Memories 'Geotagged' With Spatial Information in the Hippocampus

A still from the game participants played. They made deliveries to stores, then were asked to recall what they had delivered. (Credit: University of Pennsylvania)

New research has confirmed that cells in the hippocampus responsible for processing memories encodes ("geotags") the memories with spatial information that allows us to remember where and when it occurred. Recalling that memory can trigger other memories from the same location.

Science Daily offered a god summary of the press release, and NPR spoke with one of the principle researchers involved in the study.

Memories 'Geotagged' With Spatial Information

Nov. 28, 2013 — Using a video game in which people navigate through a virtual town delivering objects to specific locations, a team of neuroscientists from the University of Pennsylvania and Freiburg University has discovered how brain cells that encode spatial information form "geotags" for specific memories and are activated immediately before those memories are recalled.

Their work shows how spatial information is incorporated into memories and why remembering an experience can quickly bring to mind other events that happened in the same place.

"These findings provide the first direct neural evidence for the idea that the human memory system tags memories with information about where and when they were formed and that the act of recall involves the reinstatement of these tags," said Michael Kahana, professor of psychology in Penn's School of Arts and Sciences.

The study was led by Kahana and professor Andreas Schulze-Bonhage of Freiberg. Jonathan F. Miller, Alec Solway, Max Merkow and Sean M. Polyn, all members of Kahana's lab, and Markus Neufang, Armin Brandt, Michael Trippel, Irina Mader and Stefan Hefft, all members of Schulze-Bonhage's lab, contributed to the study. They also collaborated with Drexel University's Joshua Jacobs.

Their study was published in the journal Science.

Kahana and his colleagues have long conducted research with epilepsy patients who have electrodes implanted in their brains as part of their treatment. The electrodes directly capture electrical activity from throughout the brain while the patients participate in experiments from their hospital beds.

As with earlier spatial memory experiments conducted by Kahana's group, this study involved playing a simple video game on a bedside computer. The game in this experiment involved making deliveries to stores in a virtual city. The participants were first given a period where they were allowed to freely explore the city and learn the stores' locations. When the game began, participants were only instructed where their next stop was, without being told what they were delivering. After they reached their destination, the game would reveal the item that had been delivered, and then give the participant their next stop.

After 13 deliveries, the screen went blank and participants were asked to remember and name as many of the items they had delivered in the order they came to mind.

This allowed the researchers to correlate the neural activation associated with the formation of spatial memories (the locations of the stores) and the recall of episodic memories: (the list of items that had been delivered).

"A challenge in studying memory in naturalistic settings is that we cannot create a realistic experience where the experimenter retains control over and can measure every aspect of what the participant does and sees. Virtual reality solves that problem," Kahana said. "Having these patients play our games allows us to record every action they take in the game and to measure the responses of neurons both during spatial navigation and then later during verbal recall."

By asking participants to recall the items they delivered instead of the stores they visited, the researchers could test whether their spatial memory systems were being activated even when episodic memories were being accessed. The map-like nature of the neurons associated with spatial memory made this comparison possible.

"During navigation, neurons in the hippocampus and neighboring regions can often represent the patient's virtual location within the town, kind of like a brain GPS device," Kahana said. "These so-called 'place cells' are perhaps the most striking example of a neuron that encodes an abstract cognitive representation."

Using the brain recordings generated while the participants navigated the city, the researchers were able to develop a neural map that corresponded to the city's layout. As participants passed by a particular store, the researchers correlated their spatial memory of that location with the pattern of place cell activation recorded. To avoid confounding the episodic memories of the items delivered with the spatial memory of a store's location, the researchers excluded trips that were directly to or from that store when placing it on the neural map.

With maps of place cell activations in hand, the researchers were able to cross- reference each participant's spatial memories as they accessed their episodic memories of the delivered items. The researchers found that the neurons associated with a particular region of the map activated immediately before a participant named the item that was delivered to a store in that region.

"This means that if we were given just the place cell activations of a participant," Kahana said, "we could predict, with better than chance accuracy, the item he or she was recalling. And while we cannot distinguish whether these spatial memories are actually helping the participants access their episodic memories or are just coming along for the ride, we're seeing that this place cell activation plays a role in the memory retrieval processes."

Earlier neuroscience research in both human and animal cognition had suggested the hippocampus has two distinct roles: the role of cartographer, tracking

location information for spatial memory, and the role of scribe, recording events for episodic memory. This experiment provides further evidence that these roles are intertwined.

"Our finding that spontaneous recall of a memory activates its neural geotag suggests that spatial and episodic memory functions of the hippocampus are intimately related and may reflect a common functional architecture," Kahana said. 

Full Citation:
J. F. Miller, M. Neufang, A. Solway, A. Brandt, M. Trippel, I. Mader, S. Hefft, M. Merkow, S. M. Polyn, J. Jacobs, M. J. Kahana, A. Schulze-Bonhage. (2013, ). Neural Activity in Human Hippocampal Formation Reveals the Spatial Context of Retrieved Memories. Science; 342(6162): 1111-1114. DOI: 10.1126/science.1244056

From the original article:

Abstract

In many species, spatial navigation is supported by a network of place cells that exhibit increased firing whenever an animal is in a certain region of an environment. Does this neural representation of location form part of the spatiotemporal context into which episodic memories are encoded? We recorded medial temporal lobe neuronal activity as epilepsy patients performed a hybrid spatial and episodic memory task. We identified place-responsive cells active during virtual navigation and then asked whether the same cells activated during the subsequent recall of navigation-related memories without actual navigation. Place-responsive cell activity was reinstated during episodic memory retrieval. Neuronal firing during the retrieval of each memory was similar to the activity that represented the locations in the environment where the memory was initially encoded.
___

Editors' Summary

Remembrance of Places Past

The hippocampus has two major roles in cognition. Place-responsive neurons form a context-sensitive cognitive map, firing more strongly when an animal traverses specific regions of its environment. Both humans and animals thus need the hippocampus to learn their way around novel environments. Similarly, the hippocampus is critical for our ability to remember a specific event in space and time. It has thus been suggested that the spatial and memory functions of the hippocampus reflect a common architecture. Recording from neurosurgical patients playing a virtual reality memory game, Miller et al. (p. 1111) found that the recall of events was indeed associated with reinstatement of the place-firing of neurons activated as the subjects navigated through the environment.

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Brain Cells 'Geotag' Memories To Cache What Happened — And Where

by Jon Hamilton 
November 28, 2013

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Benjamin Arthur for NPR

Think back to an important event in your life: a graduation, a birth, a special Thanksgiving dinner. Chances are you're remembering not only what happened, but also where it happened. And now scientists think they know why.

As we form so-called episodic memories, the brain appears to be using special cells in the hippocampus to "geotag" each event, researchers report in Science. The process is similar to what some digital cameras do when they tag each picture with information about where the image was taken.

As a result of this automatic geotagging, memories about places and events are "fused together," says Michael Kahana, a psychologist at the University of Pennsylvania, and one of the study's authors. "You come to a location where something happened and it reminds you of an event," he says. "Or you think of an event and it reminds you of the place where it happened."

Kahana was part of an international team of scientists that figured out how the brain's geotagging system works by studying seven epileptic patients in Germany. The patients were awaiting surgery and had wires in their brains that allowed the researchers to measure the activity of individual brain cells. That gave Kahana's team a way to watch what happened as memories were formed and retrieved.

Patients in the study played a video game involving a virtual town. In the early stages of the game, "you drive around the town and you learn where the different locations are that matter," Kahana says. Once the players had formed a mental map of the town, the game had them drive to specific locations, like the toy store or the flower shop or the bakery.

Meanwhile, the researchers were monitoring activity in each player's hippocampus, which is where the brain creates the mental maps that help us navigate. These maps rely on special "place" cells that become active when we reach a specific location. And the researchers were able to identify place cells in each player that responded to specific locations in the virtual town.

Related Story: 

Brain Study Indicates Why Some Memories Persist

Once these cells were identified, the players began the last part of the video game. Now each time they arrived at a location, they learned what item they had delivered there. "So when you get to the bakery, a voice will come on and tell you you've just delivered a zucchini," says Kahana.

This created mental links between places (like the bakery) and events (like delivering a zucchini). Then came the hard part: finding evidence of those links in the brain.

To do this, the researchers monitored the activity of place cells while players recalled specific objects they had delivered. And the team found that just before a person remembered they had delivered a zucchini, there was a burst of activity in the cells associated with the bakery — the place where the delivery was made.

This suggests the hippocampus is constantly using place cells to geotag events in our lives, Kahana says.

The finding reveals a lot about how the brain provides context to episodic memories, says Howard Eichenbaum, of Boston University. Knowing where something happened is one important bit of context. But it's also important to know when something happened, he says.

Cells that act as time stamps haven't been found yet in a human brain, Eichenbaum says. But he has found cells that perform this function in the rat hippocampus.

"So it seems like the hippocampus maps things in time," Eichenbaum says, "very much the way it maps in space."

* * * * *

Transcript

ARI SHAPIRO, BYLINE: It's ALL THINGS CONSIDERED from NPR News. I'm Ari Shapiro.

