THE ASYMMETRY OF THE FRONTAL LOBE FUNCTIONS AND THE FUNDAMENTAL PROBLEMS OF MENTAL HEALTH AND PSYCHOTHERAPYVadim S. Rotenberg vadir@post.tau.ac.il Published in Dynamic Psychiatry, 2007, v. I-II, N 219-220, p. 51-68. The function of the right hemisphere is the holistic grasping of numerous interrelationships between objects and events. The function of the left hemisphere is the division of the reality on simple elements. The function of the right frontal lobe is the formation of the polysemantic context. Right frontal lobe determines the subject's integration in the polydimensional world. Polysemantic Self-image plays a key function in defense mechanisms. The functional insufficiency of the right frontal lobe displays a general predisposition to mental or psychosomatic disorders. The task of psychotherapy is the restoration of the right frontal lobe functions. Keywords: brain hemispheres, frontal lobe, mental health The investigation of the brain asymmetry developed in two different directions. On the one hand, neurologists for a century and a half have collected data of the role of the local brain structures of both hemispheres in the realization of some definite mental and behavioral functions. This direction of investigations is now equipped with modern methods of brain investigation (like positron emission tomography; CRAIK, MOROZ, MOSCOVITCH 1999). On the other hand, investigations on the bisected brain with divided hemispheres (SPERRY, GAZZANIGA, BOGEN 1969; GAZZANIGA 1970) stimulated many attempts to discover the most basic differences between hemisphere functions and to present a global concept of the brain asymmetry. In this article we are going to show that this second direction is not only a complimentary one to the first direction but even a part of it, because the most global functions that differentiate both hemispheres are functions of its frontal lobes. The investigations performed on the epileptic patients with the bisected brain brought many unexpected data. It was shown that in these patients, even in right-handed subjects, the right hand cannot copy simple geometric figures, is unable to build simple constructions of child bricks, while the left hand performs all these tasks easily. With the closed eyes patient cannot recognize with the right hand even quite familiar object while the left hand is doing it immediately. If the information was presented to left visual field (right hemisphere) the subject's behavior was relevant to the content of this information but subject was unable to explain the reasons of his/her behavior. Moreover, patients with bisected brain demonstrated periodically the behavioral signs of the inner motivational conflict that was not realized. Thus, one patient complained that he volitionally embraced his wife with his right hand (managed by the left hemisphere), and at the same time unexpectedly pushed her away with his left hand - story that in another condition in subjects with the undivided brain would brought immediately the psychodynamic interpretation. The first attempts to interpret the data of the investigations performed on these patients were superficial and ignored the possible relationships of these data to the deep psychology. The most popular assumption proposed that brain hemispheres are dealing with the different types of information: left hemisphere is processing special signs like those present in natural and artificial languages while right hemisphere is processing the natural nonverbal information like images, melodies, intonations of voice, and is also responsible for the orientation in space and in subject's own body. This concept seemed to be confirmed by the outcomes of the organic damages of the left and right brain hemispheres. For instance, the damage of the left temporal lobe is accompanied by motor and sensory aphasia while the damage of the right parietal lobe is associated with the disorientation in space. However, further investigations have shown that both hemispheres are able to deal with any kind of information (for details s. ROTENBERG 1993). More reasonable is the concept of GORDON (1978) and ZAIDEL (1984). According to these authors, the main function of the left hemisphere is the consequential analysis of any - verbal as well as nonverbal - information, while the function of the right hemisphere is the simultaneous 'grasping' of all elements of information in a holistic way. Such formation of the holistic image determines the comprehension of the object or event just before its consequential analysis. However, what is really grasped in a holistic way by the right hemisphere? The answer on this question requires the consideration of some philosophical aspects. Objective world we are dealing with in our every-day life contains not only objects, subjects and events. More important are numerous interrelationships between objects, subjects and events, real and potential. Exactly these interrelationships are making the objective world vivid, rich and dynamic. These interrelationships may be cooperative, complimentary or contradictive. Left and right hemispheres differ according to the way they are processing these interrelationships. Left hemisphere extracts few of them in order to split reality on simple elements and fragments and to analyze them in an ordered and consequential way. In contrast to it, right hemisphere grasps all interrelationships simultaneously and builds a holistic gestalt of objects or combinations of objects. The more frontal is the brain structure, the more complicated are its functions and the more prominent