Peter R. Martin: Historical Vocabulary of Addiction

Hector Warnes’ comment on Empathy

        My congratulations to Peter Martin for his brilliant narrative on Empathy and its relationship with Sympathy, its neurophysiological basis and the addictive disorders.

        I would like to pay tribute to Heinz Kohut (1913-1981) who transformed psychoanalytic technique by introducing Self-psychology (beyond Ego Psychology) (Kohut 1959).

        In the analytic practice of Self psychology, you are likely to evoke three types of transference particularly in those patients with "deficit disorders," dissolution of the Self, limitation of interpersonal bonds and short-coming of the capacity for introspection and empathy during human interactions, e.g., mirroring, idealizing and twinship/alter-ego transference. An empathic connectedness is a kind of "projective identification," or as Peter Martin puts it, a person or analyst projects one's personality... identifying himself with the object of contemplation. Martin further argues, "Probably, the first manifestation of this interconnectedness in humans is the mother-child bond," a statement supported by Bowlby’s extensive research on attachment behavior with emphasis on maternal care in primates and Spitz’s observations on early maternal deprivation in babies (Hospitalism).

        Clinical Psychoanalysis has uncovered the False Self, which is the Image one projects of oneself, and the authentic sense of Self. The latter comes about through countless empathic contacts with significant other humans which, according to Heinz Kohut (1971), are internalized as Self-objects. Of course, the starting point is having experienced a "good enough mothering."

        Henry Krystal (1988) found in drug-dependent persons an affective disturbance consisting of affect de-differentiation, de-verbalization and re-somatization. Not unlike the alexithymic person, these patients were not able to put their emotions into words and often somatized them. They experienced a sense of painful emptiness which was transiently alleviated by the use of drugs.

        Bartels and Zeki, using f-MRI scan, in 2004 wrote about the neural correlates of maternal and romantic love while mothers viewed pictures of their own and/or acquainted children. Both types of attachment behavior activate regions in the brain's reward system, particularly the dopaminergic circuits and the oxytoxin-vasopressin receptors.

References:

Bartels A, Zeki S. The neural correlates of maternal and romantic love. Neuroimage 2004;21(3):1155-66.

Kohut H. Introspection, empathy and psychoanalysis. An Examination of the Relationship between Mode of Observation and Theory. Journal of the Amer Psychoanalytic Assoc 1959;3(3):459-83.

Kohut H. The Analysis of the Self. A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality Disorders. New York: International Universities Press; 1971.

Krystal H. Integration and Self-Healing. Affect, Trauma and Alexithymia. Hillsdale, NJ: The Analytic Press; 1988.

November 25, 2021