SELFANDSYSTEMS

Relational Trauma and the Developing Right An Interface of Psychoanalytic Self and Allan N. Schore Department of and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA

Psychoanalysis, the science of unconscious processes, has recently undergone a signif- icant transformation. Self psychology, derived from the work of Heinz Kohut, repre- sents perhaps the most important revision of Freud’s theory as it has shifted its basic core concepts from an intrapsychic to a relational unconscious and from a cognitive ego to an emotion-processing self. As a result of a common interest in the essential, rapid, bodily based, affective processes that lie beneath conscious awareness, a pro- ductive dialogue is now occurring between and neuroscience. Here I apply this interdisciplinary perspective to a deeper understanding of the nonconscious brain/mind/body mechanisms that lie at the core of self psychology. I offer a neuropsy- choanalytic conception of the development and structuralization of the self, focusing on the experience-dependent maturation of the emotion-processing right brain in infancy. I then articulate an interdisciplinary model of attachment trauma and pathological dissociation, an early forming defense against overwhelming affect that is a cardinal feature of self-psychopathologies. I end with some thoughts on the mechanism of the psychotherapeutic change process and suggest that self psychology is, in essence, a psy- chology of the unique functions of the right brain and that a rapprochement between psychoanalysis and neuroscience is now at hand.

Key words: neuropsychoanalysis; right brain; trauma; dissociation; unconscious; attachment

Introduction information not only within but also between disciplines. In this period of accelerated growth At the present time a number of scientific of essential information about the human con- and clinical disciplines are simultaneously ex- dition and the natural world, the transfer of periencing a rapid expansion of relevant data knowledge across disciplinary boundaries is oc- and even a reorganization of their underlying curring at a faster rate. This trend is reflected in theoretical concepts. Indeed, the term paradigm an increasing interest in interdisciplinary stud- shift is appearing in a number of literatures. Al- ies and in integrated models that synthesize though current significant advances in various data generated at the interface of different sci- technologies and the computer sciences have entific and clinical fields. catalyzed this growth spurt, an important con- Within this context there exists a potential tributor has been the rapid communication of for new and fresh solutions to certain fun- damental problems, especially those concern- ing the essential mechanisms that lie at the core of adaptive and maladaptive human func- Address for correspondence: Allan N. Schore, 9817 Sylvia Avenue, Northridge, CA 91324. Voice: 818-886-4368; fax: 818-349-4404. tions. Until very recently these problems have [email protected] been studied from the unique vantage points of

Self and Systems: Ann. N.Y. Acad. Sci. 1159: 189–203 (2009). doi: 10.1111/j.1749-6632.2009.04474.x C 2009 New York Academy of Sciences. ! 189 190 Annals of the New York Academy of Sciences various scientific perspectives that span the so- ing a substantial reformulation from an in- ciological, psychological, biological, and chem- trapsychic unconscious to a relational uncon- ical domains. The overemphasis on special- scious whereby the unconscious mind of one ization within each of these disciplines has communicates with the unconscious mind of also fostered their isolation from one another, another. The scaffolding of clinical psychoanal- which has in turn inadvertently increased an ysis is supported by conceptions of psychic de- artificial dichotomous separation between, for velopment and structure, and it is these basic example, psychology and biology, brain and concepts that are now being reformulated. Self mind, mind and body, cognition and emotion. psychology, emergent from the seminal work Earlier impermeable boundaries of knowledge of Heinz Kohut, represents perhaps the most between disciplines also intensified a tension significant updating of classical psychoanalysis and indeed a conflict between those studying since it inception. In 1971, Kohut, trained in unconscious involuntary processes and those and then psychoanalysis, published studying conscious voluntary processes, that is his classic volume The Analysis of the Self, a de- between psychoanalysis—the science of uncon- tailed exposition of the central role of the self in scious process—and psychology—the study of human existence. He subsequently expanded behavior. the theoretical framework of self psychology This ambivalent relationship between psy- in a second volume, The Restoration of the Self choanalysis and the other sciences has existed (1977), and finally in How Does Analysis Cure? since its creation by . And yet it (1984). is often forgotten that Freud’s early career was In all his clinical work and writings Kohut at- in neurology and that in 1895 he wrote Project tempted to explore the four basic problems of for a Scientific Psychology, an attempt to create “a psychoanalysis that he initially addressed in his psychology which shall be a natural science” seminal volume: how do early relational affec- (Schore, 1997a). In this remarkable document tive transactions with the social environment Freud used what was then known about neu- facilitate the emergence of self (development of rophysiology and biology to begin to construct the self ); how are these experiences internalized a set of regulatory principles for psychologi- into maturing self-regulating