is the difference between the left and right side of the brain. Thus, both occipital lobes are responsible for simple visual sensation (simple light flashes, color, simple shapes) however the right hemisphere has an advantage in the process of comparison of the holistic units-for instance, in recognition whether two images are equal or one displays a mirror of another ( FUNNELL, CORBALLIS, GAZZANIGA 1999). The right temporal lobe is responsible for the perception of single objects (BELYI 1988) and for the recognition of words as united gestalts, while the left temporal lobe is responsible for the recognition of the word as a combination of single letters. The phonemic, syntactic and grammar organization of speech are functions of the left temporal lobe-this part of the brain is responsible for the discrimination of the single components of the speech and its hierarchy. Due to this function we are able to understand the difference between the expressions: 'Peter was beating Alex' and 'Peter was beaten by Alex'. The right temporal lobe is responsible for the discrimination of the voice intonations, for the discrimination of voices of genders - this discrimination is based on the holistic gestalt of the voice. The relevant understanding of poetry depends on the frontal part of the right temporal lobe. The right hemisphere produces more associations on the single verbal stimuli in comparison to the left one, including also very distant, indirect associations (CHIARELLO 1998; CHERNIGOVSKAYA, DEGLTN 1986). The right temporal lobe assimilates holistic melodies while the left temporal lobe is sensitive to the definite patterns in music like rhythm. The right parietal lobe is responsible for the perception of groups of objects (like pictures with a plot simple scenes) while the left parietal lobe is responsible for calculation of objects and for the fragmentation of reality (BELYI 1988). The performance of the strict and precise movements is under the competence of the left parietal lobe, while the coordination of different movements that determines the harmony of the nonverbal behavior is regulated by the right parietal lobe. The frontal part of the left parietal lobe is responsible for the direction of attention towards the definite single objects while the symmetrical part of the right hemisphere is responsible for the attention toward the broad unrestricted space. Left hemisphere accepts information only from the right visual field and frontal structures of the right hemisphere collect information from the both visual fields (WEINTRAUB, MESULAM 1987; HEILMAN, WATSON, VALENSTEIN et al. 2003; CORBETTA, KINCADE, SHULMAN 2002). As a result the damage of the frontal part of the right hemisphere causes the ignorance of the left part of the space while the damage of the left hemisphere does not cause the ignorance of the right part of the space. It is the right hemisphere that determines the alteration of attention when some rare and unexpected stimulus suddenly appear (DOWNAR, CRAWLEY, MIKULIS, DAVIS 2002). Right prefrontal area is responsible for the recognition of complicated images like human faces and right parietal lobe recognizes emotional expressions (SCHORE 2003; WAGER, PHAN, LIBERZON, TAYLOR 2003). Somebody is convinced by the emotional nonverbal expression only when all components of this expression (mimic, hand movements etc.) are forming in a holistic gestalt. At the same time, the language of deaf-and-dumb persons is a function of the left temporal lobe, although it is a nonverbal language, because every single sign in this language has to be understood according to its precise and unambiguous meaning. If the left hemisphere is damaged on the early stage of maturation, the right hemisphere can compensate its verbal functions. Moreover, the partial restoration of speech perception after the left temporal insult in adults also depends on the compensatory contribution of the right hemisphere. However, if the right hemisphere is damaged on the early stage of maturation the left hemisphere is unable to compensate the deficiency in space orientation. It means that the right hemisphere has some advantages in comparison to the left one even on the early stages of human ontogenesis (SAUGSTAD 1998). The contribution of the both hemispheres in memory is also different (ROTENBERG, WEINBERG 1999). Right hemisphere is responsible for the episodic memory, memory of personally relevant events, and this memory is based on the strong collaboration between the right hemisphere and the limbic system (MARKOWITSCH 1995). It depends on numerous interrelationships between single events what makes this memory rich and resistant to the local damage of the brain. Left hemisphere is responsible for the declarative memory based on the single linear interconnections between memory units. It is like a combination of numerous more or less independent single nets. By taking into consideration all the abovementioned data, it is possible to conclude that the common function of the all structures of the right hemisphere is the holistic approach to the world based on the simultaneous grasping of numerous interrelationships between its features and synthesis of these features. The opposite approach that contains the division of the reality on simple elements and its analysis according to the definite algorithms characterizes the left hemisphere structures and achieves its highest level in the left frontal lobe. Frontal 'left-hemispheric' logical way of thinking so organizes any sign material (whether symbolic or iconic) as to create a strictly ordered and unambiguously understood monosemantic context. This context is using only few definite connections between the multiform objects, phenomena and events in order to avoid any internal contradictions. By forming this monosemantic context subject builds a pragmatically convenient but simplified model of reality (including the reality of humans social relationships) that can be consciously recognized. The monosemantic context is a basis of: 1. Unambiguous understanding of people each other in the process of communication by using natural and artificial languages. 