Theaters of the MIND:

Psychosomatic Illness and

Its Neuro-Psychoanalytic Vicissitudes
:

--

Prepared by Dr. Uri Amit and Dr. Inna Rozentsvit, NYC, US

December 22, 2015
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 Psycho - somatic ???
"Psychosomatic" comes from the Greek words for
"mind" and "body". Psychosomatic pain is pain that
doesn't just originate from physical causes (as opposed
to, say, bleeding from a cut originates from purely
organic causes).
The word "psychosomatic" is often misunderstood to
mean: "it's all in the mind", i.e. "it's not real, it's
imaginary".

Psychosomatic pain can be just as excruciating as any

other pain. For one thing, it is very real: it occurs in the " ,
body, through bodily mechanisms ... What makes it ,
"psychosomatic" is that it is related to emotional ,
problems (i.e. it may originate from emotional "
problems, or be aggravated by emotional problems). -

Swiss psychologist Alice Miller (The Body Never Lies, 2005): Ultimately the body will rebel. Even
if it can be temporarily pacified with the help of drugs, cigarettes or medicine, it usually has the
last word because it is quicker to see through self-deception than the mind. We may ignore or
deride the messages of the body, but its rebellion demands to be heeded because its language is
the authentic expression of our true selves and of the strength of our vitality.
 Great Hypochondriacs

Hans Christian Andersen Alice James, the sister of Franz Kafka

novelist Henry James and
psychologist William James

Edgar Allan Poe Herman Melville Charlotte Bronte

Florence Nightingale Charles Darwin

:
;
;
 What Is Trauma?
the unique individual experience associated with an event or enduring
conditions, in which the individuals ability to integrate affective experience is
overwhelmed or the individual experiences a threat to life or bodily integrity.
[... ,

(Pearlman & Saakvine, 1990)

7
Trauma and Stress... Is All Stress Bad?

From: K. G. Ginsburg and S. B.

Kinsman (editors). Reaching
Teens: Wisdom From Adolescent
Medicine. 8
 Potential Responses to Trauma

(OLeary & Ickovics,)

1994 9
The husband is attempting to lead
his pregnant wife away from the
cage of the great apes at the zoo.
He is afraid that by looking at the
ape in her condition, she might give
birth to a deformed baby. The
longstanding belief that the vividly
stimulated imagination of pregnant
women could lead to "monstrous"
births persisted in popular culture
well into the nineteenth century.

Honor Daumier (1808-1879)

Bobonne, Bobonne! tu me
ferais un monstre comme ca,
ne le regarde pas tant
Le malade imaginaire
(Hypochondriac)
Honor Daumier (1808-1879)
Even as some doctors defended the
idea of "neuroses" --nervous
diseases without apparent organic
cause --others remained suspicious.
Weren't neurotic disorders better
thought of as the imaginary
diseases of tiresome patients
looking for attention?
You cannot write a prescription without the
element of the placebo. A prayer to Jupiter
starts the prescription. It carries weight, the
weight of two or three thousand years of
medicine.
Eugene F. Dubois
"The Use of Placebos in Therapy,"
Cornell Conferences on Therapy, 1946
[Placebo = of psychosomatics...]
 Doctor as a Drug...

Of equal note to advances in surgery, is the work of Michael Balint. As doctors are involved
in supporting people to cope with acute illness or impending death they must be excellent
communicators. Balint wrote extensively about the doctor-patient relationship; he was the
first to explore this in the context of consultation with general practitioners. In his most
famous work The Doctor, His Patient and The Illness, he introduced the notion [] of
the doctor as a drug, well known in the lexicon of modern general practice.
Lakasing, E. (2005). Michael Balint--an outstanding medical life . British Journal of General
Practice, 55(518), 724-725.
Balint suggested that despite relatively modest advances in medical technology, at any point
in time the doctor, through a powerful relationship with the patient, plays a critical role in
serving distressed and diseased human beings.
From: Doctors paradoxes and possibilities - by Moyez Jiwa [prevention of burnout]
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395282/
 Modern philosophy began with Ren Descartes and the other
continental rationalists, Gottfried Leibniz and Baruch Spinoza.
They were called modern because they tried to use Reason to
establish the certainty of Truth (including Religion). Descartes
found the realm of human freedom in the Mind, which he
thought was a separate substance from the material Body. He
advocated a mind/body dualism in which matter or body is
determined and spirit or mind is free and by its nature
unconstrainable.

Throughout history, the human brain has been remarkably good

at dismissing itself. Everyone from ancient Egyptians to Aristotle
has downplayed the role of the mysterious stuff between our
ears. Famed anatomist Galen gave the brain credit as
commander of movement and speech, but even he brushed
aside the white and gray matter, figuring the fluid-filled
ventricles inside the brain did most of the work.
 Un Leon Clinique la Salptrire,
1887. Andr Brouillet
Jean-Martin Charcot demonstrating in a
clinical lecture to his colleagues at the
Salptrire, a large hospital in Paris, that
the symptoms of hysteria were as real as
those of any organic disease.

At the Salptrire,
doctors
photographed and
Dsir- catalogued the
Magloire supposed organic
Bourneville markers of hysteria.
and Paul Charcot claimed that
Regnard the resulting record
Iconographie of symptoms was
Photographiq "valid for all
ue de la countries, all times,
Salptrire, all races, " and
Paris, 1877- "consequently
1880 universal."
 A phrenological mapping of the brain Phrenology was among the
first attempts to correlate mental functions with specific parts of
the brain although it is now largely discredited.

The intention [of this project] is to furnish a psychology that shall

be a natural science. S. Freud, Project for a Scientific
Psychology.
We must recollect that all of our provisional ideas in psychology
will presumably one day be based on an organic substructure.
S. Freud, On Narcissism.

