Attention and Interpretation: A scientific approach to insight in psycho-analysis and groups: Volume 5

Interpreting the inner world of ADHD children: psychoanalytic perspectives

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The remaining group members listen eagerly and attentively with a sense of relief and hopeful anticipation. Bion considered that "the three basic-assumption groups seem each in turn to be aggregates of individuals sharing out between them the characteristics of one character in the Oedipal situation".

The mind grows through exposure to truth. The evolution of emotional experience into the capacity for thought, and the potential derailment of this process, are the primary phenomena described in Bion's model. Through his hypothesized alpha and beta elements, Bion provides a language to help one think about what is occurring during the analytic hour. To attempt to apply his models during the analytic session violates the basic principle whereby "Bion had advocated starting every session 'without memory, desire or understanding'—his antidote to those intrusive influences that otherwise threaten to distort the analytic process.

Beta elements were seen as cognate to the underpinnings of the "basic assumptions" identified in his work with groups: The terms are instead tools for thinking about what is being observed. They are elements whose qualities remain unsaturated, meaning we cannot know the full extent or scope of their meaning, so they are intended as tools for thought rather than real things to be accepted at face value , p.

Bion took for granted that the infant requires a mind to help it tolerate and organize experience. For Bion, thoughts exist prior to the development of an apparatus for thinking. The apparatus for thinking, the capacity to have thoughts "has to be called into existence to cope with thoughts" , p. Thoughts exist prior to their realization. To learn from experience alpha-function must operate on the awareness of the emotional experience; alpha—elements are produced from the impressions of the experience; these are thus made storable and available for dream thoughts and for unconscious waking thinking If there are only beta-elements, which cannot be made unconscious, there can be no repression, suppression, or learning.

Beta-elements are not amenable to use in dream thoughts but are suited for use in projective identification. They are influential in producing acting out. These are objects that can be evacuated or used for a kind of thinking that depends on manipulation of what are felt to be things in themselves as if to substitute such manipulations for words or ideas Alpha-function transforms sense impressions into alpha-elements which resemble, and may in fact be identical with, the visual images with which we are familiar in dreams, namely, the elements that Freud regards as yielding their latent content when the analyst has interpreted them.

Failure of alpha-function means the patient cannot dream and therefore cannot sleep. As alpha-function makes the sense impressions of the emotional experience available for conscious and dream—thought the patient who cannot dream cannot go to sleep and cannot wake up. Successful application of alpha-function leads to "the capacity to tolerate the actual frustration involved in learning "K" that [Bion] calls 'learning from experience'". The patient's focus may wish to be "on Love and Hate L and H rather than the knowledge K that is properly at stake in psychoanalytic inquiry.

For Bion, "knowledge is not a thing we have, but a link between ourselves and what we know K is being willing to know but not insisting on knowledge. I shall consider one factor only — Envy. As summarised by Etchegoyen , "Reversible perspective is an extreme case of rigidity of thought. As Bion says, what is most characteristic in such cases is the manifest accord and the latent discord. As his thought continued to develop, Bion came to use Negative Capability and the suspension of Memory and Desire in his work as an analyst, in order to investigate psychic reality - which he regarded as essentially 'non-sensuous' Following his book Transformations he had an increasing interest in what he termed the domain of "O" — the unknowable, or ultimate Truth.

What can be known is said by Bion to be in the realm of K, impinging through its sensory channels. Bion believed such moments to feel both ominous and turbulent, threatening a loss of anchorage in everyday 'narrative' security. Bion would speak of "an intense catastrophic emotional explosion O," [52] which could only be known through its aftereffects. Where before he had privileged the domain of knowledge K , now he would speak as well of "resistance to the shift from transformations involving K knowledge to transformations involving O If any object existed, however faint, it would show up very clearly".

He was also making links with the apophatic method used by contemplative thinkers such as St John of the Cross, a writer quoted many times by Bion. Bion was well aware that our perception and our attention often blind us to what genuinely and strikingly is new in every moment.

Bion's concept of maternal "reverie" as the capacity to sense and make sense of what is going on inside the infant [55] has been an important element in post-Kleinian thought: If we accept that "Bion introduced a new form of pedagogy in his writings From Wikipedia, the free encyclopedia. Mathura , North-Western Provinces , India. Boston Graduate School of Psychoanalysis. The war of nerves. In Miller and Crichton-Miller Eds.

