Broken Babies:  What Happens When Mothers Can’t Play

This book is eating me up alive so that we can spit each other out together.

postnotes schore/ar attachment

copied from his chapter four

“The dual regulatory processes of affect synchrony that creates states of positive arousal and interactive repair that modulates states of negative arousal are the fundamental building blocks of attachment and its associated emotions.  They also allow for the maximization of the communication of emotional states within an intimate dyad, and represents the psychobiological underpinning of empathy …. (schore/ar/115)”

This would be true for any relationship where there is mutual “valuing” of one another and of the relationship itself —

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“Through the mechanism of the dyadic regulation of emotion, the baby becomes attached to the resulting caregiver who expands opportunities for positive and minimizes negative affective states. (schore/ar/116)”

At what age?  Around a year old?  Isn’t every interaction before that age part of a pre-attachment phase?

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(Lichtenberg,Lathmann, & Fosshage 1992, p. 162)  “Regulation of state lies at the heart of our theory.  In infancy … success in regulating smoothness of transitions between states is a principal indicatory of the organization and stability of the emergent and core self as well as caregiver success”  (add more quote marks as this is all quoted in schore/ar/116)

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from chap 4 in schore ar

PSCYOPATHOGENESIS:  THE NEUROBIOLOGY AND SELF PSYCHOLOGY OF EARLY RELATIONAL TRAUMA

p. 122 –

SECURE ATTACHMENT

“It is important to stress that the developmental attainment of an efficient self-system that can adaptively regulate various forms of arousal and psychobiological states – and thereby affect, cognition, and behavior – only evolves in a growth-facilitating emotional environment. The good-enough mother of the securely attached infant permits access to the child after a separation and shows a tendency to respond appropriately and promptly to his/her emotional expressions.  She also allows for the interactive generation of high levels of positive affect in shared play states.  These regulated events promote an expansion of the child’s coping capacities, and thus security of the attachment bond is the primary defense against trauma-induced psychopathology.  (schore/ar/122)”

INSECURE ATTACHMENT — TRAUMA

“In contrast to this scenario, the abusive mother not only shows less play with her infant [or certainly none at all!!] she also induces long-lasting traumatic states of negative affect in the child.  Because her attachment is weak, she provides little protection against other potential abusers of the infant, such as the father.  Affective communications, so central to the attachment dynamic, are distorted in the abused/neglected caregiver-infant relationship (Gaensbauer & Sands, 1979).  This caregiver is inaccessible and reacts to her infant’s expressions of emotions and stress inappropriately and/or rejectingly, [or with rage and very painfully]and therefore shows minimal or unpredictable participation in the various types of arousal-regulating processes.  Instead of modulating she induces extreme levels of stimulation and arousal, very high in abuse, and very low in neglect.  The enduring detrimental effects of parent-inflicted traumatic abuse and neglect on the attachment bond is now well established:  “The continued survival of the child is felt to be at risk, because the actuality of the abuse jeopardizes [the] primary object bond and challenges the child’s capacity to trust and, therefore, to securely depend (Davies & Frawley, 1994, p. 62).  Thus, “the essential experience of trauma  [is] (schore/ar/122) an unraveling of the relationship [in my case, there was NO relationship there to begin with!] between self and nurturing other, the very fabric of psychic life: )Laub & Auerhahn, 1993, p. 287).  In contexts of relational trauma the caregiver(s), in addition to dysregulating the infant, withdraw any selfobject interactive repair functions, leaving the infant for long periods in an intensely disruptive psychobiological state that is beyond her immature coping strategies.  (schore/ar/123)”

“Lachmann and Beebe (1997) pointed out that an event becomes traumatic when it ruptures the individual’s selfobject tie, without opportunity for repair, thereby dramatically altering his/her self-state.  [I would think this alone would create great degrees of despair!] Similarly, Mollon emphasized, “It is the non-availability of caregivers who can provide empathy and soothing [this makes me think of what Jon Allen said about adult abusive relationships and seeking soothing from the abuser] which means the child abused within the family must resort to pathological forms of internal escape …. [W]ithout this soothing by reliable and consistent caregivers, the traumatized child is unable to regulate his or her mental state and restore emotional equilibrium” (2001, p. 212). [What age child is Mollon talking about?] (schore/ar/123).”