I am tormented by two aims: to examine what shape the theory of mental functioning takes
if one introduces quantitative consideration, a sort of economics of nerve forces; and, second,
to peel off from psychopathology a gain for normal psychology. (S. Freud to Fliess, 1895)

So the mind fills in most of the picture. You can get a sense of this from brain-anatomy
studies. If visual sensations were primarily received rather than constructed by the brain,
youd expect that most of the fibers going to the brains primary visual cortex would come
from the retina. Instead, scientists have found that only twenty per cent do; eighty per cent
come downward from regions of the brain governing functions like memory. Richard Gregory,
a prominent British neuropsychologist, estimates that visual perception is more than ninety
per cent memory and less than ten per cent sensory nerve signals. (Atul Gawande, M.D., The
Itch []. The New Yorker, 6/30/08)
 But obsessional neurosis, in which the puzzling leap from the mental to
the physical plays no part, has actually, through the efforts of psycho-
analysis, become more perspicuous and familiar to us than hysteria
and we have learnt that it displays certain extreme characteristics of
the nature of neurosis far more glaringly.
Sigmund Freud; The Standard Edition of the Complete Psychological
Works of Sigmund Freud, 1916-1917
Joseph Breuer and
Sigmund Freud, The strong psychogenetic explanation of hysterical symptoms
Studies on Hysteria, remained a key feature of Freud's mature work and of later
New York, 1957. psychoanalysis. In his Introductory Lectures of 1916-1917, he
promoted the notion of conversion as a "puzzling leap from the
Studies on mental to the physical" and continued to describe hysterical
Hysteria included the symptoms as symbolic representations of unconscious emotional
famous case study of conflicts. During World War I, Freud's ideas about the emotional
"Anna O." origins of hysterical symptoms were often applied to shell-shock and
other "war neuroses." Soldiers displaying such somatic symptoms as
paralysis, muscular contracture, and loss of sight, speech, and
hearing for which no organic bases could be found came to be
regarded, as in Thomas Salmon's book, as suffering from conversion
hysteria. In these cases, psychogenic explanation focused on
unconscious conflicts between "fear" and "duty" ["" "" ]
with a resulting flight into illness.
https://www.nlm.nih.gov/exhibition/emotions/psychosomatic.html
Freuds discovery of unconscious mental
phenomena and the process of repression
threw new light on many bodily expressions of
mental phenomena. These mental tensions
can be discharged somatically into (1)
muscular activities leading to a change of the
body in relation to its environment; (2)
laughter, crying, screaming, or speech; (3)
respiratory, cardiovascular, and other visceral
systems. The end effects of these modes of
discharge are subjectively experienced as
feelings, affects, or emotions. Affects and
emotions can be repressed and then are no
longer experienced as such, although the
processes discharging them into specific
somatic systems can still occur.
In his study of the unconscious, Freud discovered that strongly charged but repressed fantasies,
conflicts, and memories found distorted expression in somatic symptoms and in impairments of
somatic functions. It was discovered that these symptoms were expressions, in symbolic body
language, of psychological conflicts. They were called conversion symptoms: the conflict was
converted from a purely psychological one into a disorder manifesting itself primarily through
somatic symptoms which had no organic pathological correlate. Thus one could see hysterical
paralysis, hysterical amnesia, hysterical vomiting, etc.
 The story of Ms. A: external enemies internal enemies coming back to square one...
Most people die at 25 and arent buried until theyre 75. (Benjamin Franklin)
The experience of psychic pain is not yet heartache though felt often to be related to the heart
but it contains the beginnings of the capacity to feel heartache. (Betty Joseph, 1989, p. 95).
Taught to deal with concrete and demonstrable bodily changes, we are likely to minimize or
neglect the influence of an emotional upset, or to call the patient who complains of it "neurotic",
perhaps tell him to "go home and forget it," and then be indifferent to the consequences. But
emotional upsets have concrete and demonstrable effects in the organism. (Walter B. Cannon,
The Role of Emotion in Disease, 1936)
 Joyce McDougall first became interested in psychosomatic illness when she
regularly developed a rash when she stayed at her grandparents' house as a
child. She realized the presence of her grandmother was causing the
symptom.
In the first of her four major books, Plea for a Measure of Abnormality (1978),
McDougall challenged the boundary between normality and abnormality in
sexual and gender development. The patients she described cover a wide
range of disorders, including perverse sexuality, male and female homosexuality, psychosomatic
disorders, narcissistic states and, in her view, the least analyzable of all, normality. McDougall
denounced courageously what she named "normopathy", the fear [ ] of difference, and
emphasized the creative insight [ ] of those who were thought of as
perverse or abnormal in other ways.
In Theatre of the Mind: Illusion and Truth On the Psychoanalytical Stage (1982), she went back
to her favorite metaphor, presenting patients enacting fantasies on a kind of inner stage, in
response to the pain of earlier parts of their life. The perverse sexual act functions like a dream,
a kind of hallucinatory creation of an alternative reality and serves as a solution to avoid painful
internal conflicts.
In a landmark contribution to the study of psychosomatics, Theatre of the Body: A
Psychoanalytic Approach to Psychosomatic Illness (1989), McDougall presented a bold revision
of the approach to the question of the relationship between the mind and the body. She created
the term "disaffectation", a form of what was later to be known as alexithymia the inability to
put words to feelings to describe those who had experienced overwhelming emotion that
threatened to cause a breakdown in their sense of identity.
http://www.theguardian.com/society/2011/oct/24/joyce-mcdougall-obituary
Such individuals, unable to repress the ideas linked to emotional pain, simply ejected them
from consciousness by "pulverizing all trace of feeling, so that an experience which has
caused emotional flooding is not recognized as such and therefore cannot be
contemplated". These patients were not suffering from an inability to experience or express
emotion, but from "an inability to contain and reflect upon an excess of affective
experience".
"Human sexuality is inherently traumatic," begins The Many Faces of Eros (1996). As
McDougall demonstrated convincingly, the psychic conflicts arising from the tensions
between the inner world of primitive drives and the constraining and denying forces of the
external world begin in earliest infancy, but have ramifications throughout life.

