Читать книгу Introducing Cognitive Analytic Therapy - Anthony Ryle - Страница 47

There has been a profusion of research in recent years from the field of developmental neuroscience relevant to understanding and making therapeutic use of such a concept of Self, in particular with regard to its relational and developmental dimensions. We can only highlight some of this here as it appears relevant, but those who wish to pursue these understandings further may do so through the references offered and related literature. This research includes work by a range of authors over recent years (e.g., Adolphs & Anderson, 2018; Cozolino, 2014; Damasio, 2012; Glover, 2011, 2015; Knox, 2010; Meares, 2012; Moffit & The Klaus‐Grawe Think Tank, 2013; Northoff, 2014; Northoff et al., 2006; Panksepp & Biven, 2012; Qin & Northoff, 2011; Schore, 2012; Siegel, 2012; Toth & Cicchetti, 1998; Tsakiris, Costantini, & Haggard, 2008; Uddin, Clare Kelly, Biswal, Xavier Castellanos, & Milham, 2009). Some of this research postulates firstly the existence of a deeper “core” or “proto” Self located neuro‐anatomically largely around deeper mid‐brain areas such as the superior colliculus and periaqueductal gray (PAG). This concept Panksepp also capitalizes to imply a substantive entity. This core Self, which develops early, is responsible functionally for our fundamental, unconscious, bodily sense of proprioception, and sensorimotor and rhythmic (possibly proto‐musical) awareness of Self and the outside world. Integrity of this domain is likely to be important for subsequent coherence and continuity of the Self both subjectively and clinically. Recent research suggests that higher putative sub‐cortical structures of the Self include the limbic system (involved in emotion processing and recording of associated memories), and the default mode network (DMN) which is active when an organism is otherwise inactive, and is involved in introspection, rumination, processing, and probably in contributing also to a subjective sense of Self (Raichle et al., 2001; Uddin et al., 2009). Research over recent years has suggested that it is principally right brain structures that are involved in more complex aspects of a more “autobiographical” or “idiographic” Self (Damasio, 2012; Panksepp & Biven, 2012; Schore, 2012) and also of (internalized) relational experience, however conceived of (e.g., as “internal objects,” “schemas,” or “reciprocal roles,” or the collective “nos” described from a group analytic perspective (Ormay, 2012). The right brain is increasingly understood as the location of more complex, synthetic, “bigger picture,” often unconscious and intuitive, decision making and creativity. Importantly, these structures develop on the basis of relational experience most critically over the first few years of life, that is to say pre‐verbally and at a stage before retrievable memories are laid down (Corrigan & Hull, 2018; Damasio, 2012; Panksepp & Biven, 2012; Schore, 2012). Relational interactions are also understood to be mediated by and have broader neuro‐biological underpinnings through, for example, the endocrine system and neural hormones such as dopamine and vasopressin (see e.g., Decety & Ickes, 2009; Gantt & Badenoch, 2013) and also to be mediated in part by stress hormones of the hypothalamo–pituitary (HPA) axis, such as cortisol. It is well documented that stress‐related abnormalities of the latter (including antenatally) may be transmitted transgenerationally by epigenetic mechanisms (i.e., involving control of gene “dosage” rather than the structure of DNA) and may have life‐long adverse effects on all aspects of health and well‐being (see Chapter 4 and Glover, 2011). The human capacity for intersubjectivity, empathy, and relationality is also now understood to be mediated in part by networks of “mirror neurones” (Ammaniti & Gallese, 2014; Iacoboni, 2008; Rizzolatti & Sinigaglia, 2007). These may in turn be impaired in disorders such as autism and impairment in the capacity to generate a “theory of mind.” However, some argue rather for the importance of difficulties with emotionally mediated interactions in the genesis of autism (Hobson, 2002). Variations in these various capacities (such as in autistic “spectrum” presentations), although also possibly adaptive and advantageous in certain contexts, may play a greater role than hitherto appreciated in more general problems in living and formal mental disorder (Happe & Frith, 2014; Lloyd and Clayton, 2013; Trevarthen, 2017). The role of the autonomic nervous system with regard to relationality has also been further detailed and described in recent years through an important body of work, notably through the “polyvagal” theory developed by Porges (2011). This describes the important role of notably the parasympathetic nervous system (normally a “soothing” antithetical force to the “fight or flight” responses activated by the sympathetic nervous system) largely mediated by the tenth cranial (vagus) nerve which is seen as part of a “social engagement system.” This acts through its innervation of and feed‐back from, for example, the heart, lungs and breathing, facial and throat muscles, and visceral digestive organs. All of these are implicated in the expression of emotion and in mammalian social engagement and safety‐seeking in response to threat, with important implications for normal psycho‐physiological development and, implicitly, of the Self overall. Specific implications of this theory involving trauma and dissociation are further elucidated by Corrigan (2014). This work can be seen also to complement the work of developmental psychologists such as Narvaez, Wang, and Cheng (2016) who note the importance of an “Evolved Developmental Niche” for mammalian, but especially human, infants. This implies the need for a long period of attuned support, nourishment, and affectionate care from parents, family, and a whole community. By contrast, the left brain is seen increasingly in evolutionary terms as more of an intellectual “add‐on” involved in more rational, concrete calculations and logic and language, but as essentially subservient to the right brain and sub‐cortical processes when it comes to affectively important or intuitive actions or decision making (see McGilchrist, 2009; Trevarthen, 2017). Nonetheless, important aspects of human psychology, or of the Self, are at least partly influenced by and mediated through left brain function, including more conscious beliefs and values. Furthermore, use of (verbal) language is an important mediator of thought and experience and is an important means of storing and accessing human culture overall and of enabling communication and social function (and see below). Indeed, talking therapies operate mostly in this domain, albeit accessing also in this way deeper, sign‐mediated, and symbolic levels of affect and memory. The emerging findings noted above clearly raise questions about the importance of addressing deeper and non‐verbal domains of the structure and function of the Self, as well as its relational and social context, especially perhaps for the effects of profound, especially early, relational trauma. All of these structures and processes may, it appears, be disrupted and damaged by relational adversity, psychological trauma, and stress (see further discussion in Chapter 4). This body of work evidently has considerable important implications for psycho‐social development, mental disorder, and its treatments.