structures (struc- cal processes and a neuropsychological model turalization of the self ); how do early deficits of of brain function. Freud did not publish the self-structure lead to later self-pathologies (psy- Project in his lifetime and over the course of his chopathogenesis); and how can a therapeutic rela- career never returned to the problem of creat- tionship lead to a restoration of self (mechanism ing a model that could integrate the biological of psychotherapeutic change). and psychological realms. And yet he predicted Despite the fact that he was originally trained that at some point in the future “we shall have as a neurologist, Kohut was highly ambivalent to find a point of contact with biology” (Freud, about the incorporation of scientific data into 1913). Freud thus saw neurobiology as a disci- the core of psychoanalytic self psychology. In- pline that could bridge the gap between biol- deed, like Freud before him, he eschewed his ogy and psychoanalysis, especially in the study earlier neurological knowledge and attempted of the unconscious and its fundamental impact to create a purely psychological model of the on all aspects of the human experience. unconscious systems that underlie all human Over the course of the last century,a number functioning. However, in the last 10 years, over of significant transformations have occurred in the course and since the “decade of the brain” Freud’s theory, although much of this work has an interdisciplinary perspective has emerged not transferred outside of the field. The theoret- both within psychoanalysis and the disciplines ical core of psychoanalysis, almost unchanged that border it. Because of a common interest for most of its first century, is now undergo- in the essential, rapid, bodily based, affective Schore: Self Psychology and Neuroscience 191 processes that lie beneath conscious awareness, interpret the data of various biological and a productive dialogue is now occurring be- psychological disciplines and can freely shift tween psychoanalysis and neuroscience. This back and forth between their different levels of convergence has facilitated the emergence of analysis. a new discipline, neuropsychoanalysis, and a In this chapter on the integration of self psy- subspecialization, developmental psychoanaly- chology and neuroscience, I outline my neu- sis (Schore, 1997a). This discipline returns to ropsychoanalytic work on the interpersonal Freud’s attempt to create “a psychology which neurobiological origins of the self. I first present shall be a natural science” by specifically focus- a brief overview of Kohut’s concepts that repre- ing on the essential psychobiological role of the sent the core of self psychology. Subsequently I unconscious in all human affect, cognition, and integrate interdisciplinary data in order to con- behavior. struct a neuropsychoanalytic conception of the In a number of works I have suggested development and structuralization of the self, that the time is right for a rapprochement be- focusing on the experience-dependent matura- tween psychoanalysis and the biological sci- tion of the early developing right brain. Then, ences (Schore, 1994, 1997, 2002a,b, 2003a,b, in a major focus of this work, I apply this devel- 2005a). In this period when neuroscience is opmental neuropsychoanalytic perspective to “rediscovering the unconscious,” neuropsycho- the psychopathogenesis of severe deficits in the analysis is identifying the “intrapsychic” brain self-system. Citing my work in this area, I artic- systems involved in a redefined dynamic un- ulate a model of the self psychology and neu- conscious and developmental psychoanalysis robiology of early relational trauma and the is generating a complex model of the social– etiology of pathological dissociation, an early emotional origins of the self and the early on- forming defense that is a cardinal feature of a togeny of the biological substrate of the human number of early forming psychopathologies. I unconscious. It is now clear that Freud was cor- end with some thoughts on psychotherapeutic rect in positing the unconscious mind develops change and argue that the time is right for a rap- before the conscious and that the early devel- prochement between psychoanalysis and neu- opment of the unconscious is equivalent to the roscience. Throughout I suggest that the “point genesis of a self-system that operates beneath of contact with biology” that Freud referred conscious verbal levels for the rest of the life to is specifically the central role of right brain span. I believe a deeper understanding of early psychobiological processes in the unconscious human development can never be attained by regulation of affect, , and cognition, narrowly focusing infant studies on the precur- areas of intense interest to both contemporary sors of language, conscious thought, and vol- self psychology and neuroscience. untary behavior. A complete model of human development (and psychoanalysis) can only be psychobiolog- Self-Psychological Developmental ical, not merely psychological. A deeper under- Models: Psychobiology standing of one of the fundamental questions of of Attachment science, why early developmental processes are essential to the short- and long-term survival Perhaps Kohut’s most original and outstand- of the organism, will not come from single or ing intellectual contribution was his devel- even multiple discoveries within any one dis- opmental construct of selfobject. Indeed, self cipline (Schore, 1994). Rather, an integration psychology is built upon a fundamental devel- of related fields is essential to the creation of opmental principle—that parents with mature a heuristic model of both developmental struc- psychological