She discovered psychoanalysis in her teens through reading Sigmund Freud's The
Psychopathology of Everyday Life and resolved to study psychology.

Although the ordinary material

of speech of our mother-tongue
seems to be guarded against
forgetting, its application,
however, more often succumbs
to another disturbance which is
familiar to us as "slips of the
tongue.
He that has eyes to see and ears
to hear may convince himself that
no mortal can keep a secret. If his
lips are silent, he chatters with his
fingertips; betrayal oozes out of
him at every pore. (S. Freud)
 The fact that the mind rules the body is, in spite of its neglect by biology and
medicine, the most fundamental fact which we know about the process of life.
, ,
, ,
. (Franz Alexander)

The body, that complicated machine, carries out the most complex and refined motor
activities under the influence of such psychological phenomena as ideas and wishes. The
most specifically human of all bodily functions, speech, is nothing but the expression of
ideas through a refined musical instrument, the vocal apparatus. All our emotions we
express through physiological processes; sorrow, by weeping; amusement, by laughter; and
shame, by blushing. All emotions are accompanied by physiological changes: fear by
palpitation of the heart; anger by increased heart activity, elevation of blood pressure and
changes in carbohydrate metabolism; despair [] by a deep inspiration and
expiration called sighing []. All these physiological phenomena are the results of
complex muscular interaction under the influence of nervous impulses, carried to the
expressive muscles of the face and to the diaphragm in laughter, to the lacrimal glands in
weeping, to the heart in fear, and to the adrenal glands and to the vascular system in rage
[]. The nervous impulses arise in certain emotional situations which in turn originate
from our interaction with other people. The originating psychological situations can only be
understood as total responses of the organism to its environment. (Franz Alexander,
1950, pp. 38-39)
Franz Alexander, Psychosomatic Medicine, New York, 1950.
Some useful theories re: psychosomatics that we do not have
time today to discuss in full:

Attachment Theory,
Psychoanalytic Theory,
Polyvagal Theory,
Information Transfer Systems Theory
[ ] (including
the Autonomic, Neuroendocrine, and Immune systems),
Interoception,
Theory of Dissolution
The Second Brain (Gut) Theory [gut feelings = ],
Etc., Etc., Etc....
The sympathetic division of the autonomic nervous system regulates the flight-or-fight
responses, plus relaxing the bladder, speeding up heart rate and dilating eye pupils.
The parasympathetic division of the autonomic nervous system helps maintain normal body
functions and conserves physical resources, plus controlling the bladder, slowing down heart
rate and constricting eye pupils.
The autonomic nervous system operates by receiving information from the environment and
from other parts of the body. The sympathetic and parasympathetic systems tend to have
opposing actions in which one system will stimulate a response where the other will inhibit it.
Today, the sympathetic system is viewed as a quickly responding system that mobilizes the body
for action, where the parasympathetic system acts more slowly to dampen responses.
If, for example, you are facing a threat and need to flee, the sympathetic system will quickly
mobilize your body to take action. Once the threat has passed, the parasympathetic system will
then start to dampen these responses, slowly returning your body to its normal, resting state.
The autonomic nerve pathways connect different organs to the brain stem or spinal cord.
Two key neurotransmitters: 1) Acetylcholine - often used in the parasympathetic system to
have an inhibiting effect ,while 2) Norepinephrine - often works within the sympathetic system
to have a stimulating effect on the body.

Some disorders involving Autonomic NS include Parkinson's disease, peripheral neuropathy,

aging, spinal cord disorders, and drug use. Sometimes, disorders of ANS come as a part of
other conditions, like alcoholism and diabetes. Problems can affect either part of the system, as
in complex regional pain syndromes, or all of the system. Some types are temporary, but many
worsen over time. When they affect your breathing or heart function, these disorders can be
life-threatening.
 "
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 The GUT, Our
Second Brain
The gut nervous system
and the brain are in
constant communication.
Unlike many parts of the
body, the gut has a large,
complex, semi-
autonomous brain, housing
more serotonin neurons
than the rest of the brain.
It makes the most
independent decisions of
any part of the anatomy
and its endocrine signaling
to the entire body is very
elaborate...

This second brain has been considered important in intuitive reasoning, intuition
commonly referred to as gut feelings. The gut has important roles in our experiences of fear,
anxiety, anticipation, and other important emotions.
 Polyvagal Theory
The Polyvagal Theory - proposed and developed by Dr. Stephen Porges, Director of the Brain-
Body Center at the University of Illinois at Chicago. The theory specifies two functionally distinct
branches of the vagus, or cranial nerve X. The branches of the vagal nerve serve different
evolutionary stress responses in mammals:
1. the more primitive branch elicits immobilization behaviors (e.g., feigning death =
) [ dorsal branch - originates in the dorsal motor nucleus, phylogenetically older branch;
unmyelinated , and exists in most vertebrates. Known as the vegetative vagus - because it is
associated with primal survival strategies of primitive vertebrates, reptiles, and amphibians.
Under great stress, these animals freeze when threatened, conserving their metabolic resources
]
2. the more evolved branch is linked to social communication and self-soothing behaviors. [the
ventral branch of the vagus originates in the nucleus ambiguus and is myelinated to provide
more control and speed in responding; known as the smart vagus because it is associated
with the regulation of sympathetic fight or flight behaviors in the service of social affiliative
behaviors of social communication and self-soothing and calming. This branch of the vagus can
inhibit or disinhibit defensive limbic circuits, depending on the situation.

