RIGHT HEMISPHERE INSUFFICIENCY AND ILLNESS IN THE CONTEXT OF SEARCH ACTIVITY CONCEPT*Vadim S. Rotenberg E-mail: vadir@post.tau.ac.il Dynamische Psychiatrie/ Dynamic Psychiatry, 1995, 150/151:54-60 * Paper presented at the 10th World Congress of the World Association for Dynamic Psychiatry WADP / XXIIIrd International Symposium of the Deutsche Akademie fur Psychoanalyse (DAP;, St. Petersburg / Russia, 'October 25-29, 1994 The author summarizes his concept of search activity as a general psychobiological mechanism which provides individual's development and discusses its theoretical and clinical implications. In the framework of his concept he sees psychic and psychosomatic disorders caused by a renunciation of search or by a misoriented search activity. As dreams, being a function of the right hemisphere, can restore the decreased search activity, a functional insufficiency of the right hemisphere displays a general predisposition to psychic and psychosomatic pathology. In his opinion, the restoration of search activity is based on the particular ability of the right hemisphere to produce a polvsemantic context. The author suggests that psychoanalysis and other psychotherapeutic methods activate right hemisphere functions and that hereby their effectiveness can be explained. According to the definition, search activity is oriented to change the situation or the subject's attitude to it in the absence of the precise prediction of the outcome of such activity, but by taking into consideration the accomplished outcomes at all stages of activity (Rotenberg 1984, 1993). The concept of search activity has initially been proposed in order to explain the complicated relationships between behavior, emotional state and body resistance. It was shown (Rotenberg, Arshavsky 1979) that flight and fight as well as self-stimulation of the emotionally positive brain zones display a tendency to block different forms of artificial pathology in animals (for instance experimental epilepsy, anaphilactoid edema, cardiac arrythmia etc. ), while passive self-stimulation and freezing intensify all these forms of pathology. It was necessary to identify some factors that determine the opposite effect of these two groups of behavioral patterns on body resistance. It was not the difference between positive and negative emotions because passive and active self-stimulation both represent the positive emotional state, while fight, flight and freezing are related to the negative emotional state. It was also not the difference between general activity and passivity, because panicky behavior, accompanied by motor irritation, has a negative outcome for body resistance, while the inhibition of motor activity in a form of adaptive passive avoidance or startle reaction does not cause somatic disorders. I have suggested that it is search activity and renunciation of search that determine body resistance and somatic health. Behavior of fight and flight types is classified as search behavior because in such behavior an attempt is performed to overcome or to avoid the obstacles, but the outcome of such attempt remains doubtful. Self-stimulation also acquires features of search behavior, for it is search for positive experience in the absence of a priory confidence in the success caused by the negative emotional component of active self-stimulation (Grastyan 1976). Self-stimulation is often produced from the same brain regions as exploratory behavior and positively correlates with such behavior (Panksepp 1982). It is worth to emphasize that the positive outcome of search activity on body resistance and adaptation is determined by the process of search activity rather than by the pragmatic result of this activity, i. e. by the goal achievement. The final goal even not being achieved, the positive influence of the process of searching on the body health is present in any case. Such a positive outcome of search activity is a biological encouragement of this behavior. Constructive aggression (Ammon 1970, 1993) is a manifestation of search activity, while psychosomatic disorders are characterised by the deficiency of the constructive aggression, i. e. by renunciation of search. According to Ammon (1993) the deficiency of constructive aggression depends on the early experience of hopelessness and helplessness caused by the lack of parental emotional support, which represents social energy, in early childhood. The search activity concept can explain some clinical paradoxes. For instance, it is possible to explain the nature of the diseases of achievement. According to the concept, such diseases appear as a result of an abrupt decrease of search activity after achievement of a very meaningful goal. Another paradox which can be solved is the ambiguous role of type A behavior in the development of the coronary heart disease. Type A behavior was considered to be a behavioral predisposition to the ischemic heart disease. However, recent investigations do not confirm this assumption: restlessness, time urgency, unlimited activity (all components of the type A behavior which resemble search