2. Probability forecasting and expectations 3. Cause-and-effect relationships 4. Categorization 5. Vector of time Here are two simple illustrations how this monosemantic context is working: a. Most words in the dictionary have different meanings however in the sentence (if it is not a poem) a particular word has usually only one definite meaning. It happens because in the sentence most of the single word's potential relationships with other words and notions (absent in this sentence) are cut off. b. A so-called 'Kuleshov effect' in cinema: the same human face surrounded by the plates with food vs. near the coffin is perceived subjectively as displaying opposite emotional expressions. The frontal lobe of the left hemisphere is responsible for the formation of the Self-Concept, it means for the subject's ability to separate himself from the world, for the conscious self-realization and for the ability to perceive himself/ herself as an object with different characteristics. Verbal communication, logical way of thinking and consciousness have been considered by psychologists to be the highest mental functions and consequently the frontal lobe of the left hemisphere for a long period had a reputation of the most high developed part of the brain. At the same time the functional meaning of the symmetrical right part of the brain - right frontal lobe - remained unknown and ambiguous until the very recent period. However, during the last decades have been collected data that the fronto-orbital part of the right hemisphere is responsible for the very complicated mental functions that characterize only humans. These functions include: 1. Feeling of empathy (SHAMAI-TSOORI, TOMER, BERGER, AHARON-PERETZ 2003) 2. Sense of humor (WINNER, GARDNER 1977) 3. Understanding of metaphors (WAPNER, HAMBY, GARDNER 1981). 4. Theory of mind - an ability to understand how other people understand you in the process of communication (PLATEK, KEENAN, GALLUP, MOHA-MED 2004). 5. Creativity Finally, frontal and fronto-orbital parts of the right hemisphere are responsible for the holistic self-recognition (DECETY, CHAMINADE 2003) and for the formation of the Self-image (CRAIK, MOROZ, MOSCOVITCH et al. 1999; KEENAN, WHEELER, GALLUP 2000; KEENAN, NELSON 2001; DECETY, SOMMERVILLE, 2003). Right hemisphere lesions disrupt sense of self, self-recognition and Ego boundaries. Self-image is an integrative and holistic self-presentation not divided on parts and components. It cannot be totally consciously realized being polydi-mensional and too complicated to be represented in a monosemantic way. Actually its formation is based on numerous interrelationships between the subject and his/her significant others, not only those who are surrounding him/her in the present but also those who appeared in his/her life in the past, starting from the early childhood; it includes also the relationships between the subject and different cultural domains, like the impressions evoked by literature, art, cinema etc. The damage of the temporo-parietal cortex of the right hemisphere causes the Cotard syndrome - a feeling that subject does not exist (s. PEARN, GARDNER-THORPE 2002). Self-image is more rich than the Self-Concept; it actually includes Self-Concept as a part of it and is the most important characteristic of the subject that determines the choice of behavioral attitudes and alternatives in the complicated and contradictory situations and is strongly related to the psychological defense mechanisms (see later). Twenty-five years ago I have proposed that this very important psychological structure (not less important than the consciousness and human speech) is localized in the right hemisphere and now it is confirmed. (ROTENBERG 1982) Self-image is very similar to the AMMON'S notion of identity. How to integrate, on the theoretical level, all the abovementioned highest functions of the frontal part of the right hemisphere? We suggest that in contrast to the formation of the monosemantic context by the left frontal lobe, the function of the right frontal lobe is the formation of the polysemantic context. In this context the individual facets of images interact with each other on many semantic planes simultaneously, and the whole is not determined by its single components: all specific features of the whole are determined only by interrelationships of these components. The holistic entity of the right hemisphere activity transforms in the polysemantic entity only after the formation of the monosemantic context and only in contrast to this context. Here are some illustrations of the polysemantic context. 1. Sleep dreams. The verbal reports of dreams are usually less impressive and have less meaning than the vivid images of dreams by itself, and not only for others who are listening these reports, but even for the subject himself because the impression evoked by dreams is caused by the numerous (and often contradictory) interrelationships between dream images that cannot be comprehensively expressed in the verbal report that is following the rules of the monosemantic context. 