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.
Congrats to your son. Your article was very helpful to me. I don’t know much about my first two years, but I know that my mother was a very troubled person and from reports I have read that she abandoned me on and off the first 2 years of my life. There were even more abandonments until age 5, when she dissappeared for good.
I now believe that this did do damage to me and I have been diagnosed with BPD by the Center for Addiction and Mental Health in Toronto, CAnada.
I know I have limitations with stress.
It does help to know that there was damage done and not just emotional but to my brain.
Thanks, Sonjia. As I’ll discuss in the next post, that damage doesn’t mean real growth and meaningful change are unattainable.
I do think we need to keep looking for better ways.
My feeling is that the analogy with physical disability isn’t exact. Learning shapes our brain so the damage may not be permanent. I do think there are permanent types of brain damage – I just don’t want to conclude this is true about a particular individual. (Which I think you don’t want to do either.)
I do think ideals are a problem. I also think accepting ourselves (with all our possibilities and limitations) is the way to a better life.
Me, too.
I was completely overwhelmed with gratefulness in reading this column. FINALLY someone in our field has explained in a cogent and empathic way the realistic expectations of what both the patient and therapist can hope to achieve in dealing with the type of early childhood damage that you are describing . As a believer in the grace of God , I am also a believer in accepting and embracing reality . These two concepts are not in opposition to each other, but but in fact one of those “both/and” situations as opposed to an ” either/ or” approach . We can understand the years of hard work that it will take to even begin to heal this damage , come to accept the reality of the situation ( your analogy of the brilliant professor supporting his right elbow with his left hand as he wrote ) , let go of the “victim” stance , and have the persistence to never give up HOPE. And as you suggested , look for alternative ways to develop previously hidden STRENGTHS .
This hard work can lead to a person developing CHARACTER that serves him well in becoming more resilient when faced with the slings and arrows of ordinary life. And an appreciation in the long run that this early childhood challenge has given him an opportunity to develop in ways that those who had an “easier” childhood might never truly be able to understand or appreciate. Thus we as clinicians are so blessed to be able to assist by being the containers of both hope and encouragement .
Regardless of our spiritual or non spiritual beliefs, it is true that when both patient and healer believe in change, wonderful things can happen . Thank you so much for explaining the difference between the commonly stated belief among clinicians that “nothing can ever really help a person with serious childhood damage to truly lead a normal life” with “there will always be some permanent neurological damage , but new pathways can be created which may eventually help to temper the disordered parts and allow for a meaningful and productive and love filled life” : if a person has the belief, support and determination necessary for the hard work !!
Thanks, Penny. As much as I emphasize lasting damage, I really do believe in meaningful change that can lead to a dramatically different life.
Penny, your words, “This hard work can lead to a person developing CHARACTER that serves him well in becoming more resilient when faced with the slings and arrows of ordinary life.”, are a critical growth goal and that strongly resonates with me relative to forging toward, as Joseph shared, “a meaningful and productive and love filled lifeâ€.
Thank you to both of you, Joseph and Penny, for you comments. They have helped me.
It is precisely through acceptance of ones limitations that true growth occurs. We stop deluding ourselves of an ideal self, instead we come to a grounding of who we really are. This place, though uncomfortable at first, provides serenity and peace; we are no longer in conflict with self but have found a place of compassion, self-awareness and love.
At this point, our ideal self that we envisaged no longer seems ideal. We become guided by our internal signals and follow patiently our desires. Ironically, the change we longed for begins to occur but change is no longer our preoccupation.
I completely agree with your whole article. Might I suggest if you have not already done so read the book The Brain That Changes Itself by Norman Doidge. It details case studies of people with brain damage of varying kinds and how through environmental changes they positively altered their neural pathways. I believe as psychology continues to further integrate Eastern philosophies of acceptance into therapy, we will begin to see collective great shifts towards physical brain changes.
Thanks, I’ll look for that book. The problem I find with the way so much of Eastern philosophy has been integrated so far is that it uses the language of acceptance but doesn’t really accept the inevitability of certain emotions. Instead, it promotes “acceptance” as a way to transcend those feelings.
I agree with how it has been integrated so far. Acceptance can be viewed as a means of transcending (or denying) an emotion rather than truly integrating it into one’s experience. However, true acceptance is not a means of escapism, but rather, of a complete acknowledgement of of our humanness to fully experience the gamut of human emotions. I believe that many who advocate acceptance do not fully understand what it entails; as you say, they use it to “transcend” often painful feelings. The art of acceptance is in your ability to embrace your entire being; including your pleasure and pain. As you come to do this, the truth about who you are including repressed feelings arise as Svami Prajnanpad puts:
Though there are quite a few psychotherapies now offering “acceptance” as a tool for mental duress; I do find also that they have diluted the intent of Eastern philosophies.