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1-6-7

It is only now as I begin to realize that I have damage to my ANS that I am beginning to get mad.  I would have thought just the suspicion that I’ve had all along during this research that my brain was damaged would have been enough to upset me.  But, no, it is now at the point where I am finding out that I never had any “homeostatic equilibrium” in the first place, and that the constant peritrauma of infant abuse kept my entire nervous system in a state of terror and hyperarousal so that I am only now, at age 55, realizing that I have to learn what “normal” is beyond any of my wildest thoughts – what is normal equilibrium?  What is a “state of balance,” a “state of rest?”  That is because I have never felt SAFE!!!

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IMPORTANT

“In studies of a neglect paradigm, Tronick and Weinberg described:  “When infants are not in homeostatic balance or are emotionally dysregulated (e.g. they are distressed), they are at the mercy of these states [and we still are!].  Until these states are brought under control, infants must devote all their regulatory resources to reorganizing them.  While infants are doing that, they can do nothing else:  (1997, p. 56).  The “nothing else” these authors referred to is a failure to continue to develop.  Traumatized infants forfeit potential opportunities for socioemotional learning during critical periods of right brain development (Schore, 2001b, 2002c). in (schore/ar/123)”

Gee, why do I think this information might possibly upset me?

“It should be noted that recent National Child Abuse and Neglect statistics (2000) reported that the highest victimization rate occurs in children aged 0 – 3, and that over half of fatalities due to maltreatment occur in this age group. [And what about all the invisible abuse???]  …attachment theory can offer…important information about the origins of severe self-psychological deficits.  (schore/ar/123).”

“Indeed in classic research, Main and Solomon (1986) studied the attachment patterns of infants who had suffered trauma in the first year of life.  This led to the discovery of a new attachment category, “type D,” an insecure-disorganized/disoriented pattern, one found in 80% of maltreated infants (Carlson, Cicchetti, Barnett, & Braunwald, 1989).  These authors contended that such infants are experiencing low stress tolerance and that their disorganization and disorientation reflect the fact that the infant, instead of finding a haven of safety in the relationship, is alarmed by the parent.  They noted that because the infant inevitably seeks the parent when alarmed, any parental behavior that directly alarms an infant should [what does this really mean, should?  Either it does or it doesn’t, or they don’t really even have a clue!  Is this a guess on their part?  I, for one, would like to  know.] place it in an irresolvable para- (schore.ar.123) dox in which it can neither approach, shift its attention, nor flee.  [What does this do to the ANS?] At the most basic level, theseinfants are unable to generate a coherent behavioral coping strategy to deal with this emotional challenge (see Schore, 2001c, 2002c, 2003 for a detailed description of the developmental and neuro-sychoanalysis of the disorganized/disoriented attachment).  (schore/ar/124)”

++++ now I am putting what is next over in ANS schore

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“As opposed to the interactive scenario of a secure attachment in which the caregiver contingently responds to the child’s projective identifications, the insecurely attached child is often unable to induce affect-regulating responses and engage in empathic mutual regulatory processes because the other is not sufficiently attuned to the child’s state and therefore unable to receive the infant’s emotional communications (lots of reg to score’s work here).  This prevents the establishment of a dyadic system in which the infant can safely project “valued” parts of the self into the mother (i.e., aspects of adaptive projective identification).  The insecurely attached organizations of developmental personality disorders thus have a greater tendency to use defensive rather than adaptive projective identification.  Doucet wrote, “I consider that projective identification works in two ways:  a normal way, in which the analyst-mother takes into herself a part of the patient-child’s emotional identity in order to return it to him in a detoxified and hence assimilable form, and a pathological way in which the negative aspects are so plentiful that projective identification operates to excess” (1992, p 657).  (Schore/ar/66)”

Does that mean, then, that any time an infant experiences a negative affect and then expresses it, that it is “giving” it or “projecting” it outward so that someone will return it to him in a detoxified and hence assimilable form?

