精神障碍和治疗

The Neurobiology of a New Idea – or The Death Instinct, Revisited

Abstract

Richard Brockman

Stressed mice perseverate. Stressed humans perseverate. Freud described in what I had feel was his only true “science fiction thriller” – Beyond the Pleasure Principle – how traumatized patients perseverated, that is they persisted in repeating “un pleasure”. It is I think rather unlikely that the “Death Instinct” is at the etiologic root of these behaviors for either mice or for men. Rather it may be stress and neural circuits that favor the locus ceruleus, the amygdala, and the dorsal striatum. And in order to impact these pathways, it may be necessary to intervene at the moment of anxiety. This paper describes just such active interventions at moments of anxiety – interventions informed by psychotherapy but very much expanding the boundaries of where and how psychotherapy should be done. The work is described with two patients both of whom persisted in repeating “unpleasure”.