organizations serve as selfobjects tures and functions that can accommodate and that perform critical regulatory functions for 192 Annals of the New York Academy of Sciences the infant who possesses an immature, incom- There is now agreement that current psycho- plete, psychological organization. The child is analysis is “anchored in its scientific base in thus provided, at nonverbal levels beneath con- developmental psychology and in the biology scious awareness, with selfobject experiences of attachment and affects” (Cooper, 1987). At that directly effect the vitalization and struc- this point in time, self psychology is incorpo- tural cohesion of the self. The selfobject con- rating a broad range of current developmental struct contains two important theoretical com- research into its theoretical model. In my own ponents. First, the concept of the mother–infant contributions to this effort I have integrated re- pair as a self—selfobject unit emphasizes that cent advances in into the early development is essentially an interdepen- field (Schore, 2002a, 2003a, 2005b). dence between self and objects in a system. Overviewing and integrating this data, it is This core concept was a major intellectual im- now established that the essential task of the petus for the expansion of the intersubjective first year of human life is the creation of a se- perspective in psychoanalysis. Indeed, Kohut’s cure attachment bond of emotional communi- emphasis on the dyadic aspects of unconscious cation between the infant and primary care- communications shifted psychoanalysis from a giver. Research now suggests “learning how solely intrapsychic to a more balanced rela- to communicate represents perhaps the most tional perspective. This challenged psychoanal- important developmental process to take place ysis to integrate the realms of a one-person psy- during infancy” (Papousek & Papousek, 1995). chology and a two-person psychology. Through visual-facial, auditory-prosodic, and The second component of the selfobject con- tactile-gestural communications, caregiver and struct is the concept of regulation. In his de- infant learn the rhythmic structure of the other velopmental speculations, Kohut (1971) stated and modify their behavior to fit that struc- that the infant’s dyadic reciprocal regulatory ture, thereby co-creating a specifically fitted transactions with selfobjects allows for the interaction. maintenance of his internal homeostatic equi- Kohut described critical episodes of “em- librium. These regulating self–selfobject expe- pathic mirroring” in which “The most sig- riences provide the particular intersubjective nificant relevant basic interactions between affective experiences that evoke the emergence mother and child usually lie in the visual area: and maintenance of the self (Kohut, 1984). The child’s bodily display is responded to by Siegel (1996) observes, “Kohut makes major the gleam in the mother’s eye” (Kohut, 1971). contributions to the understanding of emo- During bodily based affective communications tional life, and his conceptualizations have far- embedded in mutual gaze transactions, the psy- reaching implications for the understanding chobiologically attuned mother synchronizes and treatment of emotional states.” Kohut’s the spatiotemporal patterning of her exoge- idea that regulatory systems are fundamentally nous sensory stimulation with the spontaneous involved with affect is supported in current overt manifestations of the infant’s organis- interdisciplinary studies that are highlighting mic rhythms. Via this contingent responsiv- not just the centrality of affect but also affect ity, the mother appraises the nonverbal ex- regulation. pressions of her infant’s internal arousal and Despite his intense interest in the early on- affective states, regulates them, and communi- togeny of the self, over the course of his career cates them back to the infant. To accomplish Kohut never spelled out the precise develop- this, the primary caregiver must successfully mental details of his model nor did he attend modulate nonoptimal high or nonoptimal low to the significant advances in developmental levels of stimulation that would induce supra- psychology and psychoanalysis that were oc- heightened or extremely low levels of arousal curring simultaneously to his own theorizing. in the child. Secure attachment depends upon Schore: Self Psychology and Neuroscience 193 the mother’s sensitive psychobiological at- Self-Psychological Models tunement to the infant’s internal states of of Structuralization: Links to arousal. Interpersonal Neurobiology Importantly, research now clearly demon- strates that the primary caregiver is not al- A cardinal principle of self psychology dic- ways attuned and optimally mirroring, that tates that, as a result of optimal self–selfobject there are frequent moments of misattunement relational experiences, the infant becomes able in the dyad, ruptures of the attachment bond. to perform the drive-regulating, adaptive, and The disruption of attachment bonds leads to integrating functions that had previously been a regulatory failure and an impaired auto- performed by the external object. Kohut specif- nomic homeostasis. Studies of “interactive re- ically posited that phase-appropriate, maternal, pair” following dyadic misattunement (Tron- optimal frustrations of the infant elicit “trans- ick, 1989) support Kohut’s (1977) assertion muting internalization,” the developmental that the parental selfobject acts to “remedy process by which selfobject function is internal- the child’s homeostatic imbalance.” In this pat- ized by the infant and psychological regulatory tern of “disruption and repair” (Beebe & Lach- structures are formed. Developmental