The Polyvagal Theory (via Porges, 1995): Once upon a time, Before the advent of a complex
nervous system, the nervous system of aquatic animals could only reduce heart rate by floating,
and waiting for the excitement to go away. There was no channel for the brain to tell the heart
what to do.
 Interoception
Awareness of ones body is
intimately linked to self-
identity, the sense of being
me . A key question is how
the brain integrates different
sensory signals from the body
to produce the experience of
this body as mine, known as
sense of body-ownership.
Converging evidence suggests
that the integration of
exteroceptive signals
related to the body, such as vision and touch, produces or even alters the sense of body-
ownership . However, multisensory integration conveys information about the body as
perceived from the outside, and hence, represents only one channel of information available
for self-awareness.
Interoception, defined here as the sense of the physiological condition of the body, is a
ubiquitous (= present, appearing, or found everywhere) information channel used to represent
one's body from within.
Tsakiris M, Tajadura-Jimenez A & Costantini M (2011). Just a heartbeat away from ones
body: interoceptive sensitivity predicts malleability of body representations. Proceedings of
the Royal Society, B, Biological Sciences. 278(1717):2470-6.

Allman, J. M., Tetreault, N. A., Hakeem, A. Y., Manaye,
K. F., Semendeferi, K., Erwin, J. M., Hof, P. R. (2011).
The von Economo neurons in fronto-insular and
anterior cingulate cortex. Annals of the New York
Academy of Sciences, 1225, 5971.
http://doi.org/10.1111/j.1749-6632.2011.06011.x
VENs -large bipolar neurons located
in fronto-insular cortex (FI) and
anterior limbic area (LA) in great
apes and humans but not in other
primates; more numerous in
humans than in apes. In humans,
small numbers of VENs appear the
36th week post conception, with ##
increasing during the first 8 months
after birth. There are significantly
more VENs in the right hemisphere
(related to asymmetries in the
autonomic nervous system?). They
rapidly send basic information from
FI and LA to other parts of the brain,
while slower neighboring pyramids
send more detailed information.
Selective destruction of VENs in
early stages of fronto-temporal
dementia implies that they are
involved in empathy, social
awareness, and self-control,
consistent with evidence from
functional imaging.
Listening to your heart:
interoceptive awareness as a
gateway to feeling
Antoine Bechara & Nasir
Naqvi(2004). Nature
Neuroscience 7, 102 103.
doi:10.1038/nn0204-102

Figure 1 - The emotional

stimulus is represented in
one or more of the brain's
sensory processing systems.
 Our Economic Brain and Generous Mind
are Working Through Their Differences via:

Processes Phenomena &

Principles
Neuroplasticity (NP)
based on processes of a) Laterality principle;
development and b)
adaptation Wire together - fire
together principle;
Neurointegration (NI)
Synaptic pruning
Neurogenesis phenomenon;
Neural circuitry Dont use it lose it!
Electro-chemical process phenomenon....

Developmental NP Synaptic pruning. (See Gopnik et al., 1999.) At birth 2,500 synapses per
neuron. At age 3 15,000; at adult age half of that via pruning and apoptosis.
NP of Learning and Memory via a) change in the internal structure of neurons (especially
synapses); b) increase in number of synapses. See Tortora & Grabowski, 1996; Durbach, 2000.
Injury-induced NP based on taking on functions of the damaged cells.
45
46
 How does the trauma affect our brain?

Brain structures implicated

in the stress response:
amygdala, hippocampus,
prefrontal cortex (PFC)

Figure A represents available (so-called hard-wired) brain pathways

responding to stimuli, including the traumatic ones.
(Adopted from LeDoux, 1996)
47
 How does the trauma affect our brain?

Figure B Figure C

Figure B represents the response (fear reaction) due to acute traumatic stimulus,
when higher brain areas do not get involved in modulation of this response.
Figure C represents the response due to chronic/ repetitive traumatic stimulus,
when amygdala nuclei are primed to get a more robust response (fear/ fight-and-
flight), while higher brain areas and hippocampus look atrophied (from non-use).

48
"An emotion is a complex psychological state that
involves three distinct components: a subjective
experience, a physiological response, and
a behavioral or expressive response. (Hockenbury &
Hockenbury, 2007)
In addition to understanding exactly what emotions
are, researchers have also tried to identify and
classify the different types of emotions. In 1972,
psychologist Paul Eckman suggested that there are six
basic emotions that are universal throughout human
cultures: fear, disgust, anger, surprise, happiness, and
sadness (c, , , ,
, ). In 1999, he expanded this list to
include a number of other basic emotions including
embarrassment, excitement, contempt, shame, guilt,
pride, satisfaction, contentment, and amusement
( , , , ,
, , ,
). During the 1980s, Robert Plutchik
introduced another emotion classification system
known as the "wheel of emotions." This model
demonstrated how different emotions can be
combined or mixed together, much the way an artist
mixes primary colors to create other colors.
Plutchiks Wheel of Emotions (1980)

What do we know
about FEAR?
Once you worry
about whether you
are going to die,
nothing else seems
quite as significant
to worry about
(Kennedy, Tellegen,
Kennedy, &
Havernick, 1976)
How Men and Women See Colors

Colorful Mind,
By Lim Heng Swee
Lane, R. D.; Waldstein, S. R.; Critchley, H.; Derbyshire, S. W. G.; Drossman, D. A.; Wager, T.
D.; Schneiderman, N.; Chesney, M. A.; Jennings, J. R.; Lovallo, W. R.; Rose, R. M.; Thayer, J.
F.; Kozel, P.J., & Cameron, O. G. (2009). The rebirth of neuroscience in psychosomatic
medicine, Part I: historical context, methods, and relevant basic science. Psychosomatic
Medicine, 71(2), 117-134. doi: 10.1097/PSY.0b013e31819783be.

