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THE EVOLUTIONARYNEUROETHOLOGY OF
PAUL MACLEAN
CONVERGENCES AND FRONTIERS
Edited by Gerald A. Cory, Jr. andRussell Gardner, Jr.
Foreword by Jaak Panksepp
Human Evolution, Behavior. and IntelligenceSeymour W. Itzkoff,
Series Editor
Westport, ConnecticutLondon
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6THE TRIUNE BRAIN, ESCALATIONDE-ESCALATION STRATEGIES, AND
MOOD D ISORDERS
John S. Price
INT RODUCTION
Paul MacLean described three "central processing assemblies" in
the neomam-malian, paleomammalian, and reptilian brains that make
decisions aboutresponses to environmental social events relatively
independently. In th is chap-ter, I apply this model to explaining
the two alternat ive strategies of escalation(fight) and
de-escalation (escape or submission). At the neomammalian
levelthere is a conscious, .rational decision either to fight or
give in. At the paleo-mammalian level which relates to emotions and
the limbic system, there isdeployment of either the escalatory
emotio ns of anger, exhilaration, and so on,or of the de-escalation
emotions offear, depression, shame, etc. I suggest that atthe
reptili an level of the forebrain, the escalating strategy consists
of elevatedmood and the de-escalatin g strategy consists of
depressed mood, which isunfocu sed or self-focused. In some cases
the responses of the levels may beincompatible. The implications
for mood disorders and their treatment areexamined.
BACKGROUND
The message I got from the work of Paul MacLean entailed the
following:the mammalian forebrain has evolved into three "central
processing assemblies"for coordi nation of information and
decision-making about how to respo nd tochanges in the environment.
' These three assemblies coordinate their actio ns butmake somewhat
independent decisions. For ease of communication I talk aboutthe
rational brain situated rough ly in the neocort ex (Macl.ea n's
neomammalianbrain), an emotional brain in the limbic system
(MacLean' s paleomammalianbrain), and an instinctive brain situated
in the corpus striatum (Mac Lean's
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108 The Evolutionary Neuroe thology ofPaul MacLean
reptilian brain or R-complex). The rational brain uses all the
information that wenormally consider conscious, and its decisions
have the character ofvoluntariness with fu ll awareness. The
emotional brain has restricted access tothe information of
consciousness; its decisions have both voluntary and involun-tary
components, with only partial awareness of its dec isions; the
informationused in emotional bra in decision-making includes
elements unavailable to therational brain, as Pascal noted in his
famous aphorism "Le coeur a ses raisonsque la raison ne connait
pas" (The heart has its reasons which are not known toReason). The
instinctive brain has different sources of information that have
notbeen much studied yet; its decisions are involuntary with no
awareness of anyensuing course of action until that action takes
place.
This new conception of the forebrain replaced my previous idea,
that ofhomogeneous brain expansion since the time of the common
human andrept ilian ances tor some 250 million years ago, and
included the general princip lethat higher centres control the
lower ones, largely through inhib ition.
The numerous theories of unconscious processes attest to
psychiatry'sinevitable concern with brain or mind levels.' When
treating pat ients withdepression and anxiety, the clinicia n finds
it obvious that higher centres do notcontrol the lower ones. No
patient with his rational brain can command hisemotional brain to
fee l less depressed or anxious. From the time of Coue andSamuel
Smiles to the more recent efforts of psychological healers, peo ple
havestood before their mirrors and repeated to themselves such
phrases as, "Everyday, in every way, I am gelling beller and better
." But these techn iques do notwork . In fact, they make patients
worse, because they arouse expectat ions ofimprove ment that remain
unfulfilled, therefore resulting in disappointment and asense of
failure. An outstanding feature of psych iatric practice hinges on
the factthat the rational brain of homo sapiens, the acme of the
evolu tionary process,has no more control over the lower brain
centres than does the rider over arunaway horse.
Rational contro l over the lower brains could easily have
evolved . The factthat it has not should tell us something-namely,
that painful and incapac itat ingprocesses such as depression which
emerge so much against our conscious willare, in fact, performing
one or more functio ns of adaptive value. It appears thatthe rider
does not always know best. There is survival value in having a
horsethat sometimes makes the decisions.
WHAT NORMAL BEHAVIOR UNDERLI ES MOOD CHANGE?
