Dear colleagues, welcome to the 10th conference on psychiatry, psychology and brain studies, held in Paris in April 2019.
My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited, and a few other books on personality disorders. I am also a professor of psychology in Southern Federal University in Rostov-on-Don, Russia. I am a professor of psychology and a professor of finance in CIAS-CIAPS, the Centre for International Advanced and Professional Studies.
Having dispensed with this introduction, we can move on to my video presentation on the connection between trauma and brain, and between trauma, brain, personality disorders, and cerebral models, neural models.
Phineas Gage was 25 years old. He was a construction foreman, and he lived in Vermont in the United States in the 1860s. While working on a railroad bed, he packed powdered explosives into a hole in the ground using tamping iron. The powder heated and blew in his face. The tamping iron rebounded and pierced the top of his skull, ravaging his frontal lobes.
A few years later, in 1868, Harlow, the name of his doctor, reported the changes to Phineas Gage's personality following his accident, and this is what his doctor wrote.
He said he became fitful, irreverent, indulging at times in the cross's profanity, which was not previously his customs, manifesting but little deference to his fellows, impatient of restraint or advice, when it conflicted with his desires.
At times, pertinaciously obstinate, yet capricious and vacillating, devising many plans for future operation which are no sooner arranged than they are abandoned, in turn for others appearing more feasible.
His mind, Phineas Gage's mind, was radically changed so that his friends and acquaintances said he was no longer Phineas Gage, said the astounded doctor.
In other words, Phineas Gage's brain injury turned Phineas Gage into what we know today as a psychopathic narcissist, a grandiose narcissist.
Similarly, startling information transformation had been recorded among soldiers with penetrating head injuries suffered in World War I.
Orbital medial wounds made people pseudo-psychopathic in the language of those days. They were described as being grandiose, euphoric, disinhibited and puerile. When the dorsolateral convexities were damaged, those affected became lethargic and apathetic and they were called pseudo-depressed.
The word pseudo indicates that the doctors of their time did not feel comfortable with the diagnosis of psychopathy or with diagnosis of depression. They felt that something was wrong. After all, these people had not been psychopathic nor have they been depressed before the brain injury, before the brain trauma.
It seemed that the physiological or physical alteration of the brain, the wound, the scar, the trauma, the severance of lobes, the ruination of neural pathways had massive systemic effects on the personalities of the patients.
As Geschwind noted, many had both symptoms.
In a study titled Gray Matter Abnormalities in Patients with Narcissistic Personality Disorder published in June 2013 in the Journal of Psychiatric Research, the authors concluded, relative to the control group, narcissistic personality disorder patients had smaller GM volume in the left anterior insula.
Independent of group GM volume in the left anterior insula was positively related to self-reported emotional empathy.
Complementary whole brain analysis yielded smaller GM volume in front or paralimbic brain regions comprising the rostral and median cingulate cortex as well as dorsolateral and medial parts of the prefrontal cortex.
And here we provide the first empirical evidence for structural abnormalities in front or paralimbic brain regions of patients with narcissistic personality disorder.
The results are discussed in the context of narcissistic patients' inability for emotional empathy. This was more or less the first one documented study of connection between brain structures or brain deficiencies in this case and the lack of empathy.
It is still debatable whether a lack of empathy should remain as a main diagnostic criterion for narcissistic personality disorder.
I was the first to suggest that narcissists and psychopaths actually do possess empathy. Only the type of empathy is very different to normal empathy or empathy in normal or so-called healthy people. The empathy of narcissists and psychopaths is cold. It's merely cognitive and to some extent reflexive.
But still they do possess empathy and I dubbed it cold empathy. If they do possess empathy then all these changes in the brain observed by the authors of the aforementioned article may not actually be related to narcissistic personality disorder but to something a lot more profound.
The Diagnostic and Statistical Manual is clear. The brain injured may acquire traits and behaviors typical of certain personality disorders but head trauma never results in a full-fledged personality disorder.
