Second Draft (March 28th 2020)
We are only now beginning to fully understand how trauma and neglect can affect the developing brain of a baby and how the baby’s brain miss-wires in order to survive. For example, a baby is hard-wired to make an attachment but if the attachment person is dangerous and/or neglectful, the malleable wiring will adapt and become non-trusting. The neurons, the building blocks of the brain, in dangerous circumstances, react and change. The phrase ‘the neurons that fire together, wire together’ is positive when it describes how we learn and grow. But it is negative when it relates to babies and infants maladapting to dangerous and traumatic circumstances and remaining maladapted even though the circumstances completely change for the better.
The good news is that neuroscience, the scientific study of the nervous system, has the explanation for how the damage is done and also the answer for how the damage can be undone. In The Science of the Art of Psychotherapy (2012) Allan Shore, who has been acclaimed as today’s Bowlby, explains how psychotherapy can reverse this damage, something many people suspected but could never scientifically prove. This chapter will try to explain how a therapeutic relationship between a carer and a very traumatised child can do exactly the same thing. The same applies between any carer and cared-for person.
When I begin to teach this subject I usually ‘borrow’ a piece from Gabor Mate (1999) where he imagines a newborn foal who has just dropped from her mother onto the dewy grass in a summer meadow. The mare licks off the enveloping vernix and calmly watches as he struggles to eventually stand on four unsteady, spindly feet. By the time the sun is going down that day she will need to call him over to sleep, as he is already running around and enjoying being alive. Approximately 85% of the foal’s neurological wiring is complete on Day 1, the rest added according to the role the foal will have in later life, whether pulling a plough or winning the Grand National.
When the average baby is born, only about 15% of its wiring is installed. This basic wiring is all to do with survival: how to latch on to the breast and feed, how to stay close to the source of the food and protection, how to react to loud noises behind you and avoid precipitous drops in front of you.
It is a sobering thought that for the rest of the wiring to be installed, the baby is completely dependent on an attachment with a ‘good enough’ loving, emotionally attuned mother. Neuroscience can now prove scientifically, through brain imaging, that when the baby senses this attunement, the chemical, dopamine, is produced by the baby and this chemical alone promotes the growth of the neurological wiring which is essential for the self-regulatory system to evolve. So, to put is bleakly – no attunement =no dopamine= no capacity to self-regulate.
Worse still, too often in the absence of attunement, there may be the malign presence of abuse, trauma and neglect. The person who the baby is hard-wired to look to for protection and soothing can too often also be the source of severe stress and trauma. This can be called ‘the double whammy’, meaning not just the absence of attunement but the presence of unthinkable anxiety. In these situations the baby or infant produces the chemical cortisol, a powerful drug that we create when in great danger, as when walking absentmindedly in front of a bus and somehow getting out of the way. Babies who are in constant danger and under constant stress produce this drug in huge quantities and can become seemingly dependent on it to survive.
I usually offer a fictitious scenario like this one to illustrate the theory so far:
Melanie arrives back from school, but which Melanie, wonders her foster carer as she hears her slamming in through the front door. When she first came through that door she was quiet and shy, didn’t make eye contact, didn’t say much. This was her fourth foster placement, having become too unmanageable for previous carers. She was compliant and happy to start with, and the carer wondered what all the fuss had been about. She soon ‘settled in’. However, gradually she began to unsettle, refuse to do things, became demanding, increasingly unable to self-regulate. When she wasn’t being as sweet as pie, she was capable of being monstrous. So which Melanie is home?
“Who the fxxx are you looking at?” she roars as she sends her school-bag flying across the kitchen table.
The intuitive response, based on expectation for good behaviour and manners, would be ” We don’t accept language like that in this house. I want you to go to your room and come back when you have thought about your language and behaviour!”.
Melanie is disappointed but not surprised. As she clumps upstairs she feels confirmed in her decision not to trust her carers: they don’t get her, only want her if she is ‘good’, they probably only do it for the money. Eventually she will go back down, pretend to apologise and muddle along until the next time she can’t hold herself together. Or moves on to her fifth placement.
I believe the counter-intuitive and therapeutic response could have been something like: “I’m looking at someone who is very angry and upset. Can I ask you why?” It might bring a rejecting, contemptuous response “What do you (expletive) care?” but it also gives the carer the opportunity to say that she does care and to repeat the question, softly and with concern – “Why are you so upset and angry?”.