activity) are not related to the ischemic heart disease. Only the high competition, which is combined with other typical components of type A behavior in a part of all cases, is a real determining factor of ischemic heart disease and myocardial infarction. Competition can lead to the renunciation of search if the subject's attempt to be the best is unsuccessful, and such renunciation can be especially harmful if giving up is following a hard long-lasting activity. At the same time type A behavior without competition can have even a protective effect on heart: time urgency and emotional arousability are the inverse predictors of mortality in women with a premature acute myocardial infarction, while the relaxed type behavior which is characterized by the low time urgency increases the risk of death in these patients (Ragland, Brand 1988; Powell et al. 1993). The authors are speculating that the absence of time urgency may be a marker of depression, but it is more reasonable to suggest that it is marker of the reduced search activity. Although every high-developed animal is born with the genetic prerequisites for search activity, its development depends very much on the experience in early childhood. The opposite situations appear to be equally unfavourable for the development of search activity: conditions, in which all actions of the subject provoke invariable resistance, and conditions, in which all desires are immediately satisfied without any efforts of the subject. In animals search activity is accompanied by the hippocampal theta-rhythm and this rhythm is very good expressed in REM sleep. According to the search activity concept, REM sleep (which is associated with dream experience) is a psycho-biological mechanism that permits compensation for the biologically and psychologically harmful state of renunciation of search and ensures the restoration of search activity. All arguments for such a point of view are present in my previous publications (Rotenberg 1984, 1993). The dreams of healthy subjects represent a very specific kind of search activity, however it fits in the definition of this notion. A subject is usually active in its dreams, but at the same time it is unable to make a definite probability forecast according to dream events. In face of it, the dream does not fit only in that part of the definition of search activity that emphasizes the permanent consideration of the behavioral outcomes. However, it is true only if the dream is not self-reflective and does not include self-control, if the activity in the dream is chaotic. According to the recent investigations (Purcell et al. 1993) in the vast majority of spontaneous dream recalls the dreamer is moderately self-reflective and partly effective in the dream control. The dream presents a good opportunity for additional search activity after having given up during wakefulness. First of all, during the sleep the subject is separated from the reality, also including those aspects of reality which caused renunciation of search. Thus, the subject can start its search activity as from the beginning. Secondly, in its dream the subject is very free in its "behavior": it can solve its actual problem in a metaphoric way, or it can solve another problem that displays the actual one, because the main restorative factor is the search process itself. Moreover, in the dream subject is not restricted by the logical and conventional rules in the process of handling the problem. It is able to use right-hemispheric image thinking that is polysemantic in its nature and more flexible than logical thinking. It was confirmed in some investigations that the right hemisphere dominates during REM sleep (Hirshkovitz et al. 1979). However, it does not mean that all dream-like experiences are related to the right hemisphere. Some dream reports can be received even after callosal disconnection. But it is a problem for future investigations, whether "left-hemispheric* dreams are equal in their functions to right-hemispheric dreams. According to my conception (Rotenberg 1979, 1985, 1993, 1994) the difference between the two strategies of thinking (which is commonly associated with the function of the left and right hemispheres) is reduced to the opposite modes of organizing the contextual connection between elements of information. Left-hemispheric, or formal logical thinking, organizes any sign material (whether symbolic or iconic) to create a strictly ordered and unambiguously understood context. Its formation requires active choice from among innumerable real and potential connections between the multiform objects and phenomena of few definite connections. Such thinking will not create internal contradictions, will be most natural, and facilitate an ordered analysis. Such a strategy of thinking makes it possible to build up a pragmatically convenient, but simplified model of reality. It is based on the probability of forecasting and on the search for concrete cause-and-effect relations. In contrast, the function of right hemispheric, or image thinking, is organized to simultaneously capture an