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DOI: 10.1177/053331648301600203

1983 16: 95Group AnalysisHeinz Wolff

Mind-Body Interaction and the Psychotherapeutic Process

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7th S. H. Foulkes Annual Lecture

MIND-BODY INTERACTION AND THE PSYCHOTHERAPEUTIC PROCESS

By Heinz Wolff

I WISH first of all to thank the Group-Analytic Society for having done me the honour of asking me to give the 7th Foulkes Lecture today. Although I have not had the advantage of having been in one of Michael Foulkes’ groups as a group member or observer, I have benefited a great deal from his writings and from hearing him talk and lecture on group analysis, that particular form of group psychotherapy of which he was the originator.

As the name group analysis indicates, its origin lies in the concepts and practice of psychoanalysis which laid the foundations for Michael Foulkes’ own training as a psychoanalyst and psychotherapist, and thus ultimately for the creation by him of Foulkesian group analysis, based on his special interest and discoveries in group phenomena and processes of social interaction. Hence the GroupAnalytic Society, founded by him in 1952, and the Institute of Group Analysis, which emerged from it as the centre for education in group analysis in London, have common roots in the principles of psychoanalysis, dynamic psychotherapy and social interaction.

When I was confronted with the task of choosing a suitable topic for this lecture I therefore decided to try and make use of some psychoanalytic, groupanalytic and psychotherapeutic concepts in order to throw further light on the relationship between mental and physical phenomena, or between mind and body in health and illness, an area which has always been of special interest to me in my clinical work, first as a physician and later as psychotherapist and psychiatrist.

This lecture was delivered at the Royal College of Physicians, London, on May 23, 1983.

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The mind-body relationship is of interest for two main reasons. Firstly, because of its clinical relevance in terms of the influence of life events and personal experience on bodily function in health and disease. And secondly, because of its philosophical and theoretical implications which have been a challenge to man’s understanding of himself at least since the days of the ancient Greek philosophers.

Originally the heart or the diaphragm was considered by the philosophers to be the part of the body in which the mind or the soul was located. Even after the brain was recognised as the bodily organ on which mental activity was based, so that the question of the relationship between mind and body became a question of the relationship between mind and brain, this remained essentially a philosophical issue. The application of the methods of the natural sciences to the investigation of cerebral structure and function took a long time to develop, but in the present century clinical observations and the neuro- sciences have made and are continuing to make rapid advances, so that a great deal is now known about the influence of the brain and cerebral activity on mental functioning. Similarly. clinical and experimental psychologists, working either on their own or together with clinicians and neuro-scientists, are studying those aspects of mental processes which are amenable to objective observation and to experimentation and measurement. These disciplines have thus provided us with increasing knowledge of such phenomena as behaviour, cognition. language, memory and perception and their relation to cerebral function. On the other hand they have thrown little if any light on subjective mental phenomena, by which I mean all those inner experiences like love, hate, hope, faith, sadness, despair, imagination, play, artistic appreciation, religious experience, creativity and so on, in fact all those subjective experiences which give meaning to what we perceive, phantasize about, do and remember every day of our lives.

Psychoanalysts, psychoanalytic psychotherapists and group analysts have speciai interest and knowledge of exactly these inner, subjective aspects of mental functioning. This is why I want to share with you some thoughts on what I believe the discipline of dynamic psychotherapy can contribute to our understanding of the mind and its relationship to the body alongside the neuro-sciences and experimental psychology.

Phflosophical Conslderations I will not spend much time recapitulating all the philosophical arguments concerned with the age-old controversy between so-called mind-brain dualism and mind-brain monism. For a detailed account I refer you to Popper in ‘The Self and its Brain’ ( 3 977). Briefly, according to the dualist concept, mind and



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brain are different in nature. If’this were the case they could either be independent of and unable to influence each other; or one could influence the other; or they could interact. According to the theory of mind-brain monism, mind and b r d n are identical, in which case the hope of most, though not all modern neuro-scientists would be that ultimately all mental phenomena could be reduced to, explained and expressed in terms of cerebral function. This view is nowadays usually referred to as radical or reductive materialism. I n its extreme form all mental function would then be thought of as identical with cerebral function, so that the mind and what we consciously experience would be nothing more than a by-product of cerebral function or an ‘epiphenomenon’ which could have no influence or function of its own. Thinking, feeling, wanting. as well as conscious awareness of oneself and others, would thus become irrelevant to what happens to us in our lives and to our behaviour.

In order to avoid this extreme and clearly unacceptable form of mind-brain monism an alternative view has been put forward, namely that of psycho- physical parallelism. According to this, mind and brain are considered to be one and the same entity; but this could either be studied objectively from outside, as it were, in terms of brain function, and be described in physiological, mainly electrical and biochemical language, or it could be looked at from the point of view of the mind from inside, as it were, and be expressed in psychological language and in terms of our inner subjective experience. This view side-steps the possibility of interaction between cerebral and mental phenomena from the very outset.

