Discussion of Dr. Glen Gabbard's paper “A Neurobiological Perspective on Mentalizing and Internal Object Relations in Traumatized Borderline Patients”

This discussion first focuses on the danger of reductionism in relating biological structures to psychic structures, an important point made by Dr. Gabbard's paper. The discussion proposes a developmental interactionism between body and mind. The concept of the self-a psychological structure-serves to illustrate the complexity of relating this psychic structure to the underlying biological centers involved. The discussion then turns to the relationship between alternatives in the activation of the amygdala-prefrontal cortex-hippocampus circuit and the contextualization of negative affect. The effects of trauma on this circuit, in promoting pathological intensification of negative affect activation is relevant for the treatment of borderline personality disorder, as Dr. Gabbard pointed out. The question is raised to what extent psychodynamic psychotherapy may modify or bypass very early predisposing memory engrams of traumatic experiences. Both Dr. Gabbard and the discussant agree on the fundamental function of transference/countertransference analysis to modify the consequence of early trauma, but differ regarding the value of a constructivist as contrasted to an objectivist approach to transference analysis.