Psiquiatria / introducción | Traducciones de Psiquiatría

222 PSYCHIATRIC ANNALS 37:4 | APRIL 2007

guest editorial

guest editorial • • guest editorial

The theory that the human

mind contains both con-

scious and unconscious

components has been a cornerstone

of psychiatric thought for the past

century. The main idea behind this

important hypothesis is that infor-

mation processing in the brain oc-

curs simultaneously at two main

levels: one conscious, or fully acces-

sible to cognitive processes, and one

unconscious, or hidden from cogni-

tion. In addition, both conscious and

unconscious processes are able to

infl uence behavior.

The notion that “hidden,” or un-

conscious factors, can infl uence

behavior is consistent with human

experience. We commit “crimes of

passion,” have diffi culty dieting, and

suffer from a variety of obsessions

and addictive disorders. In a 1915

paper entitled “The Unconscious,”

Freud justifi ed his use of this impor-

tant concept:

“Our right to assume the existence

of something mental that is uncon-

scious and to employ that assumption

for the purposes of scientifi c work is

disputed in many quarters. To this we

can reply that our assumption of the

unconscious is necessary and legiti-

mate, and that we possess numerous

proofs of its existence.

“It is necessary because the data

of consciousness have a very large

number of gaps in them; both in

healthy and in sick people psychi-

cal acts often occur which can be

explained only by presupposing

other acts, of which, nevertheless,

consciousness affords no evidence.

… All these conscious acts remain

disconnected and unintelligible if

we insist upon claiming that every

mental act that occurs in us must

also be experienced by us through

consciousness; on the other hand,

they fall into a demonstrable con-

nection if we interpolate between

them the unconscious acts which we

have inferred.”1

For Freud, behavior was unin-

telligible if its only causative com-

ponent was confi ned to conscious

experiences. On the other hand, the

uncovering of unconscious factors,

like an unfolding set of clues in a

detective story, could provide logi-

cal explanations for seemingly un-

explainable acts. Freud and his in-

tellectual successors devoted many

lifetimes to defi ning practical and

theoretical systems for extracting

and understanding the unconscious

precipitants of behavior.

This issue of Psychiatric Annals

comes at an exciting time in the his-

tory of the unconscious. Experimen-

tal work has demonstrated beyond

any doubt that the brain contains

numerous circuits that operate un-

consciously, but nevertheless infl u-

ence many aspects of behavior. The

Freudian unconscious, which was

born more than a century ago, clear-

ly needs to evolve in light of the new

biological discoveries. Some would

argue more strongly that Freudian

concepts should be scrapped alto-

gether. We leave this issue for each

reader to decide. In our opinion,

many Freudian and neo-Freudian

concepts have relevance for psychi-

atrists even today, and a new con-

ceptualization, based on the best of

the old and the new, could energize

our discipline.

The articles in this issue deal

with many aspects of unconscious

processes and their relevance to

psychiatry. Dr. Iacoboni discusses

an exciting topic with wide psy-

chiatric implications in his article

titled “Face to Face: The Neural

Basis of Social Mirroring and Em-

pathy.” Dr. Iacoboni presents both

a historical perspective and the re-

sults of his original research on the

“mirror neuron” system in humans.

He describes the discovery of mir-

ror neurons, elucidates their neuro-

THIS ISSUE:

THE NEUROBIOLOGY OF THE UNCONSCIOUS

George I. Viamontes, MD, PhD; and

Bernard D. Beitman, MD

Guest Editors

Used with permission.

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222 PSYCHIATRIC ANNALS 37:4 | APRIL 2007

guest editorial • guest editorial• guest editorial

T

he theory that the human mind contains both con- scious and unconscious components has been a cornerstone of psychiatric thought for the past century. The main idea behind this important hypothesis is that infor- mation processing in the brain oc- curs simultaneously at two main levels: one conscious, or fully acces- sible to cognitive processes, and one unconscious, or hidden from cogni- tion. In addition, both conscious and unconscious processes are able to influence behavior. The notion that “hidden,” or un- conscious factors, can influence behavior is consistent with human experience. We commit “crimes of passion,” have difficulty dieting, and suffer from a variety of obsessions and addictive disorders. In a 1915 paper entitled “The Unconscious,” Freud justifi ed his use of this impor- tant concept: “Our right to assume the existence of something mental that is uncon- scious and to employ that assumption for the purposes of scientific work is disputed in many quarters. To this we can reply that our assumption of the unconscious is necessary and legiti- mate, and that we possess numerous proofs of its existence. “It is necessary because the data of consciousness have a very large number of gaps in them; both in healthy and in sick people psychi- cal acts often occur which can be explained only by presupposing other acts, of which, nevertheless, consciousness affords no evidence. … All these conscious acts remain disconnected and unintelligible if we insist upon claiming that every mental act that occurs in us must also be experienced by us through consciousness; on the other hand, they fall into a demonstrable con- nection if we interpolate between them the unconscious acts which we have inferred.”^1 For Freud, behavior was unin- telligible if its only causative com- ponent was confined to conscious experiences. On the other hand, the uncovering of unconscious factors, like an unfolding set of clues in a detective story, could provide logi- cal explanations for seemingly un- explainable acts. Freud and his in- tellectual successors devoted many lifetimes to defining practical and theoretical systems for extracting and understanding the unconscious precipitants of behavior. This issue of Psychiatric Annals comes at an exciting time in the his- tory of the unconscious. Experimen- tal work has demonstrated beyond any doubt that the brain contains numerous circuits that operate un- consciously, but nevertheless influ- ence many aspects of behavior. The Freudian unconscious, which was born more than a century ago, clear- ly needs to evolve in light of the new biological discoveries. Some would argue more strongly that Freudian concepts should be scrapped alto- gether. We leave this issue for each reader to decide. In our opinion, many Freudian and neo-Freudian concepts have relevance for psychi- atrists even today, and a new con- ceptualization, based on the best of the old and the new, could energize our discipline. The articles in this issue deal with many aspects of unconscious processes and their relevance to psychiatry. Dr. Iacoboni discusses an exciting topic with wide psy- chiatric implications in his article titled “Face to Face: The Neural Basis of Social Mirroring and Em- pathy.” Dr. Iacoboni presents both a historical perspective and the re- sults of his original research on the “mirror neuron” system in humans. He describes the discovery of mir- ror neurons, elucidates their neuro-