data are mann, 1994), the “good enough” caregiver who consonant with this, although interdisciplinary induces a stress response through misattune- data emphasize that not just optimal stressful ment in a timely fashion reinvokes a reattun- frustration but interactive repair is essential to ment, a regulation of the infant’s negatively the formation of a structural system that can charged arousal. regulate stressful affect. The formative experi- In current psychobiological models, attach- ences of the self are built out of internalized self- ment is defined as the interactive regulation object functions that facilitate the emergence of of states of biological synchronicity between more complex regulatory structures. and within organisms (Schore, 2000, 2003a, Recent research also support Kohut’s specu- 2005b). The dual regulatory processes of af- lation that the infant’s regulatory transactions fect synchrony that creates states of positive with the maternal selfobject allow for mainte- arousal and interactive repair that modulates nance of his homeostatic equilibrium. Accord- states of negative arousal are the fundamen- ing to Ovtscharoff and Braun (2001), “The tal building blocks of attachment and its asso- dyadic interaction between the newborn and ciated emotions. These interactive regulatory the mother...serves as a regulator of the de- mechanisms optimize the communication of veloping individual’s internal homeostasis. The emotional states within an intimate dyad and regulatory function of the newborn-mother in- represent the psychobiological underpinning teraction may be an essential promoter to en- of empathy, a phenomenon of intense inter- sure the normal development and maintenance est to self psychology. Kohut (1977) deduced of synaptic connections during the establish- that as a result of the empathic merger of the ment of functional brain circuits.” These re- child’s rudimentary psyche with the maternal searchers conclude that subtle emotion regulat- selfobject’s highly developed psychic organiza- ing attachment interactions permanently alter tion, the child experiences the feeling states of the brain by establishing and maintaining de- the selfobject as if they were his own. Selfob- veloping limbic circuits (Ziabreva et al., 2003). jects are thus external psychobiological regula- A large body of studies now clarifies the tors that facilitate the regulation of affective developmental neurobiology of the selfobject experiences, and they act at nonverbal lev- mechanism. In my own work I have sug- els beneath conscious awareness in the regu- gested that the self-organization of the devel- lation of self-esteem and the maintenance of oping brain occurs in the context of a rela- self-cohesiveness (Schore, 1994, 2002b). tionship with another self, another brain. More 194 Annals of the New York Academy of Sciences specifically, the self–selfobject relationship is critical period maturation of right brain systems embedded in infant–caregiver, right hemi- that process visual-facial, auditory-prosodic, sphere to right hemisphere, affective, attach- and tactile-gestural affective communications. ment communications (Schore, 1994, 2000, From infancy through all later stages of the life 2003a, 2005a). In light of the observations span, the right hemisphere is dominant for the that the emotion-processing human limbic sys- nonconscious reception, expression, and com- tem myelinates in the first year-and-a-half munication of emotion and the cognitive and (Kinney et al., 1988) and that the early- physiological components of emotional pro- maturing right hemisphere (Chiron et al., 1997; cessing (Schore, 2003a,b). With respect to em- Bogolepova & Malofeeva, 2001; Allman et al., pathy,a core process of self psychology,it is now 2005; Gupta et al., 2005; Sun et al., 2005)— thought that “self-awareness, empathy, identi- which is deeply connected into the limbic fication with others, and more generally in- system—is undergoing a growth spurt at this tersubjective processes, are largely dependent time, attachment experiences specifically im- upon...right hemisphere resources, which are pact limbic and cortical areas of the develop- the first to develop” (Decety & Chaminade, ing right cerebral hemisphere (Henry, 1993; 2003). Schore, 1994; Siegel, 1999; Cozolino, 2002). Furthermore, the “complex psychological In very recent work on mother–infant emo- regulatory structures” described by self psychol- tional communication Lenzi et al. (in press) ogy can now be located in “the right hemi- offer data from a functional magnetic reso- spheric specialization in regulating stress— nance imaging study “supporting the theory and emotion-related processes” (Sullivan & that the right hemisphere is more involved Dufresne, 2006). Indeed, the brain’s major self- than the left hemisphere in emotional pro- regulatory systems are located in the orbital cessing and thus, mothering.” Also confirm- prefrontal areas of the right hemisphere that ing this model Minagawa-Kawai et al. (2009) undergo an anatomical maturation in postnatal report a near-infrared spectroscopy study of periods of mammalian development (Bradshaw infant–mother attachment at 12 months and & Schore, 2007). The experience-dependent conclude, “our results are in agreement with maturation of this affect regulatory system is that of Schore (2000) who addressed the im- thus directly related to the origin of the self portance of the right hemisphere in the at- (Schore, 1994). Earlier research documented tachment system.” Supporting Kohut’s spec- that the development of the self and self- ulations on empathic mirroring, neuroscience awareness is reflected in the ability of 2-year- researchers now conclude that developing