What might then happen for Melanie, neurologically, is that as high as she was on cortisol, the loving attempt to tune into her by the carer would cause her to produce dopamine and the ability to self-regulate. Her possible response might then be to tearfully complain about being bullied again at school, called an orphan and a reject. Comforted by the carer, she would eventually recover, genuinely apologise for the language and offer to pick up the mess she made, the mess she unconsciously created to communicate and demonstrate how horrible, and at times uncontainable, her internal world is.
There is another key neurological finding that would also inform the above correct response by the carer. This is the realisation that we have two brains, a right brain (or hemisphere) and the left brain. Putting your right hand up to the right hand side of your head roughly locates the right brain. It was thought that the right brain does all the emotional work while the left brain does the logical work. This no longer holds true. The right brain of a preschool child learns how to speak (perhaps several languages), to count, add and subtract, as well as to feel attached and the myriad of feelings that involve growing up. The left brain is installed but is usually not activated by the happy child until she goes to school and needs a whole new space to contain and process a whole new world she is confronted by.
Melanie’s carers and the professionals in her life would be wise to assume that Melanie’s right brain, when it was at its most malleable and fragile, would have been unable to cope with the unthinkable and possibly unspeakable experiences she was the innocent victim of. So it would be naive to expect her to emotionally process the bullying at school and to be able to express it appropriately. So her only option is to act out her trauma, in the very slim expectation that her inappropriate behaviour will be understood as communication and not as ‘being bold’.
It is also possibly naive to assume that Melanie had such a ‘good enough’ start in her life that she switched on her left brain when the time came for her to do so. It makes more sense to assume that she does not have a functioning left brain so addressing her left brain as in “You need to go to your room and think hard about your behaviour” can only infuriate and may produce even more cortisol. “Can I ask why you are so angry and upset?”, asked gently, is a loving response and directed emotionally to Melanie’s right brain from the carer’s right brain.
What effective psychotherapists have been doing for years without realising it is tuning into the right brain of the client and directing that attunement from their right brain, so that it comes across as caring and empathetic. The therapist, of course, will at the same time be popping over to the left brain to access theories, remembering important facts, but always coming back to the right brain to process and think about the next step to take. This is the creative part of the process, improvising as you go from step to step, the essence of any art form.
I usually conclude this part of the training by challenging foster carers to do something radically different this day, when their children come in from school. Instead of the predictable left-brain questions “What did you learn today?” or “How did you get on today”, which are really only looking for positive answers, try this:
Before your child comes home from school try to imagine how it is for him in that environment, what he might struggle with but perhaps bottle up. However difficult it might be, the young person will want it to remain his world, separate from yours. That why most well-meaning questions are rarely answered but fobbed off with a shrug and an “Alrightwhatsfordinner?” change- the- subject- answer. But this time, mindful of his perhaps heroic efforts to hold himself together at times, and reminding yourself of how much you love him, ask instead, as if you have no right or permission to ask, “How are you doing?”. But don’t expect an answer. Your loving question is unconditional and given freely. If you want to know what happens next, try it today and see.
The really good news from the last decade of neurological science is that the damaged brain can repair and rewire. John Bowlby (2005) always believed that
the human psyche, like human bones, is strongly inclined towards self-healing. The psychotherapists job, like that of the orthopaedic surgeon’s, is to provide the conditions in which self-healing can take place (p.172).
He didn’t live to see the sophisticated brain imaging resources we have today, that vividly show the miswired and damaged brain begin to repair and rewire correctly in the course of attuned and empathic psychotherapy.
The foster carer or social care worker who wishes to provide the conditions in which the healing can take place may have to examine and review their present conditions. And as always, for the child to change, the foster carer looking after Melanie must make the first change. And that is to probably to change the habit of a lifetime and stop stressing about behaviour and trying to get improvement by using carrots and sticks. And the next change, and this isn’t easy at first, is to try to imagine what is going on inside the young person, how she might be feeling and thinking. This is the healing process and it won’t work unless you trust it. Bones won’t set and mend if you keep probing and prodding them.
The word ‘therapy’ comes from the Greek and means ‘to wait’. You need to tell yourself that once the child senses your attunement, she will begin to produce dopamine and however damaged and miswired the brain is, it will inexorably begin to heal. Finally, by way of encouragement, it is very likely that the child or adult in your care has been scanning the horizon for ever, waiting for attunement to eventually appear, waiting to become the person who he or she was born to be.
Bowlby, John (1988) A Secure Base London: Routledge
Mate, Gabor (1999) Scattered: How attention Deficit Disorder Originates and What We Can Do About It New York: Plume
Shore, Allan J (2012) The Science of the Art of Psychotherapy New York & London: Norton