There has been and to a certain extent still is considerable opposition to the possibility that mental and cerebral function could in some way be different from each other and yet capable of interacting. The historical reason for this goes back to the 17th century when Descartes introduced the dualist concept, since known as Cartesian dualism. The reason for the present-day opposition to any kind of dualistic and interactional concept of the mind-brain relationship stems from the fact that Descartes, like many of his contemporaries, postulated an immaterial soul which because of its immaterial, divine quality could not be conceived of as being able to interact with the obviously material, physical brain. Descartes believed that the soul was located in the pineal gland, a small body in the centre of the brain. He considered that everything we perceived ultimately reached the pineal gland and was there recognised and experienced by the soul. However, because of its immaterial nature the soul could not, he thought, be responsible for action and voluntary movements. He therefore postulated that there also existed in the ventricles of the brain small material substances which he thought were

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responsible for movements carried out by muscles.

contemporary of Descartes, in ‘The Anatomy of Melancholy’ (1 62 1): Similar views were expressed by the English author Robert Burton, a

‘In the upper region (of the body) serving the animal faculties, the chief organ is the brain, which is a soft, marrowish, and white substance, engendered of the purest part of seed and spirits, included by many skins, and seated within the skull or brain-pan: and it is the most noble organ under heaven. the dwelling-house and seat of the soul, the habitation of wisdom. memory. judgement. reason, and in which man is most like unto God: and therefore nature hath covered it with a skull of hard bone and two skins or membranes, whereof the one is called diira muter, or ineiiiiix, the other pia inater . . . this fore part (of the brain) hath many concavities distinguished by certain ventricles,which are the receptacles of the spirit brought hither by the arteries from the heart, and there refined to a more heavenly nature, to perform the actions of the soul’.

Nowadays the relationship between mind and brain is no longer a religious but a human and scientific issue. The Cartesian concept of soul-brain dualism which in Descartes’ days appeared incompatible with soul-brain interaction has long since been superseded by the problem of how the mind, not the soul, relates to and possibly interacts with the brain. No-one would doubt nowadays that mental function is dependent on brain function. At the same time every individual person knows that what he feels, thinks, wants, decides to do, does or phantasizes about, that is, the whole of his experience of himself and others, has a reality of its own, a psychic reality which we call our mental experience or briefly our mind. not our soul. It is the relationship of the mind, in this sense of the word, to the brain and body which I am concerned with.

The Present Scientific Position This is not the place to describe in detail what is now known about the functions of different regions or systems of the brain and about the biochemical processes governing cerebral function, and how all this relates to mental functioning. For an up-to-date account see Eccles in ‘The Self and its Brain’ referred to earlier; the Ciba symposium on ‘Brain and Mind’ (1979) and Lishman on ‘Organic Psychiatry’ (1978).

We now know that such highly developed mental functions as language, speech, ideational and mathematical ability depend on certain specific areas located in the dominant, in the majority of people the left, cerebral

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hemisphere. The results of surgery on a few patients in whom the connecting fibres between the right and left cerebral hemispheres have been divided for treatment of severe epilepsy by cutting the connecting structure, the c o r p s calloswn. have thrown a great deal of new light on the different functions and interactions between the two hemispheres (Sperry, 1974). Observations on these split-brain patients have shown that not only language but also self- conscious awareness and symbolic functioning are largely dependent on the dominant hemisphere. The minor or right hemisphere, on the other hand, is particularly concerned with spatial and pictorial ability and with non-verbal emotional experience.

Our knowledge of the cerebral basis for memory has also advanced considerably: it is now recognised that certain basal parts of the brain, the sc- called hypothalamic and hippocampal areas and their connections, as well as the neocortex, play an important r6le in memory storage. It is also now known that structural growth in neuronal cells, esQecially at the synapses, - - occurs as the result of learning and memorising, and opposite changes of atrophy are associated with disuse due to lack of stimulation; there is also evidence that learning processes depend on protein synthesis in these neurones. Knowledge is also rapidly accumulating on the function of various transmitter substances at neuronal synapses, for example in relation to changes in affect, as in depression.

These few comments have to suftice t o remove any doubts, if they were still to exist, that brain function provides the necessary physical basis for mental functioning and vice versa, that mental experience influences cerebral structure and function. We may note in passing that already in 1895 Freud attempted to correlate cerebral function and especially the function of neurones with his early psychological discoveries by trying to write a ‘Psychology for Neurologists’ or. as it was later to be called, a ‘Project for a Scientific Psychology’. He ultimately abandoned this attempt and the ‘Project’ was not published until 1950, several years after his death.

