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A difficult patient chips away at your professional façade. Your mind drifts to serotonin transporters. Is this what neuropsychoanalysis has brought us to? In “Laura and the Rhesus Monkeys: Understanding Borderline Personality Disorder from a Neurobiological and Genetic Perspective,” Dr. Nicole Koziel presented to the group a creative attempt to maintain a consistent clinical and individual approach to a young woman with borderline personality characteristics, while integrating recent findings in the neurosciences, including attachment, endogenous opioid system, genetics, serotonin transporter gene, amygdala and frontal cortex, and neuroimaging studies.
Our diverse group of clinicians and researchers grappled with the therapeutic challenge. When faced with manifest resistance, how does one tease out the contributions of hypofrontality and the developmental persistence of externalization? What are the risks and benefits of (re-)construction of specific traumatogenic experiences? We are still at an early stage of understanding gene-behavior relations and how epigenetic concepts may or may not be useful in the clinic as well as at the level of public health policy (e.g., addressing the consequences of Canada's history of removing aboriginal children to “residential schools,” where they were frequently subject to abuse and cultural suppression, as well as the current global “mass-production” of traumatized parents and children through war and impoverishment).