GR_12_02_22

December 02, 2022

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Dr. Sidney J. Blatt Lecture: "Relating With the Emotional Brain"

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00:00And.
00:04I will just pull up my slides.
00:10There they are. Hopefully for all of you too.
00:18I I never knew Sidney Blatt,
00:21but I I know of him and I know his work.
00:25And among the themes that he tackled,
00:30one of them alongside self
00:32definition was relatedness.
00:34And so I I've chosen the topic accordingly,
00:38relating with the emotional brain.
00:40Here's my disclosure to
00:41get that out of the way.
00:43I'm sure you you can all just take a
00:46little snapshot of that with my move on.
00:49There's a lot of ground to cover.
00:52I'm I'm beginning with this quotation
00:55from Freud because a lot of psychoanalysts
00:58get anxious when they hear that a
01:02neuroscientist is suggesting some
01:04revisions to their beloved theory
01:07based on neuroscientific findings.
01:10And they think that this is that this is a
01:12breaching the boundaries of what is properly,
01:15properly considered evidence suitable for the
01:19development of psychoanalytical theories.
01:22I, I, I won't read the whole quotation to you
01:25as safe to refer to the parts that are bold.
01:29Freud says there that the classification
01:31of what he called the drives.
01:33He doesn't think it can be done on
01:35the basis of psychological material.
01:37He thinks it requires definite
01:39assumptions to be taken over from
01:42some other branch of knowledge.
01:43And here he makes clear what the other
01:45branch of knowledge is that he has in mind.
01:48He says it's necessary to borrow
01:50from the science of biology.
01:52When it comes to delineating
01:54the life of the drives,
01:56and he said that who knows what
01:59neurobiology will teach us in the future.
02:01It may be new information of a kind
02:03that will blow away the whole of our
02:07artificial structure of hypothesis.
02:08So I'm at least as far as Freud
02:11was concerned,
02:12what I'm doing is legitimate,
02:14especially when it comes to the
02:16aspect of mental life that I'm going
02:18to be talking to you about today,
02:20what used to be called. Drive theory.
02:23What might be more sort of descriptively
02:27termed the basic emotional needs
02:30of the human being.
02:33Here is for its definition of drive.
02:36It's a measure of the demand
02:38made upon the mind for work.
02:41And.
02:41As I proceed,
02:43hopefully you'll get a slightly better idea
02:47of what's meant by a measure of the demand.
02:51Made upon the mind for work.
02:53What sort of work does the mind perform?
02:56So with all of this in mind,
02:58and especially this quotation,
03:00I'm now going to show you a slide
03:03which sort of summarizes very
03:06abstractly how we conceptualize
03:09drive in neurobiology today.
03:11And it's all based on very
03:14simple concept of homeostasis,
03:16which I hasten to point out was a
03:19concept that fruit was not familiar with.
03:22Introduced in the 1930s,
03:24a few years before for its death,
03:27the basic idea I've used
03:29mischievously Freudian terms here,
03:31but the the basic idea is
03:33that there's a set point,
03:35there's a there's a viable range
03:37within which we have to remain in
03:40terms of our biological needs,
03:42and deviations from that viable
03:45range are demands for work.
03:49One has to do something in order to return.
03:52Oneself back to ones viable arms.
03:56That's the basic concept of homeostasis,
04:00and when I say we have to do something,
04:02we have to do it on the basis of something
04:06which is predicted to be be likely to
04:09achieve that return to our viable bounds.
04:12The word prediction might seem odd there,
04:14but hopefully it'll become clearer
04:16as we go along when it comes to
04:19most of our autonomic needs,
04:21all of which are regulated.
04:23On the aesthetically this prediction
04:25takes the form of a reflex.
04:28So for example if you overheating,
04:32the prediction is that perspiring and
04:35breathing more rapidly will cool you down.
04:38And the same applies to our emotional needs,
04:42emotional needs.
04:43We have emotional viable bounds
04:45and I will clarify what I mean
04:48by that as I as I proceed,
04:51but these are biological viable.
04:53Towns, as you'll see,
04:55and when we deviate from those viable bounds,
04:58we feel the the demand for work,
05:02the in the form of a of an unpleasant,
05:05distressing emotional state.
05:07Then we need to do something in order
05:11to return us to our biologically
05:14viable range and that prediction.
05:18Whereas when it comes to autonomic needs,
05:21it takes the form of a reflex.
05:23But when it comes to emotional needs,
05:25it takes the form,
05:27at least initially in development,
05:29it takes the form of what
05:31we call an instinct.
05:32In other words,
05:33some sort of stereotyped response pattern,
05:35and I'll illustrate all of this
05:36with examples as I proceed.
05:38I'm starting with very general abstractions,
05:41but the crucial point for now is to
05:45understand that the instincts that we
05:48are born with the innate predictions as
05:51to as to what to do when we find out.
05:54Solves in these in these.
05:57And situations of universal
06:00biological significance,
06:01that these instinctual responses are
06:04too stereotyped. They they don't.
06:06They don't work in anything other
06:09than the most generic of situations.
06:11And so the great task of mental
06:14development is to learn what else to do
06:17over and above the innate preparedness
06:19that comes with instinctual responses.
06:23So the great task of mental development,
06:25on the view that I'm going
06:26to outline for you.
06:27Today is to learn how to meet our
06:31emotional needs by way of supplementing
06:35supplanting our instinctual
06:37predictions with learned ones,
06:40learning from experience how
06:42to meet our emotional needs.
06:44And this learning takes the form of
06:48establishing better predictions.
06:49Memories are of course about the past,
06:53but they are for the future,
06:55learning on the basis of past experience.
06:58Is in order to better predict
07:00what to do in the future.
07:01And This is why I'm using
07:03the word prediction.
07:04Learning is all about predicting.
07:08All of this will become clearer,
07:09I hope,
07:10as we proceed.
07:11The function of unpleasant feelings
07:13is simply to tell you that what
07:15you're doing isn't working,
07:16and that you're heading in a
07:18in a bad direction.