Intra-group tensions in therapy, Lancet 2: Leaderless group project, Bulletin of the Menninger Clinic, Psychiatry in a time of crisis, British Journal of Medical Psychology, vol. Experiences in groups, Human Relations, vols. The imaginary twin, read to the British Psychoanalytical Society, Nov.

In Second Thoughts International Journal of Psycho-Analysis, vol. New Directions in Psychoanalysis pp. Tavistock Publications, London, Reprinted in Experiences in Groups Notes on the theory of schizophrenia. Reprinted in Second Thoughts Language and the schizophrenic, in M. The differentiation of the psychotic from the non-psychotic personalities, International Journal of Psycho Analysis, vol. Attacks on linking, International Journal of Psycho-Analysis, vol. Experiences in Groups, London: A theory of thinking, International Journal of Psycho-Analysis, vol.

Learning from Experience, London: Reprinted in Seven Servants e. Elements of Psycho-Analysis, London: William Heinemann [Reprinted London: Notes on memory and desire, Psycho-analytic Forum, vol. Melanie Klein Today Vol. Bion's Brazilian Lectures 1. Bion's Brazilian Lectures 2. Reprinted in Clinical Seminars and Four Papers The Grid and Caesura. Four Discussions with W.

Making the best of a Bad Job. A Key to A Memoir of the Future. War Memoirs - This temporality is characterized by an impatient present tense that wants nothing to do with waiting. Defensive strategies often lead the sex-addict to experience any durable construction — implying stability — as being mediocre or as yet another constraint. Hence, the need for constant change in order to feel free … up until the day when the subject can no longer bear his addiction to change.

Engaging in a therapeutic undertaking can be the occasion for the subject to maintain a relationship in a stable rhythm as a couple, with certain overall constants. If addictive sexuality is a disorder that is easier to live with in big cities than in the countryside, this is in part due to the strong urban implantation of various venues dedicated to sexual encounters: After having spotted objects of interest in the soft zones at the bar or on the dance floor , one can head toward the hard zone to get comfortable and share sex … If they have today spread to the libertine world, backrooms were born in the American gay milieu in the s.

Strangely, they developed just as homosexuality started to come out of the shadows, as if to pay a funereal homage to the dark, hidden, clandestine, and shameful places long frequented — for lack of choice — by homosexuals repressed by the police. Somber, damp, and strong smelling, they replaced the former urinals where sexual activity took place inter faeces et urinas.

Often fitted out with minor conveniences slings , glory holes , cages reminiscent of the prison world, labyrinths … , they can be play areas that are appreciated by sex-addicts. In these spaces, there is no social identity, no faces, but body parts revealed by hands touching, caressing, feeling, entering. If the AIDS years led to the closing down of most of these places in the United States, it is in the major European cities that they flourish today.

According to different authors Carnes, Earle, Estellon, Goodman, and Poudat one finds certain common personality traits in sex-addicts such as:. Certain characteristics — the invasive presence of obsessions and the prevalence of compulsive systems — have led some authors to make a link between these clinical elements and obsessive compulsive disorders. Except that to the opposite of the sex-addict , the obsessional does not take action: The psychoanalytic clinical data of sex-addict subjects Estellon, ; Mac Dougall, gives a glimpse of a characteristic psychic functioning — quite close to a borderline functioning with recourse to certain common defensive strategies.

Splitting is the essential defensive operation used by sex-addicts. Its main aim is to avoid the confrontation of the subject, in the face of his affective ambivalence, with depressive suffering. Here, splitting radically separates affectionate impulses from sexual impulses. Sexual partners will be little invested affectively, whereas other people in the entourage friends, family, inaccessible partner are highly invested. Complementary to splitting and shored up by it, denial permits the exclusion of the field of consciousness and facilitates the isolation of those representations or affects that are not in keeping with the ideal self-image.

Everything that might fragilize the psychic life by its contradictory or ambiguous character is evacuated.

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A loss, a grieving process, a separation, for example, might in such subjects provoke reactions in which there is no apparent suffering. Denial shoring up the splitting, the sex-addict can, with complete indifference, leave any partner who has been imprudent enough to become tenderly attached to them.

