THE TWO HEMISPHERES AND THE PROBLEM OF PSYCHOTHERAPY

Vadim S. Rotenberg, V.V. Arshavsky

E-mail: vadir@post.tau.ac.il

Dynamishe Psychiatrie/Dynamic Psychiatry, 1987, 106/107: 369-377.

Human communication, primarily, implies communication by speech. This is quite natural. It is precisely speech communication which is designed to ensure unambiguous understanding between people, without which collective activity and, consequently, the entire development of human society would be impossible. Without the retention of cultural achievements in written speech handing them down from the generation to the next would be impossible, and, as a result, the descendants each time would have to erect the edifice of culture practically from the very beginning.

Human consciousness, self-identification in the surrounding world, and the ability to form abstract, or the most generalized notions are inseparably connected with speech.

The role of speech communication is indeed difficult to overestimate. But it would be an error to assume that all interrelations between people are reduced to verbal contacts. Suffice it to recall how much man learns about the mood and state of his fellow-man from the latter's intonations, gestures and facial expression. A conversation in an unfamiliar language can give a sufficiently clear idea about the mood of, and the relations between, the parties to this conversation, especially if it proceeds with emotional expression. Viewers understand good actors of silent films: all shades of the emotional experiences of the heroes of the early films of Charlie Chaplin find a ready audience response. When a misfortune befalls a person near to us we not infrequently have difficulty finding words that would exactly convey our sympathy and concern and we express them in gestures, looks and actions. A powerful role in the shaping of our relations with others is played by intuitive understanding, which frequently cannot be strictly formulated. Finally, a nursing baby who does not yet have the power of speech and does not understand words, unmistakably guesses his parent's mood and their attitude to himself and each other, and begins to cry and shows temper tantrums at the very first, even thoroughly camouflaged signs of emotional tension shown by his mother.

All these and many other facts lead the authors to draw the conclusion that, alongside, and irrespective of, speech contact, a major factor in human relations is non-verbal communication. And its distinguishing feature is not so much the fact that it proceeds without words, as the fact that, basically, it cannot be replaced by verbal, in other words, that it cannot be translated into speech symbols, for it touches and reflects the polysemantic aspects of interpersonal relations. In this form of communication manifest themselves all the distinguishing features of image thinking. Non-verbal behavior, language, facial expression, intonations and gestures are instrumental in establishing complex contradictory, predominantly emotional relations between people and between man and the world. How frequently a touch by the shoulder, a handshake or a look tell more than can be expressed in a long monologue. Not because our speech is not accurate enough. Just the contrary. It is precisely its accuracy and definiteness that make speech unsuited for expressing what is too complex, changeful and ambiguous.

As said earlier, consciousness and speech have enabled man to identify himself in the world, giving him an ability for objective self-perception. But this irreplaceable ability, which ensures to man necessary behavioral autonomy, can in individual cases - the cases of psychic and psychosomatic diseases - change into its opposite, when self-identification in the world passes into alienation and separation from the world. Then out of the entire profusion of the man-world connections remain only monosemantic, linear, flattened connections. The subject's relations with other people and even with nature can acquire an

The Two Hemispheres and the Problem of Psychotherapy exclusively formal character. Then there is no empathy, no sensory and integral comprehension of another individual. The subject enters into communication not with a real fellow-man, but with his sketchy conception about this fellow-man. The world as an object of pure analysis may then appear to be cold and alien, and man will then feel that he stands in opposition to, instead of feeling that he is an inalienable part of, such a world.