Abstract
Neuroscience was an integral part of psychosomatic medicine at its inception in the early
20th century. Since the mid-20th century, however, psychosomatic research has largely
ignored the brain. The field of neuroscience has burgeoned in recent years largely because
a variety of powerful new methods have become available. Many of these methods allow
for the noninvasive study of the living human brain and thus are potentially available for
integration into psychosomatic medicine research at this time. In this first paper we
examine various methods available for human neuroscientific investigation and discuss
their relative strengths and weaknesses. We next review some basic functional
neuroanatomy involving structures that are increasingly being identified as relevant for
psychosomatic processes. We then discuss, and provide examples of, how the brain
influences end organs through "information transfer systems," including the autonomic,
neuroendocrine, and immune systems. The evidence currently available suggests that
neuroscience holds great promise for advancing the goal of understanding the mechanisms
by which psychosocial variables influence physical disease outcomes. An increased focus on
such mechanistic research in psychosomatic medicine is needed to further its acceptance
into the field of medicine.
Lane, R. D.; Waldstein, S. R.; Critchley, H.; Derbyshire, S. W. G.; Drossman, D. A.; Wager, T. D.;
Schneiderman, N.; Chesney, M. A.; Jennings, J. R.; Lovallo, W. R.; Rose, R. M.; Thayer, J. F.;
Cameron, O. G. (2009). The Rebirth of Neuroscience in Psychosomatic Medicine, Part II: Clinical
Applications and Implications for Research. Psychosomatic Medicine, 71(2), 135-151.

Abstract: During the second half of the last century, bio-psychosocial research in
psychosomatic medicine largely ignored the brain. Neuroscience has started to make a
comeback in psychosomatic medicine research and promises to advance the field in important
ways. In this paper we briefly review select brain imaging research findings in psychosomatic
medicine in four key areas: cardiovascular regulation, visceral pain in the context of functional
gastrointestinal disorders, acute and chronic somatic pain and placebo. In each area, there is a
growing literature that is beginning to define a network of brain areas that participate in the
functions in question. Evidence to date suggests that cortical and subcortical areas that are
involved in emotion and emotion regulation play an important role in each domain.
Neuroscientific research is therefore validating findings from previous psychosomatic research
and has the potential to extend knowledge by delineating the biological mechanisms that link
mind and body more completely and with greater specificity. We conclude with a discussion of
the implications of this work for how research in psychosomatic medicine is conducted, the
ways in which neuroscientific advances can lead to new clinical applications in psychosomatic
contexts, the implications of this work for the field of medicine more generally, and the
priorities for research in the next 5 to 10 years.

http://journals.lww.com/psychosomaticmedicine/Abstract/2009/02000/The_Rebirth_of_Neur
oscience_in_Psychosomatic.2.aspx
Trends Cogn Sci. 2005 Dec;9(12):566-71. Epub 2005 Nov 4.
Forebrain emotional asymmetry: a neuroanatomical basis?
Craig AD1.
https://www.ncbi.nlm.nih.gov/pubmed/16275155
Abstract
There is considerable psychophysiological evidence to indicate that the left and right halves
of the human forebrain differentially associate with particular emotions and affective traits.
A neurobiological model is needed. Here I propose that forebrain emotional asymmetry is
anatomically based on an asymmetrical representation of homeostatic activity that
originates from asymmetries in the peripheral autonomic nervous system. This proposal
builds on recent evidence indicating that lateralized, higher-order re-representations of
homeostatic sensory activity provide a foundation for subjective human feelings. It can
subsume differing views of emotion and the forebrain because it suggests that emotions
are organized according to the fundamental principle of autonomic opponency for the
management of physical and mental energy.
Nat Rev Neurosci. 2009 Jan;10(1):59-70. doi: 10.1038/nrn2555.
How do you feel--now? The anterior insula and human awareness.
Craig AD1.
http://www.ncbi.nlm.nih.gov/pubmed/19096369
Abstract
The anterior insular cortex (AIC) is implicated in a wide range of conditions and behaviours,
from bowel distension and orgasm, to cigarette craving and maternal love, to decision
making and sudden insight. Its function in the re-representation of interoception offers one
possible basis for its involvement in all subjective feelings. New findings suggest a
fundamental role for the AIC (and the von Economo neurons it contains) in awareness, and
thus it needs to be considered as a potential neural correlate of consciousness.
Neurological studies showed that:
1) Only 8 weeks of yogic meditation
practice increased dramatically the
blood flow to the frontal lobes of the
brain.
2) Studies on Tibetan Buddhist
mediators found that during deep
meditation, the pre-frontal cortex
was highly activated.
3) Brain scans revealed that blood flow
to the brains orientation association
area, (responsible for drawing the
line between the physical self and the
rest of existence) was dramatically
reduced), producing the mystical
state of oneness.
4) Meditation helps to separate
negative emotions from decision
making.

56
Six Domains
of Integration

From: Baim, C. &

Morrison, T. (2001).
Attachment-based
Practice with Adults:
Understanding strategies
and promoting positive
change. Hove, UK:
Pavilion Publishing and
Media Ltd.

