21Psycho BM 681-694.Qxd 9/11/06 06:44 PM Page 681

21Psycho_BM 681-694.qxd 9/11/06 06:44 PM Page 681 681 BOOK REVIEWS PROJECT FOR A SCIENTIFIC PSYCHOANALYSIS A review of Affect Dysregulation and Disorders of the Self, by Allan N. Schore, New York & London: W.W. Norton, 2003. 403 pp and Affect Regulation and the Repair of the Self, New York & London: W. W. Norton, 2003, 363 pp. JUDITH ISSROFF ELDOM does one have the privilege of reviewing work as important Sand impressive as these volumes. Along with Schore’s earlier work, Affect Regulation and the Origin of the Self, these two new collections con- stitute a trilogy of carefully crafted and researched papers. They also mark “a clarion call for a paradigm shift, both in psychiatry and in biology and in psychoanalytic psychotherapies.” The papers included in the two volumes were published during the past decade with newer material added. One cannot over-emphasize the significance of Schore’s monumental cre- ative labor. Schore convincingly argues that it is self and personality, rather than con- sciousness, that are the outstanding issues in neuroscience. The development of self and personality is bound up with affect regulation during the first year of life when the infant is dependent on mother’s auxiliary “self- object,” right-brain-mediated nonconscious “reading” of her infant’s needs and regulatory capacity. Mother both soothes and excites within her infant’s ability to cope without becoming traumatized. In other words, an attuned adaptive “good enough” functioning is essential for right-brain structural-functional development. The self-organization of the developing brain can only occur in the finely attuned relationship with another self, another brain. According to Schore, Freud’s unconscious and preconscious are right- brain based rather than in the lexical-semantic-motor dominant left hemisphere. The right hemisphere is also critically involved in the maintenance 0010-7530/06 $2.00 + .05 Copyright © 2006 W. A. W. Institute 20 W. 74th Street, New York, NY 10023 All rights of reproduction in any form reserved. Contemporary Psychoanalysis, Vol. 42, No. 4 (October 2006) 21Psycho_BM 681-694.qxd 9/11/06 06:44 PM Page 682 682 BOOK REVIEWS of a coherent, continuous, and unified implicit sense of self. In his words: “Most moment-to-moment psychological processing occurs noncon- sciously.” “Rapidly communicated nonconscious social-emotional information is primarily processed and acted on at implicit levels.” “The essential self-regulatory functions that allow us to appraise and adapt to personally meaningful changes in the environment occur largely below Cs aware- ness” (Schore, 2003 b, p. xv). Schore refers to the right brain as being capable of “genuine dialogue” based on multiple converging determinants. The right brain is holistic, synthetic, and imagistic. It is capable of adaptation to situations that are “complex, internally contradictory and basically irreducible to an unam- biguous context.” This complex information is transferred to the linear ver- bal left-brain for further processing to conscious mind only once affect is regulated. Around age four, through developing corpus callosum structures, the left lexical brain allows a measure of conscious control over the emotional mind. Left and right cortical growth spurts alternate and can be correlated with various phases of human development. The infant or child’s brain can make use of crescendos of excitement only if matched by increasing affect tolerance made possible by the internalization of the soothing self- object experiences that eventually become self-regulating. Without ade- quate provision by the facilitating supplementary environmental maternal “brain,” neurological systems are pruned and lost. “Use it or lose it,” says Schore. This dynamic was already known in relation to visual cortex development. Schore’s prodigious erudition is illuminating. He draws on interdiscipli- nary literature from developmental psychology, attachment theory and research, developmental biology, neurobiology, neurochemistry, and developmental neuropsychoanalysis. He is as much at home with systems theory as with “chaos” theory’s nonlinear dynamics, and the energetic “resonance” models of nuclear physics. There are 135 pages of some 25 references per page in these two volumes, and what he quotes is always significant. Two missing references that occur to me but do not in the least detract from Schore’s overall accomplishment are Clyne’s interesting (1977) study of Sentics: A study of the Emotions, and Richard Cytowic’s work on Synaesthesia (1993). But I am confident that Schore would agree with Cytowic’s conclusion that cognition can be conceived of as but a special form of affect. Schore’s neurobiological literature is no less dis- cerningly sampled. Oliver Sachs’s