As you can see from the comments to my last post about attachment theory and the origins of shame, many people are struggling with the idea of lasting neurological damage as the result of failures in early attachment. This is a difficult truth to accept, but we’re talking about scientifically verifiable changes in the brain that result from different experiences during the first two years of life. I have no problem with people hoping that science will eventually figure out how to repair that damage; I can’t argue with religious faith when people believe that their God will do the same. But while we are waiting, full of hope and faith, we must try to make the best use of what we know. Contrary to what one of the comments suggested, facing the truth does not lead to a sense of hopelessness and despair about changing. Rather, it allows us to be realistic in our expectations and to work for attainable change, rather than hoping for salvation from science or God. I would suggest it is the hope for a “complete cure” (instead of facing the truth) than undermines the hard work of psychotherapy.
In an earlier post about the tenacity of defenses, I discussed how our defense mechanisms are mental habits of coping etched in our neural pathways. I’m not a neurologist and my ability to describe the science is limited, but based upon the work of Allan Schore and others, I think we can now expand on this idea. When there are early failures of attachment and the infant doesn’t learn to manage its own emotional experience, it instead makes use of psychological defenses to ward it off; such defenses are built into the structure of the brain as it develops. When an adult comes into my office — a person who relies heavily on denial, his neuro-anatomy has developed in a way — an abnormal way — that reflects the use of that defense. If someone else resorts to splitting and projection, her neuro-anatomy will have developed differently. These defensive strategies are inherent in the very structure of the brain as it developed.
As always, I find the analogy to physical handicaps to be useful. If someone suffered from poliomyelitis during infancy, incurring damage to his motor neurons, he may live with some kind of partial paralysis for life — to a leg or an arm, for example. One of my professors in college had suffered from polio as a child and his right arm was partially paralyzed. Did this invalidate his entire life? Did this mean he could undertake no meaningful endeavor or strive to change in other areas? Of course not. He was a highly educated man with a degree from Oxford; he is currently a Distinguished Professor with many awards, revered by his students. When he wrote on the chalkboard, he supported his right arm with his left hand at the elbow.
Likewise, having an altered brain anatomy (brain damage) as a result of early failures in attachment doesn’t invalidate one’s entire life. It’s no cause for despair. What it does mean is that you will have to take that damage into account. My professor didn’t choose to become a professional pianist or an athlete who’d need powerful arms, for instance. It means you will have to take your damage into account when making an effort. My professor had to support his right arm with his left; he couldn’t have written on the chalkboard otherwise. He didn’t give up on life simply because polio had killed off many of the motor neurons controlling his right arm. He faced his limitations, took them into account and went onto to achieve quite a lot during his lifetime.
Likewise, recognizing that your defense mechanisms are structured into your brain’s neuro-anatomy is not a death sentence, but it means you will have to take that fact into account throughout your life. These neurological changes represent an in-built propensity, a way your brain has evolved as a response to early emotional deprivation in order to compensate for it. This doesn’t mean you will never change in meaningful ways; what it does mean is that no psychiatric medications and no amount of therapy will transform you into a person who didn’t have that early experience, who grew up in an optimal environment. At the risk of speaking beyond my level of neurological understanding, I would say that you can always make new neural interconnections. You can strengthen certain neural pathways and gradually de-emphasize others. Real and important growth is possible.
In my experience, many people enter therapy longing to become an entirely different person, an ideal new self meant to disprove the shame they feel and the felt-knowledge of their damage. Part of the early work in therapy often involves challenging those expectations because the client wants to jump past the damage and suddenly become somebody new. If you challenge this wish too soon or too roughly, without respect for the person’s shame, it can easily provoke angry feelings and sometimes drive people out of treatment. Most people give up on the prospect of an ideal new self only slowly and reluctantly; they often believe there are only two options — the “new and improved” me or the irreparably damaged, shame-ridden, worthless me. At first, clients have little idea about what it means to work within their limitations; they also fear that accepting the reality of lasting damage means they are completed fucked up losers who will never change. Helping them find a middle ground where they can accept their damage and make realistic efforts to grow is difficult.
I have a powerful belief in the reality of change — not based on hope or faith but upon experience. I’ve worked with people suffering from severe borderline personality disorder, incapable of thinking and bearing their emotional experience, self-cutters and drug abusers who went on to develop minds, get married and sometimes have children. It took YEARS AND YEARS of hard work. To this day, they bear the scars of their early upbringing. They are not entirely different people, but ones who try to respect the ways in which they are damaged and therefore limited, who avoid certain experiences they find too challenging and try hard to take very good care of themselves so they can do their best. We accomplished this change without the use of drugs or hospitalizations.
In the next post, I’ll discuss what I believe are the conditions necessary for such change, and how genuine and meaningful growth occurs in psychodynamic psychotherapy, despite failures of early attachment and lasting neurological damage.