infinite number of connections and to form an integral, but ambiguous context. In such context the whole is not determined by its components, since all specific features of the whole are only determined by interconnections between these parts. On the contrary, any concrete element of such context bears a determining stamp of the whole. The perception of each concrete moment is brought in correspondence with the entire past experience, with the already shaped picture of the world, which impacts to such activity the status of thinking. Individual facets of images interact with each other on many semantic planes simultaneously. The advantages of this strategy of thinking manifest themselves only when the information itself is complex, internally contradictory and basically irreducible to an unambiguous context. As I have stressed in many previous publications, the right hemisphere and the polysemantic way of thinking play a crucial role in the psychological defense mechanisms (Rotenberg, 1982; Rotenberg, Elizur 1992): 1. All information is grasped by the right hemisphere before its conscious realization. 2. The self-image which integrates the human's behavior is based on the right-hemispheric image thinking and represents the conscious behavioral attitudes in the kingdom of unconsciousness. 3. A polysemantic context provides an opportunity for a more flexible handling of information, in comparison with a monosemantic context which is the basis of ordinary consciousness. As a result, problems can be presented and solved in a very bizarre way, by using those relationships between objects and events which are not obvious and which are usually ignored by the consciousness. It is what typically happens in dreams and what makes them meaningful and remarkable. In healthy subjects, and especially m emotionally sensitive healthy subjects, the dream contents after awaking in REM sleep are extensive, rich and polysemantic. It provides an opportunity to find a new way for search activity. In addition, the formation of the polysemantic context is less expensive for the human brain because it does not require the additional activation of the brain (Rotenberg, Arshavsky 1991). As a result, search activity in dreams can start in physiological conditions of a relative decrease of brain monoamine activity (Rotenberg 1984, 1994) - which are inappropriate for search behavior during wakefulness. However, in mentally ill persons (patients with depression, neurotic disorders, anxiety etc. ) as well as in patients with psychosomatic disorders (Rotenberg 1988) the number of dream reports is decreased, the dream contents become linear and simple and they are loosing their polysemantic feature. Such simplification of dreams, their "exhaustion" up to the total disappearance of the contents, reflects, from my point of view, a functional deficiency of the right hemisphere to produce a polysemantic context and to perform all the above mentioned tasks which are so important for the psychological adaptation. Another sign of the functional inability of the right-hemispheric image thinking is alexithymia. Alexithymia is characterized by the difficulty in distinguishing between feelings and bodily sensation, by the inability to express feelings, as well as by the lack of fantasy life, for instance reduced daydreaming etc. (Rubino at al. 1991). Subjects with alexithymia are not open to experience, they have impoverished fantasy. It is not a result of repression (Newton, Contrada 1994). It is worth to take into consideration that a human's emotions and feelings are polysemantic in its nature - it is impossible to explain the state of love exhaustively in a monosemantic unambiguous way, as well as other emotional states. Thus, the impoverished fantasy and poor imagination can be a natural reason of the main symptoms of alexithymia, i. e. the inability to feel and to express emotions. This conclusion is in a good agreement with the numerous investigations which are displaying the role of the right hemisphere in perception and in processing of emotional experience (Wittling, Rosenmann 1993). It was shown (Sackheim et al. 1978) that emotions are expressed on the left side of the face: Left side composites were judged by healthy testees to be more emotionally intense than right side composites (Sackheim, Gur 1978). The conjugate lateral eye movements in response to the emotional questions are directed to the left, reflecting the activation of the right hemisphere (Hugdahl, Carlgren 1981). During recent years the phenomenon of alexithymia has been discussed in the context of the interhemispheric transfer deficit (Miller 1986; Zeitlin et al. 1989; Henry et al. 1992). However, there are some direct evidences that alexithymia is related not to the inter-hemispheric transfer deficit of information, or at least not only to such deficit, but also to the functional inferiority of the right hemisphere. It was shown that alexithymia correlates with the right direction of the conjugate lateral eye movement (Parker et al. 1992). This is a sign that alexithymia is associated with the left