07:20Bad in the biological sense,
07:22where the basic value system
07:24is that it's good to
07:26survive and to reproduce and bad to die.
07:29Pleasurable feelings mean the opposite,
07:31that you're heading back
07:32toward where you need to be,
07:34when you are where you need to be,
07:37then you're in what?
07:38Throat called Nirvana.
07:39This thing that lies beyond the pleasure
07:41principle, a state of quiescence,
07:44a state of no perturbation.
07:46The ideal biological state,
07:49as it turns out.
07:52So the ideal situation is to have predictions
07:56which automatically meet our needs,
07:59just as in the case of breathing
08:02and temperature control and
08:03peristalsis and all of this.
08:05But it's much harder to learn
08:07how to meet emotional needs.
08:08Reflexes and instincts,
08:09as I say, are too stereotype.
08:11They don't fit the bill when it
08:14comes to the great variety and
08:17complexity and unpredictability of
08:19the of the context that we actually.
08:21Find ourselves in and.
08:23So we have to develop far more flexible,
08:26nuanced ranges of responses which
08:29are which are context sensitive.
08:32So one or two more words
08:35about prediction and learning.
08:37I said that we want to automatize
08:40these predictions.
08:41We we we start with consciousness,
08:43now known as short term memory,
08:45where you're feeling your
08:46way through the problem,
08:47and then once you have resolved
08:50the situation and then you.
08:52Consolidate a memory,
08:53a long term memory which then becomes
08:57the basis of what you do until it
08:59doesn't work in the prediction doesn't work.
09:02In which case we have what's
09:05called reconsolidation,
09:06a revision of that of that prediction.
09:08And this is the this is the process
09:10of learning from experience.
09:12Declarative memory is just the same as
09:14what Freud called the preconscious.
09:17In other words,
09:18these are memory traces which can be
09:20retrieved back into the conscious.
09:23But the ideal, as I say,
09:25is to automatize our responses.
09:27The delay,
09:28the uncertainty involved in this sort
09:31of predictive process is certainly
09:33less desirable from a biological
09:35point of view than the automatized
09:37immediate response to a needs to be.
09:39When this happens.
09:40I do that,
09:41and so there's great pressure
09:43to consolidate into the non
09:45declarative memory systems,
09:46which are simply different from
09:49the preconscious ones in that
09:51they cannot be returned.
09:53With the conscious state.
09:54In other words,
09:55they're equivalent to what in Freudian
09:57times we called the unconscious.
10:00And these predictions are
10:03consolidated into emotional and
10:05procedural memory for the most part.
10:08If you want to see a picture of all of this,
10:11then declarative memories
10:13are cortical memories.
10:16These are in the form of images,
10:18which can be brought back to mind,
10:19and thoughts that can be funky, as it were.
10:23But it involves delay,
10:24with all of the attendant dangers.
10:26As I mentioned a moment ago,
10:28the ideal is to automatize these predictions.
10:31Into motor sequences,
10:32which are not thought they're
10:35just enacted and and so and
10:37this entails mainly as I said,
10:39procedural memory and emotional memory.
10:41Not exclusively the structures that
10:43I have on the screen here but at
10:45least it gives you a basic idea.
10:47So that's the basic framework.
10:49Now let's have a look at what
10:51these emotional needs are.
10:52Remember I said that their homeostatic,
10:54but they're multiple homeos.
10:56That's just as they are for bodily needs,
10:58so too for emotional needs
11:00there are multiple homesteads.
11:02Each of which regulates an
11:04individual emotional need or drive.
11:07As for it would have called it,
11:08I'm going to that.
11:10There are various disagreements about
11:12how to classify these emotional drives,
11:14but I'm going to use the mainstream taxonomy,
11:17which was the one developed by yak panksepp,
11:20just to give you a sense of how
11:23we think about this nowadays
11:26in affective neuroscience.
11:28The first drive I used this,
11:31I put this one first,
11:32not only because I'm a psychoanalyst
11:35and and because certainly this is
11:36the drive that Freud prioritized.
11:38The sexual drive,
11:40which in Panksepp's nomenclature
11:43is called lust. It's it.
11:45It is also prioritized because it is
11:48clearly of enormous biological importance.
11:51The whole, the whole,
11:52what drives the engine of
11:54natural selection is,
11:56is reproduction,
11:56and so it's not surprising that
11:59it should be so important.
12:01And where we we've advanced in all
12:03sorts of ways since Freud's day.
12:05But of course there is,
12:07and we now are in absolutely no doubt
12:09because we know the anatomy and
12:11Physiology and chemistry of the thing.
12:13There is a sexual drive at
12:15work in the human brain,
12:16just as there is in any other animal brain.
12:19It's sexually dimorphic on the average.
12:22The sexual male typical sexual circuitry
12:25coincides with the male typical body and
12:28the female typical sexual circuitry,
12:30for the most part.
12:31That with the female typical body.
12:33But there's enormous scope for variability,
12:37in large part due to the fact that
12:40the body and the brain masculinized
12:42separately in utero by by two
12:45different processes at different
12:48stages of uterine maturation.
12:50And I,
12:51I,
12:52I,
12:52I that obviously in some respects
12:56confirms Freudian ideas about
12:59bisexuality and all of that.
13:01And also disconfirms old ideas because
13:04so much of this is established in utero.
13:07So much of it,
13:08I don't mean to say all of it.
13:10I want to emphasize just one other
13:12point here about the sexual drive,
13:15which is that although I said to
13:17you that this drive is so important
13:19because it underpins reproduction,
13:21which is so important biologically,
13:23for obvious reasons,
13:24I want to draw your attention
13:26to an important fact,
13:27which is that what motivates us the subjects.
13:31Of the mind.
13:32In other words,
13:33the the thing that is studied in
13:36psychology and the the being of
13:38the brain as opposed to the to the
13:41tissues and and and circuitries of the brain.
13:44The thing that motivates us subjectively
13:47is not our biological duty to reproduce.
