset of a movement of flight unleashed in the brainstem is more rapid but simpler than a movement of flight unleashed by a coordination between the brainstem and the inferior limbic system (thalamus and amygdala). When this circuit also passes through the prefrontal regions of the neocortex, the organism is able to handle more sophisticated behaviors of flight that take additional time to mobilize the motor functions.136 The cortex is mostly composed of association areas. These areas can process all kinds of information, support primary neurological systems (those that have specifically set functions), and enable the brain to produce behaviors requiring the coordination of many areas.
To summarize, consciousness is directly influenced by rapid automatic responses, and indirectly influenced by the processes that use particularly complex forms of data management.
CONSCIOUSNESS WEDGED IN BETWEEN THE SPEED OF THE AUTOMATIC RESPONSES AND THE PROCESSING OF COMPLEX INFORMATION
It is now possible for me to refine the model of the affective systems discussed in the preceding sections. It is such that the limbic system and the prefrontal cortex can end up with a different set of analysis about what should be done. This is often the case, as the neocortex analyzes a larger amount of information using more complex and lengthier procedures. But the dynamics of the limbic system access behavior more easily, especially via the sensorimotor cortex. This speed is possible because the analysis of the sensory signals occurring at the level of the limbic system is rudimentary and the envisaged motor responses are automatic. We have seen that these stereotypical behaviors sometimes had relevance in certain animals but are not necessarily relevant for a human being living in a sophisticated social milieu.
It sometimes happens that a standardized reaction has already been activated, while more complex forms of management are beginning to realize that this action is counter-productive. Nonconscious procedures must now alert conscious procedures that a different course of action must be found. However, there is a difficulty, because the frontal neocortex needs to recruit limbic structures to influence conscious procedures, as it cannot do this directly. Even if Fradin’s neurology is arguable, the result of this analysis is known by all teachers: the student, whatever his age or intelligence, first needs to grasp simple ideas close to his automatic thinking. Only subsequently can intelligence elaborate more complex connections, starting from simple ideas that initiate a reflection or a dialogue with another. We have here an example of a sound psychological model that tries to look respectable by presenting itself as a neurological model. However, as the neurological model Fradin uses has become obsolete, the psychological model based on it loses some of its strength.
Fradin’s neurological metaphor assumes that when the information processing systems of the neocortex detect that the body and consciousness are about to take a wrong road, it must pass through the limbic system’s standardized reactions to alert the ongoing conscious processes. If there is an emergency, its only recourse is to activate a state of crisis in the limbic system, which is experienced as stress. A state of panic ensues that impedes the motor functions from having a coherent behavior and thus slows down the course of action that had been activated. This procedure is about the same as the one that alerts consciousness with pain when the body is sick or wounded. A feeling of anxiety invades consciousness, more and more explicitly, as if to incite it to concentrate more thoroughly on a new course of action. As for the circuits of stress described by Selye and Laborit, this salutary action does not always have the means to succeed because the organism grows in complex social environments that do not always allow a relevant calibration. Anxiety, for example, puts the mind on alert but just as often prevents an appropriate reflection. That is why individuals who are anxious, depressed, or stressed spontaneously seek an environment that could help them escape a vicious circle created by the limits of their organism’s systems of auto-reparation and the destructive aspect of their social environment (the link between harassment and stress is an unfortunate current example). Often, an individual does not have the means to know which social environment fosters an adequate social support.
In his therapeutic recommendations,137 Fradin (2008,1) shows that the understanding of the expressive behaviors activated by the limbic system is not always crucial. What is important is to help the conscious subject contact the internal contradictions and escape from the hold of the automatic procedures.
It seems to me that one of the problems of the standardized reactions activated by the limbic system is that they function mostly through assimilation. The anxious reaction must be taken as a signal of a profound dysfunction, unleashed by the prefrontal cortex to impose the necessity to reflect and to arrive at a new form of accommodation to the events that the organism’s current habitual procedures cannot handle. Fradin shows that when the anxiety is approached as a signal of an inadequacy that necessitates a reflection and a behavior more complex than usual, it becomes possible to reduce the anxiety. The exercises proposed by his team encourage an enhanced attention to the multisensory perceptions that accompany these moments of crises as much as a more subtle analysis of what is happening. Briefly, as the Taoists and Spinoza already suggested, Fradin shows that to incorporate the nonconscious wisdom of one’s brain permits everyone to auto-regulate more effectively and efficiently. This an example of why cognitive therapists often appreciate approaches derived from Buddhist mindfulness.
I now attempt to extract a model of the affective dynamics from the discussions that are developed in other parts of this book (Spinoza, Hume, Darwin, and Downing) that focus on the needs of a practicing psychotherapist:
For me, the usefulness of a model such as Fradin’s139 is that it helps the therapist to understand the affective reaction as an alert reaction of the organism, and also helps him not follow automatically all of the signs produced by the symptoms of this reaction. If angry feelings erupt, it is not always necessary to express them. Fradin above all recommends to his patient to better understand and feel in a more detailed way what activates an affect. That often allows a person to find new resources within. He will then become able to approach a situation that is difficult to manage in a more constructive manner.