2. Creative works of art, poetry etc. 3. Emotional expression and its recognition (ADOLPHS, TRANEL, A. DAMASIO, H. DAMASIO, 1994) - subject cannot explain in words without the substantial failure why he/she loves somebody. Due to the activity of the frontal part of the right hemisphere fuzzy categories like 'near', 'far', 'beautiful' are subjectively understandable but it is difficult to explain them verbally. In the statement of the St. Austin "I know exactly what is space and time only until I am asked about these topics" knowledge he is speaking about is the right hemisphere knowledge. The same regularity characterizes the difference between Self-image and Self-Concept. Subject can describe himself verbally in details (self-concept) however something substantial what really makes this subject unique (self-image) would be lost. The subject's statement, "I can't accept this proposition I do not know why", reflects the interference of Self-image. RASKOLNIKOV (from DOSTOYEVSKY) on the conscious level suggested that it is reasonable and just to kill the old women who makes a profit on the expense of poor people, and that he is ready to do it. However, according to the text, when he started to kill her he seemed to be in the altered state of consciousness and not very good understood what he is doing (like in dream) and just after this criminal action he was very confused and unable to overcome a feeling of guilt. It was a voice of his Self-image that was not convinced by the reasons of the Self-Concept. It is necessary to take into consideration that 'holistic' is not a synonymous of 'polysemantic'. All the previously described structures of the right hemisphere, except of the frontal lobe, are grasping the reality in a holistic way but the formation of the polysemantic context is the function of only the right frontal lobe as an attempt to overcome the restriction of the monosemantic context created by the left frontal lobe, and only in front of this monosemantic context. For the right hemisphere by itself this dichotomy between mono-and polysemy has no sense. The different functions of the left and right frontal lobe can explain some phenomena in social psychology. In the investigations performed under the supervision of Prof. J. KUHL (BAUMANN, KUHL, KAZEN 2005) was shown that even a very simple activation of the left hemisphere (by using physical exercises performed with the right hand) determines in healthy subjects the 'infiltration' in the consciousness of the suggestions of the authority ('boss') and these suggestions are mistakenly estimated by the subject as his/her own voluntary choice. By activation of the right hemisphere such infiltration is blocked. This infiltration differs from the real voluntary integration of the suggestion because it is accepted on the formal, although conscious, level, and may at the same time cause rejection on the unconscious level, however this rejection is suppressed and repressed. It is possible to suggest that inability to perceive the holistic picture of the reality caused by the hyperactivation of the left frontal lobe makes person not protected in front of the suggestion. It can be a mechanism of the manipulation with the consciousness of the 'left-hemispheric' subjects regularly performed by mass-media. These data correspond with data of the same group (KUHL, KAZEN, in press) that in subjects with the activated left hemisphere motives of affiliation and emotional attachment are less prominent than motives of social domination, while the opposite happens by activation of the right hemisphere. The social hierarchy is especially important for the left hemisphere. Our general statements have been recently confirmed by the discoveries of the ontogenesis of the brain laterality and of the maturation of the brain (s. SAUGSTAD 1998; SCHORE 2003). On the first two years after the birth child is characterized by the domination of the right hemisphere. It displays itself in the ability to discriminate mother's voice from any other sounds and mother's face from any other objects, and to encode, according to intonation of the voice and face expression, the mother's attitudes towards the child. Already on the forth day after the birth child is able to recognize mother's voice. Generally speaking, the domination of the right hemisphere (the early development of the right occipital, temporal and parietal lobes) determines the ability of the child to grasp the reality as a holistic entity before any detailed analysis is available, to feel himself as being an integrated part of the world and to form a general attitudes towards the environment: whether it requires approach or avoidance. Such decision is essential for adaptation and even for survival. Interestingly, it is a system with a positive feedback: the neuronal connections (nets) in the right hemisphere are developing in the process of the emotional relationships with mother and under its influence (SCHORE 2001). The initial verbal communicative skills appear exactly in the same period between the 18 and 24 months, when the right hemisphere dominates, and for this reason it is not surprising that after the early damage of the left hemisphere the right hemisphere is able to take the responsibility for the verbal communication. Partly it is reliable even in the adulthood, after the functional left hemis-pherectomy (TRUDEAU, COLOZZO, SYLVESTRE, SKA 2003). This early skills of the right hemisphere to process the verbal material have presumably