Indeed the DSM says: in general diagnostic criteria for personality disorder the enduring pattern is not due to the direct physiological effects of a substance, drug, or abuse, or to a general medical condition such as head trauma.
You can find this text on page 689 of the text revision of the fourth edition of the DSM.
In my book malignant narcissism of narcissism revisited I have written it is conceivable though that a third unrelated problem causes chemical imbalances in the brain metabolic diseases such as diabetes, pathological narcissism, and other mental health syndromes.
There may be a common cause, a hidden common denominator, perhaps a group of genes.
Certain medical conditions can activate the narcissistic defense mechanism. Chronic ailments are likely to lead to the emergence of narcissistic traits or a narcissistic personality style to borrow Theodore Millon's terminology. Traumas such as brain injuries have been known to induce states of mind akin to full-blown personality disorders as I've mentioned before. Such so-called narcissism though is reversible, tends to be ameliorated or disappear all together when the underlying medical problem does the same.
Other disorders like bipolar disorder, which used to be known as mania and depression, these disorders are characterized by mood swings that are not brought about by external events, not exogenous or reactive mood swings, endogenous mood swings.
But the narcissist's mood swings are strictly the results of external events, they are reactive. As he perceives and interprets these events, so does he react with mood lability.
Phenomena which are often associated with narcissistic personality disorder such as depression or obsessive compulsive attributes, these are treated with medication.
Rumor has it that SSRIs such as fluoxetine known as Prozac might have adverse effects if the primary disorder is indeed narcissistic personality disorder. They sometimes lead to the serotonin syndrome which includes agitation and exacerbates the rage attacks typically of a narcissist.
The use of SSRIs is associated at times with delirium and the emergence of a manic phase and even with psychotic micro episodes. This is not the case with heterocyclics MAOIs and other wood stabilizers such as lithium blockers and inhibitors are regularly applied without discernible adverse side effects as far as NPD is concerned but this is curious if changing brain biochemistry never mind in which way has an effect on personality.
Then all classes of antidepressants should have had a discernible observable effect on important aspects of NPD but that is not the case. That is not true. It seems that we can interfere with brain biochemistry, can rewire the brain so to speak, can create new neural pathways or whatever, and yet NPD narcissistic personality disorder will remain monolithic as a clinical entity, will not be affected in any meaningful discernible clinical way.
Not enough is known about the biochemistry of narcissistic personality disorder. There seems to be some vague link to serotonin but no one knows for sure.
Others suggest links to dopamine. There isn't a reliable non-intrusive method to measure brain and central nervous system serotonin levels.
Anyhow, so it is mostly guesswork at this stage.
I think the whole problem, the whole problematic, is founded on a fundamental misunderstanding of the brain.
And we seem to misunderstand the brain periodically and repeatedly because we borrow technological metaphors, the brain, and by implication the mind, have been compared to the latest technological innovation in every generation.
The computer metaphor is now involved, computer hardware metaphors were replaced by software metaphors, and lately by neural or neural network metaphors. Metaphors are not confined to the philosophy of neurology, architects and mathematicians, for instance, have lately come up with a structural concept of tensegrity to explain the phenomenon of life, the tendency of humans to see patterns and structures everywhere, even where there are none.
This tendency is well documented, and probably has its survival value, but it may mislead us considerably.
Another trend is to discount these metaphors as erroneous, irrelevant, deceptive, and misleading, as I myself have just done.
Understanding the mind is a recursive business, rife with self-reference, the entities or processes to which the brain is compared are also in effect, brain children.
They are the results of brainstorming.
Everything is conceived by the mind, especially computers, what is a computer, what is a software application, what is a communication network, if not the material representation of events in the brain.
So there's a kind of tautology here, there's a kind of a close logical loop.
We use brain-children, we used our creations to understand the brain that make them.
A necessary and sufficient connection surely exists between man-made things, tangible and intangible, and human minds. Even a gas pump has a mind, a correlate.