13:51When we when we indulge in sexual behaviors,
13:54we're not trying to fulfill
13:57these biological obligations,
13:58in fact, very often,
13:59if not for the most part.
14:01We're trying and hoping not to reproduce.
14:04So what is it that motivates us?
14:07It's not the reproductive imperative,
14:09but rather the feeling in that little
14:11diagram I showed you earlier with
14:13the Red Arrows and the blue arrows.
14:15We're looking for the blue arrow.
14:16We're looking for the pleasurable feeling,
14:19which leads to satiation.
14:22And so the subject of the mind is
14:25motivated by the feelings which announce
14:28these deviations from homeostasis,
14:30and that's terribly important.
14:33Say it's again,
14:34what motivates us is the pleasure,
14:36and whatever it is, whatever,
14:38whatever does it for us,
14:40whatever gives us that pleasure,
14:42that's what that's that's
14:43what we'll choose to do.
14:44And this explains the great
14:47variety of sexual behaviors.
14:48And, and there again is an important
14:51departure from the Freudian idea,
14:54which was that the sexual function
14:56must be brought under the edges of
14:58the reproductive function, you know,
15:00in order for it to be fully mature.
15:02And this is simply not true.
15:04And all of us clinicians,
15:06unprejudiced clinicians nowadays
15:08recognise that it's perfectly possible
15:11to have mature sexual relationships
15:14which have which have no possibility
15:16of leading to reproduction.
15:19And the difficulties,
15:21the pathologizing of of,
15:23of all of this is again something
15:26that hopefully psychoanalysis will
15:29is and and and will recognize.
15:32It's hard to. It's hard to develop.
15:34Don't the the the pathologies of
15:36sexual life are revolve mainly
15:38around another important fact,
15:40which is going to become a thread
15:42through what I'm going to say,
15:43which is that we do not need
15:45to learn how to meet each one
15:47of these emotional needs.
15:49Only that's hard enough.
15:51Think about,
15:52in the case of sexuality,
15:53the reflexes and instinctual behaviors
15:56we born with the innate knowledge
15:58that the rubbing of a certain part
16:00of your anatomy at a certain rhythm
16:03and pressure will relieve that.
16:04Attention that that these behaviors
16:07like lordosis and and mounting and and
16:10intermission and trusting and so on,
16:12these things we don't need to learn.
16:13But the gap between that and what
16:15what you really need to know in order
16:18to get people to sleep with you,
16:20especially the particular individuals
16:21that you want to sleep with.
16:23The gap between that instinctual knowledge
16:25and what you really need to know is enormous.
16:28So there's an enormous amount of learning
16:30from experience how to meet this need.
16:33That's hard enough,
16:34as I was saying.
16:35But it's not only that we need to
16:37learn how to meet each one of these
16:39emotional needs in their own right,
16:41and we also need to reconcile
16:43them with each other.
16:44And so the conflict between different
16:47emotional needs is what leads to
16:50pathology in this area, that is to say,
16:53to suffering and distress.
16:54But all of this will become clearer,
16:56I hope, as I unfold.
16:58Everything I'm saying,
16:58as you can imagine,
17:00has to be said in absolutely succinct,
17:03preceed form.
17:04Almost each sentence that I'm
17:06uttering here could become the basis
17:08for a lecture in its own right,
17:11so forgive me for skimming the surface.
17:14The other way in which Freudian
17:17Dr theory needs updating
17:19is that Freud didn't recognize
17:21that much of the work that's done
17:24by the next Dr, namely seeking.
17:27He conflated it with the sexual drive.
17:30The sexual drive,
17:32it's it's circuitry is clear,
17:34it's chemistries are clear.
17:36The sex hormones testosterone, estrogen,
17:39the peptides vasopressin and oxytocin,
17:42quite different from the
17:43circuitry of this drive.
17:45Um, which is the command
17:47neuromodulator of which is dopamine.
17:50In Panksepp nomenclature,
17:52it's called seeking.
17:53It's also been,
17:54it's probably most widely known
17:57as the brain reward system.
17:59But but we we in affective neuroscience
18:02have sort of moved away from that word
18:05because it's too, it's too generic.
18:07There are many different
18:08rewards in the brain.
18:10I've just showed you too.
18:11This is the second one.
18:13It's not the same as sexual reward.
18:15And nor is it the same as several
18:17other forms of reward that I'm going
18:19to introduce you to as we move along.
18:21Seeking is triggered by lust.
18:26It's but it's also triggered by hunger
18:29and triggered by separation distress.
18:31Because whatever it is that you need,
18:34whether it be of a sexual or
18:37nutritional or attachment kind,
18:38whatever it is that you need,
18:40it's out there in the world.
18:42And So what the seeking Dr does is it it,
18:45it engages.
18:46It prompts us to engage with
18:48the world to to it energizes us.
18:51It motivates us and and perhaps the
18:54best way to to describe the state
18:58of mind that is engendered by the
19:01seeking Dr is to is to state stated
19:04in its opposite that the negative.
19:08Lack of energy and Energia.
19:12Lack of expectation that something
19:14good is going to happen,
19:16lack of interest,
19:17lack of engagement and hedonia
19:19abulia and all of these things,
19:21which of course are the hallmarks
19:25of the depressive state of mind.
19:27The opposite of those things,
19:29or what seeking does.
19:31So in fact it's it's not an
19:34exaggeration to say that as the that
19:38seeking in the extreme is mania.
19:41So that the the pole,
19:43the polls,
19:44from depression to mania in mood
19:46disorder has everything to do
19:48with the operation of this tribe,
19:51this dopamine mediated drive.
19:54I said it gets triggered by these other
19:57basic needs because whatever you need,
19:59it's out there.
20:01But in triggering seeking,
20:03you're triggering a drive in its own right.
20:06It's a drive.
20:07It's a need all of its own,
20:09which is the need to engage
20:11with what is interesting,
20:12with what feels interesting.
20:14It's therefore drives us
20:17particularly to engage with novelty.