57
 What is Mindfulness? What is Yoga?

Mindfulness can be cultivated by

paying attention in a specific way, that
is, in the present moment, and as non-
reactively, non-judgmentally and
openheartedly as possible.
(Jon Kabat-Zinn)
Yoga is a Sanskrit word that literally means
The greatest discovery of our yoke. The practice of yoga is the practice of
generation is that human yoking together or unifying body and mind,
beings can alter their lives by which really means penetrating into the
altering their attitudes of experience of them not being separate in the
mind. As you think, so shall first place. You can also think of it as
you be. (William James) experiencing the unity or connectedness
between the individual and the universe as a
whole. (John Kabat-Zinn) 58
What is included
in Mindfulness?
Discovering patience
Understanding
acceptance
Seeing fresh
Finding trust
Letting go
Letting go through
forgiveness
Avoiding "quick-fix"
solutions
Overcoming perfectionism
Finding out from failure

Shamash Alidina: Mindfulness

For Dummies, 2nd Ed.
 References
Beauchaine, T. P., Gatzke-Kopp, L., & Mead, H. K. (2007). Polyvagal theory and developmental
psychopathology: Emotion dysregulation and conduct problems from preschool to
adolescence. Biological Psychology, 74, p. 3.
Cannon, W. B. (1936). The Role of Emotion in Disease.
Freud, S. (). Psychopathology of Everyday Life.
Low, P. (n.d.). Overview of the autonomic nervous system. Merk Manual: Consumer Version.
Retrieved from http://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-
disorders/autonomic-nervous-system-disorders/overview-of-the-autonomic-nervous-system.
McDougal, J. (1978). Plea for a Measure of Abnormality.
McDougal, J. (1982). Theatre of the Mind: Illusion and Truth On the Psychoanalytical Stage.
McDougal, J. (1989). Theatre of the Body: A Psychoanalytic Approach to Psychosomatic Illness.
McDougal, J. (1996). The Many Faces of Eros.
McEwen, B., Bulloch, K., & Stewart, J. (1999). Parasympathetic function. Research: Allostatic
Load Notebook. University of California, San Francisco. Retrieved from
http://www.macses.ucsf.edu/research/allostatic/parasym.php.
Porges, S. (1998). Love: an emergent property of the mammalian autonomic nervous system.
Psychoneuroendocrinology, 23 (8), 837-61.
Porges, S. (1995). Orienting in a Defensive World: Mammalian Modifications of our
Evolutionary Heritage. A Polyvagal Theory. Psychophysiology, 32, 301-318.
Porges, S. (2001). The polyvagal theory: phylogenetic substrates of a social nervous system.
International Journal of Psychophysiology, 42, 123-146.
Porges, S. (2003). The Polyvagal Theory: phylogenetic contributions to social behavior.
Physiology & Behavior, 79, 503-513.
Porges, S. (2004). Neuroception: a subconscious system for detecting threats and safety. Zero
to Three, 32, 19-24.
Porges, S. (2011). The polyvagal theory: Neurophysiologial foundations of emotions,
attachment, communication, and self-regulation. New York: W. W. Norton & Company.
Porges, S. (2011). The polyvagal theory: Neurophysiologial foundations of emotions,
attachment, communication, and self-regulation. New York: W. W. Norton & Company. pg. 69.
Reed, S. F., Ohel, G., David, R., & Porges, S. W. (1999). A neural explanation of fetal heart rate
patterns: A test of the polyvagal theory. Developmental Psychobiology, 35, p. 109.
Schag K, Leehr EJ, Martus P, Bethge W, Becker S, Zipfel S, Giel KE. (2015). Impulsivity-focused
group intervention to reduce binge eating episodes in patients with binge eating disorder:
study protocol of the randomised controlled IMPULS trial. BMJ Open, 5(12); e009445. doi:
10.1136/bmjopen-2015-009445.
Lokko HN, Gatchel JR, Becker MA, Stern TA. (2015). The Art and Science of Learning, Teaching,
and Delivering Feedback in Psychosomatic Medicine. Psychosomatics, pii: S0033-
3182(15)00155-3. doi: 10.1016/j.psym.2015.09.006.
Zijlema WL, Wolf K, Emeny R, Ladwig KH, Peters A, Kongsgrd H, Hveem K, Kvaly K, Yli-Tuomi
T, Partonen T, Lanki T, Eeftens M, de Hoogh K, Brunekreef B; BioSHaRE, Stolk RP, Rosmalen JG.
(2015). The association of air pollution and depressed mood in 70,928 individuals from four
European cohorts. Int J Hyg Environ Health, pii: S1438-4639(15)00156-X. doi:
10.1016/j.ijheh.2015.11.006.
Morita C, Tsuji H, Hata T, Gondo M, Takakura S, Kawai K, Yoshihara K, Ogata K, Nomoto K,
Miyazaki K, Sudo N. Gut Dysbiosis in Patients with Anorexia Nervosa. PLoS One, 10(12),
e0145274. doi: 10.1371/journal.pone.0145274.
Doherty AM, Gayle C, Morgan-Jones R, Archer N, Laura-Lee, Ismail K, Werner A. (2016).
Improving quality of diabetes care by integrating psychological and social care for poorly
controlled diabetes: 3 Dimensions of Care for Diabetes. Int J Psychiatry Med;51(1); 3-15. doi:
10.1177/0091217415621040.
Magnenat, L. (2015). Psychosomatic breast and alexithymic breast: A
Bionian psychosomatic perspective. Int J Psychoanal. 2015 Dec 18. doi: 10.1111/1745-
8315.12450.
Krause-Utz A, Schmahl C. (2016). A More Global Look at Altered Neural Structure and Resting-
State Function in Borderline Personality Disorder. Biol Psychiatry; 79(2):76-7. doi:
10.1016/j.biopsych.2015.10.011.
Karl SR, Holland JC. (2015). The Roots of Psychosomatic Medicine II: George L. Engel.
Psychosomatics, 56(6); 630-3. doi: 10.1016/j.psym.2015.07.012.
Erickson JM, Quinn DK, Shorter E. (2015). Moria Revisited: Translation of Moritz Jastrowitz's
Description of Pathologic Giddiness. J Neuropsychiatry Clin Neurosci,
:appineuropsych15080205.
