Biomedical subjects
Publications and source records attributed to P C Horton.
A woman was 3 years postmastectomy when she presented a dream whose manifest content suggested a new malignancy. A Pap smear showed carcinoma-in-situ. She lived another 8 years, during which time she had a number of new dreams that correctly raised the likelihood of an active cancer despite normal physical exams and negative Pap smears. This case report suggests that the dream may be an early cue for the presence of a disease process.
The author tested the hypothesis that the comforting substrate is located in the right parietal area of the brain. Sixty subjects (39 women, 21 men) were given two forced-choice tasks treated as comparison experiments. Given the choice between two identical bright red balls (one on the left and one on the right), only 20% of the right-handed subjects chose the left ball (p < .01). Given the choice between identical stuffed, white bears, which were described as grieving and urgently in need of comfort, 54.5% of the subjects chose the left bear (p < .05, with ball selection as control and analyzed by the binomial). Considering only discordant pairs (left bear-right ball combination or vice versa), 20 of 23 subjects chose the left bear (p < .0002). Results suggest the possibility that right-brain lateralization of the comforting substrate is more pronounced among females, especially mothers.
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Alexithymia is conceptualized as both affect-deficit disorder and continuous personality variable. Two-hundred-sixty-four adolescents were surveyed using (1) a core symptom questionnaire for alexithymic state; (2) the Toronto Alexithymia Scale (TAS), and (3) the Solacing Methods Questionnaire. Three percent were positive for core symptoms and used significantly fewer solacers than matched controls (p = 0.048); the affect-deficit disorder hypothesis is supported. Twenty-three percent were TAS-positive suggesting the need for a trait measure. However, only one of the 8 core symptom subjects was TAS-positive raising a question about the sensitivity of the TAS to the extreme cases on which the alexithymia concept is based. While 62.5% of the matched controls reported using memories for solace, none of the core symptom subjects did; one of the alexithymic's central problems may consist in finding psychological as opposed to action-oriented and physical comfort.
Thirteen alexithymic patients and 13 panic disorder patients were compared with matched controls regarding their use of self-solacing strategies. Whereas the panic disorder group used significantly more (p less than 0.001) solacing objects, activities and sounds than normals, the alexithymic subjects used significantly fewer self-solacing strategies (p less than 0.001). In view of the developmental, clinical and subjective importance of the ability to solace oneself, the hypothesis that alexithymia may, in some cases, represent a basic feeling deficit is supported.
The achievement of a state of solace is a developmental necessity to the unfolding of the capacity for positive emotions. In addition, solace is a significant subjective component of noninstinctual feelings such as love, joy, gratitude, and rapture. Pure solace is experienced primarily in relation to the sense of self, whereas the solace derivatives connect, in varying degrees, with objects external to the self. Psychiatrists see many patients who are unsolaceable and who, because of this, cannot experience sustained positive emotion of any kind. Those diagnosed as personality, conduct, and behaviorally disordered, as well as those with alexithymia, are particularly likely to exhibit a basic unsolaceability. The psychiatrist should also be alert to a deficiency of positive emotion in those with attention deficit disorder and the so-called learning disability syndrome. The coexistence of unsolaceability with features of right parietal cortex dysfunction suggests a directionality of positive emotional experience and parietal neocortical activity. The tertiary zones of the right parietal cortex appear to be the structural system most likely to subserve complex positive affects.
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The author presents three case reports of individuals with personality disorder, none of whom demonstrated significant ability for transitional relatedness before therapy. In therapy, he conceptualized for the two adult patients the importance of their inability to experience in the transitional mode; he offered concrete potential transitional objects to the one child patient. The therapeutic results were good.
An inability to relate transitionally is a major feature of personality disorder. The developmental independence of transitional relatedness from verbal-symbolic growth, its orienting function, and the nature of its visual and tactile components support the conclusion that it is a function of the nondominant parietal lobe. Therefore it can be hypothesized that dysfunction of this area is the cerebral analogue of personality disorder. The fact that unawareness of illness ("anosognosia") in conjunction with grossly intact intellectual function is common to both personality disorder and minor parietal lobe dysfunction further supports this hypothesis.
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