20:19And with interesting new situations
20:22and the way we understand this is
20:26scientifically is that anything
20:28that's interesting in other words
20:31novel in other words not yet known
20:33is biologically a dangerous thing.
20:36Uncertainty and unpredictability and
20:38novelty are dangerous things and so we are,
20:41we believe that this drive is
20:44proactively seeking to to reduce
20:46it's engages with uncertainty.
20:49In advance in order to in order to reduce it,
20:52so that when we encounter this
20:55situation under more urgent
20:57circumstances, then we have some knowledge,
20:59some understanding of it.
21:01And so think of a dog in an open
21:03field doesn't just sit there and
21:05explores and it explores in particular
21:08those things that that are novel.
21:10In the process it learns how to satisfy
21:13hunger and thirst and sexual needs and so on.
21:16It learns where these
21:18things can be satisfied.
21:20This is the way in which all of these more
21:23basic needs or channel through seeking,
21:25but at the same time,
21:26it just gets to understand.
21:28It's an epistemic philic drive,
21:30a drive to know.
21:32I should mention,
21:34as probably most of you know,
21:37that an excessive activation of this
21:39drive beyond manic states of mind
21:42leads to megalomanic states of mind and
21:45ultimately psychotic states of mind.
21:47So the it's a very interesting
21:50scientific question as to why excessive
21:53seeking should should lead to the
21:55clinical phenotype of psychosis.
21:58Gives us some some new points of insight
22:00into what the psychotic state of mind.
22:02Was all about.
22:03No, as I keep saying I have to,
22:06I have to just skim the surface.
22:08So Freud this, this drive,
22:10it's close to what Freud
22:12called the libidinal drive.
22:14As I said,
22:15this broadened idea of sexuality,
22:17but I it's it's clearly distinct
22:21from the sexual drive.
22:23I and I'm later on going to introduce
22:25you to some other drives which Freud
22:28incorporated under the heading of libido,
22:30which are again turn out to be clearly
22:34distinct emotional needs all of their own.
22:37And you see how all of this is building
22:40up the idea of what the basic kinds of
22:44human relationship are and what what
22:46kinds of relatedness are we seeking,
22:49at least at the most basic biological level.
22:51And I hope it's also
22:53beginning to become apparent.
22:54That a knowledge of these basic emotional
22:58needs and urges has implications for
23:01our understanding of psychopathology.
23:04I've spoken here, I spoke earlier
23:08about about sexual difficulties,
23:10and I'm I'm speaking here
23:13about mood disorders,
23:14as I as I've already said,
23:16but this this system also
23:19has important role to play,
23:22not only in psychosis, as I've also.
23:24Already said,
23:25but in addiction it is a craving system,
23:29and the fact that it's mediated by
23:32dopamine has everything to do with why
23:36certain drugs of abuse are just that.
23:39They are.
23:40Drugs like cocaine and amphetamine
23:43activate this system exquisitely so.
23:46In fact,
23:47another way of illustrating what the system
23:49does is to just think about how people
23:51behave when they're snorted cocaine.
23:53It's kind of.
23:54Over optimistic.
23:55Over energised.
23:56Over interested expectation.
23:58Something good is gonna happen.
24:00I don't know what it's gonna be,
24:00but I'm gonna be there.
24:01You know that kind of irritating,
24:04overexcited state of mind that the
24:06pleasure in which I say again is
24:08quite different from sexual pleasure.
24:10It's an appetitive pride
24:12rather than a consumer.
24:13Try 1. Umm, so let's move on.
24:17Here's the third one.
24:19It's an aggressive drive,
24:21but we call it rage because
24:22there are many kinds
24:23of aggression in the brain.
24:25In fact, the drive that I
24:27mentioned earlier seeking it,
24:30it underpins predatory aggression.
24:33Cold aggression like a a
24:36lion chasing a Springbok.
24:38It's the lion is not chasing the
24:40Springbok because it's enraged.
24:42It doesn't hate the springbuck.
24:44It loves this.
24:45Spring back his lunch.
24:46And so this kind of cold,
24:48predatory aggression driven by
24:49seeking is quite different from
24:51what we are talking about here,
24:53which is hot aggression, rage.
24:55And and think about that homeostatic,
24:58the homeostatic viable bounds
24:59when it comes to rage is that
25:02there's nothing frustrate, no,
25:04no frustrating impediment standing
25:05between me and what I mean.
25:08Nothing preventing me from getting what
25:10I need, nothing standing in my way.
25:13And so this.
25:14This. This,
25:16this frustrating impeding is the demand.
25:20It's a I'm now moving out of my,
25:23out of my preferred state
25:24when it comes to this drive,
25:26and there's something I must
25:28do to return myself.
25:29That's the that's the demand for work.
25:32The innate prediction that we are
25:35born with is affective attack.
25:37In other words, bear your teeth,
25:39borrow your bra,
25:40raise your 4 limbs, and and and.
25:44Put your nails out if you can and and attack.
25:48Lunge at the at the source
25:50of the of the frustration,
25:53trying to get rid of it.
25:54And I said at the beginning that these
25:59innate instinctual predictions are too basic,
26:02they're too gross,
26:03they're too crude,
26:04they're they're too generic that you can't
26:08attack everything that frustrates you.
26:11For example,
26:12it might be bigger than you.
26:15For another example,
26:16it might be your attachment object,
26:19somebody that you need and and so
26:22the difficulties that I mentioned
26:24that the outset of of of the,
26:27the,
26:28the,
26:28the innate prediction being too simplistic,
26:31but also the difficulty I mentioned
26:33a few minutes ago of these drives
26:36conflicting with each other.
26:38I'm I'm busy illustrating that point here.
26:41So in order to get yourself
26:43back into your viable bounds
26:45when it comes to this drive,
26:47you have to learn from experience what
26:50else to do other than it's simple,
26:53effective attack.
26:55Um, the.
26:56Let me think if there's anything
26:58else I should tell you about this.
27:01Yeah,
27:01I think I should.
27:03And when I say that the this
27:06drive is triggered by impediments,
27:09by things stopping you,
27:11they're standing between
27:13you and what you need.