It is also conceivable that representations of the non-human parts of the universe exist in our own minds, whether a priori, not deriving from experience, or a posteriori, dependent upon experience.
This correlation, call it what you will, this emulation, this simulation, this representation, in short, this close connection between the excretions, the output, the spin-offs, the products of the human mind and the human mind itself is a key to understanding the brain.
And this claim is of course an instance of a much broader category of claims that we can learn about the artist by his art, we can learn about the mind of the creator by studying his creation, and generally we can learn about the origin by any of the derivatives, the inheritors, the successors, the products, the byproducts, and the similes, their own.
This general contention that we can reverse engineer, so to speak, we can go from the product to the producer, from the child of the mind to the mind, from an object to the brain that designed it. This general contention is especially strong when the origin and the product share the same nature.
If the origin is human, and the product is human, for example, parents and child, there is an enormous amount of data that can be derived from the product and safely applied to the origin. We can study the child and learn a lot about his mother and father, of course the closer the origin is to the product, the more we can learn about the origin from the product.
We have said that knowing the product we can usually also know the origin.
The reason is that knowledge about any product collapses the set of probabilities and increases our knowledge about the product's origin, originating mind.
Yet the converse is not always true.
The same origin can give rise to many types of entirely unrelated products. The same mind can give rise to numerous products which have little to do with each other. A good poet can also be a great carpenter, a good painter can be a great general in the army. They can create products that have utterly nothing to do with each other, that share no common denominator, that are divorced from each other and yet come from the same brain and from the same mind.
There are too many free variables here.
The origin, the mind, exists as a wave function, a series of potentialities with attached probabilities. The potentials being the logically and physically possible products and these products come into being in us, as a kind of collapse of the wave function.
What can we learn about the origin by crudely perusing the product?
Let's assume that all we have are the products and let's assume that we don't have much time to study. We can just cursory glance at them, peruse them, and prompt them. If we do that, we can learn mostly observable structural and functional traits and attributes.
We cannot learn almost anything about the true nature of the mind that made them. We cannot know the true nature of anything actually.
This is the realm of metaphysics, not of physics.
Consider, for example, quantum mechanics. It provides an astonishingly accurate description of micro processes and of the universe without saying much about the world or about reality or about the essence of the cosmos.
Modern physics strives to produce correct predictions, not to expound upon this or that worldview. Modern physics describes, it does not explain.
Where interpretations are offered, for example, the Copenhagen interpretation. Quantum mechanics, they invariably run into philosophical snags.
Modern science uses metaphors. We use words like particles, we use words like waves, and we use words like the mind. These metaphors have proven to be useful scientific tools in the thinking scientists kit.
But these metaphors are not reality as these metaphors develop. They trace the developmental phase of the origin, but they are not the origin.
Okay, let's go back to the brain.
Consider the software metaphor of the mind.
The mind is software. The computer is a thinking machine. It is limited. It is simulated. It is recursive. It is mechanical. But it's a thinking machine.
Similarly, the brain is a thinking machine. It is much more agile, much more versatile, much more non-linear, much more qualitatively different to a computer. There is no question about that too.
But both of them are thinking machines. The computer, the brain, whatever the disparity between the two, they must be related somehow to one another.
There are even people like Ray Kurzweil and others would say that is only a question of time until computers become brains and brains can be utterly understood in terms of artificial intelligence computers.
This relation is by virtue of two facts.
One, the brain and the computer are thinking machines, as we mentioned. But there is a second reason.
It is the latter, the computer is the product of the former. It's a product of the brain.
Thus the computer metaphor is an unusually tenable and potent metaphor. It is likely to be further enhanced, should organic or quantum computing transpire.
At the dawn of computing software, applications were offered serially in machine language and with strict separation of data, which was called structures and instruction code, which was called functions or procedures. The machine language reflected the physical wiring of the hardware.
