Psychoanalysis, Neuroscience and the Stories of Our Lives

The Relational Roots of Mental Health

Sarah Sutton

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429776021
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychische Gesundheit in der Psychologie

Psychoanalysis, Neuroscience and the Stories of Our Lives: The Relational Roots of Mental Health offers a new understanding of identity and mental health, shining the light of twenty-first century neurobiology on the core tenets of psychoanalysis. Accessibly written, it outlines the great leaps forward in neuroscience over the past three decades, and the consequent implications for understanding mental health symptoms today.

Central to the book is the idea that the seeds of mental illness are discovered not in the individual's own fallibilities, but in the complex relationships we experience from our very first moments. Integrating the latest neuroscientific research, it depicts the individual as inherently interdependent with their environment, their neurobiological and emotional foundations framed by the context in which they are raised. Integrating traditional psychoanalytic ideas with findings from neurobiology and neuroscience, it reframes the oedipal set up, examines clinical depression as the presence of absence, and revisits resistance and the neurobiology of denial. Weaving narratives drawn from clinical practice, and highlighting implications for contemporary lives, the book is a tour de force, smashing the myth that our minds develop separately from the world around us.

This clear, lucid book, providing a timely overview of emotional and neurobiological development, will appeal to both psychologists and psychoanalysts. It will be also be a key reference work for mental health professionals, particularly those working in early years services.

Chapter 1

What you see is what you get

The nature of perception

A powerful truth is expressed in the old adage seeing is believing, but it is not the whole story. In this chapter, we will look at the nature of perception, and the ‘evidence’ of our eyes. It turns out to be much less straightforward and unequivocal than it sounds: what we see and how we see it are shaped by experience. Every possible level of perception is mediated by past experience; the very word ‘recognition’ means that it has been presented to our cognition before. We essentially allocate a meaning, out of our store of possible matches, before our conscious minds respond. Furthermore, we do not see new or conflicting perceptions once the received ‘fact’ is established in our minds and those of the people around us. No matter how extreme and omnipresent the evidence is, there is no limit to what the left brain (McGilchrist, 2009) will deny if it does not fit the received version. I hope to show how this process has implications for our sense of identity, and indeed for our mental and social health.

You may well have seen this picture of the impossible elephant, in which our eyes edit out the confusing legs:

Figure 1.1 The impossible elephant

The ‘McGurk effect’ (McGurk & MacDonald, 1976) is another visual trick, this time with sound effects. Type the phrase into a search engine, and you will see that a sound track is mismatched with a clip of someone talking. We hear one thing with our eyes open, another when they are closed. With our eyes open, visual perception cues tell us what we must be hearing; our hearing proves to be overruled by our eyes. What we take in from the world around us, what is present to our senses then, is not so much a presentation as a re-presentation, a post hoc rationalization. We are unconsciously working out what we could be hearing in the context of what we are seeing, which itself is influenced by what we have seen in the past. We know that the shape of the mouth cannot be making the sound, and so we do not hear it, but hear what would fit with the evidence of our eyes. In terms of perception, context is everything. Meaning, even in information so apparently undisputed as what we see with our own eyes, is not inherent. It is what we do with it that matters. And what we do with it is match it to previous experience (Ramachandran, 2012).

It turns out there is no such thing as immediate, that is, unmediated experience. Or rather, perhaps the absence of mediation constitutes what we see as madness. I will come back to this point later, in thinking about the link between trauma and mental health, but want to emphasize here that experience has to be mediated to make any kind of sense. It is clear from the impossible elephant and the mismatched sound clip that the sense it makes depends entirely on context.

In our earliest days, we use the mind of our caregiver, so often our mother, for context cues about meaning. We learn about what is acceptable, what can find expression in this relationship, through the emotional responses we read in her face and body. Later, we use the minds of others who matter to us in this way, as their emotional responses are reflected in their faces and body language. Once the early pattern is set, on the whole we use our own context-specific ways of understanding what happens to us – even, as we have seen, the ‘evidence’ of our own eyes. We discover through interacting with the world, in our particular socio-relational context, and past experience dictates what we perceive. The mind is excellent at filling in the gaps – for example, take peripheral vision. We have no perceptual cone cells for colour in our peripheral vision; instead we have rod cells there, which are good on picking up movement but unable to distinguish colour, and so what we should see is grayscale at the edges of our visual field. We do not; we see the colours we would expect things to be. Our perceptual system actually colours in the gaps, according to what we expect to find. Furthermore, we exclude contradictory evidence – like the actual sound in the McGurk effect experiment, or the actual shape of the impossible elephant.