chil- olds to recognize their own visual image in a dren rely upon a “right hemisphere-mirroring mirror (Amsterdam, 1972). Functional mag- mechanism—interfacing with the limbic sys- netic resonance studies show tem that processes the meaning of observed or that when subjects look at an image of their imitated emotion” (Dapretto et al., 2006). own face, activation seen in occipito–temporo– Ongoing neurobiological research on the parietal junction and the right frontal opercu- mother–infant intersubjective dialogue indi- lum (Sugiura et al., 2005), and self-face recogni- cates, “A number of functions located within tion activates a frontoparietal “mirror” network the right hemisphere work together to aid mon- in the right hemisphere (Uddin et al., 2005). itoring of a baby. As well as emotion and face Indeed, a substantial amount of research processing the right hemisphere is also spe- indicates that the right hemisphere is spe- cialized in auditory perception, the perception cialized for generating self-awareness and of intonation, attention, and tactile informa- self-recognition, and for the processing of tion” (Bourne & Todd, 2004). Social experi- “self-related material” (Miller et al., 2001; ences thus facilitate the experience-dependent Decety & Chaminade, 2003; Fossati et al., 2004; Schore: Self Psychology and Neuroscience 195

Platek et al., 2004; Feinberg & Keenan, 2005; in the unique survival defenses for dealing with Perrin et al., 2005). Neuroscientists now suggest early relational trauma. Laub and Auerhahn that the essential function of the right lateral- (1993) propose that the essential experience ized system is to “maintain a coherent, con- of trauma is a disruption of the link between tinuous, and unified sense of self” (Devinsky, the “self” and the mothering “empathic other,” 2000). Summarizing this knowledge Molnar- and therefore the maternal introject, or moth- Szakacs and colleagues (2005) assert, “Studies ering (selfobject regulatory) function, is defi- have demonstrated a special contribution of the cient or “damaged.” They further contend “it right hemisphere (RH) in self-related cognition, is the nature of trauma to elude our knowledge own-body perception, self-awareness, autobio- because of both defence and deficit...trauma graphical memory and theory of mind. Many overwhelms and defeats our capacity to orga- studies of self-face recognition have also found nize it.” In line with these self-psychological a RH advantage, suggesting a special role for principles, current neuropsychoanalytic mod- the RH in processing material related to the els now posit that, under the impact of devel- self.” These data clearly indicate that self psy- opmental trauma, specific defensive and defec- chology is in essence a psychology of the unique tive regulatory structures develop that lie at the functions of the right brain. core of the patient’s psychopathology (Schore, 2002b). Psychoanalysis, psychiatry,and developmen- Self-Psychological Models tal traumatology are all now converging on of Psychopathogenesis: Negative dissociation, the bottom-line survival defense Impact of Attachment Trauma against overwhelming, unbearable, emotional on the Right Brain experiences. Longitudinal attachment research demonstrates an association between traumatic At the core of Kohut’s model of psy- childhood events and proneness to dissocia- chopathogenesis is the central hypothesis that tion, described as “detachment from an un- the mother’s traumatic failures of empathic bearable situation,” “the escape when there is mirroring lead to enduring defects in the in- no escape,” and “a last resort defensive strat- fant’s emerging self. Self psychology thus pro- egy” (Schore, 2003b, in press). Although Kohut poses that disturbed physiological regulation never used the term dissociation, in his last book results from primary disturbances in selfob- (1984) he characterized an early interaction in ject experiences and that a defective self and which the traumatized child “walls himself off” an impaired regulatory structure lie at the from traumatizing experiences: foundation of early forming psychopathologies. If the mother’s empathic ability has remained in- Kohut (1971) highlighted the importance of fantile, that is, if she tends to respond with panic “the role of specific environmental factors (the to the baby’s anxiety, then a deleterious chain will personality of the parents, for example; cer- be set into motion. She may chronically wall her- tain traumatic external events) in the genesis self off from the baby, thus depriving him of the beneficial effect of merging with her as she returns of the developmental arrest,” especially when from experiencing mild anxiety to calmness. Alter- “the mother’s responses are grossly unempathic natively,she may continue to respond with panic, in and unreliable...no transmuting internaliza- which case two negative consequences may ensue: tion can take place, and the psyche...does not the mother may lay the groundwork in the child for develop the various internal functions which a lifelong propensity toward the uncurbed spread- re-establish narcissistic equilibrium.” ing of anxiety or other emotions, or by forcing the child to wall himself off from such an overly intense Although there is a long history of contro- and thus traumatizing [experience, she] may foster versy within psychoanalysis, the field is now in the child an impoverished psychic organization, very interested in the problem of trauma and the psychic organization of a person who will later 196 Annals of the New York Academy of Sciences

