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Randall D. Marshall

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One of the most interesting social phenomenons in my field in the past ten years has been the way that biological psychiatry and psychoanalysis have finally shaken hands and sat down at the same table. There is a tremendous amount of evidence now that early developmental experiences, and we're not talking about one time experiences but usually something about a repeated experiences, or overriding factors in environment, have more or less permanent effects on the developing brain.

So it doesn't take much stretch of one's imagination to figure that these permanent residues are what you would be talking about in your psychotherapy. The way that a traumatizing relationship in your early life continues to affect your marriage, and your relationship with your colleagues, and your relationship with your boss. You can be completely aware of it, but it still affects you. It still has its place in your life. The question is, "Can more be done than that? Could there be a biological therapy that could act to further suppress those negative influences on your adult life?"

That's an open question, but I do think there are going to be limits to what psychotherapy and learning can do in terms of overriding those influences that come from memory and emotion centers in the brain. I say "overriding" because we know that traumatic experiences, conditioning experiences, leave more or less permanent traces.

And, so for example, when a fear gets extinguished in animal experiments, the lesson doesn't disappear. It gets over-learned by a new lesson. So these are very important implications for psychotherapy, for the biology of psychotherapy.

There was a recent imaging study that suggested that psychotherapies work by activating the cortex, which is where a lot of the thinking and language centers are, the conscious thinking and processing. And the medications work primarily through the emotion centers, which are in the lower parts of the brain, and have, of course, powerful influences on the cortex and the thinking centers, but suggest that the therapies and the medications could work through complimentary mechanisms.

One interesting possibility for PTSD is that whether you're working from the top down or the bottom up, you eventually end up at the same place. And for PTSD, that would be stabilization of the emotion centers, regulating anxiety and depression, and other nasty mood states, and suppressing the trauma memories that get so indiscriminately activated in these patients.



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