27:15This appoints to its its central
27:17role in what in psychoanalysis
27:20is called superego formation.
27:22The superego is that object which prohibits,
27:27which prevents which says.
27:28Ohh and so the activation of this
27:31drive and the objects that activate
27:33this drive have everything to do
27:36with the beginnings of superego
27:38development and also with the problem,
27:41the conflicts involved,
27:42which I've been alluding
27:43to now more than once.
27:45So when I speak of those conflicts,
27:47let me let me go on to the
27:49next of the of these drives,
27:51which we call fear anxiety.
27:54When I said that you can't
27:56just attack everyone,
27:57that frustrates you.
27:58Uh, for example,
27:59they might be bigger than you.
28:01Well, if, for example,
28:02they might be your father,
28:04your whose father never frustrated them.
28:07So the instinctual prediction
28:09is attack the *******.
28:11But of course you can't, for one thing,
28:14because he's he's bigger than
28:15you and you scared of him.
28:17And so there we have the
28:20conflict between rage and fear.
28:22And again, this contributes
28:23fundamentally to the development
28:25of what we call the superego it is.
28:28Why the superego is feared?
28:30The prohibiting object is feared
28:33to and so there's the paranoid
28:35dimension to the relationship between
28:38the self and this kind of object,
28:41the object which which which
28:43is forms the nucleus of what
28:46we call the Super regular.
28:48Before I move on to other such conflicts,
28:52let me just dwell with the fear.
28:54Drive itself for a moment
28:56and point out that here,
28:57the homeostatic settling point,
29:00the Nirvana, is I am not in danger.
29:02There's no threat to life and limb.
29:04That's where we need to be.
29:06And so for the most part,
29:08as long as we're staying out of danger,
29:10this drive is not activated.
29:11But should, should you, should you,
29:14should you move into a dangerous situation?
29:18Then there's a demand on
29:20the mind to perform work,
29:21to do something and unpleasant
29:23feeling called fear,
29:25which which motivates,
29:26which drives you to do something about it,
29:29to relieve this particular
29:32variety of unpleasure.
29:34And we have an innate prediction
29:36that we are born with an instinct
29:39which is to freeze or to flee.
29:43But if all you could do whenever you
29:46feel scared is to freeze or to flee,
29:50you would have an anxiety disorder.
29:53So we have to learn what else to do,
29:56how better to manage our anxieties.
29:58And of course,
29:59it depends a great deal on
30:01what's triggering that anxiety.
30:03You have to learn what to fear,
30:05and you have to learn what fears of,
30:08for example,
30:09an instinctual kind triggered by the
30:12innate the objects of our common phobias,
30:14things like heights and snakes and
30:17creepy crawlies and dark places
30:19and confined spaces and so on.
30:21You know,
30:22you have to learn what else to fear.
30:24Uh,
30:24and you have to learn better
30:26ways of dealing with those fears.
30:29Over and above,
30:30other than freezing and fleeing
30:32and there again, you see it.
30:35Everything depends on context.
30:37You can't just have one stereotyped response.
30:39There are different responses which
30:41apply in different situations,
30:43and the learning of how to overcome
30:46these innate predictions in relation to
30:48these innate triggers is is the great task,
30:51as I keep saying,
30:53of emotional development,
30:54learning how to meet our emotional
30:57needs and remember I've spoken here.
31:00Here we have a conflict between two
31:03emotional needs between the drive
31:05called Rage and the drive called fear.
31:08I'm about to introduce you
31:10to another such conflict,
31:12and it also will allow me to to
31:16explain why we call this drive
31:19fear rather than anxiety.
31:21It's because there are two
31:23types of anxiety in the brain.
31:25Panic anxiety and fear anxiety
31:27are not the same thing.
31:30Fear has to do with trepidatious
31:33response to threat.
31:34To life and limb. And as I said,
31:38the instinctual prediction is to escape,
31:40to avoid the to to to freeze or run away.
31:44Whereas this anxiety is an anxiety
31:48about separation and loss,
31:50and it has to do with our attachment needs.
31:53All mammals have this drive,
31:55in fact, birds have it too.
31:57And it's it's a drive to stay close
32:00to our attachment objects, that is,
32:03to our caregivers and whereas.
32:06In the case of PIA,
32:07the instinctual prediction is plea.
32:09In the case of panic,
32:11the instinctual prediction is
32:13look for the caregiver approach.
32:15It's quite different from fear and this
32:19also points to why whereas one might treat.
32:25Yeah, anxiety with a benzodiazepine 1 might
32:29treat panic anxiety with an antidepressant,
32:33because this has to do
32:35with separation and loss.
32:36It's a quite different system.
32:38As I said, a quite different need.
32:41And you'll notice that 2 words up here.
32:44I'll I'll come to the second
32:46word in a moment,
32:47but let me first of all speak
32:49about the panic side of things I've
32:50said it has to do with separation,
32:52distress.
32:53We all have to attach because we mammals
32:56can't look after ourselves when we're little,
32:59we're helpless.
33:00We need to be fed by somebody
33:02amongst other things.
33:04And so we attach in the case of
33:06human beings where with well within
33:08the first six months of life to
33:11a reliable caregiver and then
33:12if we become separated. Problem.
33:14Usually it's a.
33:16Then we feel this panicky state of
33:19anxiety which triggers an instinctual
33:22response, which is distress separation,
33:25distress vocalizations and search behavior.
33:27Mommy, where are you? You lost it.
33:29Me.
33:31And that, again, sadly,
33:34doesn't always work as, as,
33:37as well as we we all know we don't
33:40remember it.
33:40But we learned early on that that's
33:44not enough of a response to separation.
33:48That you need to have much
33:50more sophisticated, nuanced,
33:51flexible repertoire of responses of
33:53ways in which you get mummy's attention back.
33:57It gets get her to to, to give you the.
34:01The love and care that you serve,
34:03that you so desire.