be unable to be empathic himself, to experience a source of threat, triggering a startle reaction human experiences, in essence, to be fully human. in the infant’s right hemisphere, the locus of What can ongoing studies in developmen- both the attachment and the fear motivational tal psychology, , and neu- systems. The maternal stressor activates the ropsychoanalysis tell us about the neurobiology hypothalamic–pituitary–adrenal (HPA) stress and of attachment-relational axis, eliciting a sudden increase of the energy- trauma and about dissociation, the mechanism expending sympathetic component of the in- by which humans “wall themselves off” from fant’s autonomic nervous system (ANS); this re- overwhelming emotional trauma? In this last sults in significantly elevated heart rate, blood section I discuss interdisciplinary studies, which pressure, and respiration, the somatic expres- indicate that experiences with a traumatizing sions of a dysregulated psychobiological state caregiver negatively impact the child’s attach- of fear–terror. This active state of sympathetic ment security,right brain maturation, and sense hyperarousal is expressed in increased secre- of self and thereby lay the groundwork for tion of corticotropin releasing factor (CRF)— the use of pathological dissociation in various the brain’s major stress hormone. CRF regu- self-pathologies. lates sympathetic catecholamine activity, creat- ing a hypermetabolic state in the developing Developmental Psychobiology brain. of Relational Trauma But a second later forming reaction to re- lational trauma is dissociation in which the During the brain growth spurt, rela- child disengages from stimuli in the exter- tional, trauma-induced, arousal dysregulation nal world—traumatized infants are observed precludes the aforementioned visual-facial, to be “staring off into space with a glazed auditory-prosodic, and tactile-gestural attach- look.” This parasympathetic dominant state ment communications and alters the develop- of conservation withdrawal occurs in helpless ment of essential right brain functions. In con- and hopeless stressful situations in which the trast to an optimal attachment scenario, in a individual becomes inhibited and strives to growth-inhibiting relational environment the avoid attention in order to become “unseen.” primary caregiver induces traumatic states of The dissociative metabolic shutdown state is enduring negative affective arousal in the child. a primary regulatory process by which the This caregiver is inaccessible and reacts to her stressed individual passively disengages in or- infant’s expressions of emotions and stress in- der to conserve energies, fosters survival by appropriately and/or rejectingly and therefore the risky posture of feigning death, and al- shows minimal or unpredictable participation lows restitution of depleted resources by im- in the various types of arousal-regulating pro- mobility. In this hypometabolic state, heart cesses. Instead of modulating, she induces ex- rate, blood pressure, and respiration are de- treme levels of stimulation and arousal, very creased while pain-numbing and pain-blunting high in abuse and/or very low in neglect. And endogenous opiates are elevated. This energy- because she provides no interactive repair, the conserving parasympathetic (vagal) mecha- infant’s intense negative-affective states last for nism mediates the “profound detachment” of long periods of time. dissociation. Studies in developmental traumatology re- In fact there are two parasympathetic va- veal that the infant’s psychobiological reaction gal systems in the brainstem medulla (Porges, to trauma comprises two separate response pat- 1997). The ventral vagal complex rapidly terns: hyperarousal and dissociation (Schore, regulates cardiac output to foster fluid en- 2001, 2002c). In the initial hyperarousal stage, gagement and disengagement with the social the maternal haven of safety suddenly becomes environment, aspects of a secure attachment Schore: Self Psychology and Neuroscience 197 bond of emotional communication. On the Right Brain Pathological Dissociation other hand, activity of the dorsal vagal com- and Self-Psychological Deficits plex is associated with intense emotional states and immobilization and is responsible for the Workers in the field of developmental trau- severe metabolic depression, hypoarousal, and matology now assert that the overwhelming pain blunting of dissociation. The traumatized stress of maltreatment in childhood is associ- infant’s sudden state switch from sympathetic ated with adverse influences on not just be- hyperarousal into parasympathetic dissociation havior but also on brain development (de is described by Porges (1997) as “the sud- Bellis et al., 1999). During the intergenera- den and rapid transition from an unsuccessful tional transmission of attachment trauma, the strategy of struggling requiring massive sympa- infant is matching the rhythmic structures of the thetic activation to the metabolically conserva- mother’s dysregulated arousal states. This syn- tive immobilized state mimicking death associ- chronization is registered in the firing patterns ated with the dorsal vagal complex.” Whereas of the stress-sensitive corticolimbic regions of the ventral vagal complex exhibits rapid and the right brain, dominant for coping with neg- transitory activations, the dorsal vagal nucleus ative affects (Davidson et al., 1990). Describing exhibits an involuntary and prolonged pat- the essential survival functions of this lateral- tern of vagal outflow, creating lengthy “void” ized system, Schutz (2005) notes “The right states associated with pathological dissociative hemisphere operates a distributed network for detachment. rapid responding to danger and other urgent How are the dual traumatic contexts of problems. It preferentially processes environ- hyperarousal