Think back to an important event in your life: a wedding, a graduation, maybe a special Thanksgiving dinner. Chances are you remember not only what happened, but where it happened. For years, scientists have tried to figure out how the brain creates this link between an event and a place.

NPR's Jon Hamilton reports on a new study that seems to have an answer.

JON HAMIILTON, BYLINE: Michael Kahana, from the University of Pennsylvania, says what's remarkable about the links between places and events is how strong they are.

MICHAEL KAHANA: You come to a location where something happened and it reminds you of the event. Or you think of an event and it reminds you of the place where the event happened.

HAMIILTON: Just ask a Red Sox fan where they were when their team won the World Series a few weeks ago.

Kahana wanted to know how the brain forges these powerful links. So he teamed up with researchers in Germany to study the brains of seven patients with severe epilepsy.

KAHANA: These are patients who are undergoing a neurosurgical effort to map seizures in the brain so they have electrodes implanted.

HAMIILTON: Which allowed the researchers to see what individual brain cells were doing, as patients formed new memories and then retrieved them. The team focused on cells in the hippocampus, an area that creates the mental maps we use to navigate in the world. Kahana says the patients played a video game involving a virtual town.

KAHANA: And the role that you play in this virtual town is you drive around the town and you learn where the different locations are that matter.

HAMIILTON: Once the players had formed a mental map of the town, Kahana says, they were asked to drive to specific locations, like the toy store or the bakery.

KAHANA: And each time they arrive at one of these locations, they will be informed that something happened. And the something that happened is they delivered an object. So when you get to the bakery, a voice will come on and tell you you've just delivered a zucchini.

HAMIILTON: That created mental links between places, like the bakery, and events, like delivering a zucchini. After the game ended, the scientists asked players to remember the objects they had delivered. And Kahana says activity in the hippocampus suggested how the brain was linking places and events.

KAHANA: The brain is doing a kind of automatic geotagging.

HAMIILTON: He says it's doing this with special cells that start firing when we reach a specific location, like the bakery. And the experiment showed that these same cells also start firing when people recall something that happened at that location, like delivering a zucchini. Kahana says the cells appear to be adding information about location to our memory of an event.

KAHANA: When you're trying to remember the event, that geotag pops up. And by popping up what I mean is simply that those neurons in the hippocampus that told you where you were, those neurons reactivate just before you remember zucchini.

HAMIILTON: That suggests the neurons associated with a place actually help us retrieve memories about what happened there.

Howard Eichenbaum, of Boston University, says the new study reveals a lot about how the hippocampus provides context to our memories of events. But he says location isn't the only sort of context that matters. It's also important to know when something happened. And Eichenbaum says his research turned up another set of specialized cells in the rat hippocampus that put a sort of time stamp on memories.

HOWARD EICHENBAUM: So it seems like the hippocampus maps things in time exactly the way it maps in space. In fact, it's arguably just another dimension of our experience.

HAMIILTON: Eichenbaum says having this time stamp on each memory lets us do something very important.

EICHENBAUM: It allows us to replay events in our heads in the order in which they happened.

HAMIILTON: Eichenbaum says that ability, when combined with location information, can be a lifesaver. Say you're an animal that recently survived an encounter with a predator. Eichenbaum says you might avoid a second encounter if you can remember where the first one occurred and what sequence of events led to your brush with death.

EICHENBAUM: For survival the key feature would be what was I doing just before I got myself into this mess.

HAMIILTON: The new research appears in the journal Science.
Jon Hamilton, NPR News.

Dr. Jane and Tim McGregor - Empathic People are Natural Targets for Sociopaths

This is an interesting and informative post on how empaths can deal with and walk away from sociopathic individuals. Dr. Jane McGregor and Tim McGregor are the authors of The Empathy Trap: Understanding Antisocial Personalities (2013).

Empathic people are natural targets for sociopaths - protect yourself

Dr Jane and Tim McGregor
Addiction Today
Wed, 30 Oct 2013 


© Fotolia Olly
The empathy trap: therapists and counselors almost by definition are empathic, to facilitate clients' recovery - but this quality can mean those carers are targets for sociopaths, aided by what Dr Jane & Tim McGregor call "apaths". The first UK article on this cruel sport shows how to identify and thus avoid it.

People targeted by a sociopath often respond with self-deprecating comments like "I was stupid", "what was I thinking" of "I should've listened to my gut instinct". But being involved with a sociopath is like being brainwashed. The sociopath's superficial charm is usually the means by which s/he conditions people.

On initial contact, a sociopath will often test other people's empathy, so questions geared towards discovering if you are highly empathic or not should ring alarm bells. People with a highly empathic disposition are often targeted. Those with lower levels of empathy are often passed over, though they can be drawn in and used by sociopaths as part of their cruel entertainment.

Sociopaths make up 25% of the prison population, committing over twice as many aggressive acts as other criminals. The reoffending rate of sociopaths is about double that of other offenders, and for violent crimes it is triple.

But not all sociopaths are found in prison. There is the less-visible burden of sociopath-induced emotional trauma which, if left unchecked, can lead to anxiety disorders, depression, and post-traumatic stress disorder.

Chronically traumatized people often exhibit hyper-vigilant, anxious and agitated behavior, symptoms such as tension headaches, gastrointestinal disturbances, abdominal pain, back pain, tremors and nausea.

Exposure to and interaction with a sociopath in childhood can leave lifelong scars. This can apply to people in therapy - and for those who in recovery trained as therapists, re-exposure as an adult can trigger old emotions and PTSD.

This article is not about sociopaths per se but about surviving the harm they cause.

EVERYDAY SOCIOPATHS

Many sociopaths wreak havoc in a covert way, so that their underlying condition remains hidden for years. They can possess a superficial charm, and this diverts attention from disturbing aspects of their nature.

The following case history illustrates how people can be systematically targeted until they feel they can barely trust their own sense of reality - what we call "gaslighting". Sociopathic abuse is targeted abuse. It can wreck lives. Victims can become survivors, but at huge cost.

At school, 'James' took a dislike to a classmate, 'Sam', who was sensitive and popular. He would mock him for auditioning for the school play or for getting upset over failing a test. The situation deteriorated when it became known that Sam's parents were separating. Sam appeared to be taking it with fortitude, to the admiration of his peers. He also got attention and sympathy from the school staff, especially James' favourite teacher: ie, the one he manipulated most easily.

James decided on a plan of covert bullying. He started a whispering campaign implying that Sam's parents were not splitting up, that he had said they were in order to seek attention. Sadly, this was all too successful and over the next few days Sam was met with silence and verbal bullying from his hitherto-supportive classmates.

James continued his campaign, targeting Sam's close friends over the next few days. They found themselves accused of misdemeanors such as sending offensive emails/texts. Then the 'favorite' teacher went on "leave with immediate effect" after accusations of assaulting a pupil. Where had the accusations come from? Guess.

This case shows how deliberately sociopaths, from a young age, can target others. Taking advantage of people's credibility and goodwill, James exploited the situation. With a more perceptive head teacher, this sociopath might have been found out, but he knew who to manipulate and how far he could go.

SEE THE EMPEROR/EMPRESS'S CLOTHES


© Franceso Pirrone
To deal with sociopaths effectively, you first need to open your eyes. In The Emperor's New Clothes by Hans Christian Anderson, two weavers promise the emperor a new suit of clothes that is invisible to those who are stupid and unfit for their positions.

When the emperor parades before his subjects, all the adults, not wishing to be seen in a negative light, pretend they can see the clothes. The only truthful person is a child who cries "But he isn't wearing any clothes!".

You, too, need to see sociopaths as they really are. We are conditioned to keep quiet, which often means turning a blind eye to or putting up with abuse.

The boy in the tale represents those who see the problem behavior for what it is and find the courage of their convictions to make a stand. Sight becomes insight, which turns into action. Awareness is the first step in limiting the negative effects of contact with a sociopath.

INTERACTIONS OF THE SOCIOPATH

Let's look at what we term the Socio-Empath-Apath Triad, or Seat. Unremitting abuse of other people is an activity of the sociopath that stands out. To win their games, sociopaths enlist the help of hangers-on: apaths.

The apath. We call those who collude in the sport of the sociopath apathetic, or apaths. In this situation, it means a lack of concern or being indifferent to the targeted person.

We have highlighted the importance of seeing the problem for what it is via the tale of the Emperor's New Clothes, which represents the collective denial and double standards which are often a feature of social life. The apath in this context is someone who is willing to be blind: ie, not to see that the emperor/empress is naked.

Apaths are an integral part of the sociopath's arsenal and contribute to sociopathic abuse. Sociopaths have an uncanny knack of knowing who will assist them in bringing down the person they are targeting. It is not necessarily easy to identify an apath; in other circumstances, an apath can show ample empathy and concern for others - just not in this case. The one attribute an apath must have is a link to the target.

How apaths, who might otherwise be fair-minded people, become involved in such destructive business is not hard to understand, but it can be hard to accept. The main qualifying attribute is poor judgment resulting from lack of insight. They might be jealous of or angry at the target, and thus have something to gain from the evolving situation.