34:06It's a very different type of pleasure,
34:08the establishment of reunion,
34:10very different from the other
34:12pleasures that I spoke about earlier.
34:14And it is mediated by opioids,
34:16new opioids.
34:18And having mentioned that,
34:21you can immediately see something
34:23interesting about this system
34:25in addition to the seeking one.
34:28This one also is very important in
34:31addiction here in the case of opiates.
34:36Common abuse of opiates,
34:38of course it's very well known in the
34:41United States, but, but, but also,
34:43you know, more extreme than just
34:45the painkilling types of opiates.
34:48You know, the, the, the, the,
34:49the abuse of morphine and heroin.
34:52It's an addictive system par
34:55excellence because it's made to it's,
34:59it's made for addiction.
35:00The attachment is an addiction.
35:02It's the primal addiction and so.
35:06People who are unable to satisfy this need
35:09through the mental work that I spoke of.
35:11In other words, the predictive work,
35:13the learning from experience,
35:14how to meet this need,
35:16which is which is jolly hard to learn.
35:19How to get people to love
35:20you and stick with you,
35:21stay with you and be with
35:23you when you need them.
35:24Those who fail in this fundamental task,
35:28one possible outcome is turning to
35:32artificial forms of of new opioid.
35:36Supplies through the abuse of of these drugs.
35:43So that's some of the important
35:46things I wanted to say about panic.
35:50But if you it then shifts over.
35:52Panic is the acute response to separation.
35:56If if you don't establish reunion
35:58within a reasonable time frame
36:00and then then this drive shifts
36:02over to what's called grief,
36:04or at least the instinctual.
36:06Response shifts over to what's
36:08called grief in this nomenclature.
36:11Symbologies nomenclature that these two
36:14terms are replaced by protest and despair.
36:18They mean the same thing.
36:19That that cascade from acute separation
36:23distress to slump to giving up is is
36:28is universal in the mammalian series
36:31and it is the IT is the underlying.
36:37Undoubtedly the underlying normal
36:39prototype for for the for the for the
36:43depressive phenotype for depression
36:45it it's it involves whereas the panic
36:49component is new opioid mediated as
36:53I said the the the grief or despair
36:57phase is involved shutting down of
37:00seeking what I mentioned earlier so
37:03via a cap from the new opioids by a.
37:06The capo builds dynorphin through to the
37:09shutdown of of this dopamine circuit.
37:12That's our understanding of the,
37:14of the, the, the, the,
37:16the Physiology of that separation
37:19distress cascade.
37:20Um,
37:21so the link between these two addictive
37:26brain systems is is a very deep one?
37:29And there's a long biological story
37:32as to why the animal US included,
37:35why we shift from protest behaviour
37:38to despair.
37:40But it's it basically revolves around
37:42the fact that there's a cost benefit
37:46ratio involved in protesting in distress,
37:49vocalizations and and and searching.
37:52You announce your vulnerable state to
37:55predators and you wander away from home base.
38:00And you use up your metabolic resources
38:03at the time that you need the most.
38:06And so this is our understanding
38:09why this horrible,
38:10this horrible emotional response exists,
38:14which is literally to give up
38:17and and just lie there.
38:19That paradoxically or ironically
38:21rather maximizes the chances
38:23that you that you will survive,
38:26that you won't be gobbled up by
38:28predators that you will be found.
38:30By your caregiver, if please God,
38:32she returns. And so on.
38:34That's our understanding of the of the
38:38normal phenotype of, of despair of, of.
38:42And it has everything here nice overlaps
38:46with psychoanalytical understanding of
38:49of depression having to do with loss.
38:54For you all those years ago, of course,
38:57wrote that famous paper on mourning
38:59and Melancholia, which reminds me
39:02that I was Speaking of conflicts.
39:04So here we have another great conflict,
39:08ubiquitous conflict in
39:10in in human development,
39:12which is the conflict between rage,
39:15which I mentioned earlier, and attachment.
39:19You the one drive the rage drive
39:21is to get rid of frustrating.
39:24Impediments.
39:25And the other drive is to keep
39:28your attachment object with
39:29you forever and always.
39:31But what if your attachment object
39:33is the source of frustration?
39:35I mean whose mother never frustrated them?
39:38And so this is a ubiquitous conflict,
39:40a giving rise to guilt,
39:42guilt being the inhibition of the
39:44rage aspect in the conflict in order
39:47to preserve the attachment in order
39:50in order not to drive away and lose
39:52the love of the attachment object.
39:54That there's a need to inhibit the rage
39:57to internalize it in the form of guilt.
39:59And there we have the other major
40:02dimension of super regular development.
40:04So the conflict between rage
40:06and fear on the one hand,
40:08and rage and and and and
40:11attachment on the other,
40:12these are the foundations of the
40:15conflicts that we have with with our
40:18super regular and I I hope that I'm,
40:21I'm, I'm even in so few words able.
40:25I'm, I'm being able,
40:27I'm managing to convey something of
40:30the deep substructure that we are
40:34beginning to labor that underpins
40:37the the clinical psychological
40:40phenomena that was observed or that
40:43were observed by The Pioneers of
40:46psychoanalysis all those decades ago.
40:49And how we are beginning to attain
40:52new understanding of of of of
40:54what the fundamental mechanisms.
40:56Law underpinning all these things.
40:59Now,
41:00I told you that there are two
41:03types of anxiety in the brain and
41:06that's why we don't call fear.
41:10The fear emotional need,
41:12we don't call it anxiety,
41:15we call it fear in order to
41:17differentiate it from panic.
41:19There's also two different types
41:20of attachment need in the brain,
41:22which is why we don't call this
41:24the attachment drive.
41:25And it's one of two attachment drives,
41:28and here's the other one.
41:29It's a it's a drive to to, to nurture,
41:33to take care of vulnerable little ones.
41:37Obviously, biologically,
41:39it's clearly the case.
41:41That the the the prototype of
41:45such a a vulnerable, needy,
41:48dependent object is 1's own offspring.
41:51But I put this slide on the screen in
41:54order to make the point that it's not
41:56only our own offspring that evoke this need.
