‘The rising Self in psychotherapy. Neuroscience, psychopathology and phenomenology of the Self’ was the title of the conference which the main focus was on the recent Antonio Damasio revolutionary researches and theories concerning the Self connected to the newly Vittorio Gallese researches and theoretical reformulations about inter-subjectivity.
I firmly believe there is a strong connection between the Damasio researches outcomes and the theory of Gestalt Therapy, so I want to centre this article on the Antonio dialogues with the aim of stimulating your whole person, from the toe to the head, on making new links and becoming aware of this potential powerful connection (Neuroscience-Gestalt).
Antonio starts his presentation with a question: ‘why should we talk about feelings and their nature and origins?’. His proposed answer is “because it is not possible to give a comprehensive account of how minds are made without understanding what feelings are made of biologically; feelings are essential to account for consciousness and self”. In fact feelings can be nowadays understood as a distinct step to the process of life regulation, of homeostasis; they are also related to our behaviour and our social behaviour and the construction of cultures; and finally, some of the main diseases are diseases of feelings e.g. depression, pain syndrome, addiction etc.
Starting to analyse the biological context, Damasio briefly introduced the goals of homeostasis which the first goal is the immediate life regulation in terms of the maintenance of integrity of the soma, process that is related also to the social regulation insofar as our body is in a social context and need to function socially to ensure our species continuation. The goals of homeostasis are implemented by extra programs, which, as we will see, are related to feelings in terms of experiences turning in our mind. In fact, the homeostasis begins with basic action programs capable to resolve complex problems activating standard but elaborated responses which don't require any kind of decision. These programs are pre-set or instinctual and the learning process , through condition and habits, can expand them and their ways of functioning. They drive motivations and the emotions in the proper sense, for instance appetites for food, drink, sex, for the exploration and play, but also the care and attachment to progeny and mates.
At this point Antonio makes a distinction between the terms of emotion and feeling. Proper emotions, such us fear, anger, joy, disgust, happiness, are at the base of feelings; more complex emotions, so called social emotions (shame, embarrassment, content, pride, compassion and admiration) are functional to the self-regulation in social context, the interaction with others. Also these emotions precede corresponding feelings and go well beyond the Self.
Feeling is the experience we have at the body state and it includes the emotions in terms of set of actions and the experience we have about it. So we can feel an emotion and also we can feel many other events happening in our body, for instance we can feel thirsty, hungry, cold, hot or comfort, discomfort, well or not well, which have nothing to do with emotions. They are states of the body. And of course, experiencing an emotion – action program - our body adopts certain states, have the experience of these – states of emotions – and we feel emotions.
Remaking the point, the action programs are complex and composed by preparatory actions, for instance when we experience fear we activate our heart, lungs, gut, etc. having a sequence of activations within a complex schema and strategic behaviours e.g. focusing our attention to the object that caused fear to us and using complex motor reactions like freezing our body or running (fight-or-flight response). What about our brain? There are command units in it that direct the execution of these action programs and are located in very specific brain regions: periaqueductal grey, nucleus accumbens, hypothalamus and amygdala to name a few. Those regions can be trigged by internal conditions of the body, receiving messages from organs or other parts, or by the external world. Keeping the example of fear, we can activate this action program looking to something dangerous, when we are in a dangerous situation and we respond to a real possible danger, or only thinking about something that leads us to fear, so just using our minds, imagination, creativity. In fact, our sensory systems are constantly monitoring both the inside and the outside world and we can respond to these stimulations depending on how much attention we pay to one or the other.
Thus, to make the point of this process, we first perceive the situation – from the outside/inside – then we respond to this perception – set of action by activating specific brain regions – and finally we perceive the internal transformation of our body been caused by the previous factors. It is this last part of our perception that becomes feeling. Thus feelings are the result of the experience of these actions (or more specifically are both the result of the engagement of these actions and the register of these set of internal sensory processes).
Another important consideration is regarding the intensity of activations of different parts of our body while we feel emotions and this has been shown by a Finnish researcher. He asked to the participants to focus their attention on their body while were stimulated by emotional words, stories, movies and facial expressions, and indicate, colouring two different human silhouettes, with red which parts of the body they feel activating and with blue the ones they feel decreasing in activation. The results show that most of the participants have very similarly coloured some body parts related to specific emotions and those body parts were corresponding to specific organs and in particular they coloured the head and the torso. Another important aspect of this research is regarding the skin and here Damasio pointed out the skin is a proper organ, because it is thick and full of vascular veins and terminals buttons and also it constantly changes during the emotional state.