At other times, the apath might not want to see the 'bad' in someone, particularly if the sociopath is useful. Or they might choose not to see because they have enough on their plate and do not possess the wherewithal or moral courage to help the targeted person at that time. Usually, be it active or passive involvement, the apath's conscience appears to fall asleep. It is this scenario that causes people blindly to follow leaders motivated only by self-interest.

Readers might know of Yale University professor Stanley Milgram's experiments to test the human propensity to obey orders, as participants gave increasingly large electric shocks to subjects. Afterwards, he wrote an article, The Perils of Obedience: "Ordinary people, simply doing their jobs and without any particular hostility on their part, can become agents in a terrible destructive process".

Apaths are often fearful people. They are the ones most likely to go with the flow, to agree that the emperor/empress is wearing new clothes. They might also fail to perceive the threat: a danger is of no importance if you deny its existence.

An apath's response to a sociopath's call to arms can then result from a state of 'learned helplessness'. Apaths behave defenselessly because they want to avoid unpleasant or harmful circumstances [including the sociopath turning on them]. Apathy is an avoidance strategy.


© Andreas Gradin
The empath. Often, the person targeted by the sociopath is an empath. Empaths are ordinary people who are highly perceptive and insightful and belong to the 40% of human beings who sense when something's not right, who respond to their gut instinct. In The Emperor's New Clothes, the empath is the boy who mentions the unmentionable: that there are no clothes.

In the 1990s, researchers suggested that there was a positive relationship between empathy and emotional intelligence. Since then, that term has been used interchangeably with emotional literacy.

What this means in practice is that empaths have the ability to understand their own emotions, to listen to other people and empathise with their emotions, to express emotions productively and to handle their emotions in such a way as to improve their personal power.

People are often attracted to empaths because of their compassionate nature. A particular attribute is that they are sensitive to the emotional distress of others. Conversely, they have trouble comprehending a closed mind and lack of compassion in others.

Very highly empathic people can find themselves helping others at the expense of their own needs, which can lead them to withdraw from the world at times.

It is odd. Most of us enjoy watching films and reading books about heroes who refuse to go along with the crowd, which suggests there is something admirable about people who make a bold stand.

But in real life, watching someone raise their head above the parapet often makes the rest of us feel queasy. Most - the 60% majority - prefer the easy life. It was interesting to discover, when doing the research for this book, how often people see empaths in problematical terms.

Empaths use their ability to emphasize and to boost theirs and others' well being and safety. Problems arise for empaths, however, when there are apaths in the vicinity. Empaths can be brought down, distressed and forced into the position of the lone fighter by the inaction of more apathetic types round them.

THE SOCIOPATHIC TRANSACTION

Often empaths are targeted by sociopaths because they pose the greatest threat. The empath is usually the first to detect that something is not right and express what s/he senses.

As a consequence, the empath is both the sociopath's number one foe and a source of attraction; the empath's responses and actions provide excellent entertainment for sociopaths, who use and abuse people for sport.

The world of the empath is not for the faint-hearted. In the context we are discussing, empaths often find themselves up against not only the sociopath but often a flock of apaths as well. Apaths are afforded pole position in the sociopath's intrigues.

But this prime spot comes at a price for, in what we call the "sociopathic transaction", the apath makes an unspoken Faustian pact with the sociopath, then passively or otherwise participates in the cruel sport.


© Fotolia Olly
SOCIOPATH-EMPATH-APATH TRIAD

The usual set-up goes like this: the empath is forced to make a stand on seeing the sociopath say or do something underhand. The empath challenges the sociopath, who straight away throws others off the scent and shifts the blame on to the empath. The empath becomes an object of abuse when the apath corroborates the sociopath's perspective.

The situation usually ends badly for the empath and sometimes also for the apath, if their conscience returns to haunt them or they later become an object of abuse themselves. But, frustratingly, the sociopath often goes scot free.

Sociopaths rarely vary this tried-and-tested formula because it virtually guarantees them success.

Sociopaths draw in apaths by various means: flattery, bribery, disorienting them with lies. A sociopath will go to any lengths to win her game. The best way to illustrate the interplay, and the ease with which apaths are pulled in, is by another short story.

'Steve and Robin' were microbiologists at a prestigious university, collaborating on an important vaccine trial. The department head, Ben, hoped to gain substantially; success could see his status in his field rise and prove the catalyst for a glittering career.

His colleagues worked relentlessly collecting data, then Ben drafted a paper for submission to a respected journal. He decided that the outcome didn't look tantalising, so falsified key results in order to present findings in the best light. On completing the draft, he sent the paper for comment to his colleagues. Steve replied by email that he was happy with the manuscript; he used the opportunity to suck up to his boss. But Robin was aghast, noting colossal errors. With great urgency, he rattled off an email to Ben.

Receiving no response to this or a phone call, Robin went to find Ben in person, discovering him in the cafeteria with Steve. But he was too late. Ben had poisoned Steve's mind, saying that Robin had challenged him over the accuracy of the results, due to a longstanding grudge. Ben said he had to pull Robin up about his own work several months back. Steve was different, Ben implied. He intimated Steve would be on course for promotion "especially if we get this paper out and secure funding for the next-stage trials".

By the time Ben joined them, Steve, though initially shocked, had been won over by Ben's swift flattery and insinuations

Robin crossed the cafeteria to them. "Hi, you two got a moment?" Briefly there was an awkward silence. Steve exchanged a look with Ben, who gave a slight conspiratorial smile, now that the transaction was done and the sport under way. "Yes, we were just talking about the paper. By the way, I did see your email, but if you look at the paper thoroughly, I think you'll find that everything is correct." Steve replied with a smug look that "I'm with Ben on this one". Robin was floored. "You can't be serious? You're happy for it to go off to be reviewed with all these serious errors? Our reputations will be left in ruins."

He decided to make a stand. He asked for his name to be removed as a co-author but was exasperated to learn that it was sent off to the journal anyway. More frustratingly, it was published. Meanwhile, the workplace became a source of stress for Robin as he struggled to cope with the backlash from colleagues who saw his intervention as an attempt to sabotage their work. People avoided him and, when they did talk to him, the conversation was stilted.

Eventually Robin arranged a meeting with Ben to have it out once and for all. But Ben took control of the agenda. "Robin, I have to be honest with you, many of your colleagues are unhappy about the way you handled things and some have made complaints. They don't trust you to conduct yourself professionally after you attempted to sabotage their hard work. Mercifully the reviewers saw what a fine trial we'd conducted and didn't get wind of your attempted slur.

"We can't afford to have a saboteur on the team. So I've discussed this with the dean and he agrees there is no future for you here, and there's no other way to deal with this. You've got to go."

Any phase of this story sound familiar?

THE GASLIGHTING EFFECT

In the story above, the actions of Ben and Steve have a 'gaslighting' effect on Robin. Gaslighting is a systematic attempt by one person to erode another's reality.


© unknown
The syndrome gets its name from the play and films of the same name in which a murderer strives to make his wife doubt her sanity and get others to disbelieve her.

Gaslighting is a form of psychological abuse in which false information is presented in such a way as to make the target doubt his/her memory and perception. Psychologists call this "the sociopath's dance". It could involve denial or staging of strange events.

This is Machiavellian behaviour of the worst kind. And anyone can become a victim of the sociopath's gaslighting moves: parent and child, in-laws, friends, groups of people including work colleagues.

Psychotherapist Christine Louise de Canonville describes different phases that the abuser leads the relationship through:

• the idealisation stage, where the sociopath shows herself in the best possible light - but this phase is an illusion, to draw her target in
• the devaluation stage begins gradually so the target is not alert to the sociopath's transformation to being cold and unfeeling, but will begin to feel devalued at every turn; the more distressed the target becomes, the more the sociopath enjoys her power, and her abuse can become more extreme
• the discarding stage - the target is reduced to an object to which the sociopath is indifferent, seeing the game as won; the sociopath rejects any connection, moving on to the next target. 

Gaslighting does not happen all at once so, if you suspect in the early stages of a relationship that you are being gaslighted, you can protect yourself by walking away.
To learn more, including how to recover from exposure to a prolonged sociopathic transaction, buy The Empathy Trap: Understanding Antisocial Personalities by Dr Jane and Tim McGregor (Sheldon Press, ISBN 978-1847092762).

* * * * *

DR JANE McGREGOR is a freelance trainer and lecturer at the Institute of Mental Health, University of Nottingham. She holds a PhD in public health and worked in the NHS and voluntary sector, mostly in the field of addiction treatment.

TIM McGREGOR is freelance consultant and trainer, and a mental-health practitioner of many years' standing. He has worked in the NHS and voluntary sector, most recently as a commissioning adviser.

Yes, Your Toddler Really Is Smarter Than A 5-Year-Old (NPR)

 

Alison Gopnik's lab at UC Berkeley has revolutionized our understanding of infant and toddler intelligence. In some new research, Caren Walker, one of Gopnik's graduate students in cognitive development, led a study that showed that older children tend to focus on objects rather than the relationships between them. "Learning may actually harm these kids' abilities to do abstract reasoning," said Walker.