In the same way, when the sex-addict feels strangely affectionate toward a partner, reactions of distress or violence can appear. The mechanism of idealization functions in a way that is complementary to splitting. A new person can be strongly idealized: Splitting allows, when the deceptions or frustrations have spoiled the perfection of this object, to denigrate them, to disdain them, and deinvest them as easily as the touch of a finger is able with a remote control to zap a boring TV program instantaneously. I am thinking of a certain patient who regularly changed sexual partners: This is the phenomenon of devalorization.

A corollary of omnipotence, it allows one, without suffering, to get rid of an object when it does not bring the expected or desired satisfaction. Splitting thus ensures that a part of the Ego remains idealized the grandiose self in such a way that the feelings of suffering, frustration, deception, desire, or hatred, when they are experienced, can always be imputed to the action of an ill behaving other. These charicatural reactions permit the Ego — whose frontiers are unsure — not to collapse.

This defense mechanism constitutes a veritable motor for the zapping mode of functioning described above. From a relationship point of view, addictive sexuality can be understood as a phobic strategy that allows one to avoid any real encounter with others. One often finds at the basis of these compulsive practices two types of relationship anxiety: Haunted by these anxieties, the problematic of attachment becomes unbearable.

In such a configuration, the certainty of a breakup is preferable to the torments of its uncertainty. The fact of systematically leaving the other, anonymous person allows one not to suffer the anxiety of being invaded and even less the worries of abandonment. Thus, one avoids the depressive suffering linked to deceptions caused by the other in whom one might have believed and to whom one might have become attached. Curiously, what takes place is a reversal of the latent desires and the pragmatic and compulsive behavior: This sexual frenzy often covers up a strong and denied affective deficiency.

Sexual addiction: insights from psychoanalysis and functional neuroimaging

During sexual activity, drugs may be used by the more dependent subjects: Currently, the most common are poppers, cocaine, and GHB, we will here describe poppers and GHB as they are more specifically used during sexual activity. Poppers are vasodilators originally used in medicine to cure certain cardiac illnesses, containing butyl and pentyl nitrates; sniffed in a non-medical use, their effects are almost immediate: The user feels a strong sensation of inner heat and sensuality is exacerbated.

The effect of the sniff lasts about 2 min. GHB is a very powerful anesthetic. In a liquid form, it can be drunk pure or mixed with non-alcoholic drinks. The effects depend largely on the dosage but vary from euphoria, relaxation, somnolence, deep comatose sleep, and unconsciousness to the loss of inhibitions, an intensification of perception, a need to talk, or slight vertigo. In the organism, GBL turns into GHB; more dangerous; being more difficult to dose, it can provoke potentially fatal comas.

Insolent and seductive, risk taking allows one to leave behind the securized world in which one is immersed. Barebacking unprotected sex despite the risk of transmission of the HIV virus is more and more frequent among sex-addicts in the gay world. On top of the risks of HIV, this practice increases the risks of contamination of various other sexually transmitted diseases that can prove dangerous if they are not detected in time Syphilis, Hepatitis B.

When he becomes interested in searching for stronger sensations, the sex-addict can direct his sexuality toward more hard-core practices fist-fucking, bondage, SM, urophilia, scatophilia, etc. It is in these aspects that addictive sexuality can become a source of suffering, of isolation, and marginalization. The results of the studies by Peretti-Watel et al. Depression often constitutes the backdrop on which sexually addictive behavior is constituted and chronicized. The loss of belief in the positive effects of a relationship, the loss of hope in others, progressively makes one lose sight of the meaning of a life that has — despite the erogenous sensations that exhaust themselves in compulsive repetition — become sad and empty.

In this chapter, it is interesting to summarize some recent studies issued from cognitive neuroscience that investigated human male sexual behavior in general and, for some of them, its compulsive practice. Although using very different theoretical and experimental settings, sexual affiliation is for us one of the most promising context to articulate a dialog between neuroscience and psychoanalysis. Today, what do we know on the neural circuits involved in human male sexual arousal?

Is that possible to identify variations within these neural processes when sexual practice is becoming compulsive? Here are the two main questions of this section. From now several decades, the growing development of neuroimaging techniques shed light on brain processes with a new angle. It is now possible to record brain activity in a wide variety of perceptual, cognitive, or motor paradigms.

