Diamond, N., 2005. Attachment, The Body and Trauma. Reformulation, Autumn, pp.25-26.
(This paper is based on Nicola’s presentation to the ACAT Conference 2004)
As the neuroscientist Jaak Panksepp states ‘’The Brain is not in a vat, but of a body in a world.’’ The world of others is not an addition but a requirement for structuring, organising, and constituting the brain-body.
When an infant is born, it is radically dependent on another for survival. Through this dependency a co-regulation of emotional and somatic states becomes established. Co-regulation includes the action of hormones, nervous system, and other biochemical processes. Neural connections are stimulated in the brain through relating to the other (mother or other key person). This psycho-physical inter-subjective-inter-corporal connection can be attuned or mis-tuned, depending on the attachment style of the caregiver. Tuning is established non-verbally by facial and body expressions exchanged between mother and baby. Facial expression, gestures, mirroring, body tension, all convey feeling and alter somatic states in baby and also in mother.
When there is extreme privation, as with Romanian orphans who receive no emotional care or physical contact, pet scans of the brain show severe deficits. Left day and night in their cots, fed by automated feeding bottles, these orphans, by age nine, show a lack of activity, a black space, in the pre-frontal lobes, which govern emotional and social development. The child who has had normal development, in contrast, shows an active, brightly lit up pre-frontal area.
The case of the Romanian orphans shows that interaction with another human being is required for emotional and brain development. If the infant does not receive any relational stimulation in the first two years of life, the window of opportunity closes and can not be opened later. This is why a feral child, raised over the first years of life by wolves, could never master the use of language and why deaf children, who cannot hear at all, cannot start to learn to speak, even if aided, after five years of age. They have missed the critical period.
We have to recognise the limits set by neuro-physiological development and its dependence on environmental triggers. In most cases, there is some deprivation but not the extremes of privation. In other words, there is an experience of interaction, either positive or negative, that stimulates neuronal wiring and firing for better or worse. As we will see, neglect or abuse can impair neural cells, alter or inhibit production of chemical secretions, and so change nervous function of the body. In cases of severe neglect, there is pruning of the neuronal cells, as shown in MRI scans by Perry and Schore.
The immune system can be lowered by separation from, or loss of, the attachment figure. Examples of this were seen in the orphanages studied by Spitz in the1940s. Orphans who had no emotional caregiver experience had high mortality. A condition of failing to thrive and literally failing to grow was also observable in these orphaned children. Lowering of the immune system may occur in the Elderly as when a partner dies and the other follows soon after.
A common view has been that if we emphasise the importance of the early years, that the perspective is determinist. In contemporary attachment /developmental studies, development is not considered linear. Although it is true that the first two years of life are profound and significant, mainly because the baby is unformed and absolutely receptive, like a sponge absorbing the environment, it is also the case that memory is reinterpreted retroactively from the present in an ongoing way. Later events can alter the meaning of the past, counteract previous experience. Attachment experiences across the life cycle need to be taken into account. A later, more positive attachment experience may result in re-interpreting and rendering less powerful the negative and earlier childhood experiences. Thus, adolescence can result in a fundamental re-organisation of childhood experience.
In attachment terms, the most disturbed child shows ‘disorganised attachment’, which can be the result of neglect and/or maltreatment. During the trauma of abuse there are heightened cortisol levels, which affect memory function. During abuse the child gets both overexcited and detached, resulting in a paradoxical tension of hypo-and hyper-arousal. This can be immobilising.
There are more ‘subtle’ disturbances in interaction, which may be called missteps in the dance. These, being less concrete and tangible, may be more difficult to detect in the consulting room. They have to do with subtle failures in sensitivity and non-verbal affective dynamics of interaction. They may have a cumulative effect.
There is preverbal memory in the form of enactment. Children who have been abused, remember through action not words.
Sometimes unprocessed trauma leaves its mark on the body. It may be expressed via the neuro-motor system, as in the client who suffered a sudden loss of their beloved father, in early years, resulting in a rippling jerk movement throughout the body every couple of minutes. A man who, as a child, was beaten repeatedly by his father, showed his trauma by cowering with his shoulders turned inwards and by tiptoeing as if not to be heard. While his father was alive, the client had an inability to masturbate.
So, trauma lives on in the body--a speechless terror--because the left brain, in the face of terror and in response to stress hormones, is knocked out of action. The amygdala is overactivated, as Van Der Kolk has shown. Trauma lives on as bodily flashbacks. One of my previous clients, a sexually abused boy, felt intense sensations in his anus and mouth, vividly lived as the now moment. He felt as if it took his body over, and he had no control.