a long-lasting consequences: I have proposed (ROTENBERG 2001) that the inner speech of adults represents the organization of the verbal material according to the rule of the polysemantic context. It corresponds with the idea of VlGOTSKY that the inner word (the basis of the inner speech) represents, on the one hand, a precise and definite meaning of the object (as a conditional sign), while on the other hand incorporates numerous senses of the other, previous and consequent words, thus tremendously enlarging the boards of its own meaning. Actually it is a metaphor of the polysematic net of senses. The translation of the inner speech into the communicative speech means a translation from the right hemisphere polysemantic context to the left hemisphere monosemantic. After the second or third year of life the left hemisphere starts developping more actively than the right one. In the school years the left hemisphere starts to dominate (in Western culture countries). It is not only the development of language but first of all the development of the left hemisphere way of thinking that determines the distinguishing of self from social environment. The final point of this development is the maturation of the left frontal lobe and the formation of the self-concept and the conscious model of reality. It is very important for a person's adaptation in society, for volitional behavior, but the domination of the left frontal lobe has also some serious disadvantages: it brings a subject the feeling of separation from the world that can achieve the level of the opposition to the world. It brings also a feeling of disintegration of the world divided into numerous pieces and details. In order to feel himself comfortable and to be successfully integrated into the polydimensional world a person on this level has to overcome the restrictions of monosemantic context. Subjects require a new step, a new level of integration that is different from the initial and relatively primitive integration in the world typical for early childhood when a subject still had no experience of the separation of the self from the world. This new level of integration is based on the function of the right frontal lobe that is the last structure of the brain to be matured. It is a difference in brain maturation between genders. In women the maturation of the left hemisphere starts earlier and the final maturation of the both frontal lobes achieves its highest point earlier than in men. In men the maturation of the right frontal lobe is delayed in comparison to women (s. SAUGSTAD 1998). In the context of the abovementioned statements, it is possible to give a new interpretation of the Bible story of the fruit eating that was the reason why Adam was pushed from the Paradise. A concept that Adam was punished because he has done it without permission and prematurely is not very convincing because according to the classical Jewish Bible the initiative and the own choice is what G-d is waiting from the man. Adam was in Paradise in the condition of the childhood, he does not separate himself from the environment, like it happens in childhood. Every his intention was immediately carried out in action how it really happened in small children when they are not restricted in their activity. Such condition being prolonged had no chance to change by itself. My explanation is the following one. Adam was in a childish paradise without self-consciousness, without the ability to analyze the environment and to separate oneself from it. It corresponds to the initial domination of the right hemisphere. For the further maturation it is necessary to make the next step. After eating a fruit Adam started to realize himself and found himself in front to a real world with all its contrasts, contradictions and conflicts. He found himself different from Eva and in the new relationships with her, he found that both of them are nude (what means a critical view on himself and on Eva). He found a holistic world to be broken in pieces like it happened when the logical-analytical approach dominates. Thus by eating a fruit (presented by Eva - women are characterized by the earlier left brain maturation) Adam has pushed himself from the childish Paradise where everything is in harmony - in order to became adult and to perceive and analyze the reality and himself in a proper way. It was an unavoidable step of maturation. However, to find himself in the decomposed world the subject is not integrated in is very stressful. Subject requires a new integration that corresponds to the creativity and to the polysemantic view on the world that overcomes the restriction of the pure analytical view. To come to this new level of integration requires a lot of efforts. Thus this Bible story corresponds with the modern view on brain maturation. The longer is the process of the maturation of the structure in ontogenesis, the higher level achieves the function performed by this structure. The delay of the maturation of the right frontal lobe presents an advantage to the men in the development of the polysemantic way of thinking displayed, for example, in the level of creative skills. However, this long maturation can have also some negative consequences: the longer is the period of maturation, the longer is the period of the increased vulnerability of the structure that is sensitive to any types of damage - infection, physical and psychological trauma. Thus the longer process of maturation of the brain in men may explain the relatively higher number of serious mental disorders like schizophrenia. Even