How the Brain Talks to Itself

A Clinical Primer of Psychotherapeutic Neuroscience

Jay E Harris

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9780789004093
• eBook ISBN: 9781317760788
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

How the Brain Talks to Itself synthesizes discoveries in cognitive neuroscience with a psychoanalytic understanding of human dynamics and a working model for clinical diagnosis. In studying how the brain talks to itself to solve survival problems, this text looks at two sets of situations. In the first, neural possibilities mesh adaptively. In the second, dysfunction clouds the picture--something has gone wrong with the brain, in the life, or in a combination that ends in clinical syndromes.

Unlike other books in this area that have narrow focuses, How the Brain Talks to Itself gives you an extensive and thorough exploration of the human condition by examining the effect that impairment of the left hemisphere has on goals and ambitions, problemsolving, the formation of syndromes, the use of transitional object transference in stabilizing patient identity, and how the brain registers, organizes, assesses, reflects, and acts on data. You'll find this information gives you a comprehensive framework for diagnosing and treating your patients. Chapters will further enhance your knowledge and help you improve your skills by:

• amplifying what we can learn from the conventional mental status exam
• prioritizing and targeting therapeutic interventions
• providing a framework for fitting advances in psychopharmacology into psychotherapy
• reconciling disparate forms of psychotherapy in the context of a neural-systems informed "structural therapy"
  
  How the Brain Talks to Itself combines vast domains of data so that higher cortical functions consistently relate to their corresponding identity functions. You'll explore the mechanisms that link synaptic potentiation to the emotionally and cognitively organized memories that sustain development. These mechanisms process the cognitive, social, and emotional data that are needed for problemsolving. You'll also see how the ways in which synaptic potentiations are comprised by definable varieties of stress that lead to the spectrum of DSM-IV syndromes.
  
  Author Jay E. Harris, MD, derives functional and structural principles from all of the disciplines--psychoanalytic psychology, cognitive neuroscience, clinical psychiatry, neurology, and linguistics--relevant to the brain's development, information processing, problemsolving, and syndrome formation. He includes case histories, clinical vignettes, and diagnostic examples of mental status dialogues with patients to help you in your understanding of this complex topic. You'll find that How the Brain Talks to Itself answers many questions you have about the brain's role in identity formation and resultant clinical sydromes.

Chapter 1

The Functional Anatomy of Consciousness

Man is a structure-making, problem-solving animal.

This is a chapter about the relationship between the brain’s structure and its problem-solving function. Human survival skills reside in the prefrontal system’s evolved capacity to create structures that solve problems. This capacity has two dimensions. The brain talks to itself, and it talks to others. The brain’s structure determines how it talks to itself, and its function determines how it talks to others. Because the brain is an interactive structure that eschews chaos, the question we have to ask ourselves is, how does the brain coordinate its inner speech with its outer speech to resolve problems?¹

A NEURAL SYSTEMS APPROACH TO THE BRAIN’S INNER LANGUAGE

When we start thinking about this question, we face a problem right away. The infant brain does not work exactly as the child’s brain does, and the child’s brain does not process data as an adult’s does. Mature brains and old brains also have their own neurobiological systems. A cognitive neuroscience model will have to create a developmental portrait of the brain as it elaborates human and individual identities. Thus, our model will have to employ a neural systems top down approach that focuses on relevant identity changes that demarcate the stages of life.

But there is more to the brain’s internal communication than infant brain talking to infant brain, adult brain talking to adult brain, and so forth. The infant brain talks to the adult brain, and as it is de rigueur to say, the adult talks to the child within. The brain’s capacity to access our life’s experience is more than impressive. The way we solve problems recapitulates the development of our intrapsychic identities.

To understand and use this neural systems approach, we will follow the principles elaborated in the introduction:

Solving Problems, the Brain Talks to Itself

Using language as a coding system, the problem solver keeps track of activated prefrontal modules. These activated associations are the products of parallel-processing, prefrontal networks.

Each Hemisphere Thinks and Behaves Differently

Cognition organizes language to formulate behavior. Each hemisphere employs its own form of cognition. Left prefrontal dorsolateral cortex (the agent’s inner speech zone) organizes planned behavior. Right prefrontal dorsolateral cortex (the procedural self’s social speech zone) organizes responsive behavior. The executive unifies the two forms of cognition as a simple sentence before we act or speak (articulatory rehearsal).