cerebral lateralization and the dysfunction of the right hemisphere. It corresponds with the preoccupation with the details of external events in alexithymic subjects. According to modern investigations, alexithymia characterizes not only psychosomatic disorders (Alkin, Alexander 1988), but also depression (Parker et al. 1991), bulimia nervosa (Jimerson et al. 1994), neurotic ani psychotic disorders (Rubino 1993), posttraumatic stress disorders (Henry et al. 1992). Thus, it is possible to conclude that alexithymia, as well as the functional insufficiency of dreams, is the common feature of the wide rank of mental and psychosomatic disorders. It means that the dysfunction of the right hemisphere may be a general pathogenetic mechanism of these disorders. I have proposed this hypothesis in 1973, and the recent investigations are going to confirm it. These recent investigations are also in a good agreement with the statement (see Ammon 1993) that structural common features are to be found in psychosomatics, depression and schizophrenia and the shifting of symptoms may occur in the course of these diseases. The inability to form a polysemantic context which is very much related to the Hole in the Ego (Ammon 1973) is the most common feature of these diseases. In previous publications (Rotenberg 1993, 1994) I have suggested that the functional deficiency of the right hemisphere, the inability to produce a polysemantic context, may be caused by the lack of emotional relationships between the child and the parents. Such emotional relationships, being polysemantic in their nature, stimulate the development of the right hemisphere functions and correspond to these functions as a key to the lock. If these emotional relationships are insufficient, the right hemisphere will become inefficient, its contribution in psychological defense mechanisms and emotional stabilization will be lost, and it will be a general predisposition to the subsequent mental and psychosomatic disorders. All these suggestions are in line with the ideas of Ammon (1986) that the deficient parental emotional support predisposes subjects to the mental and psychosomatic disorders in future. The lack of the positive social energy in childhood is the main reason of the subsequent Hole in the Ego (Ammon 1973) which characterizes alexithymic persons. Some recent investigations confirmed this approach: the best predictor of alexithymia is having grown up in families with a lack of positive emotional communications (Berenbaum, James 1994). If right hemisphere functional deficiency is a crucial point in the pre-disposition to different mental and psychosomatic disorders, it will be reasonable to suggest that different forms of psychotherapy are effective due to the restoration of image thinking, in parallel with the restoration of search activity. We have already discussed this topic previously (Rotenberg, Arshavsky 1987) and we have come to the conclusion that the importance of the emotional relationships between psychotherapist and client can be explained by the restoration, in the process of such relationships, of the right hemispheric activity. In this way the emotional relationships in the process of psychotherapy are covering the initial deficiency caused by the lack of emotional relations in early childhood. Speaking about the different forms of psychotherapy, it is necessary, first of all, to stress the increasing role of art therapy in modern psychotherapy. Art therapy is addressed to the right hemisphere and is using right-hemispheric skills. Dance therapy and creative self-realization are successfully used in Ammon's school of Dynamic Psychiatry as well as in the Israel Center of Rehabilitation through the Functional Art. All of them are related to the right hemisphere activity and stimulating its function. The therapeutic use of metaphors (Trad 1993, Sledge 1977) can partly be explained according to the same approach because metaphors are processed by the right hemisphere (Winner, Gardner 1977). Moreover, even the therapeutic effect of psychoanalysis can be explained according to the conception of the activation of the right hemisphere functions. The typical features of psychoanalysis - working with free associations, concentration on dream contents, flexible game with images and metaphors - they all correspond to the right hemisphere activity. It is very natural that the positive effect of psychoanalysis, as well as the positive effect of other psychotherapeutic methods, correlates with the restoration of spontaneous dream reports, which are related to the sufficient right hemisphere functions. In addition, in psychoanalysis the patient is trained to become an objective supervisor of his own problems, conflicts and mental processes, and this position helps to maintain search activity. Thus, in conclusion I want to stress, that the functional insufficiency of image thinking predisposes subjects to different disorders (mental and somatic) by itself because it prevents the restoration of search activity. Literature:
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