In an evoluti onary analysis of psychopathology, we must
determine whatkind of behaviour is being affected. A depression may
or may not be adaptive,but it likely, at least, exaggerates or
distorts some piece of adaptive behaviour.[0 the case of mood
disorders, no general agreement exists on what this normaladaptive
behaviour might be; except, perhaps, that it involves some form
ofsocial behaviour. The extreme incapacity of depression can on ly
be maladap tivefor nonsocial events. Generally, we agree that when
depression has a cause, it
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Escalation, De-escalation, Mood Disorders 109
involves some form of loss or failure. But if, for example, in a
group of ourhunter/gatherer ancestors, hunting had gone badly, it
would not be adaptive forthe hunters to become so depressed that
they were unable to gather effectively.As with foraging deci sions,
so with predator avoi dance, there is little place fordepressed
mood . Only in the case of dealing with climatic adversity do we
get asuggestion that depression might perform some function
analogous to hiberna-tion during the winter, and keep us out of
harm' s way until spring comes along.But, in spite of the attention
devoted recently to seasonal affective disorder(SAD), psychiatry is
not a seasonal matter, and there is no suggestion that wemight
close our consulting rooms during the summer and take jobs as
water-skiinstructors.
Socia l theories of the adaptive value of depression take the
form of cries forhelp, changes of social niche, relinquishing of
unattainable social goals, andadjustment to loss. At the time I
first became engaged with this field, it wasthought that depression
served some function in relation to loss, separation orbereavement.
This reasoning never convinced me. Although it was c lear that
asocial or romantic bond of many years ' duration could not be
broken withoutsome grief, it never seemed likely that a depressive
episode of several months 'duration could be adaptive following the
loss of a good ally or partner.Depression is incapacitating, and if
you lose a partner, there is the work of thepartner to do in
addition to your own, so that an increase in capacity wou ld bemore
advantageous than depression.
SOCIAL COMPETITION
More likely has been tbe possibility that elevation and depress
ion of moodserve a function in relation to soci al competition. The
reasons for this are asfollows:
Depressed patients feel like failures and losers.'Manic patients
feel successful and like winners."The basic strategy set of social
competit ion contains the two alternativestrategies of escalation
(fight) and de-escalation (flight or submission), \vhichhave
similarit ies to elevated and depressed mood, respective
ly.'Competing animals can switch rapidly from escalation to
de-escalation in theway that a manic-depressive patient can switch
from mania to depression.Monkeys who have failed in social
competition and thus are low ranking maybehave in a restricted and
dysphoric manner similar to that of depressedpatients."
However, there are problems with this line of thinking:
Some high-ranking people are depressed.Some low-ranking people
are perfectly happy.
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110 The Evolutionary Neuroethology 0/Paul MacLean
Some depressed patients are very powe rful-c-they may be
stubborn, demandingand manipulative. Aaron Beck warned, "Beware of
locking horns with adepressed patient. oryou may be pushed clean
out of the consulting room!"Depressed patients do not act in a
submissive way or show deference to morepowerful people.
In our discussions of these matters, we played with ideas of
there be ing twodifferent types of submission, voluntary and invo
luntary, and that depressionreflected only involuntary
submission-so that an alternative to depressioncould be those forms
of vo luntary submission that go under the terms ofhum ility,
reasonableness, and willingness to compromise. But the water
wasmurky, and we could not see the way ahead clearly.
THE TRIUN E MIND/BRAIN
The n came triune brain theory. Although it would be too much to
say that allthen was light, it did clarify our ideas great ly. One
cou ld say that we passed thewhite light of
escalation/de-escalation theory through the prism of triune
braintheory and saw the resolut ion of clearly identifiab le
parterns of behaviour ateach level of the triune brain (see Table
6.1 next page).
In response to social adversity, or ranking stress as we called
it, each level ofthe triune brain seemed to make a decision between
escalation and de-escalation.Somet imes the dec isions agreed .
Then there was like ly to be a quick resolutionof the conflict thro
ugh either defeat, acce ptance of defeat, and reconci liation onthe
one hand, or success, acceptance of the other's submission, and
reconcil-iation on the other. At other times the decisions did not
agree, and then tro ubleensued, leading to psychopatho logy.