I want to stress at this point that the upto-date neuro-psychological findings o f the kind briefly referred to have made it clear that t o speak of either the brain or the mind is a gross over-simplification. The brain, although one organ anatomically speaking, consists of many different parts, systems and connecting fibres, of millions of neurones, synapses and collections of ncurones. We have learned to think of many different cerebral functions and physiological processes each of which needs to be studied in its own right.

Similarly, the concept of the mind as an entity needs to be revised. The ‘mind’ is in fact not a thing or object located somewhere in the body or in space but a word used to embrace a multitude of different, though often

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interrelated, psychological processes and mental phenomena and personal experiences. This fact is well known not only to psychologists but especially to psychoanalysts, who are used to thinking in terms of multiple internal object relationships, mental representations, thoughts and phantasies, conscious, preconscious and unconscious mental processes, wishes, feelings, defence mechanisms and so on. The days when one could speak of rhe mind or the brain and their inter-relationship are over: instead we are now concerned with a multiplicity of cerebral and mental phenomena and their relationships.

I want here to refer particularly to man’s ability to be consciously aware of himself and others, that is. to the phenomenon of consciousness in general and of self-conscious awareness in particular. We are all able to reflect on ourselves, to observe our own feelings. thoughts and actions, or to be introspective. In fact it is one of the tasks of psychoanalysis, psychotherapy and group analysis to increase and refine our patients’ knowledge of themselves, as well as our own understanding of ourselves. The cerebral basis of consciousness and self-awareness is still far from being understood but as conscious experience is closely related to our ability to think and to express our thoughts through language. that is. in symbolic form, there is reason to believe that the speech area in the dominant hemisphere on which symbolic function and language depend may also be connected with our capacity for self-awareness (Popper and Eccles. 1977).

Although conscious awareness of the environment and of others and possibly to a limited degree even of the Self may occur in the case of some higher mammals, it is clear that man’s ability to think, to express himself and to communicate with others in symbolic terms, that is through language and speech, and to be aware of himself as a unique individual are among the most characteristic and highly developed features of the human species. If we accept the concept of Darwinian evolution and recognise that the human species has evolved through natural selection, it follows that the highly complex human brain is the result of such an evolutionary process. The evolution of the human brain has made it possible for mankind to develop its characteristic mental functions. including those of self-awareness, symbolism and language, and thus to our ability to relate to and to understand others, to exist as unique individuals in social organisations and to control society and our physical environment to an extent which vastly exceeds that of any other animal species. In this sense the evolution of the brain and hence of mental processes and social functioning has given the human species an advantage over all other species in existence so far.

I must, however, remind you of the fact that these physical evolutionary processes and resulting social developments are by n o means all of advantage

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to our species. Freud (1929) already drew attention to the fact that some of these highly developed human functions could under certain circumstances be used to our disadvantage and even to self-destruction. The concluding paragraph of ‘Civilization and its Discontents’, reads as follows:-

‘The fateful question for the human species seems to me to be whether and to what extent their cultural development will succeed in mastering the disturbance of their communal life by the human instinct of aggression and self-destruction. It may be that in this respect precisely the present time deserves a special interest. Men have gained control over the forces of nature to such an extent that with their help they would have no difficulty in exterminating one another to the last man. They know this, and hence comes a large part of their current unrest, their unhappiness and their mood of anxiety. And now it is to be expected that the other of the two ‘Heavenly Powers’, eternal Eros, will make an effort t o assert himself in the struggle with his equally immortal adversary. But who can foresee with what success and with what .result?’

Today this danger is vastly greater even than it was when Freud wrote this paragraph in 1929. Mankind is now facing the threat of destroying itself as the result of the discovery of nuclear weapons, through nuclear war. Scientific discoveries and social developments which have followed the physical evolution of the human brain have left mankind with this most serious conflict between survival and self-destruction, between love and hate. Conflicts between these two opposites are characteristic of every human individual and they make their appearance in every social organisation, including the therapeutic group. In all individual and group psychotherapy, therefore, we have to deal with this basic human issue of how to contain aggressive and destructive impulses, and how to foster the capacity for human concern as a balancing force to counter aggressive behaviour. However, these remarks anticipate the next part of this lecture, namely, further consideration of the structure and function of the mind.

The Mind as the Hlghest Level of Biological Organization I hope I have made it evident by now that cerebral processes provide the essential physical basis on which the occurrence of mental processes depends. Mental processes, however, differ from cerebral processes in as far as they take place at an even higher level of biological organisation than the physical processes within the brain. The concept of levels of biological organisation is fundamental to our present-day understanding of the mind-brain and mind-

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body relationship. At each level of biological organisation the principle applies that the ‘whole is greater than its parts’. A single cell o r a unicellular organism like an amoeba, although it is composed of atoms, molecules, and chemical substances which interact with each other, has a structure and function of its own, and as such it relates to and interacts with its environment. This principle applies at every higher level of organisation. so that each organ, which consists of a multitude of cells. has its own structure and functions, dependent, of course, on its component cells. The human organism as a whole similarly has its own characteristics and functions: these, in turn, depend on all the component organs which make up the body, and on their interaction. Moreover, the behaviour of the organism as a whole influences its various organs and its component cells by as it were a feed-back process, or so-called downward causation.