In addition to a considerable increased knowledge of the brain circuits involved in general cognitive processes, two fields meet an exponential development: These two approaches converge on questions such as the investigation of brain processing of emotional informations emitted by conspecifics. In this regard, recent studies have helped to highlight the connections between cognitive and neural systems involved in the production of the action and the perception of the action by a third party.

The above-developed perspective is now extending to the topic of emotions. For example, to be exposed to a disgusting flavor activates the same neural structures than to observe a disgust facial expression in another person see the example of the insula in Phillips et al. Insular lesions prevent both the experience of disgust and the recognition of social cues conveying disgust Calder et al.

Comparably, the neural circuits of nociception are activated both by real pain and the representation of the affective state of someone in pain Morrison et al. These results suggest that neural structures involved in emotional information processing also participate in the intersubjectivity of interacting people. However, the recovery between activated structures is not total. This suggests a certain amount of dissociation between regions involved in self-perception and those involved in other perception. Although a functional context such as empathy encompasses an intrinsic social component, relationships between individuals first obey to an intrinsic interattraction motivational component that can be either positive or negative.

However, this interattraction component can be studied within different functional contexts. Among these contexts, sexual behavior and its associated neural circuits has been more and more studied during last years, shedding light on interesting new results for socioaffective neuroscience. Until the end of the 90s, the investigation of mental and neural representations associated to sexual behavior was poorly studied but is now exponentially emerging. However, it has to be noted that this is mostly investigated in human males.

At the moment, an exponential number of scientific studies investigates the neural correlates of human male sexual arousal. Here, we would like to underline some recent results issued from socioaffective neuroscience studies that used sexual affiliation to study motivated social interactions and provided more general results. Here, we will first focus on results obtained in healthy human males and secondly on very preliminary data from patients that could be involved in CSB occurrence. To understand the present assumptions of neuroscience on the neural networks that could be involved in sexual addiction, it is necessary to present some interesting recent results on the role of the brain on healthy human male sexual motivation.

First, it has to be noted that functional magnetic resonance imaging fMRI , that is, the possibility to use MR imaging to identify brain activations thanks to local blood flow variations recording, was discovered in In this article, we present the main results from studies with two objectives: Mainly, to explore the neural correlates of healthy human male sexual motivation, these studies used fMRI.

Among other neuroimaging techniques, fMRI has a relatively good spatial resolution, but a quite poor temporal resolution around 1 second instead of milliseconds regarding the classical temporal unit of the cell functions. Currently, an attempt that can be offered to try to overcome this pitfall is to try to unify the corresponding psychological and neural components in a neurobehavioral model. For healthy human male, a neurobehavioral model has been proposed Redoute et al.

Therefore, this is important to bring together a psychological process and a cerebral activation and to explain how these processes articulate with the other components of the model. Here, we sum up some data related to cognitive and physiological components of the neurobehavioral model. With several decades of studies of the neural correlates of healthy human male sexual arousal, the feasibility of this scientific approach has been widely demonstrated.

In other words, the presentation of decontextualized visual sexual stimuli within a scanner was valid. Although the experimental setting and procedures were not ecological to study sexual arousal, behavioral results indicate a possible induction of sexual attitudes. Regarding brain processes involved in visual sexual material processing, a good example is illustrated in Fig.

In accordance with the hypotheses of the study, the recorded brain activations were interpreted as involved in the cognitive processes linked to motivational information processing Mouras et al. For example, activations were identified in the inferior parietal lobules IPLs; Fig. Interestingly, these areas were known to be activated in monkeys during visual fixation episodes occurring during environmental exploration Lynch et al.

For this region, an early activation was thought, for example, as being involved in enhancing attentional mechanisms toward motivationally relevant targets. Through a more precise study of temporal activations for this part of the brain, we were able to demonstrate activations within the superior parietal lobules. In this study one of the first fMRI studies , these activations were nonetheless sustained not only during all visual sexual stimuli presentation period but also in the early as for IPLs. These results were in accordance with a very short categorization time for sexual stimuli Pizzagalli et al.

