Comorbidity of Affective Neuroscience
Working in his lab with rats, Jaak Panksepp found seven primary-process emotional systems built into the brain by evolution. We and all other mammals are born with these innate neural systems in our brains. We are always on the lookout for something that we might need or want, or something that might just interest us or satisfy our curiosity. Our SEEKING systems keep us in a state of engagement with the world. “Beginning at birth, it is “a goad without a goal.”
- SEEKING (expectancy)
- RAGE (anger)
- FEAR (anxiety)
- LUST (sexual excitement)
- CARE (nurturance)
- PANIC/GRIEF (sadness)
- PLAY (social joy)
All seven primary affects converge on the periaqueductal gray (PAG) at the lower midbrain or atop the brain stem. Here, all the emotional action systems, especially negative affective systems with their powerful and effective charge, converge.
Too many therapists are untrained in biology and physiology. Their training is basically a soft psychology. They have little training with the massive complexities of the underlying neuroanatomies and neurochemistries of mental illness. Few have training in Affective Neuroscience. Abeit, this is changing today, but slowly.
Most emotional disorder is not due to a single emotional system or a single chemical imbalance. Most people reflect the concept of “comorbidity with several emotional and chemical unbalances. That is essentially what comorbidity means, that more than one psychiatric syndrome occurs at the same time. Generalized categories such as depression are ambiguous, implying both generalized malaise and sickness. A more accurate comorbid description would need to address the emotional systems involved and the ways that their over or under-arousal contribute to the clinical symptoms.
The categories of the DSM-5 do not sufficiently address these issues. An example of this is Post-Traumatic Stress Disorder (PTSD). PTSD is a complex condition involving several different emotion systems. In addition to chronically overactive manifestations of the FEAR and PANIC/GRIEF systems, PTSD is a state of terror that is often accompanied by RAGE.
Another example of comorbidity is depression. Depression is a comorbid mix of psychological pain, anxiety, angry irritability, as well as diminished urges to seek and pursue life interests. A diagnostic description would need to address the many emotional systems involved.
DSM-5
The DSM-5 reminds me of Photoshop. Each new update is based on the same basic underlying structure. This works for Photoshop, but not for the DSM-5. A couple of reasons we have been stuck with this outdated manual is that research grants were actually denied if they cut across D.S.M. disease categories. And on a clinical level, if psychiatrists want to get reimbursed by insurance companies, they had better conform rigidly to the categories of disease specified in the D.S.M.
I continue to bring attention to the field of Affective Neuroscience and the lifetime of work pursued by Jaak Panksepp. I feel this will become the basis for a completely revised DSM. In the meantime, I urge therapists to read and study his two books documenting a lifetime of research: “Affective Neuroscience: The Foundations of Human and Animal Emotions,” and “The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions.”
Self-help books that help:
Total Self-Renewal through Attention Therapies and Open Focus
The Open-Focus Brain: Harnessing the Power of Attention to Heal Mind and Body