Here is the abstract followed by the NPR story on the paper.

Toddlers Infer Higher-Order Relational Principles in Causal Learning

Caren M. Walker, Alison Gopnik

Abstract

Children make inductive inferences about the causal properties of individual objects from a very young age. When can they infer higher-order relational properties? In three experiments, we examined 18- to 30-month-olds’ relational inferences in a causal task. Results suggest that at this age, children are able to infer a higher-order relational causal principle from just a few observations and use this inference to guide their own subsequent actions and bring about a novel causal outcome. Moreover, the children passed a revised version of the relational match-to-sample task that has proven very difficult for nonhuman primates. The findings are considered in light of their implications for understanding the nature of relational and causal reasoning, and their evolutionary origins.

Full Citation:
Walker, CM, and Gopnik, A. (2013, Nov 22). Toddlers Infer Higher-Order Relational Principles in Causal Learning. Psychological Science; ePub ahead of publication. doi: 10.1177/0956797613502983

Yes, Your Toddler Really Is Smarter Than A 5-Year-Old

by Nancy Shute
November 25, 2013



Children under age 2 can reason abstractly, researchers say. Jandrie Lombard/iStock
Parents, does your 18-month-old seem wise beyond her years? Science says you're not fooling yourself.

Very small children can reason abstractly, researchers say, and are able to infer the relationships between objects that elude older children who get caught up on the concreteness of things.

In experiments at the University of California, Berkeley, children as young as 18 months were able to figure out the relationship between colored blocks.

The child would watch a researcher put two blocks on top of a box. If the blocks were identical, the box would play music. The majority of children were able to figure out the pattern after they were shown it just three times. They would then help the researcher pick the correct block.

The toddlers did much better at this task than do chimpanzees and other primates. The non-human primates have to practice doing the task themselves thousands of times to figure it out. And even then, it's only with lots of treats thrown in.

That's not such a big surprise. What really got the researchers' attention is that the diaper set did better at this sort of abstract thinking than children who were just a few years older.

 

TED Radio Hour: What Do Babies Think?

"Older kids tend to be really bad at analogies," says Caren Walker, a graduate student at in cognitive development who led the study. It was published online in the journal Psychological Science. She says that older children tend to focus on the objects rather than the relationships between them. "Learning may actually harm these kids' abilities to do abstract reasoning."

Walker is working in the lab of Alison Gopnik, a developmental psychologist who has made a career out of devising experiments that reveal the inner thoughts of children still too young to talk. Her take is that babies are smart, and in many ways smarter than adults.

In this experiment, the box actually hides a wireless doorbell, and the researcher moving the blocks controls the music by tapping a hidden button with her foot. But the illusion of control is compelling, not just for the toddlers but for the parents who watch the experiment with their children, Walker says.

The researchers tested their hypothesis by running the same experiment but letting the children see only one of the pair of blocks. They couldn't get the right answer more often than they would by chance. By contrast, 61 percent of the children got it right when they could see the blocks.

And in a third variation, almost 80 percent were able to correctly deduce that they needed to choose sets of blocks that included pairs if they were going to do the experiment.

"Even as incredibly young children, 18-month-olds are extremely powerful little learning machines," Walker told Shots.

Walker and Gopnik are repeating the same experiment with older children, to see if they do indeed lose this very early ability to think abstractly, only to regain it later in the context of language and culture.

Steve Taylor Ph.D. - Does Your Self Exist?

In his Psychology Today blog, Out of the Darkness, Steve Taylor, Ph.D. recently argued that the claim made by neuroscience and some philosophers that we have no unique self - that it is an illusion created by our brains - is rubbish.

Taylor states, paraphrasing his misunderstanding of the science: "The brain is just a soggy clump of grey matter - how could that soggy mass possibly give rise to the richness and depth of consciousness?" This is not his argument - he is conflating consciousness with a unitary self. We are fully conscious beings (well, most of us), and we are also a collection of subpersonalities that our brain manages in such a way that without developing subject/object awareness, we are unable to distinguish the subpersonalities, so they appear to be one personality, one self.

He goes on to mention Vedanta and meditation, making this assertion about meditative experience:

It [consciousness] appears to be full of energy - a powerful energy which itself has a quality of well-being, or even bliss. (This is what Indian Vedanta philosophy describes as satchitananda - being-consciousness-bliss.) There is also a quality of spaciousness - somehow my own consciousness seems to become wider and larger, to spread beyond my own brain or body.

But most importantly in terms of my argument in this article, in these moments, one of the qualities of consciousness is a sense of ‘I’. There is still a sense of identity, even if this sense may be different to that of normal consciousness. This identity does not feel separate or boundaried. It may feel a part of something greater than itself, but still has a sense of I-ness.

Again, he goes only part of the way in these statements. Spend some time in meditation, as the Buddhists suggest, trying to find the "I" of self - it's not there. The more you seek the self/I, the more one discovers vast emptiness, the emptiness filled with bliss.*

Does Your Self Exist?

Is there anyone there inside your mind? Of course there is!

Published on November 27, 2013 by Steve Taylor, Ph.D. in Out of the Darkness

If there is one concept which has been under constant attack by psychologists and philosophers over the last few decades, it is the idea of ‘you’—that you exist as a real entity or ‘self’ inside your own mental space.

Many modern philosophers and scientists suggest that this sense of being an 'I' is illusory, or just a simple product of brain activity. Somehow the billions of neurons in your brain work together to produce it, and all of the thoughts and feelings which it incorporates. The philosopher Daniel Dennett speaks of the illusion of the ‘Cartesian theatre,' the sense that there is ‘someone’ looking out at a world ‘out there’, and also watching our own thoughts pass by. In reality, says Dennett, there are only mental processes. There are streams of thoughts, sensations and perceptions passing through our brains, but there is no central place where all of these phenomena are organised. Similarly, the psychologist Susan Blackmore has suggested that the self is just a collection of what she calls ‘memes’ - units of cultural information such as ideas, beliefs and habits. We are born without a self, but slowly, as we are exposed to environmental influences, the self is ‘constructed’ out of the memes we absorb.

Modern neuroscience seems to reinforce such views. Neuroscientists claim to be able to ‘locate’ the parts of the brain responsible for mental phenomena such as aesthetic appreciation, religious experience, love, depression and so on, but they haven’t found a part of the brain associated with our underlying sense of self. Therefore, they feel justified in concluding that this doesn’t exist.

‘Ghosts don’t Exist’, says the Ghost

There are many problems with the attempt to ‘reduce’ our sense of self to brain activity. This is what is sometimes called the ‘hard problem’, to distinguish it from the ‘easy problems’ of mental abilities and functions such as memory, concentration and attention. Whilst we might be able to understand these phenomena, the problem of how the brain might produce a conscious self is on a completely different level. The brain is just a soggy clump of grey matter - how could that soggy mass possibly give rise to the richness and depth of consciousness? To think that it could is a ‘category error’ - the brain and consciousness are distinct phenomena, which can’t be explained in terms of each other. And on a more practical basis, after decades of intensive research and theorisising, no-one has yet put forward an even slightly feasible explanation of how the brain might produce consciousness. The ‘hard problem’ seems completely insurmountable.

There is a basic absurdity in these attempts to show that the ‘self’ is illusory. They always feature a self trying to prove that it doesn’t exist. They are caught in a loop. If the self is an illusion to begin with, how can we trust its judgements? It’s a bit like a ghost trying to prove that ghosts don’t exist. Perhaps it may be right, but its illusory nature doesn’t inspire confidence. Dennett and Blackmore are presuming that there is a kind of reliable, objective observer inside them which is able to pass judgement on consciousness - and that presumption contradicts their own arguments. That is the very thing whose existence they are trying to disprove.

Related to this, there is a problem of subject/object confusion. All of these theories attempt to examine consciousness from the outside. They treat it like a botanist examining a flower, as an object to scrutinize and categorize. But of course, with consciousness there is no subject and no object. The subject is the object. You are consciousness. So it is fallacious to examine it as if it is something ‘other.’ Again, you are caught in a loop. You can’t get outside consciousness. And so any ‘objective’ pronouncements you make about it are fallacious from the start.

Subjective Investigation

So does the self exist? Is there really anybody there inside your own mental space?

I think the best way to answer the question is to take a different approach. Rather than attempting to analyse consciousness from the outside as if it is an object, the best approach is to embrace subjectivity, and delve into your own consciousness.

Try meditation, for example. In deep meditation, you might find yourself in a state of complete mental quietness and emptiness, with no thoughts, no perceptions, no information processing and no concentration. In fact, this state can be seen as the ‘goal’ of meditation (at least according to some traditions). The philosopher Robert Forman has called it the ‘pure consciousness event’ - a state in which consciousness exists without content, and rests easefully within itself.

