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Developmental disruptions of the self-other distinction and psychopathology Dr Susan Mizen MBBS FRCPsych Honorary Consultant Psychiatrist in Psychotherapy Exeter PhD student The University of Exeter.
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Developmental disruptions of the self-other distinction and psychopathology

Oct 17, 2022

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Developmental disruptions of the self-other distinction and psychopathologyDr Susan Mizen MBBS FRCPsych
Honorary Consultant Psychiatrist in Psychotherapy Exeter
PhD student The University of Exeter.
Aikaterina’s innovations
(M)other and the infant form a single psychosomatic homeostatic unit in the first instance inside the same predictive envelope
The distinction between self and other is made on the basis of contingency
In the first 4/5 months oriented to detection of contingency
Thereafter oriented to non- contingency
Multisensory integration: Sensory and motor modalities integrated - amodal perception
Active inference based on contingency and non-contingency
likely cause self or likely cause other
The importance of proximal interactions
Proximal interactions are embedded in homeostatic regulation
They are the foundation of representation of self and other both cortically and subcortically
More research findings There are two distinct representations of the body in the brain
The body interior The objective body
In the first instance the psychosomatic boundary of the self does not co-incide with the skin
The psychosomatic boundary is a generative model it is not fixed Sense of Ownership So(O) Sense of Agency (A)
The accuracy of Generative models can be adjusted (Precision) Interoceptive Exteroceptive
What is left unexplained The content of perceptual distortions
The emotional origins of perceptual distortions
The emotional significance of the psychic boundary the generative model
represents.
The influence of object relations and defences on perceptual, motor and
executive functions
Our three stage model attempts to fully integrate the observed clinical phenomena in narcissistic patients with these neuroscience findings
Our proposal: a three-part, hierarchical of the self-other distinction: 1. The homeostatic self-other
distinction
Clinical findings in narcissistic patients: Personality Disorder, Eating Disorders and Somatisation
The Relational Affective Model
Loss of the narcissistically cathected object
Melancholic and paranoid defences
Projective identification in narcissism Rey states:
“The infant, in a state of absolute dependence, must come to terms with the reality that the other is at once needed, good and separate”.
When this cannot be negotiated:
ANALYTIC
NEUROSCIENTIFIC
Intolerance of prediction error
Britton
Where this cannot be negotiated, either separateness or need are defended against by
ACQUISITIVE and
Inside the object (Agoraphobic)
The mind and body of the other belong to me
Otherness is denied and separateness is attacked.
Two minds / bodies are felt to be one inside the same skin.
Psychomotor retardation – ultimately static states
Objectivity is intolerable (Wordless affect)
Hyper-subjective
B M (Acquisition)
Outside the object (Clautrophobic)
Painful, threatening parts of me are disavowed and treated as though they belong to you
Attachment and need is denied, attacked and projected. “I need nothing”.
One mind and body is felt to have become two.
Psychomotor acceleration- manic states
M B
Loved
Acquisition – hypersubjective
Mr C
Mr C presented as aloof, egocentric and imperious, oblivious to the world around him except insofar as it affected his own wellbeing. He appeared unable to see things from the other person’s point of view, eschewing social convention. He only took the initiative to address a complaint. He took nothing in and never expressed gratitude, seeming to have withdrawn into a cocoon of self-sufficiency, and yet, he was simultaneously very needy and demanding. He was hypochondriacal and intolerant of frustration of any kind, expressed mostly to the nursing staff, whom he treated as though they were combined into one big mother, whose function was to meet his personal needs immediately. His intolerance of frustration was also expressed towards his arm and his rehabilitation regime. He expected and demanded to make a total and complete recovery. He seemed to harbour an intense need to regress, to be looked after and cared for, and yet consciously abhorred dependence and vulnerability of any kind. He closely resembled ‘his majesty the baby’, in a word he was narcissistic.
