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The Toronto Group continues to study ways to “fill” apparent gaps and inconsistencies in our patients' narratives and behavioral sequences. Freud's pioneering work inspires us to search for conflicts that may underlie apparent deficits in the presence of severe disruptions, whether psychologically or neurologically based.
With the help of David Pincus of Cleveland, we discussed a study of intranasal oxytocin and mentalization in depression, of which he is co-investigator. Elia Abi-Jaoude, a Toronto psychiatrist who carries out neuroimaging studies, also helped us to interpret the results of the study, whose authors consider “depression as a possible ‘disconnection’ syndrome, neurobiologically instantiated.” We were reminded that the “hard data” are best augmented by the first-person, qualitative perspectives of individual subjects. Within limitations of experimental design and methods, the study concluded that depressives show less emotional engagement and increased cognitive appraisal of faces on a standard measure of mentalization, consistent with depressives guarding against (repressing?) painful states.
Do we indeed have free will, or, for that matter, “free won't”? In an impressive synthesis of numerous imaging studies, Jonathan Downar, a psychiatric resident with a Toronto Ph.D. in neuroimaging and a fellowship in neuroeconomics at Baylor, illustrated how “decisions” can be detected well before the subject becomes conscious of them. Furthermore, the anatomical location of the activation can be correlated with the degree of personal relevance of the decision. Intention, defined by comparing various clinical syndromes as a particular sensation comprising both doing and feeling-as-if-doing, appears to be “located” somewhere in the middle of a chain of causality, primarily on the medial wall of each hemisphere (cingulate and medial prefrontal cortices).
We discussed the importance of understanding how complex neurological circuitry arises, out of the body ego, in the