Pushkar DJ, Kolontarev KB. (2015). Treatment optimization in patients with erectile
dysfunction. Urologiia(4); 90-2, 94-5. Russian.
Klink A, Huettig F. (2015). The challenge of erosion and minimally invasive rehabilitation of
dentitions with BEWE grade 4.Quintessence Int. doi: 10.3290/j.qi.a35262.
Schnabel RB, Wild PS, Prochaska JH, Ojeda FM, Zeller T, Rzayeva N, Ebrahim A, Lackner KJ,
Beutel ME, Pfeiffer N, Sinning CR, Oertelt-Prigione S, Regitz-Zagrosek V, Binder H, Mnzel T,
Blankenberg S; Gutenberg Health Study Investigators. (2015). Sex Differences in Correlates of
Intermediate Phenotypes and Prevalent Cardiovascular Disease in the General Population.
Front Cardiovasc Med;2:15. doi: 10.3389/fcvm.2015.00015. eCollection 2015.
Jo HG, Schmidt S, Inacker E, Markowiak M, Hinterberger T. (2015). Meditation and attention: A
controlled study on long-term meditators in behavioral performance and event-related
potentials of attentional control. Int J Psychophysiol. pii: S0167-8760(15)30051-9. doi:
10.1016/j.ijpsycho.2015.11.016.
Arnautov VS, Reyhart DV, Smulevich AB, Yakhno NN, Terluin B, Zakharova EK, Andryushchenko
AV, Parfenov VA, Zamergrad MV, Romanov DV. (2015). The linguistic validation of Russian
version of Dutch four-dimensional symptoms questionnaire (4DSQ) for assessing distress,
depression, anxiety and somatization in patients with borderline psychosomatic disorders.
BMC Res Notes; 8(1):770. doi: 10.1186/s13104-015-1766-8.
Koyama KI, Amitani H, Adachi R, Morimoto T, Kido M, Taruno Y, Ogata K, Amitani M, Asakawa
A, Inui A. (2015). Good appearance of food gives an appetizing impression and increases
cerebral blood flow of frontal pole in healthy subjects. Int J Food Sci Nutr, 13:1-5.
Figura A, Ahnis A, Stengel A, Hofmann T, Elbelt U, Ordemann J, Rose M. (2015). Determinants
of Weight Loss following Laparoscopic Sleeve Gastrectomy: The Role of Psychological Burden,
Coping Style, and Motivation to Undergo Surgery. J Obes, 626010. doi: 10.1155/2015/626010.
Epub 2015 Nov 15.
Banihashemi M, Hafezi M, Nasiri-Toosi M, Jafarian A, Abbasi MR, Arbabi M, Abdi M, Khavarian
M, Nejatisafa AA. (2015). Psychosocial Status of Liver Transplant Candidates in Iran and Its
Correlation with Health-Related Quality of Life and Depression and Anxiety. J Transplant,
329615. doi: 10.1155/2015/329615.
Sauchelli S, Arcelus J, Snchez I, Riesco N, Jimnez-Murcia S, Granero R, Gunnard K, Baos R,
Botella C, de la Torre R, Fernndez-Garca JC, Fernndez-Real JM, Frhbeck G, Gmez-Ambrosi
J,
Tinahones FJ, Casanueva FF, Menchn JM, Fernandez-Aranda F. (2015). Physical activity in
anorexia nervosa: How relevant is it to therapy response? European Psychiatry, 30(8):924-31.
doi: 10.1016/j.eurpsy.2015.09.008.
Heuft G, Hochlehnert A, Barufka S, Nikendei C, Kruse J, Zipfel S, Hofmann T, Hildenbrand G,
Cuntz U, Herzog W, Heller M. (2015). Normativ-empirische Bestimmung des Personalbedarfs
in der Psychosomatischen Medizin und Psychotherapie/ Normative-empirical determination
of personnel requirements in psychosomatic medicine and psychotherapy. Z Psychosom Med
Psychother. 2015;61(4):384-98. doi: 10.13109/zptm.2015.61.4.384. German.
Mller JJ, Loetz C, Altenhofen M, Frick E, Buchheim A, Baumann K, Man Ging CI. (2015).
Bindung und psychosomatische Gesundheit bei katholischen Seelsorgenden/ Attachment and
psychosomatic health among Catholic pastoral professionals. Z Psychosom Med Psychother.
2015;61(4):370-83. doi: 10.13109/zptm.2015.61.4.370. German.
Psychoanalysis contributed to the understanding of psychosomatic relationships by
providing a procedurefree associationwhich made it possible to study sequences
connecting psychological and physiological phenomena. It included the previously undiscovered
linkage of unconscious ideas. In addition to improved observation and data gathering,
psychoanalytic theory provided a plausible means of reasoning and of understanding previously
unintelligible and irrational phenomena, such as dreams and neurotic symptoms. The
psychoanalytic method not only permitted the reconstruction of unconscious motivational links
and conflicts, but also allowed them to be brought to consciousness and, thus, to be used
therapeutically.
Freuds discovery of unconscious mental phenomena and the process of repression threw new
light on many bodily expressions of mental phenomena. These mental tensions can be
discharged somatically into (1) muscular activities leading to a change of the body in relation to
its environment; (2) laughter, crying, screaming, or speech; (3) respiratory, cardiovascular, and
other visceral systems. The end effects of these modes of discharge are subjectively
experienced as feelings, affects, or emotions. Affects and emotions can be repressed and then
are no longer experienced as such, although the processes discharging them into specific
somatic systems can still occur. In his study of the unconscious, Freud discovered that strongly
charged but repressed fantasies, conflicts, and memories found distorted expression in somatic
symptoms and in impairments of somatic functions. It was discovered that these symptoms
were expressions, in symbolic body language, of psychological conflicts. They were called
conversion symptoms: the conflict was converted from a purely psychological one into a
disorder manifesting itself primarily through somatic symptoms which had no organic
pathological correlate. Thus one could see hysterical paralysis, hysterical amnesia, hysterical
vomiting, etc.
 Psychoneuroimmunology- brave new area of scientific enquiry