I have experienced this state myself. Paradoxically, although consciousness is empty, it has a quality of fullness too. It appears to be full of energy - a powerful energy which itself has a quality of well-being, or even bliss. (This is what Indian Vedanta philosophy describes as satchitananda - being-consciousness-bliss.) There is also a quality of spaciousness - somehow my own consciousness seems to become wider and larger, to spread beyond my own brain or body.

But most importantly in terms of my argument in this article, in these moments, one of the qualities of consciousness is a sense of ‘I’. There is still a sense of identity, even if this sense may be different to that of normal consciousness. This identity does not feel separate or boundaried. It may feel a part of something greater than itself, but still has a sense of I-ness. You could compare it to a wave which has a sense of its own existence as a wave but at the same time is aware of itself as a part of the sea. There is still an ‘I’ which has awareness of itself and of its situation.

From this point of view, it appears that consciousness or identity is not an illusion. In this state, there are no ‘memes’ and no streams of mental processes, but consciousness still appears to exist. I would therefore say that the sense of self is fundamental to us, from the deepest levels of our being. Of course, this fundamental sense of ‘I’ is acted on by all kinds environmental, social and psychological influences, and becomes ‘constructed’ to a large degree. You could compare it to how a Roman fort is built upon and expanded over centuries until eventually it develops into a modern city. But there is a fundamental kernel of ‘I-ness’ which is always there, underlying all of the activity and all the construction.

Of course, this is just my own subjective experience. I shouldn’t make any universal claims for it - although, as Robert Forman has pointed out, the ‘pure consciousness event’ seems to be universal in the sense that human beings from culture to culture have independently described experiences of it throughout history. Ultimately, however, the only real way to substantiate this is for you to try it out yourself - to reach a deep state of meditation, and see if your own experience accords with mine.

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~ Steve Taylor PhD is a senior lecturer in psychology at Leeds Metropolitan University, UK. He is the author of Back to Sanity: Healing the Madness of the Human Mind. stevenmtaylor.com

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* Here is a Zen story and explication around the idea of "vast emptiness" and "I don't know," via The Story of Zen.

Bodhidharma

Vast emptiness, no merit

Bodhidharma's reputation as a Dhyana master was said to have preceded his arrival in China, and so the Chinese Emperor Wu, a devout Buddhist, called upon Bodhidharma to visit the Imperial Palace to teach. Having sponsored the construction of a great many Buddhist monasteries and temples and patronizing the teachers of the various Buddhist sects, Emperor Wu—in accordance with his understanding of their teachings—assumed that he would gain much 'merit' in the form of a happy and prosperous reign. And he assumed he was earning an auspicious rebirth in what some Buddhist schools called a 'Pure Land' where, unlike on earth, all the conditions of life would be conducive to his attainment of Enlightenment.

Emperor Wu: "I have built many temples, copied innumerable Sutras and ordained many monks since becoming Emperor. Therefore, I ask you, what is my merit?"

Bodhidharma: "None whatsoever!" answered Bodhidharma.

Emperor Wu: "Why no merit?"

Bodhidharma:: "Doing things for merit has an impure motive and will only bare the puny fruit of rebirth."

Emperor Wu, a little put out: "What then is the most important principle of Buddhism?"

Bodhidharma: "Vast emptiness. Nothing sacred."

Emperor Wu, by now bewildered, and not a little indignant: "Who is this that stands before me?"

Bodhidharma: "I do not know."

This legendary interchange, with Bodhidharma's inspiring directness and unsparing responses, became for later generations of Chan practitioners a model for telling things as they are, without pulling any punches.

No merit

No merit, Bodhidharma told the astounded emperor! No merit, no lack of merit. No giver of merit, no receiver. Although the emperor likely misunderstood the teaching as a rebuke, Bodhidharma was pointing to the true merit that derives from seeing one's own true nature, one's Buddha nature.
 

Vast emptiness

"Vast emptiness, nothing sacred." Right from "the beginning" we see Zen's spare uncompromising tone. And, as Peter Mathiessen points out, great mystery and power.

This "emptiness" was neither absence nor a void. . . Like the empty mirror on which all things pass, leaving no trace, this ku contains all forms and all phenomena, being a symbol of the universal emphasis. Thus this emptiness is also fullness, containing all forms and phenomena.

"I do not know."

And with "I do not know." Bodhidharma launches Zen with the supreme answer. As Peter Mathiessen observes, not-knowing:

. . . echoes "vast emptiness," yet goes still deeper to the unnameable source where there is noting-to-know, were nothing exists outside the doing and being of this present instant witout past and future. . . . Like emptiness, this not-knowing is very close to us, therefore hard to see. It is the source or essence of our life, and of Zen practice . . .

This "not-knowing" links Bodhidharma directly to the existing Taoist notion of wu-nien (no thought) and is an early example of Buddho-Taoist vocabulary.

From TEDxPrague, 2013, Dr. Daniel Siegel, one of the co-founders of interpersonal neurobiology, and author of several excellent books, spoke on the connections between brain and mind.

Dr. Siegel is the author of The Developing Mind, Second Edition: How Relationships and the Brain Interact to Shape Who We Are (1999/2012), Parenting From the Inside Out (2004), The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being (2007), The Mindful Therapist: A Clinician's Guide to Mindsight and Neural Integration (2010), Mindsight: The New Science of Personal Transformation (2010), Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind (2012), and Healing Moments in Psychotherapy (2013), among other books.

Are We Our Mind?: Dan Siegel at TEDxPrague 2013

Dan Siegel - Are we our mind?

Published on Nov 28, 2013

Daniel J. Siegel is a respected global neuroscientist, professor of psychiatry at the University of California at Los Angeles (UCLA) and the Executive Director of the Mindsight Institute which offers development for individuals and groups focused on exploring the links between mind, human relationships and basic neurobiological processes. He has published extensively on psychotherapy and children's psychology.

What made Dr. Siegel attractive for us was his unique ability to make complicated scientific concepts exciting for the general public. His book Mindsight offers the general reader an in-depth exploration of the power of the mind to integrate the brain and promote well-being. He has been invited to lecture for the King of Thailand, Pope John Paul II, His Holiness the Dalai Lama, Google University, TED and TEDx.

PETER FONAGY - Psychoanalysis Today

Okay, so not quite today - this article is from 2003 - but this Psychoanalysis is so far from what Freud was teaching that they don't even seem cut from the same cloth. The one thing that binds them is the belief that unconscious factors affect mental health.

Here is some background info on Peter Fonagy from Wikipedia:

Peter Fonagy (born 1952) is a Hungarian-born British psychoanalyst and clinical psychologist. He studied clinical psychology at University College London. He is Freud Memorial Professor of Psychoanalysis and head of the department of Clinical, Educational and Health Psychology at University College London, Chief Executive of the Anna Freud Centre, a training and supervising analyst in the British Psycho-Analytical Society in child and adult analysis, a Fellow of the British Academy, and a registrant of the British Psychoanalytic Council. His clinical interests centre on issues of borderline psychopathology, violence, and early attachment relationships. His work attempts to integrate empirical research with psychoanalytic theory. He has published numerous articles and has authored or edited 16 books.[1]

The development of psychoanalysis has gone through a variety of new iterations, each one building on the past and moving farther and farther away from Freud's original vision. Here are some of the stages, with their Wikipedia links:

• Structural theory (Freud's id, ego, superego) 
• Ego psychology (Heinz Hartmann, Kris, Rappaport, Lowenstein, Otto Kernberg) 
• Object relations theory (Melanie Klein, Ronald Fairbairn, Donald Winnicott, Harry Guntrip, Otto Kernberg)
• Self psychology (Heinz Kohut, Ernest Wolf, Arnold Goldberg, Frank Lachmann, Paul and Anna Ornstein, Marian Tolpin) 
• Jacques Lacan and Lacanian psychoanalysis (Lacan) 
• Interpersonal psychoanalysis (Harry Stack Sullivan, Frieda Fromm-Reichmann, Clara Thompson, Erich Fromm) 
• Relational psychoanalysis (Stephen Mitchell, Lew Aron, Jessica Benjamin, Adrienne Harris, and Peter Fonagy) 
• Intersubjective psychoanalysis (George E. Atwood, Robert Stolorow, Stephen A. Mitchell, Jessica Benjamin, Bernard Brandchaft, J. Fosshage, Donna M.Orange, Colwyn Trewarthen, Beatrice Beebe, Frank M. Lachmann, Herbert Rosenfeld, and Daniel Stern)

As you can see from this list, Fonagy was one of the relational psychoanalysts, a group that grew out of Kohut's Self Psychology. Right now, the leaders in psychoanalytic thinking are the relational and intersubjective schools, with a lot of overlap between the two in theory and in practitioners.

The small I study with here in Tucson identify, very informally, as Intersubjective Relational Self Psychologists (the ordering of the terms reflects their centrality). 

Full Citation:
Fonagy, P. (2003, Jun). Psychoanalysis today. World Psychiatry; 2(2): 73–80.

