One of the many courses taught at TBIPS is Repetitive Painful
States which addresses the ways experience is encoded implicitly and
procedurally, that is, sub-symbolically without language. Painful past
experiences of mis-attunement, humiliation, contempt, neglect and other forms
of psychological and emotional abuse, as well as physical and sexual abuse,
often lead to dissociation as a way of self protection. One way the brain
separates or dissociates occurs through the ‘unlinking’ of the amygdala (the
emotional brain which stores perceptional, emotional, procedural experience) and
the hippocampus (which gives language and context to experience thereby
creating explicit memory). The stress hormone cortisol causes increased blood
flow to the amygdale while decreasing perfusion to the hippocampus. Many
experiences, then, just do not have words! Alexithymia thus ‘speaks’ to the inability to
tolerate certain affect (emotion) states—perhaps because these states were not
tolerated by the parent or not regulated as to be made bearable—and so they
cannot be known. The therapist who awaits explicit (verbal) narrative in order
to make interpretations may feel useless and incompetent, and may blame the
patient.
Physical symptoms that are in excess of physical
diagnoses or that stump physicians from coming up with diagnoses are often
called psychosomatic. It has long been thought that psychosomatic symptoms are
a way the body can express what the mind cannot put into words. Repetitive Painful States then must also
introduce candidates and students to concepts about Psychosomatic illnesses (In
fact,TBIPS provides an entire course dedicated to ‘psychosoma’—as if there were
ever a dichotomy between the two). One paper we read in the Repetitive Painful
States course is by Krueger, which notes that somatic experience is the first form
of affect. When parents selectively
attend to only the physical needs of the infant, ignoring emotional needs and
duress, the infant may learn “to organize experiences around pain and illness
in order to obtain attention and affection.”
Krueger reminds us that physical sensations, like
proprioception and the skin, allow the infant to differentiate the bounds of
the self from the rest of the world. This body cohesion, aided by touch and
secure holding, is the first awareness of self.
When the caregiver allows for over or under stimulation, the infant
learns experientially an incompetence about the boundaries of the self. Krueger
posits that certain disorders—addictions, self cutting, eating disorders, for
example—may all be an attempt to discover the boundary of the self and its
contiguity to the world, an attempt to delimit the boundedness of
selfhood. Self injury, for example, may
help to create body awareness and replace the lost sensation of an
underdeveloped or dissociated emotional life.
Krueger,
D. (2001). Body self: development, psychopathologies and psychoanalytic
significance. Psa Study of the Child, 56:238-259.