42:00That's the prototype of it,
42:01but it's distressing for us
42:04who who to to come across a.
42:09Babies crying.
42:12Vulnerability and and and distress of
42:16this kind we we we want to put it right
42:19and so that unpleasure that the demand
42:22for work that's evoked by this drive.
42:26I'm speaking about it in the
42:28prototypical situation where the
42:29parent who's whose child whose babies
42:31crying and they're they can't put it
42:33right there no matter what they do.
42:35Of course we've got instinctual predictions.
42:37Pick the baby up,
42:39Rocket Singh Materies sort of soothing.
42:42Sounds. But as every parent knows,
42:44that doesn't always work.
42:45And so you've got to learn from
42:47experience what else to do.
42:49And again, it's a whole business
42:51of context of learning and learning
42:53a lot more than just the what the
42:56what the basic triggers that we
42:58are born with provide us with.
43:01Learning from experience about what this
43:04crime might mean in this situation,
43:07what might I do here?
43:08What might I do there?
43:10But I I wanted to make the
43:12point that this very same need,
43:14as with all of the needs that
43:15I've spoken about,
43:16don't apply only in the prototypical
43:20childhood situations that that that I've,
43:22that I've used as my main exemplars,
43:25that they persist throughout life.
43:27These are the basic emotional
43:29needs of the human being we need.
43:32There to take care of vulnerable
43:34and distressed others.
43:35And and if we can't put it right,
43:38then it agitates us in the
43:41prototypical situation.
43:42Think of postpartum depression the the
43:45mother who's overwhelmed and by the way,
43:47the chemistry of this, of this drive,
43:50it's again driven by or mediated by estrogen,
43:54but and and oxytocin,
43:57but also prolactin and progesterone,
44:00all of which of course increase enormously.
44:02During pregnancy and and and even
44:05more so at childbirth, these,
44:08the chemistries of of this system
44:12mediate this kind of feeling.
44:14And I I spoke there about postpartum
44:16depression is an extreme version of it.
44:18But what I was wanting to to get on to
44:21say is that that distressing feeling,
44:23that unpleasure of not being able
44:25to make it right,
44:26not knowing what to do,
44:27not feeling confident that one can,
44:30feeling overwhelmed by the need.
44:33Of the of the distressed dependent.
44:36That same sort of feeling arises
44:38in all sorts of social situations.
44:40I live in a very unequal society,
44:44unfortunately,
44:45where we all too frequently are
44:48confronted by people in enormous need,
44:51people who are poor,
44:52people who starving,
44:53coming and banging on your on your
44:56car window, begging.
44:57And it's distressing and we don't like it.
45:00And it's that's again speaks
45:02to this homeostatic.
45:04The the the viable bounds
45:05here is that you know,
45:07the the vulnerable and dependent are OK.
45:11If they're not, it distresses us.
45:13But what do we do about that?
45:16This is the the business
45:17that I'm talking about.
45:19The great emotional the great
45:21task of mental development,
45:22of learning how to meet these emotional
45:25needs and and the conflicts again.
45:27There's sadly there's a conflict
45:29here between this attachment drive
45:31and rage. Again it frequently triggers
45:33irritation you know because I don't want
45:36this person with all of their needs,
45:39you know to be causing me this
45:42unpleasant emotion and and even in the.
45:46Difficult, but the baby situation.
45:48Unfortunately, you clinicians
45:49all know that this can lead to
45:52to very unfortunate outcomes.
45:54The conflict between the care need
45:56and and and the and the rage,
45:58the irritation and frustration
46:01that that that it can arouse.
46:04So that's six of the seven
46:06I want to tell you about.
46:09One more of the basic emotional
46:12basic categories of emotional
46:15relatedness in in the human brain.
46:17Before I come to the last one,
46:19I just want to point out that these two
46:21attachment drives that are just mentioned,
46:24they too were included by Freud
46:26under the heading of libido.
46:28So this overly generalized
46:30understanding of the sexual drive.
46:34We thought that all pleasures are
46:36somehow ****** but clearly these are
46:39these are there's a variety of quite
46:41distinct forms of pleasure in the brain,
46:44and they mediated by quite distinct circuits.
46:48They're quite distinct,
46:49quite distinct chemistries,
46:51triggering quite distinct behaviors.
46:52And and all of this,
46:54as I hope I've been able to at least
46:57indicate in this brief presentation,
46:59all of this has implications for our
47:04understanding of psychopathology.
47:06The last of the 70s that play drive.
47:09It comes as a great surprise to
47:11people to learn that all mammals,
47:13us included need to play.
47:16It is a biological Dr and it's why
47:19it's so surprising is because it's
47:21easy to see why fear that is to
47:24say the need to be safe or rage.
47:27That is to say the need to get rid
47:29of things that are that are that are
47:31standing between you and and and and
47:33and what you need in order to survive.
47:35That you have to be able to
47:37stake your claim and defend it.
47:39Otherwise you've had it,
47:40biologically speaking.
47:41Likewise separation, distress.
47:42It's clear what its biological role is.
47:45But play play, by its very nature,
47:49is not even real. It's just play play.
47:52And so why such a apparently frivolous
47:55activity should be a basic emotional
47:59drive is, as I say, a great surprise.
48:03So when you when we study this empirically.
48:06You ask any child what's your favorite thing,
48:09they say play.
48:11Say why and they say it's fun.
48:13That's the scientific question.
48:15Why is it so much fun?
48:17And Please note,
48:18fun is another particular type of pleasure.
48:21Not the same as as orgasm.
48:26And this and the pleasure of
48:28of of finding a safety from,
48:31from danger and the pleasure
48:32of getting rid of that,
48:34of that frustrating boss,
48:35that's who's getting in your way and
48:37preventing you from having anything you want.
48:39And the pleasure of plays is
48:42something quite different.
48:43But the the scientific question is why?
48:45Why is there so much pleasure
48:47attached to this absurd activity?
48:49There is rough and tumble play,
48:51which is the prototypical form of play.