Psychoanalysis Today

PETER FONAGY

Abstract

The paper discusses the precarious position of psychoanalysis, a therapeutic approach which historically has defined itself by freedom from constraint and counted treatment length not in terms of number of sessions but in terms of years, in today's era of empirically validated treatments and brief structured interventions. The evidence that exists for the effectiveness of psychoanalysis as a treatment for psychological disorder is reviewed. The evidence base is significant and growing, but less than might meet criteria for an empirically based therapy. The author goes on to argue that the absence of evidence may be symptomatic of the epistemic difficulties that psychoanalysis faces in the context of 21st century psychiatry, and examines some of the philosophical problems faced by psychoanalysis as a model of the mind. Finally some changes necessary in order to ensure a future for psychoanalysis and psychoanalytic therapies within psychiatry are suggested.
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Psychoanalysis today is an embattled discipline. What hope is there in the era of empirically validated treatments (1), which prizes brief structured interventions, for a therapeutic approach which defines itself by freedom from constraint and preconception (2), and counts treatment length not in terms of number of sessions but in terms of years? Can psychoanalysis ever demonstrate its effectiveness, let alone cost-effectiveness? After all, is psychoanalysis not a qualitatively different form of therapy which must surely require a qualitatively different kind of metric to reflect variations in its outcome? Symptom change as a sole indicator of therapeutic benefit must indeed be considered crude in relation to the complex interpersonal processes which evolve over the many hundreds of sessions of the average 3- 5 times weekly psychoanalytic treatment. Most psychoanalysts are sceptical about outcome investigations.

Surprisingly, given this unpropitious backdrop, there is, in fact, some suggestive evidence for the effectiveness of psychoanalysis as a treatment for psychological disorder. The evidence in relation to psychoanalytic outcomes was recently overviewed by Gabbard et al (3), and suggestions for enriching this literature with ongoing naturalistic follow- along investigations were offered. But the absence of evidence is only part of the problem. Indeed, it may be symptomatic of the scientific difficulties that psychoanalysis faces in the 21st century. I will review the evidence base of psychoanalytic treatments and go on to examine in more detail the problems faced by psychoanalysis as a body of ideas rather than as a mode of treatment.

DATA GATHERING AND PSYCHOANALYSIS

Psychoanalysts emulating the founder of the discipline take special pride in discovery. This has led to an abundance of psychoanalytic ideas. Yet this very overabundance of clinically rooted concepts is beginning to threaten the clinical enterprise (4). The plethora of clinical strategies and techniques that are not all mutually compatible creates almost insurmountable problems in the transmission of psychoanalytic knowledge and skills (5). Sadly, this also leads to resistance to the systematization of psychoanalytic knowledge, since those whose frame of reference depends on ambiguity and polymorphy can be threatened by the systematization of clinical reasoning. The source of the problem of theoretical diversity lies in psychoanalytic methods of data-gathering. As is well known, data is not the plural of anecdote. Psychoanalytic practice has profound limitations as a form of research. Psychoanalytic theory precludes the possibility that psychoanalysts can be adequate observers of their clinical work. The discovery of the pervasiveness of countertransference has totally discredited Freud's clinician- researcher model. In the absence of a genuine research tradition, academic disciplines will appropriately distance themselves from psychoanalytic study, in much the same way that they hold journalism at arm's length.

Progress in disciplines concerned with the mind has been remarkable. Excluding information from these disciplines is a high risk strategy at a time when interdisciplinary collaboration is perceived as the driving force of knowledge acquisition. Modern science is almost exclusively interdisciplinary. Many major universities have been restructured to facilitate interdisciplinary work. The impetus is for the abolition of discipline based departments and the re-configuring of medical faculties in terms of interdisciplinary research groupings (scientists working on similar problems regardless of their discipline of origin). It is likely that many basic questions that psychoanalysts have not been able adequately to answer, such as how psychological therapy cures, will only be illuminated by interdisciplinary (neuroscientific) research.

The last 30 years' advances in all the neurosciences have negated the reasons for the earlier psychoanalytic disregard of this field (6). Neuroscientists are no longer just concerned with cognitive disabilities or so-called organic disorders (7,8). Recent reviews of neuroscientific work confirm that many of Freud's original observations, not least the pervasive influence of non-conscious processes and the organizing function of emotions for thinking, have found confirmation in laboratory studies (9,10). If Freud were alive today, he would be keenly interested in new knowledge about brain functioning, such as how neural nets develop in relation to the quality of early relationships, the location of specific capacities with functional scans, the discoveries of molecular genetics and behavioral genomics (11) and he would surely not have abandoned his cherished Project for a Scientific Psychology (12), the abortive work in which he attempted to develop a neural model of behavior. Genetics has progressed particularly rapidly, and mechanisms that underpin and sustain a complex gene-environment interaction belie early assumptions about constitutional disabilities (13). In fact, for the past 15-20 years the field of neuroscience has been wide open for input from those with an adequate understanding of environmental determinants of development and adaptation.

It may be that the difficulty in pinpointing the curative factors in psychoanalytic treatment is directly related to the limitations of the uniquely clinical basis for psychoanalytic inquiry. The impact of psychoanalysis cannot be fully appreciated from clinical material alone. The repetition of patterns of emotional arousal in association with the interpretive process elaborates and strengthens structures of meaning and emotional response. This may have far-reaching effects, I would argue, even on the functioning of the brain and the expression of genetic potential. A range of studies have already suggested that the impact of psychotherapy can be seen in alterations in brain activity, using brain imaging techniques (14-16). These studies as a group provide a rationale for the hope that intensive psychoanalytic treatment might meaningfully affect biological as well as psychological vulnerability. This field is in its infancy but is progressing so fast that it seems highly likely that many future psychoanalytic discoveries about the mind will be made in conjunction and collaboration with biological science.

HOW PSYCHOANALYSIS WILL (COULD) BENEFIT FROM AN INTERDISCIPLINARY DIALOGUE

Whilst clinical psychoanalysis needs little help in getting to know an individual's subjectivity in the most detailed way possible, when we wish to generalize to a comprehensive model of the human mind, the discipline can no longer exist on its own. A general psychoanalytic model of mind, if it is to be credible, should be aligned with the wider knowledge of mind gained from a range of disciplines. This is already happening, albeit informally. Psychoanalysts cannot help incorporating advances about discoveries relevant to mental function because these are invariably contained in all our intuitive, common sense, folk psychologies or theories of the mind (17,18). Folk psychology develops alongside scientific discovery. The impact of psychoanalysis on psychiatric disorder over the course of the 20th century offers the best evidence for this. Our culture's acceptances of Freudian discoveries have made it more difficult for individuals to claim dramatic dysfunctions such as blindness, anesthesia, and paralysis. Medicine has advanced to a point where individuals must accept that the absence of a pathophysiological account for a bodily dysfunction implies emotional determinants - thus the disguise function of the physical symptom is lost and the point prevalence of conversion hysteria plummets. Just as common-sense knowledge of medicine and psychology impacts on our patients, so it must unconsciously influence the nature of psychoanalysts' theoretical musings. Thus, 'scientific advances' infiltrate psychoanalytic theory by the backdoor of the analyst's preconscious.

Mitchell (19), by contrast, claimed that 'no experiment or series of experiments will ever be able to serve as a final and conclusive arbiter of something as complex and elastic as the psychoanalytic theory'. Indeed, Mitchell writes that "ultimately it is the community of psychoanalytic practitioners who provide the crucial testing-ground in the crucible of daily clinical work". As we have seen, the community has been singularly unsuccessful in definitively eliminating theories, in part because of the loose definitions adopted to define underlying concepts. This is inevitable if the mechanisms or processes that underpin the surface function described are not well understood. The meaning of the construct has to be sensed or intuited. In psychoanalysis, communication, whether in writing or clinical discourse, occurs in terms of its impact upon the reader. As Phillips (20) puts it, paraphrasing Emerson, in psychoanalytic writing there is an attempt to "return the reader to his own thoughts whatever their majesty, to evoke by provocation. According to this way of doing it, thoroughness is not inciting. No amount of 'evidence' or research will convince the unamused that a joke is funny". In psychoanalysis we accept that something has been understood when the discourse about it is inciting. Elusiveness and ambiguity are not only permissible, they may be critical to accurately depict the complexity of human experience. It is here, in the specification of the mental mechanisms whose effects psychoanalytic writings describe and whose nature they allude to, that systematic research using psychoanalytic methods as well as methods from other disciplines will turn out to be so useful. Gill (21), in his discussion of the possible validation of psychoanalytic concepts, adopted a similar approach and suggested that Mitchell underestimated the potential contribution of systematic, not necessarily experimental, research on the psychoanalytic situation.