We have been concerned at the amount of criticism MacLean has
receivedfrom his fellow neuroanatom ists, but we note that these
criticisms have beenover deta ils, and have not challenged the esse
nt ial concept of three relat ivelyindependent central processing
assemblies; in fact, in the ir authoritative mono-graph on the
evolution of the venebrate nervous system, Butler and Hodosstate:
"Longitudinal transmission of information within the nervous system
andthe presence of rostrocaudally localised areas of integration
and control arekeystones of the chordate nervous sys tem.' :" p
-165
The most efficient way to bring about conflict resolution
operates at therational level. One of two competitors should be ab
le to say, "The other guy ismore powerful, so I will give in." The
lower agonistic strategy sets can be leftalone and this could be
called funct ional agonism. But, unfortunately, the humananimal
often prefers to not give in. On the way to my present location, I
passed aTvshirt with the capt ion, "Never surrender," and this sums
up a slogan which hasbeen reiterated over the centuries ever since
the Titans were thrown out ofHeaven .
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Escalation. De-escalation. Mood Disorders I I I
Table 6.1. T he Socia l Competi tio n Stra tegy Set at Three
Levels of theTriune Brain /Mind
Rational!Neocortical
Emotional!limbic
Instinctive!Reptilian
Esca lation
Formation of goalsProclamat ion of goalsOvercoming of
oppositionSocia l part icipationSelf-assertionDecision 10 fight
on
Joy, raptureEnthusiasmOceanic feelingAngerIndignation
Increase of RH P/SAHPIncrease of resource valueIncrease of
"ownership" valueIncrease of energyElevated mood (IDS)
De-escalation
Giving up ofpersonal goalsAdoption ofothers'
goalsSubmissionAcceptanceResignationSelf-effacement
BoredomApathyShameGuiltDepressed emotion
Loss of RHP/ SAHPLoss of resource valueLoss of "o wnership
value"Loss of energyDepressed mood(ISS)
Another form of functional ago nism works as follows : The
rational braindec ides to fight , but the emotional and/or instinct
ive bra ins dec ide to de-escalate. These de-escalations affect the
thinking of the rational brain , moving itin a more pessimistic
direction. To put it techn ically, there is a loss of resource-ho
lding potential (RHP), resource value and "o wners hip," so that
the individualfee ls less con fide nt of winning, sees the prize as
less valuab le, and feels lessentitled to the owne rship of the
prize.' Due to th is more pessim istic thinking, therational level
switches its strategy from escalation to de-escalation, there
isgraceful losing, with the way paved for reconciliation. In this
process, the lowerbrain controlled the upper brain . And this seem
s to be its funct ion. The uppe rbrain seems designed for
escalation, to win at all costs, and not to jeopardise itsfight ing
effic iency by any thought of possible damage or defeat. This
moni-tor ing of possible defeat has been relegated to, or reta ined
by, the lower brain .In some way the lower bra in seems to keep a
tally of punishment rece ived, andwhen this gets too great it
exerts its authority tell ing the upper brain to de-escalate. The
upper brain, which was in any case having a fair ly difficu
ltencounter, now has the added handicap of depressive incapacity.
So, if it doesnot capitulate grace fully at this stage, the
individua l likely gets carr ied out of thearena on a
stretcher.
We have identified depression with instinctive de-escalation,
and the com-monest cause of prolonged instinctive de-escalation
appears to be continuedinappropriate rational escalation, or, to
put it another way, blocked rational de-
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11 2 The Evolutionary Neuroethology of Paul MacLean
escalation. There are many causes for this, and I will defer
discussion of them toa later section.
Prolonged instinctive de-escalation may also stem from
inappropriate ernot-ional escalation. An exam ple entails the
patents whose child has been killed by adrunken hit-and-run driver.
The parents know there is nothing they can do at therational level.
but there is often sustained anger that cannot be satisfied
orusefull y discharged . The continued "punishment" and hurt
accesses the instinc-tive agonistic strategy set and if
de-escalation is selected, chronic depressionensues that cannot be
resolved because continued emotional escalation persists.
The third clinical variety is emotional de-escala tion assoc
iated with rat ionalescalation . This describes,
characteristically, wives consulting for marriageguidance' They
experience emotional distress, weep, and otherwise
de-escalateemotionally. But at the rational level they have esca
lated in that they aredetermined to change the ir husbands'
behaviour; to make him less spendthrift,or less unfaithfu l, or j
ust to pay them more attent ion. Their failure to achieve
thischange for the bette r in the husbands took them to marriage
guidance. But thehusbands typically sit in the sess ion
stony-faced, turned away from theirweeping wive s, apparently
unmoved by their distress. They do not want tochange, but they feel
confused by their wives' behaviour, escalated at one leveland
de-escalated at the other.