When a foreign toxin or bacteria, called an

antigen, enters the body, immune system cells
race to the site of invasion. These cells are
called lymphocytes (T and B cells) and
macrophages. Receptors on the surface of
these cells recognize and bind to the invader.
The binding process triggers the production of
chemical signals called interleukins. Interleukins At the same time that interleukins
allow immune cells to mature, communicate (sometimes called lymphokines and
with each other, and to make antibodies and monokines) allow immune cells to
other substances that remove the invader. signal one another, they also allow
immune cells to signal the brain--and
https://www.nlm.nih.gov/exhibition/emotions/frontiers.html
vice versa.
Life is like riding a bicycle. To keep your balance you must keep moving.
(Albert Einstein, letter to his son Eduard; February 5, 1930)
.
. ( ,
; 5 1930 )
So many people today and even professional scientists seem to me like someone who
has seen thousands of trees but has never seen a forest. A knowledge of the historic and
philosophical background gives that kind of independence from prejudices of his generation
from which most scientists are suffering. This independence created by philosophical insight is
... the mark of distinction between a mere artisan or specialist and a real seeker after
truth(Albert Einstein)
, - -
, .

, .
...
, ...
The reciprocal relationship of epistemology and science is of noteworthy kind. They are
dependent upon each other. Epistemology without contact with science becomes an empty
scheme. Science without epistemology is -- insofar as it is thinkable at all -- primitive and
muddled. (Albert Einstein)
[Epistemology is a branch of philosophy that investigates the origin, nature, methods, and
limits of human knowledge.]
Brains never stop changing
http://www.livescience.com/129
16-10-facts-human-brain.html
Scientific wisdom once held that once you hit
adulthood, your brain lost all ability to form
new neural connections. This ability, called
plasticity, was thought to be confined to
infancy and childhood.
Wrong. A 2007 study on a stroke patient
found that her brain had adapted to the
damage to nerves carrying visual information
by pulling similar information from other
nerves. This followed several studies showing
that adult mice could form new neurons.
Later studies found more evidence of human
neurons making new connections into
adulthood; meanwhile, research on
meditation showed that intense mental
training can change both the structure and
function of the brain.
 Left vs. Right: Battle in Brain Discovered

Most animals, including humans, have functionally

lopsided brains. Some things are processed in the left
hemisphere, others on the right side. While some of
the differences are learned and others
inherited, the spectrum of possibilities indicates something more random may be at work,
too. A new study of zebrafish embryos suggests a tug-of-war in the developing brain is
responsible for at least part of this asymmetry. Researchers have known that brain cells
called neurons migrate long distances in a developing brain. The battle to attract nerve cells
to one side or the other is governed by a protein called Fgf8, the new study found. The
protein acts as a magnet to attract nerve cells to one hemisphere of the brain.

A scanning Electron Microscope view of the ventricle wall with

part of the surface (blue) peeled off so that you can see the
migrating cells oriented similarly to the bending of cilia.
http://www.livescience.com/542-journey-brain-cell.html
 Difference Between the Right Brain and Left Brain?
Much of what is known about brain function is owed
to Roger Sperry, whose experiments examined the
way the human brain's hemispheres operate both
independently and in concert with each other. The
two hemispheres communicate information, such as
sensory observations, to each other through the thick
corpus callosum that connects them.
In general, the left hemisphere is dominant in language: processing what you hear
and handling most of the duties of speaking. It's also in charge of carrying out logic and exact
mathematical computations. When you need to retrieve a fact, your left brain pulls it from
your memory.
The right hemisphere is mainly in charge of spatial abilities, face recognition and processing
music. It performs some math, but only rough estimations and comparisons. The brain's right
side also helps us to comprehend visual imagery and make sense of what we see. It plays a
role in language, particularly in interpreting context and a person's tone.
"Brain asymmetry is essential for proper brain function," professor Stephen Wilson
of University College London told Live Science."It allows the two sides of the brain to become
specialized, increasing its processing capacity and avoiding situations of conflict where both
sides of the brain try to take charge."
http://www.livescience.com/32935-whats-the-difference-between-the-right-brain-and-left-
brain.html?li_source=LI&li_medium=most-popular
Trends Cogn Sci. 2005 Dec;9(12):566-71. Epub 2005 Nov 4.
Forebrain emotional asymmetry: a neuroanatomical basis?
Craig AD1.
https://www.ncbi.nlm.nih.gov/pubmed/16275155
Abstract
There is considerable psychophysiological evidence to indicate that the left and right halves
of the human forebrain differentially associate with particular emotions and affective traits.
A neurobiological model is needed. Here I propose that forebrain emotional asymmetry is
anatomically based on an asymmetrical representation of homeostatic activity that
originates from asymmetries in the peripheral autonomic nervous system. This proposal
builds on recent evidence indicating that lateralized, higher-order re-representations of
homeostatic sensory activity provide a foundation for subjective human feelings. It can
subsume differing views of emotion and the forebrain because it suggests that emotions
are organized according to the fundamental principle of autonomic opponency for the
management of physical and mental energy.