However, in a correctly educated individual the ability for self-identification in the world, for logical thinking and for establishing monosemantic connections is happily and harmoniously balanced by an ability for establishing polysemantic connections, for non-verbal communication and for the use of image thinking, which ensures integration with the world not at the rational, but at the sensory level. If image thinking is really to balance the distinguishing features of logical thinking and to ensure man's psychic balance and sensory integration with the world, this thinking is to be well-developed and functionally adequate. Only then can man endlessly draw his strength from his innumerable polysemantic connections with nature and other people, like Antheus who pressed himself against the earth. Perhaps at the basis of this mythological image lies exactly the intuitive sensation of power, which lends man a sensory contact with the world, made possible by image thinking. The formation of this type of world perception, the development of an ability for direct sensory interaction with all that exists begins from still unrealized early childhood impressions, from the relations which develop between the child and his mother. Not so long ago scientists gave principal attention to disclosing in the process of man's individual development an ability for articulate speech and logical thinking. The ability for the non-verbal world perception was regarded as inborn and exhibiting little dependence on postnatal development, on human contacts. But research of recent years, in particular, of the Giinter Amman school, has shown that the successful development of this ability also necessitates a correctly organized contact with the immediate environment. Polysemantic contacts with the world become established, above all, through polysemantic contacts with the parents, through the perception of the contacts between the members of the primary group, the family, which are so significant for the baby.

The deficiency of image thinking and the unquestionable predominance of formal-logical thinking not only impoverish the individual, depriving him of the joy of feeling the world with its entire wealth of colour and of the pleasure of feeling that he is an inseparable part of this inexhaustibly rich world. The deficiency of image thinking also creates prerequisites for constant conflicts both with the world and with himself. After all, by its very nature logical, verbal thinking is alternative. It does not recognize ambivalent relations, simultaneous acceptance and rejection, half-tones between white and black, or intermediate variants between "yes" and "no". The good cannot simultaneously be slightly bad, or the true a bit erroneous. If A and В are equal to С separately they have to be equal to each other. Logical thinking is remarkably correct. Its basic principle is that "yes" should be "yes" and "no" should be "no". It is irreplaceable in solving the problems each of which has only one solution, which stems directly from the initial conditions. Such are the majority of the concrete production problems. But then, the majority of the purely human problems connected with interpersonal relations do not correspond to these principles of solution. The alternative formulation of the question makes these problems simply insoluble. When in the case of a motivational conflict the same style of behavior appears to an individual to be simultaneously attractive and impermissible nothing can be solved here by a cavalry-like attack of the most impeccable logic. Complex circuitous ways are necessary here. Each variant of the solution of an intrapsychic motivational conflict or an interpersonal conflict connected with it has both strong and weak, positive and negative aspects. There is no weighing them on the precision scales of logic.

Thus, the unchallenged domination of formal-logic-sign thinking can result in dead-end conflicts which will limit the potential for search activity and easily create a state of renunciation of search. On the contrary, image thinking, as has repeatedly been emphasized, opens up new surprising and non-trivial approaches to, and possibilities of, search both in waking and in dreaming. Whereas the functional insufficiency of the "right-hemispheric" mode of information processing decreases the potential of adaptation and opens the doors for various forms of pathology.

The authors assume that the insufficiency of image thinking is not only one of the vivid manifestations of neurotic and psychosomatic disturbances, but also an important element of the pathogenesis of these diseases. This element arises from the shortage of emotional-sensory interpersonal relations, deepening this shortage itself.

Such an understanding of the role of interpersonal relations in the formation of world perception and in the establishment of polysemantic contacts with the world in all its manifestations makes possible a fresh view both of the essence and of the tasks of psychotherapy. The relevant literature published in the last few years shows a serious mistrust in the fundamental conceptions and postulates which explain the curative effect not only of psychoanalysis, but of all forms of psychotherapy. Complex theoretical constructions, which include notions such as "transfer", the overcoming of repression, and bringing hidden complexes and motives to consciousness are being more and more frequently replaced by the simple idea that the basis of any psychotherapy is emotional contact with the patient and his trust in, and affection for, the doctor, which always represent only a response to the unmistakably felt doctor's affection for, and readiness to understand and help, the patient.

