Affect Regulation

Recent developments in neuroscience and psychopharmacology, and the widening range of patients suffering from trauma seen in psychoanalytical treatment, shed new light on the problems of affect regulation.

The Moderator, Mortimer Ostow, asserted that recent emphases in psychoanalysis on the ideational aspects of affect had neglected an understanding and clarification of the more biological aspect of character that is ‘mood’. In his view, mood generates ideation and can be thought of as an instinctual reaction to a biological state. Advances in neuroscience related to emotional states have brought evidence regarding the alterations of brain chemistry and strengthened the view that there may be more inherent biological factors that determine mood than was previously thought. Ostow strongly emphasised the value of pharmacology to stabilise mood. He noted that since 1962 he had actively proposed the use of psychopharmacological agents when indicated as an adjunct to psychoanalysis.

The first panellist, Henry Krystal, gave a paper entitled ‘Optimizing affect function for psychoanalysis’. His main focus was on patients who suffer from alexithymia. He observed that these patients lack an ability to identify what they experience emotionally, are stiff and constricted. They use action, psychosomatic mechanisms or substances to manage affect and they experience emotion as frightening or frustrating. The alexithymia patient is difficult to treat psychoanalytically and may require initial modifications of technique as well as medication.

Krystal elaborated two pathways to alexithymia. First, infantile psychic trauma rooted in the failure of emotional containment in the mother/infant dayad. The repetitious lack of containment may leave an infant in an overwhelmed state of mind resulting in inconsolability. Subsequently, there is an inability to develop adequate means of tolerating frustration, managing feelings and the phantasies associated with them that interferes with the proces