the subtle damage of the right frontal lobe during stress before its final maturation may disturb the integration in the world and the formation of the defense mechanisms. In front of many different concepts, it is reasonable first of all to determine the main function of the defense mechanisms. I do not agree that this function is to prevent the realization of any negative emotional feelings. It would be maladaptive because subject has to cope with events that cause such feelings and often has such opportunity. I suppose that the task of defense mechanisms is to prevent the disintegration of the self and of the goal oriented holistic behavior, and for these reasons they prevent the realization of only those information that may cause such disintegration. However, by accepting this view we are not avoiding the well-known paradox: how defense mechanisms that are functioning out of the consciousness are protecting consciousness and take into consideration its needs? I suppose that the concept of self-image localized in the right frontal lobe can solve this paradox. As we have stressed, it belongs to the kingdom of the unconsciousness but at the same time incorporates among others also the conscious attitudes (self-concept is a part of the self-image, is integrated in the self-image which is the highest instance of personality). Thus it represents consciousness in the domain of unconsciousness. On the other hand, right hemisphere displays attention to the both sides of space and collects all information and all possible interrelationships between facets of information (WEINTRAUB, MESULAM 1987). Moreover, right hemisphere has an advantage in the speed of information processing. (SCHWEINBERGER, SOMMER 1991). Thus self-image is able to grasp and to estimate information on the unconscious level before its realization, and to decide what is relevant for the consciousness and what is not. The latter is not allowed to enter the consciousness (by mean of repression). The perceptual defense (denial) is another mechanism. On the first glance it is also paradoxical in its nature: in order to increase the threshold of perception for the inappropriate information and not to allow only this information to be accepted by the brain, the latter has to decide what information has to be blocked, so it has to be somewhere informed about this information. This paradox may be one of the reasons why this defense was denied by some authors or mixed with repression by other. However, it is possible to give a reasonable explanation for this mechanism. Brain estimates any information in the context of the previously formed model of reality with expectations based on the previous experience. Brain is able to use probability forecast to predict whether the present information that is not destructive by itself can be followed (and was previously statistically significant followed) by the dangerous information the subject has to be protected from. Thus the relatively neutral information in the particular context may be estimated as a sign for increasing the perceptual threshold. One clinical case confirms this theoretical assumption. Once I spoke with my friend known as being very suspicious and vulnerable according to the health problems. He was worrying at that time about a small furuncle on his face and asked me whether I suppose it can be dangerous. In a psychotherapeutic way I explained him that it is not a problem et al, and that it is quite enough to use iodine for few days. However, for occasion another person heard our conversation and he interfered with the following message: "O, you have not to be so sure and irresponsible. One if my friends had a similar furuncle, it increased, an inflammation developed, a blood-poisoning appeared, and he died from encephalitis." I was really shocked by this sudden comment and became so confused that I reacted in a stupid way: "O, what are you saying? Even died? Incredible!" And suddenly my friend asked me with a great surprise: "Who died? Why you are speaking about death? Has somebody mentioned death?" It was obvious that he missed the most terrible part of the message. How can this be explained? My friend applied to me with his worries being sure that I will calm him down as usually. When another person, a stranger, started his speech with the attention eliciting phrase, "Don't be so sure etc." and afterwards started to tell the story, it was a sign that something inappropriate can come up that can frustrate my friend. According to this sign his perceptual threshold increased and he actually missed the most frightening end of the story. However when I have opened my mouth and started to speak the perceptual threshold immediately dropped, because from me, according to the previous experience, he expected only positive information. And suddenly he heard my confused reaction: "Even died?" being at that moment unprotected by the perceptual defense. This means, that first of all the perceptual defense really exists - if it would be a repression, my sentence would be also repressed. Secondly, this defense is not perfect enough: if the (monosemantic) context does not contain relatively neutral but predictive information, subject is not protected enough. On the other hand, the information that is really not predictive can be for occasion estimated as a signal one, as a result the perceptual defense can be activated and subject can loose some important information that does not require defense. The role of the right frontal lobe in the formation of self-image, in the relevant integration in the