Each Module has a Life of Its Own

A module is the basic structural unit of cortex. Modules are links in associational networks. Each prefrontal hemisphere has three kinds of data inflow networks: cognitive (lateral cortex), social (intermediate cortex), and emotional (medial cortex). In addition to its participation in one of these six possible data inflow networks, each prefrontal module also participates in the prefrontal system’s behavioral outflow.

Consciousness Develops Cyclically

Functional distributed systems develop in three cyclical spirals. The spiraling begins in the left hemisphere and moves to the right. Within each hemisphere, the movement is from lateral to medial cortex. These spirals induce characteristic paths of integration in the two hemispheres. Each cycle triggers new paths of integration, and these paths are hierarchically superior to the earlier ones. Prefrontal networks consequently develop hierarchically organized modular fields. The closer a module is to the top of a pyramid, the more abstract the data it codes.

We have to deduce these principles, because we experience system consciousness (reflection on experience organized by identity) in a unified way. Having deduced them, we can see that to solve problems, we filter data through parallely distributed networks of prefrontal structures (agent, social subject, subject, procedural self social self, and self). These structures are intrinsic to our personal identities. When we have a problem, we use them to assess whether processed data can trigger behavior compatible with our identities.

Let us summarize the types of assessments that the prefrontal cortex makes. The lateral zones code cognitive formulations of ongoing significant and salient experience. When present experience evokes them, the intermediate zones code signals derived from previously conditioned social experience. The medial zones code feedback from our emotional responses. Since every sentence solves a problem, every sentence includes contributions from our cognitive, social, and emotional life.

Here is an example of how our prefrontal identity system works to coordinate its component zones. In order to use anxiety as a signal system, we have to first sample the feedback from a minor anxiety discharge. Then we code the signal anxiety in language. Only then can we modify our behavior. If warranted by intermediate and medial signals, the executive can also evoke long-term, emotionally organized source memory. These are masses of explicit associations available to cognition.

HOW DOES THE BRAIN MANAGE CONSCIOUSNESS?

In his Project for a Scientific Psychology, Freud saw system consciousness as an indwelling sense organ that perceives the activity of those neural systems that make the most direct and simultaneous contact with the sensory world and our biochemical milieu (1895). System consciousness is the sixth sense. This executive, observing sense uses language to code how the brain is working. Thus, as a prefrontal assessment system, system consciousness makes data suitable for entering the executive structures of our personal identity.

Freud’s system consciousness also manifests a motor quality—attention. Together, the thalamus and cerebellum create quick motor shifts in attention that focus perception. The thalamus evokes consciousness of sensory stimuli by passing signals from the ascending reticular activating system to the frontal and prefrontal areas. If, like general lighting on a theater’s stage, the thalamus sets the stage for consciousness, then the cerebellum spotlights the data we attend. The cerebellum is a

computational system for providing the optimal context for the smooth interdigitated, coordinated neural action of whatever systems are needed from moment to moment to achieve a specified goal within the context of continuously fluctuating internal and external contexts. (Courchesne et al., 1994, p. 861)

Once aroused and attending, executive metafunctions regulate a hierarchy of activated perceptual and motor networks required to solve problems. First, an executive sense of unified identity brings our higher cortical functions into selected and simultaneous use. Higher cortical functions are the ego functions; they are not the ego, which will be defined later. Each higher cortical function—thought, initiation, apperception, synthesis, defense, adaptation, etc.—derives from a different reference point in identity.

HOW DO METAFUNCTIONS REGULATE INTRAPSYCHIC IDENTITY?

The brain’s two hemispheres are not identical twins. The dominant left hemisphere organizes our initiatives, while the nondominant right hemisphere organizes our responses. The division of labor shows up at the highest level of prefrontal organization. Hereafter I will use the following anthropomorphisms:

—executive to refer to the executive metafunction that transcallosally synthesizes speech and identity

—supervisor to refer to the left prefrontal, supervisory metafunction that integrates what we mean to do or say

—observer to refer to the right prefrontal metafunction that represents the reality of the self in the world

In later chapters, I will show that these anthropomorphisms are justified, for metafunctions embody intrapsychic identity.

Using our functional model, we can say that while solving problems prefrontally:

• the left hemisphere supervises inner speech,

• the right hemisphere observes social speech, and

• the executive function synthesizes inner with social speech as articulatory rehearsal.

Without the mediation of language, the brain cannot embody its left hemisphere’s volition, its right hemisphere’s observation of reality, or its reflection on its intrapsychic identity states. The advantage that language confers on us as problem solvers is that it codes both sensory representations and motor schema.