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“The right hemisphere is specifically impacted by early attachment experiences – in fact, these object relational affect-communicating experiences facilitate its maturation (Henry, 1993; Schore, 1994, 1996, 1998a, 1998b, 2000a, 2000c, 2002e).  In face-to-face interactions, the child uses the output of the mother’s emotion-regulating right cortex as a template for the imprinting, the hard wiring of circuits in his/her own right cortex that will come to mediate his/her expanding capacities.  In other words, the regulated emotional transactions of adaptive projective identification that promote a secure attachment have potential structure-inducing effects.  They mediate “between intrapsychic and interpersonal phenomena” (Ryle, 1994) by acting as a medium for the transmission of “intrapsychic externalizations” (Loewald, 1970), thereby allowing for the organization of internal structural systems involved in the processing, expression, and regulation of emotionally charged information.  (schore/ar/74)”

“On the other hand, a history of cumulative relational trauma, or of frank abuse and neglect, represents a growth-inhibiting environment for the maturation of the right brain (Schore 1997b, 2001b).  The insecurely attached infant’s all-too-common stressful experiences with a caregiver who chronically initiates but poorly repairs [or, like in my case NEVER repairs] intense and long-lasting dysregulated states are incorporated in right-brain long-term autobiographical memory (Fink et al., 1996) as a pathological internal object relation, an interactive representation of a dysregulated-self-in-interaction-with-a-misattuning-object [I need to find that article on brain regions for processing objects!] (Schore, a997b, 1997c).  (schore/ar/74)”

a dysregulated-self-in-interaction-with-a-misattuning-object

vs a regulated self in interaction with an attuning object

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“It is well known that the infant’s attachment system is activated when he/she is under stress, and this occurs even when the caregiver is the source of traumatic stress.  Krystal noted that psychic trauma is the outcome of being confronted with overwhelming affect that produces “an unbearable psychic state which threatens to disorganize, perhaps even destroy all psychic functions” (1978, p. 82)  This means that during the interpersonal transmission of a stressful state the child is also bidding the mother to interactively regulate this stress.  Thus, at the “heightened affective moment” of the defensive projective identification, the child in the developmental context…due to a failure of interactive regulation, is in a dysregulated and therefore intolerable state.  Ogden (1990b) described how the projector (the patient) induces a feeling state in the other (the therapist) that corresponds to a state that the projector is unable to tolerate.  (schore/ar/75)”

75)”

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LACK OF POSITIVE IN INFANCY

anhedonic

“It is important to note that for certain personalities positive states need to be disavowed, and this points to the important function of adaptive projective identification in the treatment of preoedipally disordered, insecurely attached patients, especially those who present with anhedonic [“a psychological condition characterized by inability to experience pleasure in normally pleasurable acts” – would that include, say, not being able to enjoy a beautifully sunny day – always having that sense of foreboding or loss or despair?  Interesting that in the Greek roots, hedonic has the same root as the word “sweet.”  Wanting all the sweets, or not getting any at all.  Maybe a form of psychological diabetes!] symptomatology.  [Well, damn!  I suppose this would describe lucky me!!] Seinfeld underscored the long-term psychopathogenic effects of “the lack of actual positive experiences in the patient’s early life that would serve as receptors for the taking in of later positive relations” (1990, p. 11; italics added).

Receptors – like not anticipating pleasure, having no associational neurons for future pleasure to “stick to?”  Has to be tied to “Just because someone doesn’t love me doesn’t mean I am unlovable.”  “Just because mother won’t let me JOIN with the family or with her doesn’t mean I am unworthy of belonging – I am NOT satan’s child!”

Tied also to the fact that nobody can love me enough that I can FEEL it on the inside of myself.  That is the truly saddest part of this attachment disorder!  And….it’s not ER’s job to make me feel better, even though I love to be with him!

So I am doing both a negative and a positive “projective identification” with him – negative that I am afraid he doesn’t miss me, sad when I can’t see him – and so happy when I can, finding great pleasure in his company!  He is no doubt a hedonist, seeking pleasure, while I am the opposite – not being able to FEEL it when others can – on some very deep level I believe that I would be worth more if ER wanted to spend more time with me.  That’s really sad.

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P 79 –

THE CENTRAL ROLE OF BODILY STATES IN PROJECTIVE IDENTIFICATION

“The therapist’s facilitating behaviors combine with the patient’s capacities for attachment to permit the development of the alliance.  Importantly, it emerges from the positive aspects of the mother-child relationship.  (schore/ar/79)”

And what if there were no positive aspects of the mother-child relationship?  Or does the capacity for attachment correlate directly to the degree of positive aspects there were in the relationship?

