For many years, it was thought that consciousness resided in the most recent part of the brain, the cerebral cortex, while everything below that in the brain stem was unconscious and only reached cortical awareness when it might involve a change in behaviour. This now seems erroneous. Recent discoveries in neuroscience suggest that consciousness and feelings are generated in the primitive midline structures in the brain stem, that regulate the internal bodily systems via the hypothalamus and autonomic nervous system and are responsible for bodily feelings and positive or negative states of being rather than external perceptions.
Children born with a condition known as hydrancephaly, in which there is no cerebral cortex, just a space filled with fluid, are fully conscious, can wake and sleep at appropriate times and demonstrate a whole range of emotions in response to relevant stimuli. On the other hand, patients with very discrete lesions in the brain stem can either show absence of particular emotions or be completely unconscious even though the cortex is intact. Moreover, stimulation of centres in the brain stem of other mammals can generate specific patterns of emotional behaviour.
This suggests that brain stem structures are not only responsible for consciousness, they can also determine the quality of consciousness in terms of feelings. The fact that the same brain stem structures incorporate centres that control certain key visceral functions, sleep, hunger, respiration, balance, temperature control and defaecation suggest that our emotional feelings derive from visceral sensations. It also explains why disturbances in gut function are often associated with disturbances in temperature control, balance, sleep, arousal/sensitivity. What we regard as our feelings are probably derived from sensations that were important for survival and reproduction: hunger, disgust, exploring, attachment, sex, pain, fear, conflict and loss.
By attributing feeling to experience, this ‘affective’ consciousness exists to promote survival and reproductive success, but as the higher brain centres develop, it comes to motivate the cognitive strategies for regulating not only such behaviours as foraging, reward, freezing and flight, attack, care, separation distress and play but also feeling states such as interest, delight, fear, rage, affection, grief and joy. These are all mediated by midline brain stem structures, many of which have a particular chemical signature: serotonin for well-being, dopamine for seeking behaviour, noradrenaline for fear (fight and flight), GABA for care, oxytocin for attachment.
As I have outlined in other posts, there is a hot line from the gut to the centres of feeling and consciousness in our brain stem. Much of what we feel comes from our gut. As Nietzsche once said, ‘the gut is the seat of all prejudice’. This is why we talk about gut feelings and use gastrointestinal metaphors when talking about feelings: you may me sick; I can’t stomach it; it gives me the shits. So can what happens in our gut generate feelings in the brain stem that ‘affects’ how we think about things?
Over the last few years, there has been an increased awareness of how a variety of mental and otherwise unexplained illnesses may be generated or influenced by the bacteria in the gut. Dysbiosis can alter permeability allowing bacteria to gain access to the immune system and the circulation and influence the way the brain works. Moreover, gut bacteria produce dopamine, serotonin, GABA and noradrenaline; many of the neurotransmitters as used by the centres in our brain stem.
There is still a lot of work that needs to be done to join up the dots, but an intriguing possibility is that by amplifying our feeling state, our gut bacteria may enhance certain memories and the way we think about experience.
Feelings always express some need. We feel the tension and then work to resolve it. This applies to every feeling, from those that have to do with our homeostatic needs like hunger, thirst, cold, drowsiness and illness to those that express our psychological needs, like pain, anxiety and anger. They all trigger attempts to resolve the feeling by negating it. Even learning resolves the tension by conversion to a fixed memory that can be stored away until needed. And the way we think about what happens changes our feelings until we learn to think about it in a different way.
But some feelings cannot be put right. Strong emotions that arise from traumatic experience can disrupt cognitive processing, so we may experience emotional turmoil without having any insight into what happened. This feeling is not negated but can persists as a state of hyperarousal, dysphoria or illness, which acts as a filter through which other aspects of life are perceived. Even quite innocuous things may be seen as traumatic. This not only explains how neglect or trauma that occurs before conscious memory can be consolidated, may set a pattern to perception or behaviour throughout life, but also why people may never get over the illness that follows the collapse of a relationship, the guilt of an action that can never be put right, the crippling shame that can never be forgiven, or the severe disappointment arising from needs that could not be met. Drugs and diet never ‘cure’ those many cases of IBS that arise from trauma.
When something is blocked from conscious thought, it is known as repression. The memory is too upsetting to be thought about and so is stored with all the unresolved affect. Thus the same feelings not only colour all experience in a negative hue, but the dysphoria occurs whenever the unconscious memory is triggered by association. So if trauma cannot be resolved, the illness may last for many years, occurring whenever the memory of what happened is rekindled. Those who eventually get over their illness often do so by changing their life so that the memory wears away from disuse and is replaced by more positive associations.
Dissociation may be regarded as a more extreme form of repression, whereby traumatic associations or memory traces may cause lapses, absences, alternative identities or physical symptoms that may bear some symbolic relationship to what has happened. Lacking any clear memory of what happened and not wishing to revisit it, the victim often presents the symptom as the source of the problem.
Freud wrote that the aim of psychotherapy was to challenge and undo repression, making what is unconscious, conscious in order to determine what is driving our thoughts and actions so we can alter them. At a conference, I attended recently, the neuropsychoanalyst, Professor Mark Solms questioned whether that was actually what happens. Once memories are fixed by the epigenetic creation of new synapses, you cannot actually get rid of them. You cannot change the past, he said, but you can change the feeling of what is happening now and that may help with both repression and dissociation.
The ways we feel and behave are repeated in all relationships, but when they occur in the context of therapy, they can be identified and reconsidered. The therapist may question the way the patient interprets what happens, encouraging them to see the reality of what is happening now, thereby altering the emotional salience, so that with repetition and working through they can consolidate a thought that is more appropriate to the current context. According to Solms, psychoanalytical therapy works well when matched with cognitive behavioural therapy.
Since our patients suffer more from feelings, changing the way we feel about what happens by seeing them in context may work better if we can also change the emotional salience directly. This would explain how healthy live style choices, such as diet and exercise and therapeutic methods, such as EMDR, EFT, hypnotherapy, body psychotherapy, yoga and other therapies that encourage mindfulness may work together with psychoanalytical psychotherapy to reduce the impact of experience and build resilience. Moreover, recent insights into ways in which gut bacteria may modulate feeling states, suggests that modulation of gut bacteria by diet might even reduce the effect of experience so that what happens can be thought about and memories processed in a way that builds resilience?