polydimensional world by the mean of the polysemantic way of thinking and in defense mechanisms can explain the development of mental and psychosomatic diseases in subjects with the deficiency of the right frontal lobe function. Subject with such deficiency find himself unprotected in front of the complicated and contradictive reality. The main mental and psychosomatic diseases are characterized by the right hemisphere dysfunction. In schizophrenia such dysfunction represents itself in the deficiency of the following functions: perception of facial emotional expression (BOROD, MARTIN, ALPERT, BROZGOLD, WELKOVITZ 1993); visuo-spa-tial task performance (GABROVSKA-JOHNSON, SCOTT, JEFFRIES etal. 2003); ability to grasp global forms; clumsy behavior; general deficiency and the disintegration of self-image (s. ROTENBERG 1994); affective blunting; lack of empathy; inability to create a polydimensional picture of the world. Depression is also characterized by the deficient right frontal functions (BENCH, FRISTON, BROWN et al. 1992; ROTENBERG 2004): inability to interpret the nonverbal information (facial expression, voice prosody, gestures), poor face recognition, less vivid imagery, lack of dream reports, lack of cognitive flexibility. A common factor in mental and psychosomatic disorders is alexithymia that is presumably a sign of the right hemisphere deficiency (ROTENBERG 1995). Thus, the main task of psychotherapy is the restoration of the patients' right frontal lobe skills, the polysemantic way of thinking. It is a common place that the basis of any form of psychotherapy is the emotional empathy between the psychotherapist and the client. Speaking in our terms, this empathy is the first thread that restores the violated vivid and polysemantic relationships between the client and the world. For this reason, the scale of the psychotherapists' personality has to be at least as high as the scale of the personality of the client. Although the concrete forms are less important than this basis, it is possible to show that very different forms of psychotherapy have common roots related to the right frontal lobe functions: art therapy, dance therapy and music therapy are activating the right hemisphere skills and creativity. Altered states of consciousness very often used in psychotherapy like meditation, yoga, and hypnosis are activating the same structures of the brain (ORNSTEIN 1972; ROTENBERG, ARSHAVSKY 1995). Positive social energy in the process of group therapy according to G. AMMON is actually based on the vivid net of polysemantic interrelationships between group members. Even in classical psychoanalysis the analytical intervention by itself is secondary, while dream reports and free associations are directly stimulating and developing the right hemisphere skills. I suggest that it is more important than the analytical interpretation of dreams and associations. It is not an occasion that from session to session in psychoanalysis as well as in other forms of psychotherapy the length of dream reports and the number of free associations increases, and it is a sign of the success of psychotherapy. It is important for the mental health restoration by itself, does not matter how correct are the interpretations presented by the therapist. I have come to the conclusion that the classical statement of psychoanalysis: 'Cure through the realization of complexes and repressed wishes' has to be replaced by another statement: 'Realization of the complexes and previously repressed wishes through the cure based on the activation of the polysemantic way of thinking. And as result - through the reintegration of the subject in the polydimensional world.' Only after this reintegration is achieved step by step, subject does not need more massive repression for the protection of the self-image and integrative holistic behavior, and as a result subject can realize some problems that previously paralyzed him.
REFERENCES Adolphs, B.; Tranel, D.; Damasio, H.; Damasio, A. (1994): Impaired recognition of emotion in facial expressions following bilateral damage to the human amygdala. Mature 372:669-72. Raumann, N; Kuhl, J.; Kazen, M. (2005): Left-hemispheric activation and self-infiltration: Testing a neuropsychological model of internalization. Motivation and Emotion 29:135-163. gelyi, B. 1. (1988): The role of the right hemisphere in form perception and visual gnosis organization. Intern. J. Neuroscience 40:167-180. Bench, C; Friston, K.; Brown, R.; Scott, L.; Frackowiak, R.; Dolan, R. (1992): The anatomy of melancholia: focal abnormalities of cerebral blood flow in major depression. Psycholog. Medicine 22:6Hl-6\5. Borod, J.; Martin, C.; Alpert, M; Brozgold, A.; Welkovitz, J. (1993): Perception of facial emotion in schizophrenic and right-brain damaged patients. Journal of Nervous and Mental Diseases 181:494-502. Chernigovskaya, T. V.; Deglin, V. L. (1986): Brain functional asymmetry and neural organization of linguistic competence. Brain andLanguage29:\A\-\5i. Chiarello, C. (1998): On codes of meaning and the meaning of codes: semantic access and retrieval within and between hemispheres. In: M. Beeman, C. Chiarello (Eds.) (1998): Right hemisphere language comprehensiomPerspective from cognitive neuroscience; pp. 141-160. Mathwah, NJ: Erlbaum. Corbetta, M.; Kincade, J. M.; Shulman, G. L. (2002): Neural systems for visual orienting and their relationships to spatial working memory. J. Cogn. Neurosci. 