Adolescent Psychoanalysis

(Anonymous comments may be left by clicking the response button at the end of each section)

Functional MRI and Adolescence

Chapter 3

In spite of the above-mentioned seeming drawbacks, many adolescents can be analyzed, Not only can they be, but also they tend to benefit at least as much or more than any age group. Benefits that may occur seem to be twofold: adolescents may be helped with the difficulties that surround nearly all adolescents; Further, analysis may assist in the laying of a sound foundation for the future of an individual adolescent These possible benefits seems to occur in three ways: emotion-ally, intellectually, neurologically.
There is recent functional MRI research that may suggest why this latter point, that of us helping to ‘lay down’ a sound neurological/emotional foundation for the future, may be true, even in Neurological terms.

Jay Giedd, MD, a practicing child and adolescent psychiatrist and Chief of Brain Imaging in the Child Psychiatry Branch at the National Institute of Mental Health is the lead researcher “In a particularly interesting study, wherein Dr. Giedd looked at the brains of 145 normal children by scanning them at two-year intervals. This was work Giedd was only able to do with magnetic resonance imaging, because it re-quires neither harmful dyes nor radiation, making the study of normal children, as opposed to sick ones, ethically tenable. What the researchers have found has shed light on how the brain grows and when it grows. It was thought at one time that the foundation of the brain’s architecture was laid down by the time a child is five or six. Indeed, 95 percent of the structure of the brain has been formed by then. But these researchers have discovered changes in the structure of the brain that appear relatively late in child development suggesting that functional anatomical developments of the prefrontal cortex and cerebellum rather than beginning to decrease, actually increase. Dr. Giedd and his colleagues found that it (pre-frontal cortex and the cerebellum) appears to be growing again just before puberty. The pre-frontal cortex sits just behind the forehead. It is particularly interesting to scientists because it acts as the CEO of the brain, controlling planning, working memory, organization, and modulating mood. As the pre-frontal cortex matures, teenagers can reason better, develop more control over impulses and make judgments better. In fact, this part of the brain has been dubbed “the area of sober second thought.”
“The fact that this area was still growing surprised the scientists. Although they knew that the brain of a baby grew by over-producing synapses, or connections, they had not known that there was a second period of over-production. In a baby, the brain over-produces brain cells (neurons) and connections between brain cells (synapses) and then starts pruning them back around the age of three. The process is much like the pruning of a tree. By cutting back weak branches, others flourish. The second wave of synapse formation described by Giedd showed a spurt of growth in the frontal cortex just before puberty (age 11 in girls, 12 in boys) and then a pruning back in adolescence.
Even though it may seem that having a lot of synapses is a particularly good thing, the brain actually consolidates learning by pruning away synapses and wrapping white matter (myelin) around other connections stabilize and strengthen them. The period of pruning, in which the brain actually loses gray matter, is as important for brain development as is the period of growth. For instance, even though the brain of a teenager between 13 and 18 is maturing, they are losing 1 percent of their gray matter every year.
Dr. Giedd hypothesizes that the growth in gray matter followed by the pruning of connections is a particularly important stage of brain development in which what teens do or do not do can affect them for the rest of their lives. He calls this the “use it or lose it principle,” and tells FRONTLINE, “If a teen is doing music or sports or academics, those are the cells and connections that will be hardwired. If they’re lying on the couch or playing video games or MTV, those are the cells and connections that are going to survive.” )

Adolescents have at least two, or three or more languages. One is much like our ‘adult’ language. This language and it’s words are relatively agreed upon by many adults with respect to meaning and use. Sadly, the study of nearly any ‘adult’ word, in fact, shows that the definition of each word is shrunken. By ‘shrunken’ I mean that amongst the many possible meanings of a word, most of the alternative meanings are discarded. This shrinking is not only related to the words themselves but on the people who use these words and concepts to think and to write and speak. For example, the word ‘depression’ actually has as many meanings as there are people to think/feel them. Of course each individual’s idiosyncratic meaning also changes, making matters even more complicated. But, in our field , for exam-ple, the meaning of ‘depression’ is so shrunken that it’s meaning has long since de-parted. The net result of this ‘shrinking’ is the loss of meaning, the illusion of knowing, and the likely end of curiosity.

This first language is so unnatural to children and adolescents, that they must study hard and long to learn it. It must be learned since so much of our world relies on it—adult speak. Further, we have all met adolescents who seem to have mastered this language early on and use it exclusively—‘the grown up to soon’, ‘missed out on his childhood’ adolescent. Many of us would judge this patient easier to treat, an adolescent who speaks ‘adult speak’ to his analyst who is only able to ‘adult speak’. This is a formidable task, however. Not that it is our province to educate, to ‘teach’ this adolescent to be an actual adolescent is difficult at best. Perhaps that is neurologically impossible.

Then there is adolescent language two, which begins slowly at about age 10-11, peaks around 16-18 and then diminishes to be followed by the growing presence of adolescent language 1, ‘adult speak’. One might hypothesize there is a parallel between ‘adolescent speak and act’ and neurological growth. To wit, the rise and fall of adolescent speak and act seem to parallel the growth of and then pruning of the neurons and synapses of the pre-frontal cortex. Perhaps in adolescence we are seeing what a human being, in our culture at least, looks like with too many neurons and synapses whose wiring is somewhat questionable. And, then, we get a chance to see the other side of this slope—less neurons, less synapses and more hard wiring. Less adolescent and more adult.

Psychoanalysis, by definition, is not a treatment modality. As understood by Freud and Bion, that is the case. Absent memory and desire, there can be no ‘treatment’ as such. Nevertheless, we have all had the experience of patients’ ‘improving’, ‘doing better’ seemingly almost no matter what we do, what theoretical schools we come from, etc.—with the exception of adolescents, where technique matters greatly. If one considers that learning may be the key, learning secondary to understanding, then our work may look ‘curative’ even if that was not the aim.