48:55When you study play empirically,
48:58despite it being such fun and
48:59children loving it so much,
49:01what you observe amazingly, is the
49:05majority of play episodes end in tears.
49:09So despite kids loving to do it so much,
49:12it tends to end up, it ends, it ends badly.
49:15And one of the children
49:16says to the other one,
49:17I won't play with you anymore,
49:19you are not being fair,
49:21and that word fairness has a lot to do.
49:25With why play breaks down.
49:27So in studying play,
49:29we came to to discover that there's a thing
49:33called sort of loosely called the 6040 rule.
49:36It's probably better called the 7030 rule.
49:39It varies from species to species,
49:41and it's not an exact number,
49:43but what it refers to is the fact
49:45that in play there's always one
49:47who dominates and one who submits,
49:50and that dominance submission
49:53ratio if it exceeds.
49:55Uh, roughly 6070 or so.
49:582:30 or 40 or so.
50:01In other words,
50:02if the submissive 1 gets less than
50:0530 or 40% of turns to be able to be
50:07the one who's calling the shots,
50:09the one who's on top,
50:10the one who's doing the chasing.
50:11But then it's not fun for them anymore.
50:13And then they weren't playing,
50:14so there's a reciprocity,
50:16a turn taking.
50:18That's that seems to be fundamental
50:21to successful play and and I'm I'm
50:24using the biological prototype.
50:26You know rough and tumble.
50:28Where the one animal invites the
50:30other one to play by running it.
50:32The the invitation is accepted if if,
50:35if the if the if the runner is is
50:36chased and then they do this sort of
50:39thing you're seeing on the screen.
50:40Now there's this kind of
50:42wrestling thing that goes on,
50:43they love it and then they swap
50:45and the one that was being chased
50:47because the chaser and the one
50:49who was underneath is on top
50:51and not in equal measure.
50:52But as long as it's roughly
50:546040 then the game persists.
50:57And it's not only in the prototypical.
50:59Think about the kinds of games
51:01that are played in in in in
51:03Western cultures games like.
51:05Mommy, baby it is mommy baby.
51:08Teacher, pupil Dr patient,
51:10cop, robber.
51:11You know there's a hierarchy in
51:13all of these games and the the
51:16the Your little brother is happy
51:18to be the robber and be locked up
51:20and you are the cop as long as he
51:23gets a turn to be the cop later
51:25or he gets the turn to to to say
51:27well now let's play you know this
51:29other game and and so there's a
51:32need for mutuality and reciprocity.
51:35And if you breach that rule,
51:37the 6040 rule, the game breaks down.
51:39And Please note,
51:41rule boundaries is another very
51:44important part of how play works.
51:47Another boundary in play that's
51:49that's very important is that the
51:52boundary between play and reality.
51:54So playing at cops and robbers is a game.
51:58And you know, as I was just saying,
52:00but if you lock your brother up
52:02and throw away the key, you know,
52:03then it's not play anymore.
52:05It's just locking up your brother.
52:06And that's no longer about play, it's
52:08about fear and rage and things like that.
52:11So the crossing of that boundary
52:13is also how play breaks down.
52:15So we think that play, in short,
52:17has everything to do with learning.
52:19About how to find your place in the group.
52:22How to meet your needs in
52:23relation to the needs of others.
52:25The negotiation and the
52:27development of empathy.
52:28The capacity to take account that.
52:31The need to take account of the
52:33feelings of the of the Playmate in
52:35order to sustain the fun of the game.
52:38And we think that social hierarchies
52:40the pecking order or established.
52:42Think back to your days on the
52:44playground was a serious business,
52:46whether you up or down high status or.
52:49Your status in the group or not,
52:51the group,
52:51whether anyone wants to play with you or not,
52:54these are things that really matter to kids.
52:56And this is all of this points
52:59to that we're a social species.
53:01Social group relations need to be,
53:04need to be modulated.
53:05Especially the formation of higher
53:07all mammal species or hierarchical
53:09but the most viable hierarchies of
53:11the one in which there's something
53:13in it for everybody that there's
53:15that there's it's not too,
53:17there's not a bully in charge but rather.
53:20Somebody who who's who's able to
53:22tolerate turn taking and recognize
53:24the the needs of the of the
53:26submissive party in the in the group.
53:29Now look there's as I told you a
53:31million more things I could say
53:33we learned through play how to
53:34because it's safe it's not real.
53:36We learn how to how to regulate our
53:39fears and our rages and our lusts
53:41and so on through games and so play
53:44also is terribly important for for
53:47for for for the learning to regulate.
53:50All the other emotional needs,
53:51but I I must, I must come to an end.
53:54I see I've in fact gone a few
53:56minutes over my time,
53:57so I just want to say the following.
53:59Remember,
54:00this is all remember my title and
54:02these are the basic categories
54:05of human emotional relationship.
54:07Unlike Freudian Dr Theory which
54:10was objectless,
54:11these drives are all object related
54:13and you can't speak of a of a panic
54:16grief drive without Speaking of
54:18an attachment object and a fear.
54:20Drive without Speaking of a dangerous
54:22object and a a rage drive without
54:24Speaking of a of a frustrating
54:26object and so on.
54:27So these are intrinsically object
54:29related drives and we've learned a
54:31hell of a lot more about the basic
54:33emotional needs than we knew about
54:35Infrared's day as he predicted we would.
54:38And if you want to learn more then
54:40please look at this paper which I
54:42have on the screen here at the end.
54:45It's an Open Access journal if
54:47you just Google my
54:49name and neurobiological.
54:51Underpinnings and and frontiers
54:52it'll come up and and and that'll
54:56lead you to to the the wider
54:58evidence base that I'm drawing on
55:00and and and the very interesting
55:03literature in this field all of
55:05which is of substantial clinical
55:07relevance both in psychotherapy and
55:10in and in psychiatry more generally.
55:14Thanks for your attention.
55:15I'll end there. Thank you.
55:18Thank you so much Doctor Solms.
55:20That was just a.