Psychoanalytic Association of New York (PANY)
Monday September 19, 2016, 8:30pm

Fourteenth C. Philip Wilson, MD, Memorial Lecture

Pathologic Attachment, Neurodevelopment and Psychoanalysis of Psychosomatic Patients

W. Scott Griffies, MD, DFAPA

NYU School of Medicine, Smilow Seminar Room
550 First Avenue (near 32nd St.)

This paper focuses on how pathologic attachment affects the neurodevelopment of stress regulation circuits and thus informs psychoanalytic treatment.  Case studies will be presented and formulated through both a mind and brain lens.  Brain language will be aimed at an audience of clinical psychoanalytically oriented psychotherapists working with psychosomatic patients.  Traumatizing attachment experiences may become embedded in the procedural circuits of subcortical brain structures blocking the healthy development of higher ordered mentalizing and symbolizing cortical capacities. This pathologic internalization can then lead to abnormalities of fundamental stress regulatory circuits such that stress is intensified within the body by a phenomenon called central sensitization, which can facilitate somatic illness. Lacking healthy regulatory functions and deficits in mentalization, a predominantly prefrontal cortical function, patients tend to become fixated, or regress, to a somatic mode of mental functioning with a heightened bodily stress response.  Neurologically and experientially ill-equipped to regulate their own chronic tension and arousal, these patients desperately seek attachment to another person who can serve as an external regulator. And, reflexive, conditioned, procedural circuits within brain structures such as the basal ganglia coordinate a non-mentalized behavioral response in attempt to secure an attachment and prevent a primitive abandonment and/or psychic annihilation.  Psychoanalytic work with these patients requires awareness that they lack, at first at least, the mentalizing facility of a separate mind.  A core aspect of the work then is non-interpretive and relational aimed at the creation and facilitation of the patients separate capacity to know their mind and inherent thoughts, feelings, beliefs, and ideas.    

W. Scott Griffies, MD, DFAPA currently is the Medical Director for the Psychosomatic Medicine Service at Duke Raleigh Hospital.  Prior to his recent move to Duke Department of Psychiatry and Behavioral Sciences, he lived and worked in New Orleans for 25 years.  While there, he was a psychoanalytic psychotherapy supervisor and faculty at the New Orleans-Birmingham Psychoanalytic Center. He also was an Associate Professor of Clinical Psychiatry at Louisiana State University Health Science Center and a faculty with the LSU Psychosomatic Medicine Fellowship, Residency Director and the Carl Adatto Professor of Psychoanalytic Psychiatry.  He won numerous teaching awards and worked and directed services predominantly focused on psychiatric aspects of medical and surgical patients.  In 2008, he established the New Orleans Center for Mind Body Health in downtown New Orleans.  His practice interests and writing has focused on combining medication and psychotherapy in the treatment of psychosomatic patients.  His most recent publication has been the chapter entitled “Non-mentalizing and non-symbolizing psychic functions and central sensitization in psychosomatic patients” in From Soma to Symbol edited by Phyllis Sloate PhD.    

Educational Objectives

1. Participants will be able to recognize and deepen their understanding of psychosomatic patients with non-mentalizing and non-symbolizing mental functions and their tendency to form symbiotic somatic transferences. 
2. Participants will be able to have a general conceptual knowledge of a theoretical model of how pathologic attachments shape the neurodevelopment of dysfunctional stress processing circuits leading to the neurobiological phenomenon of central sensitization, which leads to increased threat sensitivity and regression within the transference.
3. Participants will have increased knowledge of modifications of psychoanalytic technique that can enhance the development of a mentalizing and symbolizing psychic apparatus that facilitates de-somatization and mind-language.