If we apply this principle to the mind-brain relationship it follows that while mental processes depend on individual cerebral structures and functions, the multiplicity of mental processes, commonly referred to as the mind, functions at a higher level of biological organisation than the brain. The mind has its own structure and function and as such it has to be studied and described at its own level of organisation, that is in psychological and experiential terms. It cannot be described in or reduced to the terms governing cerebral function, which belong to a lower level of biological organisation.

The following analogy, taken from group analysis, may help to clarify this further. One of the most important concepts underlying group psychotherapy, and Foulkesian group analysis in particular, is that the therapeutic group, while it consists of its individual members and the group conductor, functions as a whole. Each member of the group, through what he says, through his behaviour and interactions with other members, or just by his silent presence contributes to the atmosphere or, as Foulkes called it, the matrix of the group as-a-whole. Foulkes’ ideas concerning the group matrix have recently been reviewed by Roberts (1982). The group evolves or emerges from its component members but it functions as a whole at a higher level of, in this case, social organisation. It has its own structure and function which goes beyond the sum of its parts, that is. beyond the sum of its individual members. Foulkes (1964) says: ‘It becomes easier to understand our ciaims that the group associates, responds and reacts as a whole. . . In this sense we can postulate the existence of a group mind in the same way as we postulate the existence of an individual mind’. Equally important is the fact that the group in turn affects its individual members and the conductor. Each member’s feelings, thoughts, phantasies and behaviour are constantly being influenced by what is going on in the group as a whole. We are thus confronted in the grouptherapeutic process

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with constant interaction between the individuals in the group and the group as a whole. The group affects and influences each member, just as each member contributes to the structure and function of the whole group. We have here a perfect example of upward and downward causation, or of a feed-back system between two levels of organisation.

This analogy may help us understand better how all the separate structures and functions of the brain similarly make up the totality of our mind, which functions as a whole but is more than the sum of all the component brain functions. The mind or what we experience in turn affects our brain and its functions by what I have already referred to as downward causation. Just as the individual group members and the group as a whole are in a constant state of interaction, so are cerebral and mental functions, or brain and mind, interacting with each other. The mind cannot exist without the brain, just as the group cannot exist without its individual members. The brain by upward causation influences the mind, and the mind by downward causation in turn influences the brain and through the brain other parts of the body, just as the group affects its members and their behaviour in the group, through a constant process of interaction.

The Mind and its Functlons Having thus established that the mind emerges from the brain, or to put it in terms of function, that mental function emerges at the next higher level of biological organisation from cerebral function and that mental and cerebral functions interact with and influence each other, we are ready to consider what determines the development of each individual person’s mind, its content, its functions, and the nature of that individual’s experience. It is at this point that we need to give full recognition to the influence of the personal, social and cultural environment on mental development and conscious experience (Crook, 1980).

To an audience largely composed of psychotherapists, group therapists, psychoanalysts, psychologists and sociologists it may appear self- evident that it is the influence of the outside world and of our relationships to objects and people with whom we interact from infancy onwards, and later with society at large, which determines the development, content, structure and function of the mind. While the brain provides the necessary physical basis for mental functioning, it is the social and cultural environment which is responsible for its content and meaning. The outstanding contribution which the individual’s experience in infancy and childhood makes to the development of mental functioning, of personal attitudes and the meaning of experience has, of course, been studied in great detail by psychoanalysts and dynamic

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psychotherapists, and more recently also by psychologists (Trevarthen, 1977; Schaffer, 1977).

In this context I would also like to draw your attention to the important distinction between mechanism and meaning made by Denis Hill in his Ernest Jones lecture given in 1970. Mechanisms belong to the level of cerebral function; meanings belong to the level of mental function. It is psychoanalysis which has made such an important contribution to our understanding of how human development from birth onwards and throughout childhood, adolescence and adulthood shapes the meaning and nature of our experience and the functions of the mind. These mental functions need to be studied, understood and described in psychological, psychodynamic and psycho-social terms. They require full recognition of the individual’s subjective experience as well as of inter-subjective experience between persons and groups of people. Objective observations of cerebral mechanisms and of human behaviour, however important they are as instruments of research, have to be integrated with the study and description of subjective experience, of phantasy and of intrapsychic processes if we are to increase our understanding of individuals, groups and social organisations. The contributions made by Foulkes and group analysis in some of these respects speak for themselves.