Antonio mentioned this fascinating research to make clear that feelings force the attention to the body condition that cause them simply because we need to learn what are adverse and advantageous circumstances, so we can anticipate scenarios in future situations and apply suitable behaviours. Thus, feelings confer benefits on the individual and evolutionary advantages on the species. They are sentinels and motivators and they are not dispensable decorations. Finally, feelings are mental experiences that accompany body states related to both physiological conditions (e.g. hunger, thirst, pain) and emotions corresponding to our perception of the situation (stimulated by the external world and linked to the physiological regulation), and they open the way to higher level of homeostatic regulation.
So, the way Damasio approaches to the mystery of self and mind and their relation to the brain is upside down, and the order of seeing this issue has been wrong until now, and, unfortunately, is still wrong for many neuroscientists. In fact Damasio had problems proving his view: the most classical philosophy of mind and many scientists look at the mind, and even the self, beginning to think about the kinds of perceptions that dominate our lives, especially the visual and auditory ones, that very rapidly are translated into language. As the language dominate our life, we tended to research and study mostly these two perceptive systems and images in the brain that go with them and their links with the language. Thus the starting point to understand mind, consciousness and self has always been the brain. This old intuition is understandable, but being reasonable doesn't make it right, Antonio said.
The current perspective of Antonio Damasio is that our mind, self, subjectivity, begins in connection with our inner world, our interiors, the origins of our self is in our body.
As far as we know our body communicate through the neural system with our brain where there are important areas involved in the perception and experience of feelings, such as hypothalamus, insular cortex, cerebral cortex and the brain stem. Particularly the insular cortex is very importantly implicated: it has been demonstrated by neuroimaging that any kind of feeling changes the court of the insular cortex in both sides. Anyway, it is interesting to see how the damage or destruction of the insular cortex doesn't inhibit the experience of feeling, some researches have shown. Also the anterior cingulate cortex is involved in feelings, but, observing a patient with damages in the ACC and the insular cortex has been shown that the perception of feelings also survive to that lacks. Holding these evidences, Damasio states the importance and the central role of the brain stem. That patient had, in fact, a regular brain stem.
The brain stem is a complex structure with many little groups of neurons which also the hypothalamus is part of. The origins are there and the feelings start from there, especially from some nucleus: parabrachial nucleus, colliculus – particularly the superior colliculus, and the periaqueductal grey.
The fascinating discovery is that, similarly to the cortex, also these regions produce maps, and they map the whole body with its single different organs. Thus, the brain stem is the first region of the brain where we have the full view of our entire body, and it is critical to the generation of feelings. The insular cortex is an important part of the upper brain stem because provides the first full integration of the body state to the central brain system. So, elaborating the brain stem maps, the insular provides more specific maps of feelings states that are suitable for interconnectedness to other cortical maps related to memory, vision, language and, in this way, very complex states start to go on in our mind which require the involvement of the central cortex.
Figure 1: Schematics of key brain-stem nuclei involved in life regulation (homeostasis). Three brain-stem levels are marked in descending order (midbrain, pons, and medulla); the hypothalamus (which is a functional component of the brain stem even if it is, anatomically, a part of the diencephalon) is also included. Signaling to and from the body proper and to and from the cerebral cortex is indicated by vertical arrows. Only the basic interconnections are depicted, and only the main nuclei involved in homeostasis are included. The classic reticular nuclei are not included, nor are the monoaminergic and cholinergic nuclei. (from Self Comes To Mind, Antonio Damasio, 2010)
Another important distinction need to be made: the images we make of our body are not equivalent to the images we make of the outside world. The images we do with our body state are completely tied with the state of our body and how life is running within our living organism. Because these images are significant for our homeostasis, they are necessarily dominated by a valence as pain or pleasure or some degrees in the between, or also well-being or malaise. (I would like to give you a simple example: I got the virus a couple of days ago, my stomach communicates to the brain stem that its acidity is not good at all, so I make the map of my stomach and I feel it burning a bit and I feel pain. It is afternoon, I am quite hungry too – my stomach is a great communicator! I enter in my favourite cafe and see a lovely chocolate cake, my retina goes crazy seeing that and sends many information to my visual cortex that start making hearty maps. My insular cortex sends also its maps, and I feel the stomach again and make the choice of having only a hot drink. In this way my body will work better and quicker to rebalance my homeostasis!)