The above does not constitute an attempt to suggest that psychoanalytic concepts can be 'tested' or 'validated' by the methods of another science. Rather, systematic observations could be used to investigate the psychological processes underpinning clinical phenomena, which psychoanalysts currently use the metaphoric language of metapsychology to approximate. Inter-disciplinary research cannot test psychoanalytic theory, it cannot demonstrate that particular psychoanalytic ideas are true or false. What it can do is to elaborate the mental mechanisms that are at work in generating the phenomena that psychoanalytic writings describe. It is here, in the specification of the mental mechanisms whose effects psychoanalytic writings describe and whose nature they allude to, that systematic research using psychoanalytic methods as well as methods from other disciplines will be useful. This in turn will help to systematize the knowledge base of psychoanalysis so that integration with the new sciences of the mind becomes increasingly easier. Not only will psychoanalysts be able more readily to show that their treatment works, but they will have new possibilities of communicating with other scientists about their discoveries. It is to this set of opportunities that I would now like to turn. The integration of psychoanalytic ideas with modern science is unlikely to interest investigators from other disciplines unless psychoanalysis can actually contribute to directing or to informing data collection in these disciplines. For psychoanalysis to be taken seriously as a scientific study of the mind, it has to engage in systematic laboratory studies, epidemiological surveys or qualitative exploration in the social sciences.

Of course, methods for such systematic research are still in their infancy. The validation of theory poses a formidable challenge. Even apparently easily operationalisable constructs such as defense mechanisms have rarely been formulated with the kind of exactness required by research studies. Extra-clinical investigations, however, may help to constrain theorizing; for example our growing knowledge of infants' actual capacities may enable us to limit speculation concerning the impact of infancy on adult function. The projective processes of infancy are unlikely to work in the adultomorphic way described by Bion (22-24) and Klein (25-27), but this does not mean that these descriptions do not contain important truths about adult mental function, simply that 'infancy' is used metaphorically in these theorizations about mental process. For example, evidence from infant research provides strong evidence for Bion's containment concept. It uses the more readily operationalizable notion of 'marked mirroring' to denote the mother's capacity to reflect the infant's affect, while also communicating that the affect she is expressing is not hers but the infant's (28-30). Mothers who can 'mark' their emotional expression (add a special set of attributes, such as playfulness, to their expression of the child's affect that makes it clearly different from their own expression of that affect) appear to be able to soothe their baby considerably more rapidly. This may not be all that Bion meant by containment, but it seems to be linked to his hypotheses concerning the subsequent problems faced by individuals whose caregivers were unable to provide this mirroring encounter with emotion regulation. Restricting theory building to the clinical domain is foolhardy in the extreme.

To summarize, psychoanalysis could benefit from integrating its working theories with research findings from other fields by elaborating the psychoanalytic psychological models of the mechanisms involved in key mental processes. This in turn would help to systematize the psychoanalytic knowledge base, so that integration with the new sciences of the mind becomes increasingly easier. Not only will we be able more readily to show that our treatment works, but we will have new possibilities of communicating with other scientists about our discoveries. The integration of psychoanalytic ideas with modern science is unlikely to interest investigators from other disciplines unless psychoanalysis can actually contribute to directing or to informing data collection in these disciplines. Merely reviewing ideas in developmental science or neuroscience for their proximity to psychoanalytic hypotheses has scant relevance to them. For psychoanalysis to take its place at the high table of the scientific study of the mind, it has to show its mettle in the battlefield of systematic laboratory studies, epidemiological surveys or qualitative exploration in the social sciences.

THE EVIDENCE BASE OF PSYCHOANALYTIC TREATMENT

The evidence base for psychoanalytic therapy remains thin. There is little doubt that the absence of solid and persuasive evidence for the efficacy of psychoanalysis is the consequence of the self-imposed isolation of psychoanalysis from the empirical sciences. Few would dispute the assertion that psychoanalytic theory is in a perilous state. The psychoanalytic clinical situation might have yielded all that it can offer to advance our understanding of mind. Yet 'importing' extra-clinical data is often fiercely resisted and those psychoanalysts who have attempted to do so have commonly been subjected to subtle and not so subtle derision.

Psychoanalysts have been encouraged by the body of research that supports brief dynamic psychotherapy. A meta-analysis of 26 such studies has yielded effect sizes comparable to other approaches (31). It may even be slightly superior to some other therapies if long term follow-up is included in the design. One of the best designed randomized controlled trials (RCTs), the Sheffield Psychotherapy Project (32), found evidence for the effectiveness of a 16 session psychodynamic treatment based on Hobson's model (33) in the treatment of major depression. There is evidence for the effectiveness of psychodynamic therapy as an adjunct to drug dependence programs (34). There is ongoing work on a brief psychodynamic treatment for panic disorder (35). There is evidence for the use of brief psychodynamic approaches in work with older people (36).

There are psychotherapy process studies which offer qualified support for the psychoanalytic case. For example, psychoanalytic interpretations given to clients which are judged to be accurate are reported to be associated with relatively good outcome (37,38). There is even tentative evidence from the reanalysis of therapy tapes from the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program that the more the process of a brief therapy (e.g. cognitive-behavioural therapy, CBT) resembles that of a psychodynamic approach, the more likely it is to be effective (39).

Evidence is available to support therapeutic interventions which are clear derivatives of psychoanalysis. However, most analysts would consider that the aims and methods of short-term once a week psychotherapy are not comparable to 'full analysis'. What do we know about the value of intensive and long-term psychodynamic treatment? Here the evidence base becomes somewhat patchy.

The Boston Psychotherapy Study (40) compared longterm psychoanalytic therapy (two or more times a week) with supportive therapy for clients with schizophrenia in a randomized controlled design. There were some treatment specific outcomes, but on the whole clients who received psychoanalytic therapy fared no better than those who received supportive treatment. In a more recent randomized controlled study (41), individuals with a diagnosis of borderline personality disorder were assigned to a psychoanalytically oriented day-hospital treatment or treatment as usual. The psychoanalytic arm of the treatment included therapy groups three times a week as well as individual therapy once or twice a week over an 18 month period. There were considerable gains in this group relative to the controls and these differences were not only maintained in the 18 months following discharge, but increased, even though the day hospital group received less treatment than the control group (42). The cost-effectiveness of these treatments is surprisingly impressive, with the cost of psychoanalytic partial hospital treatment comparable to treatment as usual for these patients, and the costs of the treatment mostly recovered in terms of savings in service use within 18 months of the end of treatment (43-46). Trials with similar patient groups using comparisons of outpatient psychoanalytic therapy treatments with extended baselines have yielded relatively good outcomes (47) as did comparisons with treatment as usual (48). Several prospective follow-along studies using a pre-post design have suggested substantial improvements in patients given psychoanalytic therapies for personality disorders (49-51). Uncontrolled studies, however, particularly those with relatively small sample sizes and clinical populations whose condition is known to fluctuate wildly, cannot yield data of consequence concerning what type of treatment is likely to be effective for whom.

A further controlled trial of intensive psychoanalytic treatment of children with chronically poorly controlled diabetes reported significant gains in diabetic control in the treated group which was maintained at one year follow-up (52). Experimental single case studies carried out with the same population supported the causal relationship between interpretive work and improvement in diabetic control and physical growth (53). The work of Heinicke also suggests that four or five times weekly sessions may generate more marked improvements in children with specific learning difficulties than a less intensive psychoanalytic intervention (54).

One of the most interesting studies to emerge recently was the Stockholm Outcome of Psychotherapy and Psychoanalysis Project (55). The study followed 756 persons who received national insurance funded treatment for up to three years in psychoanalysis or in psychoanalytic psychotherapy. The groups were matched on many clinical variables. Four or five times weekly analysis had similar outcomes at termination when compared with one to two sessions per week psychotherapy. However, in measurements of symptomatic outcome using the Short Check List-90 (SCL-90), improvement on three year follow-up was substantially greater for individuals who received psychoanalysis than those in psychoanalytic psychotherapy. In fact, during the follow-up period, psychotherapy patients did not change, but those who had had psychoanalysis continued to improve, almost to a point where their scores were indistinguishable from those obtained from a non-clinical Swedish sample.

A large scale follow-up study of a representatively selected group of psychoanalytically and psychotherapeutically treated individuals was recently reported from the German Psychoanalytic Association's collaborative investigation (56). A selection of patients whose treatments had taken place in a designated time period were interviewed by independent assessors and outcomes assessed by both standardized and interviewer coded instruments. While the group had been quite impaired at the time of referral according to retrospective assessments, on follow-up over 80% showed good outcomes. Follow-up data was favorable in relation to both anxiety and depression and savings were also demonstrated in relation to the use of hospital and outpatient medical treatment of physical symptoms replicating earlier German investigations (57). This carefully conducted study also provided important qualitative data in relation to the experience of psychoanalytic treatment and the relatively common disjunction of psychological changes at the level of self-understanding, and interpersonal-relational and work-related domains.

Another large pre-post study of psychoanalytic treatments has examined the clinical records of 763 children who were evaluated and treated at the Anna Freud Centre, under the close supervision of Freud's daughter (58-61). Children with certain disorders (e.g. depression, autism, conduct disorder) appeared to benefit only marginally from psychoanalysis or psychoanalytic psychotherapy. Interestingly, children with severe emotional disorders (three or more Axis I diagnoses) did surprisingly well in psychoanalysis, although they did poorly in once or twice a week psychoanalytic psychotherapy. Younger children derived greatest benefit from intensive treatment. Adolescents appeared not to benefit from the increased frequency of sessions. The importance of the study is perhaps less in demonstrating that psychoanalysis is effective, although some of the effects on very severely disturbed children were quite remarkable, but more in identifying groups for whom the additional effort involved in intensive treatment appeared not to be warranted.