In a fourth clinical variety the pat ient de-escalates at all
levels , but thesubmission is not being accepted by the important
othe r person. Th is occurssometimes from ignorance, sometimes from
cruel ty. The fifth and final exampleof dysfunctional ago nism is
seen when the instinctive strategy set is too eas ilyaccessed, and
de-escalat ion occurs inappropriately to the situation.
Thesepatients are oversensitive, too easily moved to tears.
Sloman's chapter in thisvolume deals with them extensively.
T REAT MENT
The treatment that arises from our model can be listed in four
stages with theinjunction: Try the first stage first, and if that
doesn't work, try the second stage,and so on.
l . Find a rational solution. There is nothing wonderful about
the operation ofthe lower levels, and their mobili sation of
emotional distress and depressedmood sugges t failsafe mechanisms
because the higher-level has failed to solvethe problem.
The therapist's task involves:
(a) identifying the contlic t.
(b) estimating the chances of winning, or of leaving the are na,
or ofsubmitting the conflict to arbit ration; and if any of these
seem possible,helping the patient achieve them.
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Escalation, De-escalation, Mood Disorders 113
(c) if the problem is one of blocked voluntary yielding
(inappropriaterational-level escalation), devising a means for the
patient to give in (orgive up) without loss of face. This best
happens before the admini-stration of antidepressant drugs, because
the "giving-up" component ofthe depressive cognitions may help. In
fact, when this situation arises,this giving-up depressive
cognition typically has not been strongenough to achieve the
necessary yielding. It needs the depression plusthe therapist to
complete the job.
(d) if a third party is causative, dea ling with the problem.
Such a thirdparty may be demanding obedience that conflicts with
obedience toanother, therefore preventing the pat ient from making
a desired submis-sion. This occurs commonly in patients caught
between the demands ofa dominant parent and a dominant spouse. They
cannot submit to bothat the same time, because the demands are
incompatible. Or the thirdparty may not accept the submiss ion,
perhaps because he or she fails torecognise what is going on.
(e) if the patient' s instinctive agonistic strategy set is too
easily access-ed, perhaps due to "k indl ing" by phys ical or
emotional abuse in child-hood, setting in motion appropriate
measures. These may range fromlong-term individual psychotherapy to
a self-assertion class . (SeeSloman, this volume.)
(I) if the patient has had to give up some unatta inable goal or
much-loved incentive, considering the need for "bereavement
counselling" ofsome sort. Rosen' discusses this we ll.
2. Refram ing the situation. If the situat ion that gave rise to
the depressionseems insoluble, consider how it may seem differen
tly to the pat ient. Here therat ional brain tries to control the
informational input to the emotion al brain.Since it cannot infl
uence the emotional bra in directly, this represents the
closestapproximation to infl uencing the decision-making function
at the emotionallevel. The best reframing process in the Western
wor ld is Chr ist ianity. Reframedpain and suffering take on
Christ-like qualit ies: the more one suffe rs, the moreone shares
the exper ience of the Sav iour. Gurdjie ff reframed suffer ing to
hisdisciples as opportunities to work on the self and so improve
the "true self "which, given enough opportunity and enough work,
might become immorta l."The class ical reframing, quoted by
Watzlawick, II is Tom Sawye r's punishmentof having to pa int a
fence. Th is prevented him from go ing fish ing with hisfriend s,
so Tom reframed it as a marvellous opportunity to have fun with
paint.Th is reframing gained such success that his friends forgot
all about fishing andbegged him to let them do the job themselves.
For the parent of a ch ild killed bya hit-and-run driver, it may
help to see the driver as someone sick rather thanbad, perhaps as
someone in the throes of epi lepsy or a heart attack.
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114 The Evolutionary Neuroethology of Paul MacLean
3. Substitute group conflict for individual conflict. We have
suggested thatthe tendency to depre ssive illness evo lved as pan
of the yielding component ofritual agonistic behaviour. Essentially
this stems from a dyadic interaction. Thesame considerations do not
apply to conflict between groups because groupconflict lacks the
primitive ritual quality of dyadic encounters. In other words,when
groups lose a conflict, the members may become demoralised, but
they donot become depre ssed in the way that individual losers do.