Therefore, these activations were interpreted as the anatomical support of an early amplification of attentional processes directed toward visual sexual stimuli. Brain areas activated in response to visual sexual stimuli as compared to neutral stimuli. Figure from Mouras et al.

Adapted with permission from Mouras et al. Through published studies, a recurrent question is to know if the identified psychological and cerebral processes are specific to the functional context of sexual behavior.

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Importantly, the male sexual function is characterized by a highly specific physiological response, that is, the genital response. For this purpose, a specific MR-compatible device able to record volumetric penile plethysmography concurrently to cerebral BOLD responses was manufactured. This was applied in two recent studies Mouras et al. It allowed to precise the involvement of a specific neuronal system in the brain — the mirror neuron system — for visual sexual stimuli processing, which means visual stimuli with a high motivational relevance.

Importantly, the mirror neuron system was first discovered in monkey as a specific category of motor neurons with an increasing firing rate either during the observation of an action or the mere realization of this action. Today, the question of the involvement of this system within socioaffective information cerebral processing is one of the major debates for contemporary cognitive neurosciences. A recent study Carr et al. Consequently, it was important here to assess the degree of implication of these mirror neurons in the observation of sexual exchange.

Therefore, our hypotheses were that 1 in response to the presentation of sexual visual stimuli, the magnitude of activation of the brain networks involved in movement observation and motor imagery would predict the intensity of genital response and 2 the level of the erectile response would predict the amplitude of the BOLD response in primary and secondary somatosensory areas corresponding to the projection of the penis.

Three results are developed here see Fig. Parasagittal sections showing brain areas where the fMRI signal was correlated with the concurrent penile volumetric response. X refers to the distance in millimeters from the sagittal plane. Correlation profiles between BOLD and plethysmographic signals as a function of the lag between the two signals. The vertical axis represents the Z statistic associated with the correlation coefficient between the two signals, and the horizontal axis the lag, which is the time interval seconds by which the correlated values are separated.

Positive lags are those where the plethysmographic response was correlated with subsequent values of the BOLD signal from Mouras et al.

The first region in which the variations in BOLD signal were correlated to those of genital response was the left frontal operculum. In the functional context of sexual affiliation, two interpretations are possible regarding the role of this neural system: On the other hand, the behavioral response was also recorded by physiological the erectile response and some of the efferences of the frontal operculum to the insula could be the corresponding anatomical support. Therefore, these results place the physiological response at the center of the processes involved in social relations with a strong motivational component.

These results are in accordance with those showing a possible anticipatory activation of this network, that is, before the observation of motor scenes Kilner et al.

The concept of addictive sexuality

For somatosensory areas, important results have been obtained. Everything happens as if the observation of sexual explicit scenes induced activation only in motor areas corresponding to the hand, but also in areas of the somatosensory cortex corresponding to the representation of the hand. Such processes may play a role in recognizing emotions in others by the observer Adolphs et al. The exploration of the neural networks involved in healthy human sexual behavior through modern neuroimaging techniques remains recent, centered on healthy human male sexual motivation. Even if the number of studies on this topic is growing exponentially, there are still a lot of scientific questions to solve.

As shown by this article, the question of the neural circuits involved in addiction is an important topic. In the field of sexual addiction, different kinds of data are now available. Today, modern neuroimaging techniques such as MRI allow using different modalities to record during the same experimental session either data regarding the anatomical properties of the brain or its functional properties through neural activations recorded in any kind of behavior.

However, from one study to another, the evaluation method to assess and evaluate compulsive sexual behavior have been different. Recently, Miner et al. To recruit patients with a certain homogeneity, authors used as inclusion criterion the CSB syndrome. In , Coleman et al. As explained by authors, this syndrome shares criteria with other addictions such as bulimic behavior and pathological gambling.

Although this study was the first to present data on patients with a CSB, important hypotheses have been proposed through the report of single cases. The first one is the disruption of frontal brain areas that usually have an inhibitory effect on sexual behavior and that could induce an hypersexuality. Here, the recorded informations were only anatomical. With highly specific settings, diffusion tensor imaging DTI gives very precise information on cerebral white matter organization and integrity.

Therefore using DTI, authors compared cerebral microarchitecture in a group of patients with CSB and a group of appealed control participants. In parallel, informations were recorded from both groups through standardized questionnaires dealing with 1 intensity of symptoms of the CSB; 2 intensity of different traits related to impulsivity; and 3 skills regarding emotional regulation.