Thus, to resume:
1. our body and our brain are integrated in a unique relationship, thanks to the brain stem, which loops are interactive and operate obeying the convergence/divergence principle;
2. we can map the outside world and combine these maps with the inner world ones;
3. we can translate all of these representations, generate memories, claim them back and so enrich our Self;
This why the core is in the brain stem and it is there not just to produce consciousness, but because feelings are necessary to govern life.
We need to feel to make ourself able (consciously or unconsciously) to cope with issues happening either internally and/or externally, in such a way that we don't disturb our homeostasis in any terrible, dangerous way. For this reason consciousness naturally emerges without a conductor, until the moment in which we are mature enough that we can, in certain circumstances, consciously direct our thinking.
Talking about the relational self and human development, Antonio Damasio explained that very rapidly, in development, we connect our inner state to the outside world, because we need to learn being sociable to interact with our mother. Anyway, physiologically, the core of the Self is not the external perception of what is happening outside, but what is going on in terms of inner representations of the body state. Thus, Damasio theorises different levels of complexity of the Self: Primordial Self, Core Self and Autobiographical Self. The Primordial Self starts in a sort of bubbles up from the inner state then starts to be functionally surrounded by the Core Self and then the Autobiographic Self which includes our history, memories, different aspects of our identity. All these selves are related to a core, the origin, and this is still the mysterious point.
Antonio is currently running new researches on the cellular level of making feelings, observing reactions going on inside neurons and specifically inside axons of certain kind that can be related to feelings state. So, which is the bottom of the story, of our Self? How minds, consciousness and self are made? We don't know yet, “but we have a possible beginning... and if we don't begin with the body we can't go anywhere”.
Damasio ended his brilliant dialogue underling that consciousness and self are not our property but are functions belonging to many living creatures: even if of different quality than ours, also animals have consciousness, self and feelings because they also need to regulate their life process, their homeostasis.
I would like to end this article with a couple of curiosities taken from Damasio pre-conference workshop that I find interesting in Gestalt terms.
The first is about internal and external representations. When we connect with our inner world, our brain either represents the inside world and automatically affects this representation. And (in a normal condition) this only happens in relation to the interior. For instance, I am in front of you and look at you, my retina makes images that are repeated in the visual cortex, but my brain doesn’t do anything to you as an object, you are there, I am here and I am making that perception of you. When I “look” at what is going on in my gut or my heart, that image coming into my brain is automatically affected by my cerebrum, and it influences not only the image but also the state of my gut or heart itself. The two, the brain representing the internal state and the organs giving origin to the state, form a compact.
The second curiosity is concerning the perception of bodily rhythms. When we perceive the state of our body we perceive its natural rhythm, like the breathing and the heart rhythms. Thus, this perception is part of the feeling experience. Another intriguing issue is related to the rhythm of music and the rhythm of life. Here Damasio briefly underlined the old origins of music as art and its close relation to our bodily rhythms. (In my opinion, a very interesting aspect is that to listen to music first involves also the brain stem and is well related to emotional states, researches shown. We listen and play music because we like it and evokes emotions that we like to contact because we want to amplify our present emotional state or because we want to change it and make a shift of mood generally to feel better). Music is related to our emotions that are linked to our life rhythm: when we have a certain kind of rhythm we feel happy and also feeling happy we can change our life rhythm. Thus life rhythm and emotions are influencing each other and one can provoke the other or vice versa (thinking about psychopathologies, it is quite easy to make a link with the people suffering of bipolar disorder in their periods of mania then depression).
I am still feeling excited when I talk to someone about the Damasio speech because thanks to his researches he showed that we are one, we are “compact”, and that our feelings are important and to listen them in terms of body sensations and emotions is essential for our homeostasis, thus to preserve our life and socially our specie. Only writing that my body rises up, I feel my head electrical, happiness is my prevalent emotion, my Self is well nourished and open to get more, and I like to go for a break listening to some vibrant music. This is only the beginning of the end of dualism.