Therefore , if thepatient can join other people engaged in the same
conflict, the whole operationmay switch from individual agonistic
behaviour to an intergroup process. Thepare nts who lost their
child to the hit-and-run driver can join other parents andexpress
their grief and rage in a group fashion, and hopefull y thereby
direct theirenergies into such positive action as campaigning for
more severe laws on drunkdriv ing.
4. Last, provide salves and ointment s to the symptoms
themselves. Thisshould represent very much a last-ditch action. One
hopes that in most cases oneof the preceding three methods would
have worked . If not, the symptoms maybe addre ssed directly. I am
indebted to Leon Sloman for the vignette of thealpine climber who
has a panic attack on the side of a snow-covered mountain.He heard
a rumble and feared an avalanche. His breathing acce lerated by
anxietycaused him to blow off too much carbon dioxide, his blood
became alkaline, andhis muscles went into tetany. In this case,
encouraging him to breathe moreslowly results in restoration of the
acid -base balance of his blood to normal sohis legs move again and
he can walk to safety. Of course, even here, commonsense must be
used. The therapist chose the breathing. He would have had
lesssuccess ifhe had applied ointment to the tetanic muscles.
In this case, we accept that higher level solutions were not
available. Thetherap ist might have done better to prod uce a cell
phone and summon up ahel icopter to take the patient off the
mountain to safety. Or refram ing thesituation, he could have
pointed out that they were not in fact on a real mountainat all-
they were actors taking pan in an alpine movie, and the rumbling he
hadheard was the movement of a mock Mont Blanc on its castors to
take up a newlocation. However, we accept that the deus ex machina
of a helicopter is seldomto be summoned, even with a cell phone,
and that most climbers who pan ic atthe thought of an avalanche are
on real mountains and not taking pan in films.But this direct
attack on symptoms represents a last resort, unlike somecognitive
behaviour therapists who spend time trying to argue patients out
oftheir depressive de lusions.
RESEARCH
Like other evolutionary interpretations, the foregoing
represents speculationin the last resort untestable. But definit
ive implications for treatment result.These might have been deduced
from anoth er theory, but they have not.Treatment either works or
it does not; and this can be tested in a controlled trial.The
following plan would constitute such a test: (I) recruiting a
center already
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Escalation. De-escalation. Mood Disorders 115
conducting manualized psychotherapy of depressio n, e.g.,
interpersonal therapyor IPT;12 (2) inserting into their research
desig n addi tional or replacementinterventions based on the
evolutionary theory as delineated above. \Ve predictthat the
results wou ld show qu icker and greater powc=r.
THE TRIUNE MIND
For centuries, thinkers have expressed intimations that the mind
functions ina way dictated by the triune nature of the brain.
Plato, in a chap ter entitled "Thethree parts of the soul"
describes various fu nctions and asks: "A re we using thesame part
of ourselves in all these three experiences, or a different part in
each?Do we ga in knowledge with one part, feel anger with another,
and with yet athird desire the pleasures of food, sex, and so on?
Or is the whole soul at work inevery impulse and in all these forms
of behaviour?" 13. p. 132
Eastern philosophy, brought to the West after World War I by
Gurdj ieff,' oused the metaphor of the horse and cart to describe
the mind. It talked of adriver, a horse and a cart, and of the
connec tions between the three elements.The driver represents the
rational mind, the horse the emotional mind, and thecart the
instincti ve mind. Thi s philosophy aimed to create a fourth
element, the"true sel f" representing a "master," who contro lled
the driver, and told himwhere to go. Gurdj ieff established a teach
ing centre near Paris; its prospectusproclaimed:
a modern man represents three different men in a single
individual- the first of whomthinks in complete isolation from the
other parts. the second merely feels. and the thirdacts only
automatically. according to established or accidental refl exes of
his organicfunctions . . . they not only never help each other. but
are . on the contrary. automaticallycompe lled to frustrate the
plans and intentions of each othe r; moreover, each of them.
bydominati ng the other in moments of intensive action, appears to
be the master of thesituation, in th is way falsely assuming the
responsibili ty o ~ the real "I." 14. p 138
CONCLUSION
In summary, the concept of the tr iune mind has been part of
human folkknow ledge for over two millennia . Paul Macl.ean ' s
description more recentlyprovided a neuroanatomical basis for this
knowledge. offering an enormousboost to the heur istic value of the
triune model. In this chapter and elsewhere" Iattempted to demo
nstrate some applications to psychiatric practice; and in thefuture
I wou ld anticipate that it wi ll have a profound influence on the
fields ofindividual and social psychology.