This section concludes my attempt to show that situating intelligence in the neocortex and affects in the limbic system was just a projection onto the brain of the old opposition between civilized rationality and animal passions.
The notion (not the term) of “propensity” has become a theme of this text since it was expressed by Hume and then taken up to discuss the thoughts of several authors who use a similar notion but not always with the same vocabulary. That is why it seems useful to me to specify the meaning of this word and summarize the relevance of this term in biology before approaching its utilization in psychotherapy.
It is easy to see that the habit of exercising an organ, in all living beings that have not yet suffered the reduction of their faculties, not only perfects that organ but even causes it to acquire developments and dimensions which change it imperceptibly; so that with time, it renders it quite different than the same organ considered in another living being that does not exercise it or does so rarely. It is also very easy to prove that the constant lack of exercise of an organ gradually impoverishes it and ends up annihilating it. (Lamarck, 1802, L’Organisation des Corps Vivants, I, p. 46)
Our discussion on psychophysiology confirms Hume’s intuition that the propensions of an individual are structured by innate mechanisms that require external information to complete their development. This model is compatible with the robust observation that the nervous connections of the brain are calibrated by habitual modes of functioning. However, the adaptations to the environment do not always “improve” the coherence of organismic dynamics. In some cases the adaptations required by the environment generate pathological modes of functioning. Contradictory requirements may activate damaging forms of calibration that the organism cannot integrate and that are not necessarily in accord with the needs of the individual. An example is when the adaptation to sitting on chairs creates varicose veins.140
The model of the internal propensities that inserts itself in lifestyles proposed by the theory of evolution often requires multidisciplinary studies to be understood. Indeed, propensities that integrate elements as varied as cellular dynamics and a society’s politics of urbanization demand the formation of teams that allow for a varied set of interventions.141 If the propensity is well understood in its entirety, sometimes it is possible to find an element of the circuit that makes it possible to restore the system’s mechanisms of repair. Sometimes the administration of an antidepressant suffices to allow a person to find ways of associating with a milieu of supportive people who will allow him to feel more comfortable. Sometimes individual psychotherapy makes it possible to modify inadequate representations and find a lifestyle that allows the organism to regain a more adequate amount of serotonin. Similarly, a systemic intervention on the network in which a person lives sometimes allows for the creation of new forms of alliances that support the auto-regulation of each member of the group when they are together.142
When a therapist meets a patient for the first time, he cannot know which types of intervention are required and which aspect of a propensity especially needs attention. He must have received an education and training that makes it possible for him to localize the places of a propensity that are in most need of attention and to be capable of referring the patient to colleagues when the work is not part of the interventions he competently practices. Sadly, this form of training does not yet exist!
This discussion opens up onto two great present-day theories of the self in the domain of psychotherapy, which are well summarized by Brazilian body psychotherapists Gilberto Safra and Jose Alberto Madeira Cotta (2009):
The self is the impression that something in us is the agent of one’s thoughts and behaviors. This notion was originally introduced in psychotherapeutic literature by Jung, who defined the self as what “thrusts the ego aside and makes room for a supraordinate factor, the totality of a person, which consists of conscious and unconscious and consequently extends far beyond the ego” (Jung, 1950, p. 304). The term was introduced in the psychoanalytical literature by Winnicott (1960) and Kohut (1971), and then became a fashionable concept in experimental psychology.143 In psychodynamic psychology, the experience of the self constructs itself through interactions with others. It therefore depends on the physiological and body mechanisms that support the interaction between the self of an individual and the self of those with whom he interacts.
It is difficult to engage a therapeutic intervention on dysfunctional propensities because the mechanism on which the therapist intervenes is included in such a complicated network of distinct causal chains. It is consequently impossible to foresee all of the effects of a course of treatment. We have seen that certain aspects of a propensity functions in parallel fashion, following distinct causal chains. For example, I can use George Downing’s (1996) proposal, and distinguish between at least two parallel levels: a level that follows mostly a physiological causality, and another that deals with conscious representations. We have seen that for many affective difficulties, there exists a dual causal system (physiological and mental) that creates a global mood state. Thus, a diet is sometimes indicated to reduce an individual’s high blood pressure due to an excess of cholesterol, but such a diet could also inhibit the uptake of serotonin. A person will then feel depressed for reasons that are not mental. The commonsense and “trite and banal” handling of the matter by the general practitioner, typical in these cases (“No need to become depressed! A diet, after all, is not the end of the world!”), is therefore sometimes inappropriate. The battle that the individual engages in with regard to his health becomes more difficult if the two causal systems are not explicitly identified, given that he often loses himself in the maze of his affects, his thoughts and his physiology. It is not rare that patients end up by feeling guilty, incompetent, disempowered, and resigned.
The connection between cholesterol and depression also opens up some discussions on the fact that most of the organismic phenomena are modular, that is, multimodal. This implies that cholesterol has different functions in different systems of regulation. Lowering cholesterol can be, at the same time, good for one’s health and bad for one’s mood. Once again, we must guard against linear causality that considers only one causal chain (less cholesterol = better health = greater happiness).