The difference between the psychotherapeutic schools and methods is of no substantial relevance, and classical psychoanalysis as a method of cure does not show a crucial advantage over other less theoretically developed approaches. To know is to forgive, as the saying goes. This may be true. But whoever wants to help another person cannot do so exclusively by understanding him, i.e., by making rational analysis of the motives of his behavior. It is necessary to feel the other person's preoccupations and problems as one's own, to experience them with him. Moreover, it is necessary that the other person should feel this empathy. In the doctor-patient case the two should establish that polysemantic contact which in principle does not lend itself to rational interpretation. In the authors' opinion, the empathy, or the emotional-sensory contact which ties the doctor and the patient is the first thin thread which restores the violated contact between man and the world - a contact which is not formal, but organic, direct, and symbiotic. The authors have already tried to show that the violation of such a contact and the loss of ability to effect it constitute the first and most essential step in the direction of a psychic and psychosomatic disease. And psychotherapy, to the extent to which it fills this shortage of sensory communication with the world, becomes the first step in the direction of good health.

There are many rival theories designed to explain psychotherapy's curative effect. According to a sufficiently well known point of view, at the basis of any psychotherapy, including that which is known as rational, lies suggestion

- a variety of hypnosis. According to an equally widespread conception, the task of psychotherapy is to change the patient's psychological orientations. But each of these hypotheses is vulnerable and neither is all-embracing. Indeed, the majority of psychological orientations are unconscious (especially if they lead to neurotic and psychosomatic disturbances). How can they be reshaped by purely rational arguments addressed to consciousness, as the case of

orational psychotherapy? And can the effect of what is known as nondirective psychotherapy, in the course of which the patient is simply offered to speak in the presence of an attentive, well-intentioned and deeply understanding listener - a psychotherapist - be interpreted as suggestion or explanation? It appears that the only universal explanation for the effect of psychotherapy in any of its manifestations is the doctor-patient emotional contact, which furthers the restoration of the lost or weakened ability for direct sensory world perception.

If the role of emotional relations is largely reduced to restoring the image-based sensory contact with the world, the question as to the tasks and criteria of the successfulness of psychotherapy should have an entirely new formulation. According to classical psychoanalysis, the main task of the treatment is to restore the repressed unacceptable motives and complexes to consciousness, and as soon as this scheme works the patient becomes cured. This can be summed up in the brief formula of "cure through realization". But this formula itself contains a major insoluble contradiction. After all, according to the same psychoanalysis, the repression mechanism lies at the basis of neuroses and psychosomatic disorders, and the subject unconsciously, but straining all his efforts, at the price of a psychic tension and somatic disturbances, strives to keep these motives and complexes out of his consciousness.

How does the psychotherapist overcome this resistance and why does realization bring relief, having been stubbornly rejected previously? Was the repression simply a "mistake" of the unconscious? No. Psychoanalysts have always - and correctly - seen in repression a defense mechanism which prevents behavioral disintegration. Why should this mechanism suddenly be found needless? Is this really sudden? It is on record that the attempt at imperative introduction of repressed material into consciousness without preliminary stubborn work with a psychotherapist provides desperate resistance, a negative attitude to the session, and not infrequently the aggravation of the patient's state. Realization usually sets in only in the course of a long-lasting psychotherapy. The authors believe that the realization of the repressed material is not the reason for, but a consequence and criterion of, cure. The cure itself is due to long empathic contacts that restore the ability for a sensory attitude to the world, which rehabilitates defense mechanisms (in particular, dreams). Thus, not cure through realization, but realization through cure! This is the principle which bears an all-embracing character. In the authors' opinion, the realization of dreams, contrary to Freud's assumption, is not the ultimate goal either. It is only the result of the solution of an emotional conflict at the image level, pointing to the successfulness of such a solution. Itself, the process of solution of an emotional conflict by visual images and by the restoration of search activity, in the main, runs at the unconscious level, and its efficiency necessitates a great ability to establish polysemantic connections. Thus, the right-hemispheric ability to establish polysemantic connections furthers the restoration of search activity, which ensures good health.