This is akin to the development of the embryonic brain, the embryonic mind.
In the early life of the human fetus, the human embryo, the instructions, the dna are also insulated from the data, from amino acids and other life substances.
In early computing databases were handled on a listing basis and this was called a flat file. Database bases were serial and they had no intrinsic relationship to one another.
Early databases in the 1960s, for example, and the 50's, constituted a sort of substrate, ready to be acted upon by functions by the computer. Only when they were intermixed with the computer, as a software application was run, these functions were able to operate on the structures, otherwise they were kept separately.
This phase was followed in the history of computing by the relational organization of data. A primitive example of which was the spreadsheet, in the early 1980s. Data items were related to each other through mathematical formulas.
This is the equivalent of the increasing complexity of the wiring of the brain as pregnancy progresses, as gestation progresses.
The latest evolutionary phase in programming is known as OOPS, Object Oriented Programming Systems.
Objects are modules which encompass both data and instructions in self-contained units. The user communicates with the functions performed by these objects, but not with their structure and internal processes.
Programming objects, in other words, are black boxes, an engineering term. The programmer is unable to tell how the object does what he does, or how does an external useful function arise from internal hidden functions or structures.
Objects are epiphenomena, they are emergent, they are phase transient.
In short, objects are much closer to reality as described by modern physics, actually.
Though these black boxes communicate, it is not the communication, communication speed, or its efficacy which determine the overall efficiency of the system. It is the hierarchical, and at the same time fuzzy, organization of the objects. This does the trick.
Objects are organizing classes which define their actualized and potential properties.
The object's behavior, what it does, and what it reacts to, is defined by its membership of a class of objects.
Moreover, objects can be organized in new subclasses while inheriting all the definitions and characteristics of the original class, in addition to new properties.
In a way, these newly emergent processes are the products, while the classes that they are derived from are the origin.
This process so closely resembles natural ≤and especially biological phenomena, that it lends additional force to the software metaphor.
Software as it is written today resembles very much how biology works, especially genetics.
Thus, classes can be used as building blocks.
No wonder we have evolutionary software.
Their permutations of these classes define the set of all solvable problems.
It can be proven that Turing machines are a private instance of a general, much stronger class theory, a la Principia Mathematica.
The integration of hardware, computer, brain, and software, computer applications, the mind, is done through framework applications which match the two elements structurally and functionally.
The equivalent in the brain is sometimes called. by philosophers and psychologists. a priori categories or the collective unconscious, to use a Jungian term.
Computers and their programming evolve.
Everything I'm saying now is already 20 years old.
Relational databases cannot be integrated with object oriented ones, for instance.
To run Java applets, a virtual machine needs to be embedded in the operating system.
These phases closely resemble the development of the brain-mind complex.
When is a metaphor a good metaphor?
When can we say that we have finally understood the brain via a very powerful comparison, a powerful simile?
A metaphor is good when it teaches us something new about the origin.
If we compare the brain to software, this comparison should teach us something new about the brain.
It must possess some structural and functional resemblances, but this quantitative and observational facet, the resemblance, is not enough.
There must also be a qualitative kind of resonance.
The metaphor must be instructive, revealing, insightful, aesthetic and parsimonious.
In short, the metaphor must constitute a complete, self-contained, full-fledged theory, and it should produce falsifiable predictions.
A metaphor is also subject to logical and aesthetic rules, and to the rigors of the scientific method.
So let's go back to the software metaphor.
The question we were asking is if we interfere with the brain and it has no effect on personality, for example, if we administer medication, and the medication is consumed, and the medication interferes, interjects itself into brain biochemistry, alters biochemical pathways, changes neural pathways, changes conductance, changes the excretion of neurotransmitters, they're all very powerful elements in the brain ecosystem.
And yet the personality remains the same.
What is the connection between personality and brain, what is the connection between personality and mind, and perhaps most importantly, what's the connection between mind and brain?
And so here we go back to the software metaphor.