The Research Committee of the International Psychoanalytic Association has recently prepared a comprehensive review of North American and European outcome studies of psychoanalytic treatment (62). The Committee concluded that existing studies failed to unequivocally demonstrate that psychoanalysis is efficacious relative to either an alternative treatment or an active placebo, and identified a range of methodological and design problems in the fifty or so studies described in the report. Nevertheless, the report is encouraging to psychoanalysts. A number of studies testing psychoanalysis with 'state of the art' methodology are ongoing and are likely to produce more compelling evidence over the next years. Despite the limitations of the completed studies, evidence across a significant number of pre-post investigations suggested that psychoanalysis appears to be consistently helpful to patients with milder (neurotic) disorders and somewhat less consistently so for other, more severe groups. Across a range of uncontrolled or poorly controlled cohort studies, mostly carried out in Europe, longer intensive treatments tended to have better outcomes than shorter, non-intensive treatments. The impact of psychoanalysis was apparent beyond symptomatology, in measures of work functioning and reductions in health care costs.

THE LIMITATIONS OF THE EVIDENCE BASED APPROACH

There are limitations concerning the nature of the evidence base for all psychotherapies. These limitations are well-known and their implications go well beyond the evaluation of the current status of psychoanalysis. The outcomes literature concerns RCTs administered over relatively brief periods (three to six months) with short follow-ups and a failure to control for inter-current treatments over these periods. Most evidence-based treatment reviews have been uniquely based on RCTs. RCTs in psychosocial treatments are often regarded as inadequate because of their low external validity or generalizability (63). In brief, they are not relevant to clinical practice - a hotly debated issue in the field of psychotherapy (64) and psychiatric research (65). There are a number of well publicized reasons: a) the unrepresentativeness of healthcare professionals participating; b) the unrepresentativeness of participants screened for inclusion to maximize homogeneity; c) the possible use of atypical treatments designed for a single disorder; d) limiting the measurement of outcome to the symptom that is the focus of the study and is easily measurable (66).

Belief in the supremacy of RCTs opens the door to treatments which, even if effective, one may not wish to entertain. A recent report in the British Medical Journal on the effects of remote, retro-active intercessory prayer on the outcome of patients with bloodstream infection is salutary. Leonard Leibovici (67) from the Rabin Medical Centre in Israel randomized 3,393 adult patients whose bloodstream infection was detected in the hospital between 1990 and 1996. A list of the first names of the patients in the intervention group was given to a person who said a short prayer for the wellbeing and recovery of the group as a whole. It was argued that as God is unlikely to be limited by linear time, an intervention carried out 4-10 years after the patients' infection and hospitalization was as likely to be effective as one carried out during the infection. Staggeringly, there were significant results on two of the three outcome measures. Length of hospital stay and duration of fever were both shorter in the intervention group. Mortality was also lower in the intervention group but the difference was not statistically significant. As two other independent studies also support intercessory prayer (68,69) by the American Psychological Association's criteria for empirically based treatments, this intervention should be accepted except for the heterogeneity of the medical conditions for which the treatment was used. This finding highlights the risk associated with an atheoretical stance to evidence based practice that reifies and idealises a research design. RCTs unquestionably have the potential to yield clinically relevant data in the absence of an adequate understanding of the underlying process. When James Lind in 1753 determined that lemons and limes cured scurvy, he knew nothing about ascorbic acid, nor did he understand the concept of a nutrient. Yet Leibovici's study demonstrates the absurdity which can be created by bringing the world of rigorous measurement into a domain that is totally unsuited to it.

Most importantly from the standpoint of psychoanalysis, the current categorization in evidence-based psychotherapies conflates two radically different groups of treatments: those that have been adequately tested and found ineffective for a client group, and those that have not been tested at all. It is important to make this distinction, since the reason that a treatment has not been subjected to empirical scrutiny may have little to do with its likely effectiveness. It may have far more to do with the intellectual culture within which researchers operate, the availability of treatment manuals, and peer perceptions of the value of the treatment (which can be critical for both funding and publication). The British psychodynamically oriented psychiatrist Jeremy Holmes (70) has eloquently argued in the British Medical Journal that the absence of evidence for psychoanalytic treatment should not be confused with evidence of ineffectiveness. In particular, his concern was that cognitive therapy would be adopted by default because of its research and marketing strategy rather than its intrinsic superiority. He argued that: a) the foundations of cognitive therapy were less secure than often believed; b) the impact of CBT on long-term course of psychiatric illness was not well demonstrated; c) in one 'real life trial' at least the CBT arm had to be discontinued because of poor compliance from a problematic group of patients who nevertheless accepted and benefited from couples therapy (71); d) the effect size of CBT is exaggerated by comparisons with waiting list controls; e) the emergence of a post-CBT approach (e.g. 72,73) that leans increasingly on psychodynamic ideas.

Whilst the present author is entirely in sympathy with Holmes' perspective, even if his work with Roth (74) was one of the targets of his criticism, it is only fair to expose the shortcomings of his communication. Tarrier (75), in a commentary on Holmes' piece, writes with passion: "Holmes relies on the specious old adage that absence of evidence is not evidence of absence [of effectiveness]. [...] I would have more enthusiasm for this argument if traditional psychotherapy were new. It has been around for 100 years or so. The argument, therefore, becomes a little less compelling when psychotherapy's late arrival at the table of science has been triggered by a threat to pull the plug on public funding because of the absence of evidence". Sensky and Scott (76) were similarly outraged both by Holmes' selective review of evidence and his allegations that some cognitive therapists are starting to question aspects of their discipline. The message from the CBT camp is this: if psychoanalytic clinicians are going to address the issue of evidence based practice, they will have to do more than gripe and join in the general endeavour to acquire data.

Of course, psychodynamic clinicians are at a disadvantage and not simply because they are late starters (after all, many new treatments find a place at the table of evidence based practice). There are profound incompatibilities between psychoanalysis and modern natural science. Whittle (77) has drawn attention to the fundamental incompatibility of an approach that aims to fill in gaps in self-narrative with cognitive psychology's commitment to minimal elaboration of observations, a kind of Wittgensteinian cognitive asceticism. In the former context, success is measured as eloquence (or meaningfulness) which is not reducible to either symptom or suffering. Moreover, psychoanalytic explanations invoke personal history, but behaviour genetics has brought environmental accounts into disrepute. While CBT also has environmentalist social learning theory at its foundations, it has been more effective in moving away from a naïve environmentalist position. To make matters worse, within psychoanalysis there has been a tradition of regarding the uninitiated with contempt, scaring off most open-minded researchers.

Psychoanalysts are not yet fully committed to systematically collecting data with the potential to challenge and contradict as well as to confirm cherished ideas. The danger that must be avoided at all costs is that research is embraced selectively only when it confirms previously held views. This may be a worse outcome than the wholesale rejection of the entire enterprise of seeking evidence, since it immunizes against being affected by findings at the same time as creating an illusion of participation in the virtuous cycle of exploring, testing, modifying and re-exploring ideas.

But the absence of psychoanalytic research raises a related problem that particularly concerns me. A recent study from Luborsky's research team (78) demonstrates that the allegiance of the researcher predicts almost 70% of the variance in outcome across studies, with a remarkable multiple r of .85 if three different ways of measuring allegiance are simultaneously introduced. This means that 92% of the time we can predict which of two treatments compared will be most successful based on investigator allegiance alone. This becomes a pernicious self-fulfilling prophecy, as investigators who favour less focused more long-term treatment approaches are gradually excluded from the possibility of receiving funding and, if their treatments are subjected to systematic inquiry at all, these studies are performed by those with least interest in such treatments.

CONCLUSIONS

Our aim should be to assist the movement of psychoanalysis toward science. In order to ensure a future for psychoanalysis and psychoanalytic therapies within psychiatry, psychoanalytic practitioners must change their attitude in the direction of a more systematic outlook. This attitude shift would be characterized by several components: a) The evidence base of psychoanalysis should be strengthened by adopting additional data-gathering methods that are now widely available in biological and social science. New evidence may assist psychoanalysts in resolving theoretical differences, a feat which the current database of predominantly anecdotal clinical accounts have not been capable of achieving. b) The logic of psychoanalytic discourse would need to change from its overdependence on rhetoric and global constructs to using specific constructs that allow for cumulative data-gathering. c) Flaws in psychoanalytic scientific reasoning, such as failures to consider alternative accounts for observations (beyond that favored by the author), should be overcome and in particular, the issue of genetic and social influence should be approached with increased sophistication. d) The isolation of psychoanalysis should be replaced by active collaboration with other mental health disciplines. Instead of fearing that fields adjacent to psychoanalysis might destroy the unique insights offered by clinical work, we need to embrace the rapidly evolving 'knowledge chain' focused at different levels of the study of brain-behavior relationship, which, as Kandel (7,79) points out, may be the only route to the preservation of the hard won insights of psychoanalysis.

References are available at the NCBI/NIH website.