“In Muir’s (1995) terms, the “psychobiological connection” that mediates attachment bond formation is embedded within a system of adaptive interactive projective identification, and this allows for the communication of positive states by the patient and the elicitation of relationship behavior in the therapist.  (schore/ar/79)”

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“Reciprocal transactions within a dyadic system of adaptive projective identification thus interactively generate amplified levels of dynamic “vitality” affects (Stern, 1985), the positive states that drive an attachment bond, facilitate the coconstruction of the positive transfer- (schore/ar/79) ence, and fuel hope.  These moments of intersubjective resonance also facilitate dyadically expanded states of consciousness in both the mother-infant and patient-therapist intersubjective fields (Tronick et al., 1998).  (schore/ar/80)”

adaptive projective identification

vs negative projective identification

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“[The}…failure to evolve an efficient regulatory system would cause the personality to have a deficient and decreased capacity for autoregulation, which is partially compensated for by an increased need for external regulators at later stages.  In fact, this very deficit, a direct parallel to Kohut’s increased need for pathological selfobjects in developmental disorders, is now considered to be a risk factor of insecure attachments (Maunder & Hunter, 2001)  (schore/ar/134)”

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INSECURE ATTACHMENT

“The insecurely attached infant’s all-to-common [sic] stressful experiences with a caregiver who chronically initiates but poorly repairs [or never repairs] intense and long-lasting dysregulated states are incorporated into right-brain long-term autobiographical memory as a pathological internal object relation, an interactive representation of a dysregulated-self-in-interaction-with-a-misattuning-object (Schore, 1997c).  This internal working model of a disorganized/disoriented insecure attachment stores critical exteroceptive information about the social source of relational trauma as well as the infant’s interoceptive physiological responses to the stress.  It encodes both an expectation of imminent “mutually escalating overarousal” and the autoregulatory strategy for coping with overwhelming interactive stress – the primitive coping strategy of dissociation.  (schore/ar/137)”

“A central principle of this psychoneurobiological perspective dictates that there is a continuity between early early traumatic attachment and later severe disorders of personality development (quotes a whole bunch of his stuff) (schore/ar/137)”

“As in infancy, children, adolescents, and adults with posttraumatic stress disorders and severe self-pathologies cannot generate an active coherent behavioral coping strategy to confront subjectively perceived overwhelming, dysregulating events, and thus they quickly access the passive survival strategy of disengagement and dissociation.  (schore/ar/138)”  [their state “is a disorganized-disoriented state of insecure attachment.”  Contrary to what schore is quoting here, we do not have a “mature brain that…is capable of exhibiting adult response patterns.”  He is contradicting himself here – if we had such a brain, we would USE it!  The point is, as he has said over and over and over again, our brain did not get to mature correctly!  Geezze!]

“Indeed, clinical studies affirm that the type D attachment classification is observed to utilize dissociative behaviors in later stages of life (van Ijzendoorn and the rest, 1999), and that the occurrence of dissociation at the time of a stressful trauma is a strong predictor of PTSD (Koopman and the rest…).  [what does this mean with the acute stress reaction where symptom is dissociation?  I need to check on this…..] In developmental psychopathological research, Sroufe and his colleagues concluded that early trauma moreso than later trauma has a greater impact on development of dissociative behaviors…. The characterological use of dissociation over the developmental stages was described by Allen and Coyne:  “Although initially they may have used dissociation to cope with traumatic events, they subsequently dissociate to defend against a broad range of daily stressors, including their own posttraumatic symptoms, pervasively undermining the continuity of their experience” (1995, p. 620). (schore/ar/138)”

“These “initial traumatic events” are embeded [sic] in the abuse and neglect experienced by type D infants, the first relational context in which dissociation is used to autoregulate massive stress.  The ultimate endpoint of chronically experiencing catastrophic states of relational-induced trauma in early life is a progressive impairment of the ability to adjust, take defensive action, or act on one’s own behalf, and a blocking of the capacity to register affect and pain, adaptive functions that are all critical to survival.  (schore/ar/138)”

“LeDoux described the legacy of childhood abuse:  “If a significant proportion of the early emotional experiences one has are due to activation of the fear system rather than the positive systems, then the characteristic personality that (schore/ar/1348) begins to build up from the parallel learning processes coordinated by the emotional state is one characterized by negativity and hopelessness rather than affection and optimism: (2002, p. 322).  Ultimately these individuals perceive themselves as different from other people and outside of, as well as unworthy of, meaningful attachments (Lansky, 1995).  These personalities clearly manifest the self-pathology of a developmental disorder.  (schore/ar/139)”