Out of the many mental functions which constitute the essence of being human I will refer to only a few which are of special concern to us. These include the meaning we attach to our experience; our capacity for symbolisation and hence to use language and other symbols for communication; our ability through empathy, projection and identification to understand other people and to relate to them, and our highly developed ability to be conscious of ourselves, and of our subjective experience; as well as its opposite, so well known in the psychotherapeutic process, namely to split off, project, make unconscious through repression, or to deny those aspects of ourselves and of our experience which we want to disown.

It is not possible to say exactly when an infant can first be said to attach meaning to what it perceives from within itself or from without, to what is happening to it in relation to its own body or to its environment, represented by its mother, and to its own actions or movements. All we can say is that a mother who, to use Winnicott’s expression (1965), relates to her baby in a state of primary maternal preoccupation can very early on recognise the meaning of her baby’s behaviour and respond to it appropriately, through her capacity to be a good-enough mother. At this earliest stage of development when mother and baby are still in a state of fusion it is thus the mother who carries the function of giving meaningfulness to the shared experience of the infant-mother couple. Soon, perhaps within a few days after

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birth, the situation begins to change, so that the infant itself m&y have the first inkling of what we call meaningful experience. At this earliest stage meaningfulness from the infant’s point of view is, of course, entirely non- verbal or pre-verbal; it has to do with feeling, not yet with thinking. We could speak of the infant beginning to learn from and in its relationship to its mother, that experience is associated with meaningful feelings.

How do we know and recognise that this is happening? I would suggest that the best evidence comes from the mother herself, and from those other significant adults, the father included. who are in close relation to the baby. Infant observation by psychologists. psychoanalysts and dynamic psychotherapists has contributed to our growing knowledge in this field. Equally important is what we have learned from child psychotherapists and child analysts, especially Anna Freud, Melanie Klein, Winnicott and others. Another vital contribution comes from therapists and analysts who have worked with adult patients passing through periods of regression. At such times the regressed patient has sensations, feelings, phantasies, thoughts and bodily experiences often associated with great anxiety, intense frustration, fear and hopelessness, or at other times of rest and contentment in his or her transference relationship. But the meaning of these experiences is usually unknown to the patient while in a state of regression. Instead it is what the therapist experiences in his counter-transference which combined with his training helps him to understand at a thinking and knowing level what the meaning of his regressed patient’s experience might be. It could be said that the function of attaching meaning to experience is for the time being posited in the analyst or group analyst, ‘just as it was once posited in the mother in relation to her infant.

As the infant develops further. its own separate ability to attach meaning to experience increases and is certainly very obvious when the infant reaches the age of a few weeks to two months. During these first few weeks of life we can observe the gradual emergence and development of the infant’s mental function. The cerebral mechanisms available at and developing further after birth provide the essential physical basis for this early development but it is the facilitating environment provided by the mother and soon also by others in the infant’s environment on which the emergence of meaningful mental function is so utterly dependent. It is of interest to note that while it was Winnicott (1965) who stressed the importance of the facilitating environment for maturation to take place, Trevarthen (1979), a neurepsychologist, also speaks of consciousness requiring ‘a facilitating environment’. He goes on to say that: ‘consciousness depends upon and is developed by an environment of objects and meanings which is inevitably altered by consciousness’. I find it

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encouraging to see that from these different fields of psychoanalysis, psychology, sociology and the neuro-sciences an integrated view of the nature and function of the mind is thus beginning to emerge.

Next, the capacity to make use of symbols arises out of our ability to endow objects and persons with meaning. I n infancy this can, of course, be seen in the use infants make of transitional objects, of toys and of play (Winnicott, 1971). This is accompanied by the development of phantasy and the use of baby language, leading ultimately to the specifically human capacity to use words and language for communication. I have earlier referred to the fact that the use of language is dependent on the development and function of the speech area in the dominant hemisphere of the human brain but we can now recognise clearly how the actual development of linguistic function is determined by the relationship of the child to significant others and to its social environment, and by the growing ability to use words as symbols.

Language, speech, writing. reading and related forms of communication in turn make it possible for information and creative work to be passed on from generation to generation. This leads to the evolution of culture which includes literary, artistic, scientific. social. spiritual, religious and many other forms of specifically human concepts and activities. Each individual human being’s mind is therefore constantly being influenced by the social and cultural environment in which he develops and exists. Psychotherapy, both of individuals and in groups. provides us with a unique opportunity of studying this constant interaction between the inner and outer world through such processes as introjection. identification. projection, projective identification and so on. It is, I submit, the psycho-therapeutic process based on psychoanalytic and groupanalytic concepts which has contributed so much and will, I am sure. continue to provide further knowledge and understanding of these many different functions of the mind.