WHAT IS ARTICULATORY REHEARSAL?

When the brain uses articulatory rehearsal to talk to itself, it fuses subjective and objective identity into das ich, the ego, by which Freud meant “I”/”me.” At the twin centers of behavioral preparation, the simple use of the subject, I, summons supervisory volition, while the object, me, prepares observational reaction. Equipped with dual consciousness, the executive enables us to act upon the world and react to it.

Protosentences, of which “Ah wa da—I want that—” is an example, occur at eighteen months, when the infant brain synthesizes a transcallosal identity. A legacy of early hemispheric linkage, protosentences underlie later intrapsychic communications. A simple example of the brain’s talking to itself occurs in the protosentence “I need me to open the window.” Of course, one never hears such sentences because a Chomskian transformation translates them into “I need to open the window.” The full purposes of the ego are nevertheless served by the untransformed base sentence, in which the subject initiates and the object reacts.

WHAT IS INNER SPEECH?

Inner speech is mainly a sequence of action verbs that the left brain encodes for volitional discharge. We are all familiar with what the left brain has to say. For example, while watching the 1994 Winter Olympics, I heard one of the miked figure skaters vocalizing as she went through her routine. The inner speech with which she instructed her actions was, “back, back, back, through.” This is familiar enough, and to be sure, anyone who has watched professional golf on television will recognize the players’ inner speech. Almost all men or women golfers “follow through” verbally with instructions to the ball such as: “left, left, roll, sit!” Inner speech joins action, and extends volition into the arena of effects as “body English.”

WHAT IS SOCIAL SPEECH?

As we fall asleep and lose the point of intention, we relapse into the social speech of young childhood. Perhaps this is why, for some of us, the dissolution of identity that accompanies the entrance to sleep feels dangerous and leads to insomnia. As we fall asleep, we need to feel that our identity is simple and coherent and that we will awaken revitalized.

At sleep’s portal, however, we begin to fuse with language and sensory images. As we fall asleep, we notice phrases floating and joining without meaning. Meaning dissolves without intention, and our only intention is to fall asleep. In other words, jetsam from the sea of words—ideas, idioms, phrases, and images—fuses with our entrance into sleep, as our sense of unified identity melts.

This sea is the stuff of social speech, detached from thought. On several occasions, I was treated to displays of social speech by each of my daughters when each was two and falling asleep. Whole phrases I had used during the day must have gone streaming into their mental seas, and now, they articulated whole phrases that had to have been beyond their complete comprehension.

In waking life, the executive actively selects ideas, idioms, and phrases that we absorb from social speech and combines them with the inner speech that derives from our voluntary expression. This articulatory rehearsal, the legacy of the brain’s later childhood, is the thought that constitutes trial action. In problem solving, the executive’s articulatory rehearsal organizes metafunctions by linking our behavioral repertoire of inner speech with the verbally encoded data of observation.

Legacies of the brain’s development of inner speech, social speech, and articulatory rehearsal are vulnerable to organic damage as well as to dynamic conflicts. Particular areas of damaged prefrontal cortex produce characteristic disruptions in speech functions. In the prefrontal cortex, damage to:

• the left dorsolateral zone results in the utterance of simple sentences, much like inner speech;

• the left orbital frontal zone causes unfocussed, impulsive utterance;

• the right orbital frontal zone globally disorganizes syntax (Kaczmarek, 1984); and

• either medial cortex gives rise to a tendency to initiate vocalization in monkeys and humans (Klin...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• About the Author
• Table of Contents
• Introduction
• Chapter 1. The Functional Anatomy of Consciousness
• Chapter 2. Foundations of Clinical Neuroscience
• Chapter 3. The Anatomy of Our Being
• Chapter 4. How We Become Who We Are: Incarnating Psychoanalysis
• Chapter 5. The Stages of Life
• Chapter 6. How Adults Solve Problems
• Chapter 7. The Source of Brain Syndromes
• Chapter 8. The Origins of Psychiatric Syndromes
• Chapter 9. Mental Syndromes: Unifying Hypotheses
• Chapter 10. How the Schizophrenic Brain Talks to Itself
• Chapter 11. How the Brain Reveals Its Mental Status
• Chapter 12. Mental Status: Memory and Related Functions
• Chapter 13. A Manual of Structural Therapy
• Notes
• Bibliography
• Index