TRAUMATIC ATTACHMENT AND THE PSYCHONEUROBIOLOGICAL ETIOLOGY OF BORDERLINE PERSONALITY DISORDERS

NARCISSISTIC VS BORDERLINE

“In contrast to the narcissistic infant-mother dyad that derails their attachment communications in the last quarter of the first through the second year, the borderline dyad derails much earlier in the first year. As opposed to disorganized insecure attachments discussed here, narcissistic personality disorder is the outcome of an organized insecure pattern, specifically an avoidant (adult dismissive) attachment pattern (Pistole, 1995).  This suggests a qualitatively different developmental history in these groups of personality disorders.  Recall that insecure disorganized/disoriented and not organized insecures are associated with abuse and neglect.  (schore/ar/139)”

“…a large body of studies indicates disrupted attachments and early trauma and abuse in the histories of children and adults diagnosed as specifically, borderline personality disorder (Lyons-Ruth & Jacobvitz, 1999), and thus there is a high correlation of PTSD and borderline diagnoses (a bunch of refs)….  [Zanarini et al, 1997) …report that 91% of borderline patients report childhood abuse, and 92% report some type of childhood neglect. (schore/ar/140)”

“A number of researchers in child psychiatry confirm the presence of early abuse and neglect and neuropsychological deficits in this clinical population.  The etiology of borderline pathology in childhood is currently understood to depend upon diatheses (constitutional predisposition) and stressors.  Diatheses are now identified through neurobiological and neuropsychological markers, including deficits in frontal lobe functions, and stressors are childhood trauma and parental psychopathology (Ad-Dab’Bagh & Greenfield, 2001).  The latter environmental stressors [childhood trauma and parental psychopathology] are thought to combine with neurobiological vulnerabilities to shape the clinical syndrome (Zelkowitz and the rest, 2001).  (schore/ar/140)”

Para con’t

“ In the latest models it has been suggested that the neuropsychological abnormalities of borderline children are the result of environmental stressors, specifically reflecting the effects of neonatal stress on brain development (Graham and the rest, 1999).  (schore/ar/140).”

“Subsequent neuropsychological vulnerabilities account for the cognitive limitations that negatively affect the child’s ability to integrate the traumatic experience, and interfere with the resilience mechanism [which is???] that can cope with the traumatic environment.  These neurobiological impairments endure.  (schore/ar/140)”

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mentions work of (Ovtscharoff & Brraun, 2001, p. 33) – how the dyadic interaction between newborn and mother “serves as a regulator of the developing individual’s internal homeostasis.”  In (schore/ar/118)

“This program of research clearly echoes Kohut’s psychoanalytic description of the effects of the maternal selfobject’s regulatory function on the maintenance of the infant’s internal homeostatic equilibrium, and the critical aspect of these reciprocal regulatory transactions on the development of self.  But it also describes current attachment theory, which is emphasizing the critical nature of the mutual regulation of affective homeostasis (Amini et al., 1996)….Fonagy and Target …(2002) concluded… that “attachment relationships are formative because they facilitate the development of the brain’s major self-regulatory mechanisms” (p. 328).  (schore/ar/118)”

“…face-to-face emotional communications embedded in the attachment relationship, represent right-brain-to-right-brain communications.  (schore/ar/118)”

p 121 –

“The functioning of the “self-correcting” right hemispheric system is thus central to self-regulation, the ability to flexibly regulate emotional states through interactions with other humans in interconnected contexts via a two-person psychology, or autoregulation in independent, autonomous contexts via a one-person psychology.  The adaptive capacity to shift between these dual regulatory modes, depending upon the social context, emerges out of a history of secure attachment interactions of a maturing biological organism and a psychobiologically attuned social environment.  [Boy, this is NOT something I am good at – alone or with others!}  Furthermore, this “thinking part of the emotional brain” is centrally involved in integrating and assigning emotional-motivational significance to cognitive impressions, the association of emotion with ideas and thoughts (Joseph, 1996)….  (schore/ar/121)”

This must be one of the connections to PTSD where this isn’t a completed process.

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