The basis for this streamlining is the neuronal plasticity of the brain, a speciality of human evolution. We are born with very little pre-set ‘software’. Instead we have the evolutionary advantage of being able to develop the processing we need to adapt to our specific environment, and so survive: belong, get protection, improve our chances of growing and flourishing. The more often we are exposed to a certain stimulus, the quicker we perceive it. This makes evolutionary sense; if you take too long to process information from your environment, you are at risk of being prey. The training effect of repeated exposure can be measured directly in the brain, which arrives at a result with less effort: functional Magnetic Resonance Imaging studies (Grotheer & Kovacs, 2014) show distinctly lower responses in processing areas when people are exposed to familiar environmental stimuli. It is particularly low in situations where we expect a very specific stimulus. This is efficient; we could not process everything from first principles and still function effectively. It also means we decide what we are seeing on the basis of what we have seen. Our past experiences, then, are essential in shaping our perception of the world and our relation to it, and this means that we tend to fit the experience to the template we already have. In the psychoanalytic world, this process is known as transference. Feelings and expectations from early relationships are transferred onto other people, particularly those who matter to us. Sensitive awareness of, and responsiveness to, this emotional information therefore constitute a central mechanism for therapeutic change, an idea I will explore in the final chapter.

Here though, I would like to look more closely at the neurobiology of transference. Siegel explains the cumulative exponential impact of this process:

As representational processes anticipate experience, they also seek particular forms of interactions to match their expectations. In this way, the “bias” of a system leads it to perceive, process, and act in a particular manner. The outcome of this bias is to reinforce the very features creating the system’s bias. As development evolves, the circuits involved become more differentiated and more elaborately engrained in an integrated system that continues to support its own characteristics.

(1999:305)

This means that when the brain carries out a ‘knowledge’ or ‘understanding’ task, it actually manipulates representations, as it does in the sound clip, so that any idea that there is a direct correlation between what is there and what we actually hear is misguided. I have written elsewhere:

Perceptual experience, then, is not just a function of what hits the eye, it is a function of the interrelationship between what comes in from the outside world and the central nervous system. The conclusion of a study of conscious and unconscious perception was that “perceptual processing itself is unconscious and automatically proceeds to all levels of analysis and redescription available to the perceiver” (Marcel, 1983:197). Marcel’s findings cast doubt on the assumption that there is an equivalence between what we see and what is there; it is mediated.

(Sutton, 2014:29)

Writing about perception, the neuroscientist Ramachandran writes, ‘It’s as if each of us is hallucinating all the time and what we call perception involves merely selecting the one hallucination that best matches current input’ (2012:57). He stretches a point to stress the role of imaginative representation, and the link between past and present experience of all kinds. Take, for example, a sense as ‘immediate’ as taste, which is in fact not immediate but mediated. For example, Brochet (2001) studied wine tasting and found that taste is in fact a perceptive representation; red drops added to white wine made tasters use typically ‘red’ words like plum and raspberry to describe the smell and taste. In this study, Brochet argues that a type of cognitive coherence – we might just call it recognition – is necessary for the brain’s processing of all sensory input, in order to prevent overload. Oddly, or perhaps not in terms of this chapter, experienced wine tasters’ judgements have been found to be more influenced by colour than those of non-experienced wine tasters. The longer you’ve been doing something, the more likely you are to feel you know what you are doing. I have mentioned that Siegel (1999:30) describes the mind as an ‘anticipation machine’. Out of the plethora of sensory information, we select the familiar – an interesting word: from the Latin for domestic, private, belonging to a family. We simply do not see the rest, or do not register it. In fact we delete from awareness any material that contradicts our familiar perspective, as studies of perception and consciousness (Lau & Rosenthal, 2011) have shown.

So although we can be all too sure of what we see, we cannot be sure what this very certainty may disguise – like the elephant we looked at earlier. Certainty blinds us to new possibilities; furthermore, we actively adapt what we see to what we expect: ‘[S]ubjective perception entails an ongoing reconstruction of the outside surroundings to an internal representation’ (Salti et al., 2018:5). The same study sees conscious perception as a moment-to-moment updating process, which encompasses past perceptual events and adjusts the system for future, predicted ones. In this context, the information that is being processed is part of the subjective experience. If the adjusted account of the subjective experience, the story of what is happening for any one of us, broadly fits a new situation, there is no conflict. However, in clinical populations, the story does not fit the new environment and acts to isolate rather than to connect. Therapy can work to introduce the uninvited guest of what psychoanalysis calls countertransference – feelings that often belie the appearance. These emotional crosscurrents give us clues to what might really be going on ‘below the surface’ (Armstrong, 2004).