Procedural memory, also referred to as implicit memory, is our bodily memory of how we do through action and also involves the memory of how bodily action is linked to interpersonal relationships, which were forged at the start, when mother and baby gestured to each other. The baby links somatic expression, physical distress and pleasure, to a responsive other: a relationship. This link between body expression, relationship, and the meanings derived therein develops over years, and early years are most important. In cases of relational trauma in early life there is an impairment of procedural links between body and relationship. The other has failed to be sensitively responsive; bodily expression is not brought into emotionally shared meaning. This developmental deficit, which means there is no link between somatic affect and relationship, can result in alexithymia, a condition in which the person is unable to speak about emotions. Emotion remains trapped in the somatic.
The French psychosomatics researcher, Pierre Marty, gives the example of a woman he interviews, who has run over a boy. She develops an ulcer but speaks pragmatically when asked about the accident, shows no feeling. No affect is experienced in terms of what has happened to the boy; all the affect remains as a pure somatic state: an ulcer. She can only complain of the physical discomfort it causes her, and there is no relational mourning or sense of loss or guilt expressed.
Typically, there remains a versatile plasticity in the brain’s wiring throughout life, but if trauma is repeated, then the pathways become more deeply furrowed and ‘hard wired’.
Even in cases of hard wiring, where the network patterns are there to stay, we can create new ones in the context of a facilitating relationship (therapy or otherwise). These can be superimposed on the first and activated by reflective work until, through repetition, the new pattern is installed like a second nature.
Psychodynamic reworking of procedural memory is less analytic, and more speech-related, founded on the emotional rapport established in non-verbal modes and style of being present.
Through the use of empathy, the therapist is with/embraces/tolerates the client’s pain, tunes into it and transforms beta sub-cortical-feeling states through emotional processing into sense for the client. The trauma becomes alpha process emotional reflexive mode, and the feelings become integrated into the cortex.
Reconstruction-construction of attachment history, making links between emotional state and historical and current relational experience, helps the client to stop de-contextualising their experience. It helps them to contextualise it.
Recent work of Phil Mollon argues for an energy-basis of the psychosomatic system. He says this energy base is more primordial than procedural memory and that EMDR or Tapping techniques combined with psychoanalytic insights into core emotional relational experience will facilitate resolution of trauma much quicker than traditional talking cures. See Phil’s book Psychoanalysis and the Energy Therapies.
“Towards an Interpersonal Understanding of Bodily Experience’’ in Psychodynamic Counselling (2000) Routledge
“Attachment, the Body and Trauma’’ in Attachment and the Psychoanalytic Process eds Marrone,M, Cortina,M (2002) Whurr Publishers
Attachment and Intersubjectivity Nicola Diamond and Mario Marrone (2003) Whurr Publishers
“Between Touches’’ Papers on Touch in the Psychoanalytic Space ed Galton,C , Karnac Publishers
“When Thought is Not Enough’’ How Does Therapy Work eds Ryan, J Karnac Pubs
Public lecture on Web -- Attachment and Sexuality on the Confer Website
Change of State: Learning How To Manage Unmanageable Feelings and States
Bristow, J., 2006. Change of State: Learning How To Manage Unmanageable Feelings and States. Reformulation, Summer, pp.6-7.
Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.
Lloyd, J., 2009. Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.. Reformulation, Summer, pp.34-35.
Workshop Presentation Synopses from the 2005 ACAT Annual Conference
Carroll, R., Elia, I., Compton Dickinson, S. and Webster, M., 2005. Workshop Presentation Synopses from the 2005 ACAT Annual Conference. Reformulation, Spring, pp.7-9.
Therapeutic Change that is Dialogically Structured, Mediated by Signs, and Enabled by a Relationship â€“ A Case Example
Bristow, J. and Reason, A., 2010. Therapeutic Change that is Dialogically Structured, Mediated by Signs, and Enabled by a Relationship â€“ A Case Example. Reformulation, Summer, pp.31-33.
CAT and the Cultural Formation of a Case of Anorexia Nervosa: An Italian Case Study
Cristina Fiorani and Marisa Poggioli, 2005. CAT and the Cultural Formation of a Case of Anorexia Nervosa: An Italian Case Study. Reformulation, Autumn, pp.13-17.
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