and dissociative hypoarousal ex- mental challenge, stress and pain and manages pressed behaviorally within the mother–infant self-protective responses such as avoidance and dyad? Observational research demonstrates a escape.” The right brain is fundamentally in- link between frightening maternal behavior, volved in an avoidant-defensive mechanism for dissociation, and disorganized infant attach- coping with emotional stress, including the pas- ment (Schuengel, Bakersmans-Kranenburg, & sive survival strategy of dissociation. Van IJzendoorn, 1999). Hesse and Main (1999) Current neurobiological data can be used to observe the mother’s frightening behavior: “in create models of the mechanism by which at- non-play contexts, stiff-legged ‘stalking’ of in- tachment trauma negatively impacts the right fant on all fours in a hunting posture; expo- brain. Adamec and colleagues (2003) report sure of canine tooth accompanied by hissing; experimental data that “implicate neuroplas- deep growls directed at infant.” In recent work, ticity in right hemispheric limbic circuitry in Hesse and Main (2006) document that a fear mediating long-lasting changes in negative af- alarm is triggered in the infant when the mother fect following brief but severe stress.” Accord- enters a dissociative freeze state: “Here the ing to Gadea et al. (2005) mild to moder- parent appears to have become completely un- ate negative affective experiences activate the responsive to, or even aware of, the external right hemisphere, but an intense experience surround, including the physical and verbal “might interfere with right hemisphere pro- behavior of their infant...[W]e observed one cessing, with eventual damage if some criti- mother who remained seated in an immobi- cal point is reached.” This damage is specifi- lized and uncomfortable position with her hand cally hyperarousal-induced apoptotic cell death in the air, blankly staring into space for 50 sec.” in the hypermetabolic right brain. Thus, via Note the intergenerational transmission of not a switch into a hypoarousal, a hypometabolic only relational trauma but the bottom-line de- state allows for cell survival at times of intense fense against traumatic emotional experiences, excitotoxic stress (Schore, 1997b, 2001, 2002c, dissociation. 2003b). 198 Annals of the New York Academy of Sciences

Recall that right cortical areas and their con- emotion-processing limbic regions as well as nections with right subcortical structures are with subcortical areas that generate both the in a critical period of growth during early hu- arousal and autonomic bodily based aspect of man development. The massive psychobiolog- emotions. Sympathetic nervous system activity ical stress associated with attachment trauma is manifest in tight engagement with the exter- sets the stage for the characterological use of nal environment and high level of energy mobi- right brain pathological dissociation when en- lization, while the parasympathetic component countering later stressors. Converging evidence drives disengagement from the external envi- indicates that early abuse negatively impacts ronment and uses low levels of internal energy maturation, producing enduring (Recordati, 2003). These ANS components are neurobiological alterations that underlie affec- uncoupled in relational trauma. tive instability,inefficient stress tolerance, mem- In a recent psychoanalytic formulation that ory impairment, and dissociative disturbances. echoes Kohut’s “uncurbed spreading of anxi- In this manner, traumatic stress in childhood ety or other emotions,” Bromberg (2006) links leads to self-modulation of painful affect by di- right brain trauma to autonomic hyperarousal, recting attention away from internal emotional “a chaotic and terrifying flooding of affect that states (Lane et al., 1997). The right brain, dom- can threaten to overwhelm sanity and imperil inant for attention (Raz, 2004) and pain pro- psychological survival.” Dissociation is then au- cessing (Symonds et al., 2006), thus generates tomatically and immediately triggered as the dissociation, a defense by which intense nega- fundamental defense to the arousal dysregula- tive affects associated with emotional pain are tion of overwhelming affective states. And in blocked from consciousness. the psychiatric literature, Nijenhuis (2000) as- Congruent with developmental and clinical serts that “somatoform dissociation” is an out- models, Spitzer et al. (2004) report a transcra- come of early onset traumatization expressed nial magnetic stimulation study of adults and as a lack of integration of sensorimotor expe- conclude, “In dissociation-prone individuals, riences, reactions, and functions of the indi- a trauma that is perceived and processed by vidual’s self-representation. Dissociatively de- the right hemisphere will lead to a ‘disrup- tached individuals are not only detached from tion in the usually integrated functions of con- the environment but also from the self—their sciousness.’” In functional magnetic resonance body, their actions, and their sense of iden- imaging research, Lanius et al. (2005) show tity (Allen, Console, & Lewis, 1999). Crucian predominantly right hemispheric activation in et al. (2000) describe “a dissociation between psychiatric patients while they are dissociating the emotional evaluation of an event and the and conclude that dissociation, an escape from physiological reaction to that event, with the the overwhelming emotions associated with the process being dependent on intact right hemi- traumatic memory,can be interpreted as repre- sphere function.” senting a nonverbal response to the traumatic Pathological dissociation thus reflects the memory. chronic disintegration of a right brain