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.