Review of the book entitled Affect dysregulation and disorders of the self

BOOK REVIEW

Review of the book entitled Affect dysregulation and disorders of the self

Maurício Marx e Silva

Psychiatrist. Aspiring member, Sociedade Psicanalítica de Porto Alegre (SPPA), Porto Alegre, RS, Brazil. Subeditor for Neurosciences, Rev Psiquiatr RS

^{Correspondence}

Allan N. Schore

The Norton Series on Interpersonal Neurobiology

New York, WW Norton & Company, 2003

Allan Schore, PhD, is a professor of psychiatry and biobehavioral sciences at University of California, Los Angeles (UCLA) and at the Institute of Psychoanalysis in Southern California. He is a special editor of the Infant Mental Health Journal and belongs to the editorial board of the journal Neuro-Psychoanalysis. He has published several articles, chapters and some books on psychoanalysis, neurosciences, theory of attachment, children's mental health, development psychology and psychopathology and theory of affect regulation.

Since the early 1990's, the "brain decade," especially after the publication of his book Affect regulation and the origin of the self in 1994, Schore has been researching and publishing about the integration of findings on basic neurosciences with development psychology and psychodynamics. He has been gradually building a very well based theory of the self and affects as self regulators in their interaction with the environment, markedly the intersubjective environment.

In this book, in which the author develops the integration of the evidence collected over the past years within the scope of a developmental affective neuroscience (part I) and a developmental neuropsychiatry (part II), his theory of regulation/dysregulation of affects gains an integrated and defined body. Along with that one, Schore also launched another volume, a kind of twin-book, Affect regulation and the repair of the self, in which he develops the proposal of a psychotherapy based on developmental neuroscience and of a neuroscientifically-based psychoanalysis (which supports the proposal of the great neuroscientist Eric Kandel that psychoanalysis should be recognized as a discipline related to neuroscience, and not only as a hermeneutic discipline).¹

In part I, Schore presents evidence that support the existence of a regulating system centered in the right orbitofrontal cortex, whose innate prestructuring depends on experience both for developing itself and for "how" it will develop itself (experience-dependent maturation). This regulating system anatomically and functionally coincides with the attachment system in neuroimaging studies, with the mnemonic register of primal caretaking objects and adaptation patterns to these objects. In other words, the innate survival apparel predicts, so to speak, the external participation of the mother and/or caretakers in this regulating attachment system; similarly, in certain animals, the alimentary tract of the immature offspring "presupposes" that part of the digestive process will be performed by the caretaker (book reviewer's analogy), counting on the attachment system as a guarantee that this will occur (and it is literally a matter of "life or death"). It is a homeostatic regulating system dependent on the exterior, on the other.

The notion of "critical periods" of neural plasticity for the attachment system is crucial to the author's proposal, i.e., that the same experience taking place at early development will leave different marks from those that might occur in further relationships. There is a wide review of the neurobiological bibliography, which supports the differences in brain structures involved in the human attachment system in different periods of the maturation process - such as, for example, the synaptic excess at the end of the first year of life in certain regions of the prefrontal cortex in the human baby, waiting for the synaptic "pruning" that will be guided by experiences of attachment relationship. That bibliography helps to demonstrate in humans what was already well known and accepted in nonhuman primates and other mammals, i.e., that the expression of hereditary influences on behavior usually requires and depends on transactions with the environment during critical periods for the maturation process.

According to the author's proposal, developed in part II, the experiences of affective bonding between mother and baby, especially during the first three years of life, critical period for the attachment system, are crucial in determining the structuring of subcortical neural pathways. Those experiences will further provide the "affective tone" of the cortical functioning. Repairing states of autonomic hypoactivation or excitotoxicity - for example, during the emergence of situations of shame, between 14 and 16 months of postnatal life - is a caretaker's function. Traumatic experiences, especially type D attachment patterns (disorganized/disoriented), may damage the development of sympathetic nuclei in the ventromedial hypothalamus and parasympathetic nuclei in the lateral hypothalamus, which are crucial for a further tendency to both types of violence: "hot blood," reactive, impulsive, borderline, sympathetic autonomic tone, and "cold blood," nonreactive, aiming to repair hypoactivation states, sociopathic, bradycardic, parasympathetic tone.

Schore emphasizes, in all his work, the lateralization to the right of the brain system, based on neuroimaging studies and because the right hemisphere is dominant during the first years of life. A major implication of this fact is that the register of intersubjective patterns recorded during the critical period will occur in implicit memory systems, non-episodic/declarative, therefore non-evocable through verbalization, but verifiable through conduct and behavior. The maturation of the system of declarative, episodic memory, dependent on the hippocampus and on the temporal cortex will only occur after the third year of life. This neuroscientific evidence is coherent with the tendency observed, especially over the past two decades, within the psychoanalytic technique, in the sense of building meanings based on what is collected from the relationship with the analyst and on the search for the intersubjective "matrix" (for example, in Thomas Ogden²), more than rescue of repressed memories.

Finally, based on what was quickly summarized above, this is an essential book in the process of "consilience" (E. O. Wilson³) between neuroscience of affects and bonds and more subjective approaches to the psyche, especially psychoanalysis. It is very technically written, making its reading quite hard, in a style completely different from, for example, Antônio Damásio; but its importance compensates the effort.

REFERENCES

1. Kandel ER. Psychiatry, psychoanalysis and the new biology of mind. Washington/London: American Psychiatric Publishing; 2005.

2. Ogden T. Os sujeitos da psicanálise. São Paulo: Casa do Psicólogo; 1996.

3. Wilson EO. Consilience - the unity of knowledge. New York: Alfred Knopf; 1998.

Publication Dates

• Publication in this collection
  08 May 2007
• Date of issue
  Dec 2006