Sunday, December 8, 2019

The Neurobiology of 'Stuckness' by Steven Graham, PhD

What Happened to Me When I Was Little?
The Neurobiology of "Stuckness"
Psychoanalysis has at times been referred to as the “forbidden journey” because it takes us places we (and our early caregivers) would rather not see or feel or remember. Psychoanalytic treatment is not for the timid. It takes courage even to attempt it. We can look at such work as an expedition or an adventure, and know we will not be alone as we walk through it. In fact, it is impossible to make such a trip successfully alone. The quality of the journey requires a trusted and competent and caring other. More on that in the next installment.

Most of us dare to risk the venture because we find ourselves stuck: in a depression, with anxiety, with a sense of negativity or meaninglessness, in a painful relationship, in a dead-end job, or with thoughts, memories, or feelings that intrude upon us unbidden. Dr. Allan Schore is a psychologist, psychoanalyst, and researcher whose work has attempted to integrate neurobiology, attachment theory, and trauma research with psychoanalysis and psychotherapy. He is the author of numerous articles and books (listed below), along with many YouTube videos in which he explains why people get stuck and how we can become unstuck. In addition to introducing you to this outstanding clinician and researcher, I also want to highlight a few of his insights that might prove meaningful to you. One of the important but often unasked questions I discover in my work with others is this: So, what happened to me when I was little? Schore’s insights help us begin to answer this all-important question.


The First Thousand Days is Crucial
When we add the nine months of in-utero development together with the first two years of the baby’s post-natal life, we are exploring these first 1000 days when the infant’s brain, particularly the right-brain, is expanding at a phenomenal rate. Schore’s research shows that it is the right hemisphere of the brain that is largely responsible for affect regulation (or emotional and body-based regulation) while the left brain (which develops more rapidly in the infant’s third year of life) is responsible for logic, language, and linear thought. 

Contrary to those who believe that infants are oblivious to the world around them, they are soaking it up. This is the pre-verbal stage when communication is primarily body-to-body and right-brain to right-brain. This is when children learn how it feels to be a human being, if and how they are special, loved, or worthy, what to expect from relationships, and whether their world is secure or insecure.


Later Emotional and Psychological Struggles Usually Begin During the First Thousand Days

I have heard people express with confidence how “resilient” babies are, that they can endure absent, depressed, misattuned, preoccupied, or chaotic caregivers and families during this first 1000 days and turn out to be just fine. The research proves just the opposite. It is during these early months and years of a child’s life that they are most vulnerable. We have all seen how important it is to support the back of the baby’s head and neck when holding them because they are so young and fragile. If we must take extra care with the child’s head, we must do even more so with the child’s mind.


Emotional Regulation is Crucial 

One of the most important gifts we bring to the child’s life is affect regulation, the ability to regulate the self during times of stress. Anyone who has been around a baby for any time at all knows one truth: the baby does NOT know how to self-regulate. It is up to the caregiver(s) to do this. These three processes are essential: soothing, vitalizing, and repairing.

#1. Soothing. When negative feelings (both emotional and physical) overwhelm the child, the caregiver must soothe. This requires the caregiver to show empathy, but also confidence that the distressing state is bearable and will pass. Perhaps rocking, singing, holding, feeding, or changing the diaper will eventually return the baby to a peaceful state. Over time, the baby will eventually develop the capacity to tolerate increasingly negative states of distress.

#2. Vitalizing. When babies smile or coo or want to play, it is up to the caregiver to expand this capacity as well. And so we play peak-a-boo, “this little piggie,” and other games with the baby. This will equip the developing child to experience the upper limits of the emotional range and learn to regulate it as well.

#3. Repairing. Unfortunately, caregivers cannot attune perfectly with their babies all the time. When we do misunderstand, we take responsibility: “Oh, I’m sorry. I thought you just wanted to be held, but I guess you are hungry. Let’s take care of that right now.” When we as caregivers learn to repair these misattunements, we help our babies trust that problems can be solved, especially the interpersonal ones. They also internalize the ability to show empathy toward others, which offers them a rich life in so many ways.

