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Our Right Hemispheres

Posted by Pfinstegg on February 8, 2004, at 2:54:12

I have just finished reading two extremely interesting books by Allan Shore, a psychoanalyst and neuroscientist, about the role of the right hemisphere in the development of mood disorders (Vol 1), and the role of that hemisphere in psychotherapeutic treatment (Vol 2).

In the first volume, the importance of the right hemisphere during the first three years of life was explained in great detail. It develops much faster than the left hemisphere, and is the part of the brain infants use to assess the safety of facial expressions and body language expressed by its caregiver. It does this very rapidly, in about 1/200th of a second. Once the assessment is made, messages are sent down to the amygdala and hippocampus (the centers for feeling and memory- with the amygdala specialized for fear). These centers, which altogether comprise the limbic system, in turn send messages down to the autonomic nervous system. If a fear message is sent, the body responds with increased heart rate, breathing and blood pressure. The infant feels and looks frightened, and will look away and try to avoid the gaze of its caregiver; if the fear is very extreme, the baby will freeze, go limp and hang its head down. If the message is one of "everything's OK", the infant will relax, respond with a happy look, try to move closer, etc.

In normal infant development, repeated reassuring non-verbal messages cause a part of the right hemisphere- the orbital frontal cortex- to develop well. This part can control the fear centers in the limbic system, so that, as the infant matures, it can calm itself easily after frightening incidents, and return easily to a state of well-being. But if the care-taking has been poor or inadequate, the orbital cortex does not develop as well, and the growing child has prolonged periods of limbic and amygdala-dominated fear and avoidance responses. In Vol 1, there were fascinating simultaneous photos of mother-infant pairs; it was amazing how very slight changes in the mothers' faces- disinterest, withdrawal, anger, over-intrusiveness, depression - could produce fear responses in the babies. The main point of this volume was that the kind of care-giving (mothering, almost always) which the baby receives determines the architecture of the right hemisphere by the age of three, and that "affect dysregulation" during this period determines whether the baby will grow up to have a mood disorder. He thinks that all the disorders of affect dysregulation are pretty much the same, whether they are called PTSD, BPD, anxiety or depressive disorders.

Well, it was pretty discouraging to read about the abnormal right hemisphere architecture in Vol 1! However, Vol 2 was much more encouraging. it was entitled "Affect Dysregulation: Psychotherapy and the Repair of the Self". In it, he described how all forms of psychodynamic psychotherapy, ranging from psychoanalysis to once a week psychotherapy- all the kinds of therapy which use the relationship and interactions between therapist and patient as the most important modality- actually physically repair the abnormal right orbital frontal cortex damaged during the earliest period of life. It's not done verbally, according to Shore, but in the same way that mothers and babies do it -in face-to-face interactions which takes place with split-second timing, below the conscious level. Only a minute or two later do the therapist and patient put words on to what has happened. The words are important, as they feed back from the left hemisphere to the right orbital frontal cortex, which possesses very simple language. However, the most important event is non-verbal: the right hemisphere of the patient communicating with the right hemisphere of the therapist- at lightning speed! He showed some amazing photos of functional MRIs of patients who had been treated for panic disorder, compared to a group with the same diagnosis who were still on a clinic waiting list. They were all given a big challenge- to give a speech before a group. The patients who had received psychotherapy had amygdalas which "lit up" only half as much as those who were waiting to receive it. This must be one of the first times that brain imaging has been able to prove the effectiveness of psychotherapy.

Thought you'd like to know!

Further thoughts: doesn't this make the hundreds of really heart-felt posts about the importance we place on the relationships with our therapists make a lot of sense? Instinctively, we all *know* how vital these relationships are to our well-being and future health.

So far, Shore has only written about what happens up to age 3. But he mentioned how often maternal neglect is followed by some sort of paternal abuse, whether emotional, physical or sexual, so I suspect there will be a Volume 3. But what he has written so far has convinced me that maternal neglect of some kind is enough to cause the whole range of mood disorders,which he calls "disorders of affect regulation".





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