He treated the left side of his body in the same way he did the nursing staff, as though it was another piece of external reality which refused to do his bidding. It was therefore an annoyance, but otherwise of no interest to him. It was as though he had redrawn the boundary of his physical self, so that only his torso and right limb really belonged to him. His left arm was treated like a disobedient servant. (Solms and Kaplan Solms, 2000, p162-3)
Narcissism, the brain and the body The caloric test
The presence of the therapist
The third person perspective
Disordered body ownership:
Acquisitive and attributive states in psychiatric practice
Self and other states
The Relational Affective Formulation
Emotionally Constricted (Cluster C: avoidant, Dependent, Anankastic)
Emotionally Dysregulated (Cluster B: Histrionic Narcissistic and Borderline )
Autistic Spectrum Disorder
Psychoanalytic theory
Failures of splitting Contamination of the good feed by aggression (Meltzer)
Parental
Narcissism
belonging to mother - Core Complex (Glasser)
Maternal attributive PI – Omega function (Williams)
The infant’s
The baby’s body as self: all providing and self-sufficient.
The body as other: part of the external world and hated.
(Freud)
Failures of
(Rey)
Parental narcissism: Acquisition The infant must be contingent upon (M)other.
If the infant is ‘other’ loss of the homeostatically required (M)other ensues.
If they accept the required contingency they no longer exist.
(Core complex)
Parental narcissism: Attribution The (M)other disavows an unwanted aspect of herself projecting it into the infant
The infant becomes a proxy for that part of the mother
Mother cannot tolerate proximity with or separation from the disavowed part
‘Omega function’ the infant takes in ‘poison’ with the milk.
Solution – no entry defence
Psychoanalytic theory
Failures of splitting Contamination of the good feed by aggression (Meltzer)
Parental
Narcissism
belonging to mother - Core Complex (Glasser)
Maternal attributive PI – Omega function (Williams)
The infant’s
The baby’s body as self: all providing and self-sufficient.
The body as other: part of the external world and hated.
(Freud)
(Rey)
I need you
I need you
I need you
Disavowed: Not me
Hated as other
Outside my control
Once completely in my control the body is experienced as part of the self
You need me I need
you
28 acute AN; 24 recovered AN; 35 matched healthy controls
We also observed a high correlation with Eating and Weight concerns with altercentric bias (r=.334, p=0.002; r=.468, p<0.001).
Do individuals with Anorexia Struggle to Inhibit Social Perspectives on Body?
Kirsch et al., in prep.
The Relational Affective Formulation for eating disorders
The ‘one foot in each camp’ defence
‘Ana’ The anorexic voice / subpersonality Voices and personified parts of the personality
Unrepresented aggression
Imaginary friends
£0
£100,000
£200,000
£300,000
£400,000
£500,000
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£800,000
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55
Series1
Confirmed clinical diagnosis of PD
Series1
Diagnosis
Diagnosis
0
1
2
3
4
5
6
7
8
9
10
r ex
lg ia / M E
P ai n sy
nd ro m es
H yp
oc ho
nd ria
si s
h E D
Conversion disorder
Symbolisation present
In conclusion The phenomenology of narcissism can be seen both on neurological patients and psychiatric patients
This phenomenologu points to a developmental pathway from a primary state of psychosomatic union represented in the generative model between mother and baby
A three stage process delineated the process through which the distinction between self and other are made .
Where this cannot be negotiate profound psychosomatic disturbances develop in the distinction between self and other resulting in disturbed relating to the body and to others. The symptomatology arises in the context of separation and loss.
This disturbance is characterised by regressions to states of psychosomatic unity with (M)other and states on flight from connection and need.
This has implications for psychiatric and clinical practice with patients with PD, ED and psychosomatic presentations.
Relational Affective Model References:
Mizen, C. S. (2014a) Narcissistic disorder and the failure of symbolisation- A Relational Affective Hypothesis. Medical Hypotheses: Volume 83, Issue 3, Pages 254-262
Mizen, C. S. (2014b) Towards a Relational Affective Theory of Personality Disorder Psychoanalytic Psychotherapy 28: 4.357-378
Mizen, C. S. (2015) Neuroscience, mind and meaning: an attempt at synthesis in a Relational Affective Hypothesis. Psychoanalytic Psychotherapy 29: 4. 363-381
Mizen, C. S. (2017) Preliminary thoughts on the neurobiology of innate unconscious structures and the psychodynamics of language acquisition. The Journal of Analytical Psychology (November edition)
The Bloomsbury Neuroscience Group Email: [email protected] and [email protected]