The degree to which a child has learned affect regulation may very well dictate that child’s future psychological well-being. 


Intergenerational Transmission of Trauma is Real 

Most of us as parents want to do everything we can to protect our children from any of the trauma. But what if we have not worked through our own trauma? While many whom I see in therapy easily recall painful interactions with their caregivers, others cannot remember anything out of the ordinary in their relationships with their parents at all, but then begin to tell stories about the significant trauma that their parents lived through. When we experience trauma, we may learn to dissociate, or disconnect, part of ourselves from the horrors around us in order to survive emotionally. This becomes part of our psychological way of being in the world. When caregivers who have been traumatized themselves (perhaps as children) hold their babies, they may at times dissociate, and the child’s sensitive right brain notices that mom or dad is not all there. Most often, the parent has absolutely no idea this is happening. This may also occur if the caregiver is depressed or anxious or distracted. Right-brain to right-brain, the baby is taking it all in: the sense of dread, profound sadness, overwhelming responsibility, inability to stay focused. The newborn has, of course, no words for these feelings: they live in the child’s nonverbal brain centers and often in the child’s body.


Repairing Such Damage from Childhood is Very Possible!

It is likely as we are reading these research findings that we are asking two essential questions: 1) what have I done to my children? and, 2) what happened to me? What I tell most parents I see in therapy is that it is not a matter of “if” they have wounded their children, but “how” they have done so … because we all have. One of the greatest gifts a parent of an adult child can give is the offer of repair: to recognize mistakes that were made, own them, ask for forgiveness, and attempt to restore the damaged trust to the extent that we can. The truth is that when we are parenting, we simply cannot see or know everything: this is part of the painful existential truth with which we all live. We are finite and limited, and it causes pain to ourselves and to our precious children.

The good news is that these brains of ours (and our children) are “plastic,” meaning they continue to change over time. And they can change toward health despite the trauma or neglect we may have received in our childhoods. Even though patterns were deeply established in our infancies, the first 1000 days of our lives, we have something that we did not have as infants: an intact brain which includes a fully operational left hemisphere along with the prefrontal cortex which does our thinking and planning for us. In essence, this means we can choose, in effect, to be re-parented. I will explain this in the next installment, coming out next week.



Selected Articles:
Schore, A.N. (1991). Early Superego Development: The Emergence of Shame and Narcissistic Affect Regulation in the Practicing Period. Psychoanal. Contemp. Thought, 14(2):187-250.
Schore, A.N. (1997). A Century After Freud’s Project: Is A Rapprochement Between Psychoanalysis And Neurobiology At Hand? J. Amer. Psychoanal. Assn., 45:807-840.
Schore, A.N. (2001). Minds in the Making: Attachment, the Self-Organizing Brain, and Developmentally-Oriented Psychoanalytic Psychotherapy. Brit. J. Psychother., 17(3):299-328.
Shore, A.N. (2002). Advances in Neuropsychoanalysis, Attachment Theory, and Trauma Research: Implications for Self Psychology. Psychoanal. Inq., 22(3):433-484.
Schore, A.N. (2011). The Right Brain Implicit Self Lies at the Core of Psychoanalysis. Psychoanal. Dial., 21(1):75-100.

Selected Books:
Schore, A. (1994). Affect Regulation and the Origin of the Self. Mahway, NJ: Lawrence Erlbaum Associates
Schore, A. (2003a). Affect Regulation and Disorders of the Self. Ed., New York: W.W. Norton & Company
Schore, A. (2003b). Affect Regulation and the Repair of the Self. Ed., New York: W.W. Norton & Company
Schore, A. (2019). Right Brain Psychotherapy. New York: W.W. Norton & Company
Schore, A. (2012). The Science of the Art of Psychotherapy. New York: W.W. Norton & Company
Schore, A. (2019). The Development of the Unconscious Mind. New York: W.W. Norton & Company. 

by Steven Graham, PhD

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