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What do psychoanalysts, neurologists, neuroscientists, or psychiatrists mean when they use a term such as repression? Presenter Dr. Philip Gerretsen became curious enough about his experiences as a social worker to pursue a career as a psychiatrist/clinical researcher. He shared with us his group's research with people with schizophrenia, who “lack insight” or awareness into their illness (anosognosia). There is wide variation in their ability to distinguish between externally generated perceptions and internally generated experiences. In this respect, they share something in common with patients with right-hemisphere stroke, confabulation syndromes, some dementias, conversion disorders, etc. But the specific clinical characteristics may vary in crucial ways, which only careful assessment in a fluid, flexible interacting course of treatment can reveal.
Dr. Gerretsen and colleagues conducted a volumetric study of the brains of 64 patients diagnosed with schizophrenia (of whom 9 were untreated), whose degree of lack of insight appeared to be independent of other measures of illness severity and antipsychotic medication. Their findings indicated lower grey-matter volumes in several regions: right orbitofrontal cortex (thought to suppress assignment of abnormal salience via suppression of dopamine release in ventral striatum), precuneus (seen as involved in self-apprehension), and cerebellum (involved in modulation of cognitive and emotional processes), as well as decreased white-matter volume (suggesting decreased interhemispheric traffic, perhaps resulting in the more defensive functions of the left hemisphere dominating a dysfunctional right hemisphere).
In the discussion, we addressed the descriptive similarity of the symptoms of a number of syndromes but noted the qualitative differences of affect, content of the subjects' own accounts for their difficulties, and the distinguishing features of the “repression(s)” encountered in the psychoanalytic setting. Preferably,