In this task, they were asked to push a button when a given letter appeared on a screen, hereafter called the target letter. This first version of the task was dedicated to evaluate the intensity of impulsivity. This second version of the task was dedicated to measure inattention of participants by measuring omission errors when they omit to left click on the mouse for a target letter occurrence.

The results of this study were very interesting. Regarding impulsivity, patients with higher impulsivity scores as measured by standardized questionnaires were more sensitive to negative emotions. Regarding anatomical data, two different types of analyses have been performed. These results were changing a little bit when correlational analyses were performed between anatomical and cerebral data: How to interpret these results?

Firstly, these results demonstrate that CSB shares a lot of properties with other impulsivity control disorders such as kleptomania, pathological gambling, and alimentation disorders. Thanks to the Go-noGo behavioral task, a higher level of impulsivity was reported in patients with CSB than in control participants. These results are in accordance with those demonstrated in patients with compulsive obsessional troubles as reported in a recent study using the same behavioral task in a group of patients depicting trichotillomania as compared to controlled participants Chamberlain et al.

The cerebral side was also explored in terms of anatomy and processes. The anatomical data did not support the first hypotheses of the authors. These results were different than those of previous studies reporting a disorganization of the inferior frontal cortex in other categories of impulsivity disorders Grant et al.

Although no significant results were reported, some preliminary tendencies regarding anatomical data appeared. DTI indexes variations were reported for the superior frontal lobe between patients and control participants that supports an alteration of axons within this region. For neuroimaging, a very interesting approach is to perform correlational analyses between neuroimaging and behavioral data.

For this specific study, authors demonstrated a correlation between impulsivity measures and white matter troubles for the inferior frontal gyrus. Similar results were demonstrated in studies dealing with compulsive obsessional disorders. As explained above and as postulated by Eli Coleman , CSB would be a partial response to negative affects such as depression or anxiety.

Wilfred Bion

Such an hypothesis is in accordance with responses reported in patients with higher ratings on a negative emotional scale and with behavioral and anatomical data recorded more generally in anxious troubles. As mentioned above, anatomical data would support CSB more as an obsessional compulsive behavior than an impulsivity control disorder.

Clinically, this type of addiction raises the problem of its screening. Indeed, to consult a therapist because of a too intense sexual like is not trivial. Moreover, the denial of the problems related to this kind of behavior, avoidance of suffering of depressive symptoms associated with a personal questioning do not help much these patients to consult a therapist. When a therapeutic process begins, it will promote a flexible but robust therapeutic setting so that the patient gradually learns to keep a rhythm that is to say, also invest in the therapeutic relationship rather than to go from on therapist to zap from one therapist to another one as soon as frustration is felt.

Emotional reactions on edge, acts, or acting out often make it difficult to develop a good psychic elaboration. Carnes a , b was the first to develop a behavioral method based on the 12 steps of Anonymous Alcoholics that aims to rehabilitate these individuals. The method is quite simple: Other authors such as Earl developed care programs in the same direction.

Schneider highlighted the difficulty of these individuals to stop their behavior: This simple idea has some merit to attract patients, who, desperate and alone, then have a new challenge to overcome. Indeed, abstinence will be able to afford to give, eventually, relief to a later love affair, which would — before — not resist to the temptation to change automatically because the other, that is, the partner, did not exist as such , but is the internal psychic structure really modified by this conditional abstinence?

The challenge for an analytical therapy is not to focus on the symptom. This type of care in the sense that such treatment will involve to be confronted to difficult life episodes, scarrying when it comes to open conflict and painful memories for consciousness. Moreover, as for some borderline states, the analytical cure for sex-addicts often reveals a great difficulty in remembering the past, which does not facilitate the elaboration processes. Behaviorally, which is implicitly aimed in the cure is learning a relationship with the other.

Within the model of the therapeutic relationship stable, rhythmic, challenging , the subject will learn a relational kind of consistency that he will be able to appreciate and incorporate the side of his emotional and sexual life. These psychotherapies may, depending on the intensity of pain experienced, be coupled with a medical care. On the pharmacological side, treatments are various and depend largely on their effect on the patient:

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