14:508-523. Craik, F.; Moroz, T.; Moscovitch, M.; Stuss, D.; Winocur, G; Tulving, E.; Kapur, S. (1999): In search of the self: a positron emission tomography study. Psychological Science 10:26-34. Decety, J.; Chaminade, Th. (2003): When the self represents the other: A new cognitive neuroscience view on psychological identification. Consciousness and Cognition 12:577-596. Decety, J.; Sommerville, J. (2003): Shared representations between self and other: a social cognition neuroscience view. Trends in Cognitive Science1':527 Downar, J.; Crawley, A.; Mikulis, D.; Davis, K. (2002): cortical network sensitive to stimulus salience in a neutral behavioral context across multiple sensory modalities. J. Neurophysiol. 87:615-620. Funnell, M.; Corballis, P.; Gazzaniga, M. (1999): deficit in perceptual matching in the left hemisphere of acallosotomy patient. Neuropsychologic 37 :\143-H54. Gabrovska-Johnson, V.; Scott, M.; Jeffries, S.; Thaker, N.; Baldwin, R.; Burns, A.; Lewis, S.; Deakin, J. (2003): Right hemisphere encephalopathy in elderly subjects with schizophrenia: Evidence from neuropsychological and brain imaging studies. Psychopharmacology (Berlin) 169:367-375. Gazzaniga, M. S. (1970): The bisected brain. New York: Appleton. Gordon, H. (1978): Left hemisphere dominance for rhythmic elements in dichotomically presented melodies. Cortex 14:58-70. Heilman, K. M.; Watson, R. T.; Valenstein, E. (2003): Neglect and related disorders. In: Heifman, K. M.; Valenstein, E. (Eds.) (2003): Clinical Neuropsychology; pp. 296-346. London: Oxford Univ. Press. Keenan, J. P.; Nelson, A.; O'Connor, M.; Pascual-Leone, A. (2001): Self-recognition and the right hemisphere. Nature409:305. Keenan, J. P.; Wheeler, M.; Gallup, G. Jr.; Pascual-Leone, A. Self-recognition and the right prefrontal cortex. Trends in Cognitive Sciences, 2000, 4:338-344. Markowitsch, H. (1995): Anatomical basis of memory disorders. In: M. S. Gazzaniga (Ed.) Cognitive neuroscience (pp. 765-779). Cambridge, MA: MIT Press. Ornstein, R. (1972): The Psychology of Consciousness. San Francisco: Freeman. Pearn, J.; Gardner-Thorpe, C. (2002): Jules Cotard (1840-1889). His life and the unique syndrome which bears his name. Neurology 58:1400-1403. Platek, S.; Keenan, J.; Gallup, G. Jr.; Mohamed, F. (2004): Where am I? The neurological correlates of self and other. Brain Res. Cogn. Brain Res. 19:114-122. Rotenberg, V. S. (1982): Funktionale Dichotomie der Gehirnhemispheres und die Bedeutung der Such-aktivitat fur Physiologische und Psychopathologishe Processe. In: G. Ammon (ed.) (1982): Hand-buch der Dynamische Psychiatrie. Vol. 2; pp. 275-335. Munchen: Ernst Reinhardt. ------(1993): Richness against freedom: two hemisphere functions and the problem of creativity. European Journal For High Ability 4:11-19. ------(1994): An integrative psychophysiological approach to brain hemisphere functions in schizophrenia. Neuroscience and Biobehavioral Reviews 18:487-495. ------(1995): Right hemisphere insufficiency and illness in the context of the search activity concept. Dynamische Psychiatrie/Dynamic Psychiatry 150/151:54-63. ------(2001): Dreams, Hypnosis and Brain Activity. Moscow: Center of Humanitarian Literature (in Russian). ------(2004a): The peculiarity of the right-hemisphere function in depression: solving the paradoxes. Progress. Neuro-Psychopharmacology & Biological Psychiatry 28:1-13. ------(2004b): The ontogeny and asymmetry of the highest brain skills and the pathogenesis of schizophrenia. Behavioral and Brain Sciences 27:863-864. Rotenberg, V. S.; Arshavsky, V. V. (1995): The "entropy" of right hemisphere activity and the restorative capacity of image thinking. Journal of Mental Imagery 19:151-160. Rotenberg, V. S.; Weinberg, I. (1999): Human memory, cerebral hemispheres, and the limbic system: A new approach. Genetic, Social and General Psychology Monographs 125:45-70. Saugstad, L. F. (1998): Cerebral lateralization and rate of maturation. Intern. J. Psychophysiology 28:37-62. Schore, A. (2001): The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant MentalHealth Journal'22:201-26. ------(2003): Affect regulation and the repair of the self. New York, London: Norton. Schweinberger, S. R.; Sommer, W. (1991): Contributions in stimulus encoding and memory search to right hemisphere superiority in face recognition: behavioral and electrophysiological evidence. Neuropsychologia 29:389-413. Shamai-Tsoori, S. G.; Tomer, R.; Berger, B. D.; Aharon-Peretz, J. (2003): Characterization of empathic deficits following prefrontal brain damage. The role of the right ventromedial prefrontal cortex. Journal of Cognitive Neuroscience 15:324-337. Sperry, R.; Gazzaniga, M; Bogen, I. (1969): Interhemispheric relationships: the neocortical comissures, syndromes of hemisphere disconnection. In: Handbook of Clinical Neurology, pp. 273-290, Amsterdam: Trudeau, N.; Colozzo, P.; Sylvestre, V.; Ska, B. (2003): Language following functional left hemispherectomy in a bilingual teenager. Brain and Cognition 53:384-388. Wager, T. D.; Phan, K. L.; Liberzon, I.; Taylor, S. F. (2003): Valence, gender, and lateralization of functional brain anatomy in emotion: a meta-analysis of findings from neuroimaging. Neuroimage 19:513-531. Wapner, W.; Hamby, S.; Gardner, H. (1981): The role of the right hemisphere in the apprehension of complex linguistic material. Brain and language 14:15-33. Weintraub, S.; Mesulam, M. M. (1987): Right hemisphere dominance in spatial attention. Arch. Neurol. 44:621-625. Winner, E.; Gardner, H. (1977): The comprehension of metaphor in brain damaged patients. Brain 100:717-729. Zaidel, M. (1984): Les functions de l'hemisphere droit. Recherone 15:332-349.
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