system These studies explore the evolution of a and a resultant adaptive failure of its capac- developmentally impaired regulatory system ity to rapidly and nonconsciously detect, pro- and provide evidence that prefrontal corti- cess, and cope with unbearable emotional in- cal and limbic areas of the right hemisphere formation and overwhelming survival threat. are centrally involved in the deficits in mind A poorly developed right cortical–subcortical and body that are associated with a patho- implicit self-system is inefficient at recognizing logical dissociative response (Schore, 2002c, in and processing external stimuli (exteroceptive press). This right hemisphere, more so than the information coming from the relational envi- left, is densely reciprocally interconnected with ronment) and on a moment-to-moment basis Schore: Self Psychology and Neuroscience 199 integrating them with internal stimuli (intero- be fully human.” The self-depleting structure- ceptive information from the body). This too altering cost of characterological dissociation is frequent failure of integration of the higher thus a central psychopathogenetic concept of right hemisphere with the lower right brain both self psychology and neuroscience. induces an instant collapse of both subjectiv- A central tenet of Kohut’s model of psy- ity and intersubjectivity, even at lower levels of chopathogenesis is that the long-term effects interpersonal stress. of chronic maternal failure to provide growth- In summary, the developing brain imprints facilitating selfobject regulatory functions is the not only the overwhelming affective states that genesis of a “developmental arrest.” Recall are at the core of attachment trauma but the self-psychological proposal that, because of also the primitive defense used against these early trauma, the developing selfobject regula- affects—the regulatory strategy of dissociation. tory function is deficient or “damaged.” This It is now established that maternal care in- development impairment can now be identified fluences both the infant’s reactivity (Menard, as a maturational failure of the right brain af- Champagne, & Meaney, 2004) and the trans- fect regulatory system. A large body of clinical mission of individual differences in defensive observations and psychiatric research strongly responses (Parent et al., 2005). A large body suggests that the most significant consequence of psychiatric, psychological, and neurologi- of early relational trauma is the child’s failure cal studies supports the link between child- to develop the capacity to self-regulate the in- hood trauma and pathological dissociation tensity and duration of emotional states. The (e.g., Draijer & Langeland, 1999; Macfie, principle that maltreatment in childhood is as- Cicchetti, & Toth, 2001; Merckelbach & Muris, sociated with adverse influences on brain de- 2001; Dikel, Fennell, & Gilmore, 2003; Liotti, velopment specifically refers to an impairment 2004). of a higher circuit of emotion regulation on the right side of the brain. At the beginning of this chapter I stated that Conclusion: Rapprochement a central area of inquiry of Kohut’s psycho- between Psychoanalysis analytic theory was the problem of how the and Neuroscience therapeutic relationship scaffolds the “restora- tion of self.” Early relational trauma and the Researchers now conclude that, because of characterological use of the right brain strategy dissociation, elements of a trauma are not in- of pathological dissociation are common ele- tegrated into a unitary whole or an integrated ments of the histories of severe self-pathologies sense of self (Van der Kolk et al., 1996). The of personality disorders, a clinical population of symptomatology of pathological dissociation, increasing interest to self psychology and psy- or what Kohut described as “walling one- chotherapists in general. A large multicenter self off” from intense, traumatizing experience, study of adult patients with a history of early thus represents a structural impairment and de- childhood trauma reports that psychotherapy ficiency of the right brain, the locus of a “cor- is an essential element of the treatment of such poreal image of self” (Devinsky, 2000), affective cases and indeed is superior to pharmacother- empathy (Schore, 1994; Decety & Chaminade, apy as an effective intervention (Nemeroff et al., 2003), and a “sense of humanness” (Mendez 2003). & Lim, 2004). Recall Kohut’s speculation that Any psychotherapeutic intervention with early trauma acts as a growth-inhibiting envi- these patients must treat not only traumatic ronment for the developing self, one which gen- symptoms but also the dissociative defense erates “an impoverished psychic organization,” (Bromberg, 2006). Spitzer et al.’s (2007) re- a deficit in being empathic, and an inability “to search shows that higher levels of dissociation 200 Annals of the New York Academy of Sciences predict poorer outcome in patients in psycho- early forming self-psychopathologies. This in- dynamic psychotherapy. These authors con- formation may, in turn, generate more effec- clude dissociative patients have an insecure tive models of early intervention during the attachment pattern negatively affecting the brain growth spurt and thereby contribute to therapeutic relationship and that they dissoci- the prevention of a broad range of psychiatric ate as a response to negative emotions arising disorders. in psychotherapy. Clinical authors now suggest that the treatment of traumatic dissociation is Conflicts of Interest essential to effective psychotherapy with these patients (Spiegel, 2006; Schore, 2007). The author declares no conflicts of interest. 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