If comparing the brain to software is correct, the brain must contain the following features.
Number one, parity checks through back propagation of signals. The brain's electrochemical signals must move back to the origin and forward simultaneously in order to establish a feedback parity loop.
The second requirement is that the neuron, the basic unit of the brain, cannot be a binary two-state machine.
A quantum computer, for example, is multi-state.
The neuron must have many levels of excitation, many models of representation of information.
The threshold all-or-nothing firing hypothesis must be wrong. Either it is wrong or the software metaphor is wrong, both of them cannot be right.
We may yet discover that neurons have multiple levels of excitation and arousal, not yes or no, firing, not firing, black and white.
The third requirement is that redundancy must be built into all the aspects and dimensions of the brain and its activities.
Redundant hardware, different centers to perform similar tasks, is very common.
Redundant communication channels with the same information simultaneously transmitted across them are also very common.
Redundant retrieval of data, redundant storage of data, redundant usage of obtained data through working upper memory, etc.
Redundancy is built into all known processes and elements of computing.
If the software and hardware seem ideal, if they elucidate the workings of the brain, the brain must have multiple layers and levels of redundancy and we know to a large extent it's true.
In cases of brain injury and trauma, other centers of the brain take over and perform the same tasks and functions.
The fourth requirement is that the basic concept of the workings of the brain must be the comparison of representational elements to models of the world, or theories of the world, or in my case, to theories of mind.
This is the foundation of empathy, the intersubjective agreement regarding the content of other people's minds.
We have no access to other people's minds.
We must create a theory about these minds. We must presume, we must speculate, we must deduct, we must analyze.
The only way we can interact with other people is to make a series of hidden assumptions.
For example, that they are more or less like us, that we are the same.
And so these models of the world, these models of the mind, must be somehow compared to representational elements.
A coherent picture is obtained which yields predictions and allows to manipulate the environment effectively.
Should these comparisons fail as is the case in pathological narcissism, we would have an impaired reality test and a form of autism, in effect.
Many of the functions tackled by the brain must be recursive. This is the fifth requirement.
We can expect to find that we can reduce all the activities of the brain to computational, mechanically solvable, recursive functions.
The brain can be regarded as a Turing machine, and the dreams of artificial intelligence are likely to come true sooner rather than later.
I think we are going to discover that computers and brains are one and the same. There will come a moment where our brains will be indistinguishable from sufficiently complex, self-assembling, self-recursive, and self-learning machines.
At that point the question will arise, what is the personality? Could we then say that certain computers have certain personalities? If we create androids like in the famous movie Blade Runner, could we attribute a personality to them? Is a personality nearly the epiphenomenon? An emergent quality or set of qualities? Is it dependent on complexity or is it something totally separate?
And what about the mind of the brain? Is the mind a byproduct of the complexity of the brain?
We will not know until actually we have reached this stage in computing.
Once we do, we will be faced either with totally thinking machines with personalities, or the metaphor brain is computer, computer is brain will break down.
And finally the sixth requirement is that the brain must be a learning, self-organizing entity. The brain's very hardware must disassemble, reassemble, reorganize, restructure, reroot, reconnect, and in general, alter itself in response to data.
I've actually written this sentence several years before neuroplasticity was discovered. Today we know that neuroplasticity is an extant phenomenon in the brain. And does exactly what I've described several years before.
In most man-made machines, the data is external to the processing unit. It enters and exits a machine through designated interfaces. But does not affect the machine structure or functioning.
That's not the case in the brain. The brain reconfigures itself with every bit of external data. One can say that a new brain is created every time there's new information, and it is processed.
So these are the such requirements, and only if all six of them are met can we say that the software metaphor is useful to understanding the brain.
Then, we can also understand the mind, and we can begin to have the most initial glimpse of what is the personality.
We are a very, very long way off. And any claim to the contrary is hubris, vanity, and indeed, narcissistic megalomania and grandiosity.
Thank you for listening.