It is, of course, just a theory, that should be com pared with
other theoriesdea ling with the same material. Birtchnell, for
example, has put forward a twolevel theory 16.17 that may have
advantages in certain circumstances; sometimesit is useful to
contrast the rational brain with the remainder of the brain .
ISHowever, the three-leve l theory has the advantage of dealing
with the emotions
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116 The Evolutionary Neuroethology ofPaul Maclean
separately. For instance, it clarifies the relation between
depressed emotion anddepressed mood (the former focused on an
object rap idly responds to changes inthe object's situat ion, in
contrast to depressed mood that remains unfocused orse lf-focused,
and unresponsive to circumstances present). The present theo
rychallenges previous theories of emotion, wh ich, for instance,
combine anger anddepressed emotion in the same category of negative
emotion in contrast to thepositive emo tions of joy and happ iness.
According to triune mind/b rain theory,ange r joins with joy as an
esca lating emotion , in contrast to depressed emotionsee n as a co
mpo nent of a de-escalating strategy. Empirical research wi ll deci
dewhich theory most usefully conceptualizes the data.
NOTES
1. MacLe an PD: The Triune Bra in in Evolution . New York :
Plenum Press, 1990.2. Ellenb erger HF: The Discovery oj the
Unconscious: The History and Evolut ion of
Dynamic Psychiatry. New York: Basic Books, 1970.3. Beck AT: The
development of depre ssion . In D Freedman & H Kaplan
(Eds.)
Comprehensive Text book 0/Psychiatry. Philadelphia, PA: Williams
and Wilkins, 1974.Pp. 3- 27.
4. Gardner R: The brain and communication are basic for clinical
human sc iences .British Journal oj Medical Psychology. 1998,71 :
493- 508.
5. Huntingford F & Turner A: Animal Conflict . London:
Chapman & Hall, 1987.6. Price JS: The effect of social stress
on the behav iour and physiolo gy of monkeys.
In K Davison & A Keff (Eds.) Co ntemporary Themes in
Psychiatry. London: Gaske ll,1989, pp. 459-466.
7. Butler AB & Hodos W: Co mparative Vertebrate Ne
uroanatomy. New York : WileyLiss, 1996.
8. Gardner R, Jr. & Price JS: Sociophysiology and depress
ion. In: T Joiner & JCCoyne (Eds.) The Interactional Nature 0/
Depression: Advanc es in InterpersonalApproaches, Washington, DC:
APA Books, 1999, pp. 247-268.
9. Rosen DH: Transforming Depressio n: Egocide, Symbolic Death,
and New Life.NewYork: Putnam, 1993.
10. Ousp ensky PO: In Search 0/ the Miraculous: Fragments 0/ an
Unk nownTeaching. London:Routledge & Kegan Paul, 1950 .
11. Watzlawick P, Beavin JH, Jackson DO: The Pragmatics 0/ Hum
an Co mm uni-cation: A Stu dy a/ Interactional Patterns,
Pathologies and Paradoxes. New York: W.W.Norton , 1950.
12. Weissman NM & Markowitz JC: (1994) Interpersonal
psychotherap y: currentsta tus. Archives ofGeneral Psychiatry,
1994; 51: 599-606 .
13. Corn ford FM: The Republic 0/ Plato. Translated with
introduction and notes .London : Oxford University Press, 1992.
14. Bennett JG: Gurdjleff Making a New World . I .ondon: Turn
stone Rooks , 1976.1 5~ Price JS: The adaptive function of mood
change. Brit ish Journal 0/ Medical
Psych ology 1998; 71: 465-477.16. Birtchnell J: The inner brain
and the outer brain. The ASCAP Newsletter, 1999,
12 (0 1), 11-17
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Escalat ion, De-escalation, Mood Disorders 117
17. Birtchnell J: Relating in Psychotherapy: The Application of
a New Theory.Westport CT: Praeger, 1999.
18. Price J: A case of hedonic emotionalllimbic escalat ion.
ASCAP Newsle tter 1999;12 (No.5), 1()-12.