I have left further consideration of the phenomenon of consciousness, including conscious awareness of the self and of others to the end of this part of my lecture. In this area there is still a great deal of uncertainty, in terms of understanding . of the underlying cerebral mechanisms, although much progress is now being made (Creutzfeld, 1979). But the following comments, based on knowledge derived from the psychotherapeutic process, will I hope be helpful at the level of mental functioning.

When we speak of being conscious we always mean that we are being conscious of something: that is. the concepts of object-relations theory help us to recognise that consciousness is always object-related. The object may be some aspect of our environment. a person, part of a person, a group of people, or a material object of some kind. In early childhood the infant is probably

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first conscious of sensations arising from its own body, then of some aspect of its mother, and later of the mother as a whole person. As a sense of an autonomous self, the awareness of ‘I-am-I’ develops, we learn also to become conscious of our identity, our personal attitudes and beliefs, and ultimately of many other aspects of our own inner world. These include internalised objects and associated memories, feelings. thoughts, wishes, phantasies and so on. Our mind is capable of turning conscious attention to one or more of these outer or inner objects at any one time. It is during the psychotherapeutic process that we are constantly concerned with these aspects of mental function. We are also particularly concerned with the fact that we are so often unaware, that is unconscious. of the reasons for our attitudes, beliefs and behaviour, and much of analytical psychotherapy is, of course, directed towards bringing these unconscious aspects into consciousness. Even when asleep, conscious awareness returns to us in the shape of dreams which reveal, usually by means of symbolism. some of these unconscious mental phenomena. My central conclusion in these respects is that we need to abandon the belief that consciousness is a wholesale phenomenon capable of a single explanation. There are different degrees of consciousness and unconsciousness, and in either case we have to study what determines conscious awareness, or the lack of it, in terms of cerebral function, and in terms of specific objects and functions of the mind and of our environment.

Psychosomadc Concepts The previous considerations. which have led us to think in terms of brain-mind interaction, upward and downward causation between the two, and the dependence of mental function on the personal and social environment, should help us clear up some of the misconceptions and difficulties relating to so- called psychosomatic illness, psychosomatic medicine or, as I prefer to call it, the psychosomatic approach. I will restrict myself to only a few comments.

The first of these is that the term ‘mysterious leap from mind to body’ coined by Freud, later discussed by Deutsch (1959) can now finally be dispensed with, as has been argued by Murray Jackson (1979) and others. In fact from all that I have discussed and summarised it follows that on the contrary it would be most surprising if life events and personal experience, which affect our mind and brain, in their constant state of interaction, and all we now know about the influence of the brain on the body through the endocrine and. autonomic nervous system, did not influence our state of physical health or ill-health.

The next important point is that in the field of medicine as a whole it is gradually being recognised that in many diseases it is necessary to think in

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terms of multifactorial aetiology. several biological, psychological and social factors and their interaction having, to be considered rather than one single biological or psychological cause. The belief, for example, that some physical disorder, say, duodenal ulcer. could be either entirely of organic origin or entirely psychogenic is being replaced by recognising that genetic, constitutional and acquired physical factors, as well as psychological ‘and social stresses need all to be taken into account in deciding why a particular person has developed a particular illness, o? has suffered a relapse at a particular time in his life. The belief that there is a limited number of structural diseases which are ‘psychogenic’ has been replaced by this multifactorial or bio-psycho-social approach to patients and their symptoms or illnesses in general. In the psychosomatic approach the concept of physical vulnerability to stress of one or other target organ, say, the colon in ulcerative colitis, the duodenum in duodenal ulcers, or the brain in schizophrenia, pays the necessary attention to organic or bodily aspects on the one hand and to social stresses and psychodynamic factors on the other.

I next want to emphasise that the time has come also to avoid the over- simplified view that one or other par$ular psychc-analytic explanation could account for the development of all structural or physiologically determined psychosomatic symptoms and disorders. For example, most- workers in this field have abandoned the view that specific personality types or specific conscious or unconscious conflicts (Alexander, 1950) can necessarily be correlated with specific structural diseases. This view has to some extent been replaced by a hypothesis based on object-relations theory (McDougall, 1974). This hypothesis suggests that individuals who have at an early stage of their development failed to internalise from a containing mother or mother-figure the capacity to use symbolisation and phantasy formation to contain psychic pain due to, say, separation or losses, may be especially prone to develop psychosomatic symptomatology. Or, to put it the other way round, that individuals who have developed the capacity to deal with psychic pain through symbolisation, phantasy formation and emotional self-expression might be better protected against the development of psychosomatic bodily disorders.

The problem here is that psychosomatic symptoms of one kind or another are almost universal; they occur in patients with a wide variety of personality types and internal psychic structure and function. Moreover, the same patient may have a psychoneurotic symptom,’ say I conversion hysteria br anxiety neurosis in which symbolization and phantasy are of paramount importance, at one time, and a psychosomatic symptom at some other time, or even simultaneously.