work has made a great deal of differ- ence to neurology, but Schore’s is perhaps even more revolutionary and 21Psycho_BM 681-694.qxd 9/11/06 06:44 PM Page 683 BOOK REVIEWS 683 pivotal. I am pleased to steer all my distinguished neurologist friends to these volumes. It was exciting to explore with Schore the neurobiological bases for the clinically derived observations and hypotheses. One is exposed to a mar- vellous array of research and applied theoretical lenses all brought to bear on the topics addressed through a systematic systemic array of intercon- nected hierarchies of interinfluential organizations. From a clinical point of view, it is encouraging that the right orbitofrontal cortical areas remain plastic to development throughout life, allowing for therapeutic change at any age. Modifications in implicit relational knowledge and unconscious internal representation are the major changes in psychotherapy—their physical substrate is in the right brain. Right-brain-located-affect regulation is the final common pathway of effective psychotherapies (Bradley, 2000) and the contemporary traumatic memory processing energy thera- pies (Mollon, 2005). For a psychoanalyst originally trained in the basic languages of medicine, it is a great treat to be able to become “updated” with four or five decades worth of research enabled by magnificent tech- nical advances that allow researchers to identify which parts of the brain structures are involved in the inter- and intrahuman areas. As a clinician and devotee of Sutherland, whose influential Philosophy for the Helping Professions (1983) argued that inner and outer worlds influence each other, it is wonderful to be presented with Schore’s array of evidence in support of the interconnectedness of the psychosocial inter- subjective realms. While training as a psychoanalyst in London, I was fortunate to be influ- enced by John Bowlby and Donald Winnicott (Issroff, Reeves & Haupt- man, 2005). What Schore has done is to link the implications of their work to brain hardware. The caretaker, he notes, modulates changes in the child’s energetic state and keeps arousal from becoming hyper or hypo- via shame-repair cycles that employ the autonomic nervous system. Schore emphasizes the qualitative way sensitively “good enough” attuned moth- ering is necessary to support and regulate, and also to dysregulate and then “repair” the infant. As Winnicott noticed, the mother also has to “fail” in doses with which the developing infant can cope. And so does the therapist. Schore cites evidence that has arisen from Bowlby’s revolutionary and experimentally fertile recasting of psychoanalytic concepts in testable form, and demonstrates how brain development occurs within an attachment- relational perspective leading to health and resilience or to vulnerability, the shattered minds of personality disorders, mental ill health, and later 21Psycho_BM 681-694.qxd 9/11/06 06:44 PM Page 684 684 BOOK REVIEWS posttraumatic stress and dissociative identity disorders. He demonstrates in considerable detail how infant and adult maternal-parental disorga- nized, disoriented attachment problems caused by neglect and abuse lead to defensive dissociation—a view consistent with contemporary interper- sonalists like Bromberg who notes that. “Personality disorder can be de- fined as the characterological outcome of the inordinate use of dissociation” (quoted in Schore, vol 2, p.132). But Schore does not overlook various Freudian and post-Freudian psychoanalytic and sociopsychic models. He demonstrates the validity of certain Freudian concepts, linking them to particular areas of brain functioning. Schore’s work returns us to early Freud, showing how some of the metaphors and models developed in his 1891 neurological study of dyslexia and 1894 Project for a Scientific Psychology, reappear as psychological constructs in later Freud. More than this, drawing prodigiously on volumi- nous research, he has assembled the details of the way in which they reach to influence the intrapsychic conceptual world at genetic, biochem- ical, hormonal, and multiorgan response levels. Schore documents subtle systems of psychosocial affective regulators and dysregulators, from the level of intracellular mitochondrial all the way to the plastic brain structural developmental synaptic system. He identi- fies regulatory mechanisms within the astrocytal-dendroglial, neurological, and neurohormonal somatic feedback regulatory systems. He notes the contradictory responses of the parasympathetic “freeze” and sympathetic nervous system “fight-flight” responses that occur in conditions of threat and stress and that sometimes in certain puzzling dissociative states can occur simultaneously. He suggests that abuse and neglect have a

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