THIS ISSUE:

THE NEUROBIOLOGY OF THE UNCONSCIOUS

George I. Viamontes, MD, PhD; and

Bernard D. Beitman, MD

PSYCHIATRIC ANNALS 37:4 | APRIL 2007 223 guest editorial anatomy, and discusses their clini- cal implications. Mirror neurons in humans, as Dr. Iacoboni explains, are located in the posterior part of the inferior frontal gyrus, as well as in the anterior part of the posterior parietal cortex. These neurons have a number of unique properties. First, the inferior frontal mirror neurons (contralateral to Broca’s area) en- code inferred intentions with respect to observed actions. Second, mirror neuron areas are part of a large- scale neural network that performs internal simulations of the actions of others to facilitate an understand- ing of their meaning. In this context, mirror neurons are a key component of the neural circuits that facilitate empathy. As might be expected, mirror neuron activity is impaired in socially based disorders, such as au- tism, and may represent a core defi - cit in these illnesses. Mirror neurons represent the key to sharing subjec- tive meaning among human persons. They are an essential component of social exchanges at both conscious and unconscious levels, and a criti- cal element in psychotherapeutic interactions. Drs. Viamontes and Beitman ex- plore the neuroanatomy and func- tion of unconscious circuits in their article, “Mapping the Unconscious in the Brain.” Several novel concepts are introduced, including a provi- sional, fi ve-level functional classi- fi cation of unconscious processes. The generation of maps of the self and the environment that are used by both conscious and unconscious cir- cuits to guide behavior is described in detail. The neural substrates that underlie common unconscious pro- cesses, as well as the role of emo- tions in the generation of behavior, are elucidated. Clarifying the neuro- biology of unconscious processes is the fi rst step toward the integration of a scientifically revitalized uncon- scious into the theory and practice of psychiatry. Drs. Beitman and Viamontes con- tribute a second article with a prac- tical perspective entitled, “Uncon- scious Role Induction: Implications for Psychotherapy.” The premise of this work is that when people com- municate, not only do they exchange explicit content, but also implicit signals, aimed at inducing a desired role in the listener. Moreover, the implicit, role-inducing communi- cation is usually exchanged at an unconscious level. Role-induction phenomena are extremely important in a psychotherapeutic setting. The authors make a distinction between paracommunication, or the process of exchanging implicit contents un- consciously, and metacommunica- tion, which refers to any cognitive, verbal exchanges about the relation- ship between the people communi- cating. Psychotherapists must learn to activate their “observing selves” in order to manage the paracom- munications of patients. An under- standing of unconscious role-induc- tion phenomena in psychotherapy is the fi rst step toward helping patients develop more adaptive paracommu- nications. Dr. Gabbard discusses an im- portant manifestation of the un- conscious in the psychotherapeutic setting in his article, “Unconscious Enactments in Psychotherapy.” Ac- cording to Dr. Gabbard, Sigmund Freud noted that what patients don’t remember and verbalize will be unconsciously repeated in action during psychotherapy. This is the original meaning of the term “act- ing out” and is one of the most com- mon manifestations of unconscious processes. Empirical research has provided a great deal of support for such psychoanalytic constructs as unconscious motivation. For ex- ample, prejudiced people show dis- tinct unease and subsequent func- tional impairments when exposed to the object of their prejudice. Unconscious enactments are based on recognition of an old, emotion- ally charged pattern (eg, rejection by a parent figure) and unconscious preparation of the body to deal with the predicted outcome of encounter- ing such a pattern once more. It is important for the therapist to discern the signs of unconscious enactments. The development of more adaptive behavior requires engagement of the patient’s cortical resources to enable differentiation of new patterns from the old and to develop new action sequences. Dr. Blinder discusses “The Au- tobiographical Self: Who We Know and Who We Are.” In his paper, Dr. Blinder describes how both con- scious and unconscious processes create each person’s sense of self. He defines autobiographical memory as Psychotherapists must learn to activate their “observing selves” in order to manage the paracommunications of patients.

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guest editorial • guest editorial• guest editorial

T

THIS ISSUE:

THE NEUROBIOLOGY OF THE UNCONSCIOUS

George I. Viamontes, MD, PhD; and

Bernard D. Beitman, MD