It is also important to note that an impoverishment of phantasy life, of

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symbolic functioning and of emotional self-expression thought of as characteristic of patients with psychosomatic symptoms, and described as alexithymia by Sifneos (1973) and as pensee opirutoire' by Marty and de Muzan ( 1963), whilst common in patients with psychosomatic symptoms, also occurs in patients with psychoneurotic symptoms and in normal people.

I would, therefore, like to suggest that while these and other formulations may indeed be applicable in particular patients, it is not appropriate at present to try and explain all psychosomatic symptomatology, be it due to structural disease or physiological dysfunction, on the basis of a single psychodynamic hypothesis. Instead we need further detailed studies of individual patients, and research at a variety of levels, that is,,at the level of bodily and cerebral function, at the level of psychodynamic structure and functioning, and at the level of social functioning. with special emphasis on the interactions that take place between body, brain, mind and the social environment.

The Psychotherapeutic Process Although I have based much of what I have said so far on what we have learned from psychoanalysis, group analysis and dynamic psychotherapy in general I want to conclude by briefly looking at a few of the impliiations of the concept of mind-body interaction for dynamic psychotherapy itself. This I would like to do under two closely related headings: the attitude of psychotherapists, and the work they do with their patients. For the sake of brevity I shall here use the words psychotherapy or psychotherapist, for all forms of dynamic psychotherapy, including psychoanalysis, group analysis and the various forms of analytically oriented individual, group and family therapy.

Taking the psychotherapeutic attitude first: the therapist by the very nature of his professional work and training needs to keep the focus of his attention, centred on his patient's mind with its psychic reality. It is what the patient experiences and conveys to his therapist that he is concerned with, and with the attempt to understand its meaning. Whilst as therapists we therefore fully acknowledge the reality of mental phenomena and hence of our patients' subjective as well as objective experiences, we need at the same time to remain aware of the reality of the body and its relation to mental phenomena. This implies an attitude on the part of the therapist which acknowledges the profound impact which emotional experience, including experience in the transference and in the patient-therapist relationship in general, has on bodily function. And conversely, of course, that bodily processes, our instinctual needs and the various bodily functions affect our phantasy life and personal development and thus our mental functioning both in health and in illness. The

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inescapable fact that the body in its own right is prone to illness and ultimately cannot escape death needs to be sipilarly acknowledged. Physical illness can affect mental function not only directly but also indirectly because it can lead to phantasies which are often secondary to physical symptoms, to severe anxiety, fear of loss, actual loss and other forms of psychic pain.

Freud was of course profoundly aware of the intimate relation between mental phenomena and bodily functions andsexpressed this in ‘The Ego and the Id’ (1923) where he says: ‘The Ego is first and foremost a bodily Ego’. In the light of what I have discussed in this lecture I would like to interpret this statement of his as indicating not identity of body and mind but the fact that mind and body are in a constant state of mutual dependence and interaction. To be aware of this is one of the essential attitudes required of all psychotherapists.

How then does this affect the actual psychotherapeutic work? Firstly, I want to stress how much of what the patient communicates to his analyst or therapist and in groups to the group leader and the other group members is in fact conveyed non-verbally through bodily behaviour. Although this is of course a well-known and widely recognised fact I believe that in the actual practice of individual and group therapy more systematic attention needs to be paid to this than is usual. The facial expression; restless movements of arms or legs or of the whole body: repetitive gestures, lying on the couch, or sitting up, in a state of tension and immobility, or being silently relaxed or even falling asleep; the nature of the patient’s breathing, all these and other easily observable physical phenomena need to be recognised as having meaning of which the patient is often quite unaware. The therapist can use these bodily expressions of mental processes to understand what may be going on at the time and, when appropriate. draw the patient’s attention to them, and use them as a basis for interpretation.

The other point concerning the work that is being done in therapy is connected with the counter-transference. Its central importance is, of course, acknowledged by all dynamic psychotherapists but I want to draw attention to the fact that the therapist may not only have thoughts, feelings and phantasies but also bodily sensations which arise in him during the sessions which may reflect his response to what is being conveyed to or projected into him unconsciously by the patient. Feeling tense, being restless, making movements like shifting one’s position in the chair, actual physical discomfort, like a sudden headache, or the opposite, feeling very relaxed and at ease, almost to the point of falling asleep. should be noted and an attempt be made

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to understand their meaning in terms of what the patient may be projecting into the therapist. Hopefully, as therapy progresses patients will as a result themselves become increasingly aware of the close connection between their emotional experiences and their physical sensations, symptoms and behaviour. These few remarks on the actual process of psychotherapy will have to suffce in the context of today’s lecture.

Conclusion I would like to end by sharing with you my main conclusions, if you like, my personal view, which follows from the thesis of mind-body interaction in the form in which I have put it forward.