Can experience witha particularly empathic and well balanced therapist reverse this? .I clearly made attachments to extended family members but not to a mother sent from India to Boarding school at 5yeays.My birth was a brutal affair with anaethesia,forcepts and no maternal bonding,in fact a fear and revulsion of mytrue mum.But having a nanny and family filled a gap I believe in my babyhood..Thru life I have unwittingly sought a relationship where I suckled from a girl friend, over years at a boarding school,and that seemed to sustain my hold on reality.However adults put me in the “lesbian”category,which I am not.The experiences in therapy,has taken me to womb fantasies and oral urges.And now the most intense attachment, which belies my adult wishes, with the therapist and on her departure for holidays, the love and loss is so great, I feel as if a heart attack is pending.Once through this monstrous physical and emotional pain, I feel relief, and my feelings for therapist are more easy and there is no pressure.I am thankful that the therapist holds her part with love an’strenght and for me, clarity, or else I would likely die.(I feel.)I would value any comment.I feel as if nature demands I meet that early need.With very much thanks for your site philippa
Yes, in fact, I think that experience with/attachment to a truly empathic therapist is (from my experience) the pre-condition for growth and change. I’ll be talking about it in my next post, the third discussing Schore’s video. It sounds to me as if your therapy has taken you to the place you need to go — where you feel as if you’re a baby and mommy will never come back over the holiday break. With time, as your therapist goes away and comes back again — over and over — you should develop a sense of trust and safety that she’ll return. In attaching to her the way you have, you have the conditions you need to grow. I don’t believe in “reversing” the damage, however. I don’t think that’s possible, not entirely. But you can definitely grow and develop in important ways and at the same time, adapt and take into account the ways in which your infancy shaped you.
This was nice to read because really, I don’t think anyone else is blogging about these topics. Your blog is helpful to me because I am at a place in my therapy where I am learning to work around my “brain defects” and still be a productive and thriving (as best as I can be given my background) individual. Part of my cognitive deficit is struggling to believe anything my therapist tells me about my talents, or what she tells me about my abilities to work around the negative self-talk…then I read something like this post above from a neutral person whom I don’t know, and it helps me piece it all together in a more meaningful way.
Thanks, this was quite informative and as a disabled person, brought me some hope. Thank
you I needed this.
You may want to look at the work of Dr. Diana Foscia on her theory of Accelerated Experiential Dynamic Psychotherapy (AEDP). Much of her work focuses on core effect and changing those neural pathways. Just a thought!!
Thanks for the tip — I’ll check it out.
It’s Dr. Diana Fosha. My therapist has taken some of her courses.
I really love your blog. I hope you don’t mind my numerous postings.
“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.”
“…they often believe there are only two options — the ‘new and improved’ me or the irreparably damaged, shame-ridden, worthless me..they also fear that accepting the reality of lasting damage means they are completed fucked up losers who will never change.”
I can’t begin to tell you how dead spot-on these observations are.
Well, I’m sorry to hear that it rings so true (I know how painful that feels) but I’m glad you feel understood!
Well I find myself here after initially being told I have emotionally unstable (borderline) tendencies and now only a matter of hours ago I was told narcissistic.. Although not a confirmed diagnoses.
Maybe I hiding in this safe-ish haven where at least there is some intelligence and maybe some form of understanding as to why I find myself at 21 with such difficulties. The internet is a horrific place with some very true and harrowing storys confirming my selfish, manipulative, oversensitive behaviours, followed then by the shame and guilt of what I have dragged family/friends through.
Do I really feel no empathy?
I am receiving CAT therapy, and my therapist seems like a really decent dude.
Thankyou for distilling some hope within me.
I think all of these issues exist along a spectrum. You might be capable of empathy but still struggle with the emotional conflicts you describe. You’re not a diagnostic category.
Dear Mr. Burgo,
thanks for this post and for your excellent website, which I discovered just now.
I was recently diagnosed with BPD and have been reading a lot about it in the last couple of months. One thing I find very hard is relationships. I have a two-year old son and it has been very hard with my girlfriend, a lot of fights, a lot of idealization and devaluation on my side. On the other hand, my biggest wish is to be there for my son and support him and provide him with everything he needs. And ultimately I’d really like to have a functioning relationship with my (now ex-)girlfriend. Or at least another functioning long term relationship.
I have the impression that at the core of my being (or at least my problems and the whole BPD defense mechanism stuff) there’s a huge abandonment feeling, which feels terribly old, like really primal and haunting in a way. I’m doing a schema group therapy at the moment and just recently “worked” with this part of me, or better with the part that is defending me against these feelings of total loneliness (which really seem to come from my early attachment to my mother). This was pretty intense but also encouraging in a way, although i still can’t quite grasp it.
Anyway: I struggle a lot with this abandonment (or “fear of abandonment”) feeling. I simply can’t stand being alone. I come home, turn on the computer, connect to facebook, when I had a fight with my ex-girlfriend I would instantly turn to a dating site to look for a “better” partner, sometimes when I’m alone I get this really bad feeling of not-being-there, of being cut off from everything and of total hopelessness. Maybe I felt like this as a baby?
I just wanted to ask you if you have any advice for me. My therapist told me to really connect to that tiny vulnerable part and to “reparent” it in a way, to get a talisman or symbol for this small baby or child and carry it with me.
I also read a lot about TFP and older psychoanalytic approaches. Do you think it’s really possible to “resolve” these deep abandonment issues? Does TFP deal with that?
Thanks a lot in advance,
M.