Essentially, this is how the therapist facilitates change. She (let’s say) is guided by unexpected emotions understood as responses to unconscious expectations transferred upon her by the patient. I have written (Sutton, 2014) about how the implicit qualities of the relationship are transformed through a different response which, crucially, includes recognition of the old expectations, thus wiring in new relational possibilities for the anticipation machine of the mind to draw upon. I will examine the conflict inherent in this process in the chapter ‘Getting your own back: revisiting resistance’, which looks at the core psychoanalytic concept of resistance in the light of this human adaptation.

Here, however, it is clear from the above that what you see is not all you get – far from it; that would be like saying the boat sees the whole of the ocean. The question is, how to explore the ocean depths? In the psychoanalytic tradition, ideas about the undercurrents of transference and countertransference fed into Bick’s (1964) thinking about observation. She alerted us fifty years ago to the fact that what we take in through our eyes acts as a depth charge, setting off waves of physical and emotional response in us. Modern neuroscience has supported this view. Siegel (1999), Schore (2012) and many others have shown how physiologically connected we are to other human beings, even when we are not in direct physical contact. There is an often underacknowledged undercurrent of felt experience, alongside the account of what can be seen.

The discovery of mirror neurons (Rizzolatti & Craighero, 2004) is particularly interesting here. We mentally put ourselves in another person’s position, and actually feel the feelings ourselves – to the extent that we get sweaty palms when we see someone very high, for example, even on a screen. When we see someone stumble in the street, our mirror neurons fire as if we were about to fall. These neurons give us an experience of being in the other person’s position; the feelings evoked by witnessing an action are the same as if we ourselves were in that position. This is the basis for empathy, for emotional connection. This discovery substantiates Freud’s (1930) insight that boundaries between people can be blurred, but it puts the responsibility, the causal factor, in a different place. It is not individual pathology that creates the blurring, it is the emotional link between people facilitated by the mirror neuron, intrinsic to the human brain and common to everyday experience.

I will discuss the nature and function of these interesting neurons further shortly, but it is worth mentioning here that child development research into mother-infant micro-communication shows us their evolutionary, social, and cultural benefit. In the moment-by-moment world where relational life happens, babies are born ready to adapt to the environment in which they find themselves. They take moment-by-moment survival-dependent cues for meaning from the mother’s face, to help them discover what they have to do to belong, as we see in frame-by-frame analysis of mothers’ and babies’ interactions (Beebe & Lachmann, 2002). Isolation is not an option for a newborn infant.

There is a parallel with therapy in these moment-by-moment interactions between mothers and babies, in that ‘[a]lthough the therapeutic medium is linguistic, the interactions we observe here and the patterns that emerge are largely implicit, in that much of what transpires does not enter reflective consciousness’ (Boston Change Process Study Group, 2002:1053). It is the patterning process, the flow of interaction, that seems to forge the connection, rather than any specific content at declarative level. The mother’s or therapist’s face is a guide to the relational landscape, marking out safe territory and warning of danger zones.

Infancy research confirms the physiologically reciprocal nature of emotionality, and indeed thereby the co-construction of meaning. It becomes clear in the Beebe and Lachmann (2002) research, for example, that mothers are making themselves emotionally available to their babies in a way that helps the baby begin to make sense of what they are feeling. This is evident too in Tucker’s (2006) work with parents and their infants, using filmed interactions to explore the parent’s role in mirroring, marking, and meaning-making for the infant’s developing sense of self.

External events, then, are understood through their emotional impact as mediated by the mind of an influential other (Bion, 1962), originally the mother – making her capacity for observational availability foundational to our understanding of ourselves. The Tavistock model of infant observation (Bick, 1964) is predicated on this understanding of the process of observation, involving reflecting on the waves of emotion experienced in observing a baby in their family as potential communication of states of mind/body happening in the baby and/or their family system. This model has since been used in organizational settings (Obholzer, 1987), and has been found to apply every bit as much to the waves of feeling evoked in the process of observing a case conference, or a board meeting. Reflections upon a process of observation that is three-dimensional rather than two, involving emotional depth as well as behavioural surface, can feed into understanding and transforming what goes on.

What we have to go on in a Tavistock-style observation is not just what is seen, however central that may seem. Alerted to our own blindness, and the nature of perception as part of the anticipation machine of the brain, this model of observation uses the resource of emotional undercurrents in the self, evoked by the context, and considered later from a number ...