The human mind occupies a very special position in our world. It provides meaning - and at times non-meaning - of each individual for himself and for others. The mind stands at the very centre of all that man has created in terms of thought, play, imagination, culture, art, science, social organisations, religious and spiritual experience and so on. It provides the basis in each of us for the capacity not only to act and to do, but also to exist and to be.

More specifically, in the context of today’s lecture, it is the human mind that has created the fields of psychoanalysis, group analysis and psychotherapy in its various forms. The essence of each of these is that the mind observes and studies itself. Similarly. it is the human mind that has created the scientific knowledge now available in the neuro-sciences which have thrown so much light on the brain and in turn, through the brain, on the mind itself and on their inter-relationship.

By thus giving the mind its proper place at its own level of biological organisation, whilst never ignoring its physical dependence on and interaction with the brain, as well as with the world around us, we can, I hope, avoid the pitfall of attempting to reduce mental t o physical or behavioural processes. The human mind deserves respect in its own right. With that thought may I now leave it t o the minds of each of you to consider further the meaning of what I have tried to share with you.

References

ALEXANDER, F. ( 1 950) Psychosomatic Medicine. New York. Norton. BURTON, R. (1621) The Anatomy of Melancholy. Vol. 1. pp. 153-154. London. Everyman’s

CIBA FOUNDATION SYMPOSIUM 69 (New Series) (1979) Brain and Mind. Amsterdam. Excerpta Library, 1932.

Medica.

111



GROUP ANALYSIS

CREUTZFELDT, 0. D. (1979) Neurophysiological Mechanisms and Consciousness. In ‘Mran and Mind’, Ciba Foundation Symposium 69 (New Series), pp. 217-233. Amsterdam. Excerpta Medica.

CROOK. J. H. (1980) The Evolution of Human Consciousness. Oxford. Clarendon Press. DEUTSClf. F. (1 959) On the Mysterious Leap from the Mind to the Body. New York. Int. Univ.

FOULKES, S. H. ( 1 964) Therapeutic Group Analysis. London. George Allen and Unwin. FREUD. S. (1895) A Project for a Scientific Psychology. Standard Edition. Vol. 1, pp. 283-387.

FREUD. S. (1923) The Ego and the Id. Standard Edition, Vol. 19, pp. 3-63. London. Hogarth

FREUD. S. (1929) Civilisation and Its Discontents. Standard Edition, Vol. 21, pp. 59-145.

HILL, D. (1 970) On the Contributions of Psychoanalysis to Psychiatry: Mechanism and

JACKSON, M. (1979) Psychosomatic Medicine: The Mysterious Leap from the Psychic to the

LISHMAN, W. A. (1 978) Organic Psychiatry. Oxford. Blackwell Scientific Publications. MARTY, P. AND DE MUZAN. M. ( 1 963) La Pensb Ogratoire. Rev. Fr. Psychoanal. 27, Suppl., p.

MCDOUGALL, J. (1 974) The Psychosoma and the Psychoanalytic Process. Int. Review Psyche

POPPER. K. R. AND ECCLES. J. C. (1 977)The Self and its Brain. Berlin. Springer Int. ROBERTS. J. P. (1 982) Foulkes’ Concept of the Matrix. GROUP ANALYSIS, XV, 1 1 1-1 26. SCIIAFFER. H. R. (1977) (ed.) Studies in Mother-Idant Interaction: The Loch Lomond

Symposium. London. Acad. Press. SIFNEOS, P. E. (1973) The Prevalence of Alexithymic Characteristics in Psychosomatic

Patients. Psychother. Psychosom. 22, 255-262. SPERRY. R. W. ( I 974) Lateral Specialisation in the Surgically Separaied Hemispheres. In ‘The

Neurosciences: Third Study Program’ (eds. Schmitt, F. 0. and Worden, F. G.), 5-20. Cambridge, Mass. MIT Press.

TREYARTHEN, C. (1977) Descriptive Analyses of Infant Communication Behaviour. In ‘Studies in Mother-Idant Interaction: The Loch Lomond Symposium’ (ed. Schaffer, H. R.) 227- 270. London. Acad. Press.

TREVARTlIEN, C. (1979) The Tasks of Consciousness: How Could the Brain do Them? In ‘Brain and Mind‘, Ciba Foundation Symposium 69 (New Series), 187-215. Amsterdam. Excerpta Medica. r

WINNICOTT, D. W. (1965) The Maturational Processes and the Facilitating Environment. London. Hogarth Press.

WINNICOTT. D. W.( 1971) Playing and Reality. Harmondsworth. Penguin Books.

Press.

London. Hogarth Press.

Press.

London. Hogarth Press.

Meaning. Brit. J. Psychiat. 117, 609-615.

Somatic. (awaiting publication).

1345.

Anal. 1, 437-459.

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