Louis Cozolino, my favorite psychology writer, hosted a full day lecture on ‘Neurofluency' or the ability for a psychotherapist to assess, plan, and treat based on the latest brain science. Central to Cozolino’s theory of psychotherapy is attachment theory – or how our early childhood relationships with our parents influence our adult personalities. From this perspective, psychotherapy is a process of re-parenting and learning to utilize relationships to heal repressed or hidden traumas and feelings. Cozolino’s 40 years of clinical treatment of adults and children along with his research into evolutionary psychology and brain development results in an impressive understanding of the human mind.
Evolutionary Psychology and Early Childhood Development
Millions of years of evolutionary trials have given us our big brains, but not without a cost. Most newborn animals move independently within a few hours after birth, ensuring that they aren't slow-moving targets for predators. Human infants are an anomaly– unable to walk until 12 months and fully dependent on caregivers for years. Compared to the rest of the animal kingdom, human infants are born about three months too early so that our proportionally enormous heads can safely pass through the birth canal. This physiological reality is no accident- evolution gave us our bulky brains. We aren't the biggest or most resilient animal in the kingdom, but we are exceptional in our sociability and abstract thinking – characteristics made possible by our brains' size and complexity. Our premature birth, deep dependency on others, and nuanced ability to communicate are evidence of our evolutionary strategy of collectivism.
Our lifetime of relationships with others is initiated in the dependency we all experience during infancy. Like the foundation of a house, our early years are instrumental to our adult personality. As our brains are doubling in size over the first year and reaching 80% of adult size by the age of three.
Especially important to our development are moments when we experience fear or stress as children. From a primordial survival standpoint, these are moments when our safety is threatened. The natural inclination of our deeply collective species is to seek the support of mom or dad during these occasions. Watch a tearful toddler on the playground seek its parent to see this principle in action. Childhood is full of experiences like these – increasing in complexity as we age. A well-regulated and available parent temporarily soothes a child while also shaping their child's expectations on how to handle the inevitable stresses of their future adulthood. We learn to ask for help when we are in pain be it physical, emotional, or existential. Conversely, a dis-regulated parent, that is unavailable or angry about our distress teaches us that our pain is to be kept hidden from others. These lessons from childhood form the backbone of our adult experience, determining whether we live a life of connectivity and vitality or one of solitude and shame.
Yes, the resilient, quick-breeding vermin have been instrumental in proving the correlation between early childhood stress and future quality-of-life. Humans and rats share similar brain structures as well as social dispositions. Rats are attentive and nurturing mothers that display a variety of attachment behaviors with their pups including licking, grooming, and vocalizations. To test theories of developmental psychology, scientists (sadly) disrupt these behaviors. However, these studies provide research showing that as maternal care-taking increases, so does the future adult well-being of rat pups. These studies provide quantifiable data for intuitive sense obvious to any adult caretaker.
s For example, neurons in the brain of well-mothered rats show longer dendrites (the connective arms of neurons) and more synapses (the connectors between neurons) than deprived pups. Healthy rat pups also experience an increase in brain-derived neurotrophic factor (BDNF), a hormone essential in encouraging neuronal growth. Having an attentive and available rat mother correlates with a bigger and more complex brain structure.
Increased rat mothering also correlates with increased GABA neurotransmitter receptors in the brain. Anyone who drinks alcohol or takes Xanax or Klonopin (drugs that increase GABA) knows the powerfully calming effect of GABA. Well-mothered rats have more GABA receptors, consequently making them more relaxed in adulthood than their poorly mothered brethren.
Also, rats' immune systems and stress responses are profoundly shaped by their early mothering experiences. The class of hormones known as glucocorticoids is essential to regulating the hypothalamic-pituitary-adrenal axis a.k.a. our fight-or-flight system. The more glucocorticoid receptors present in the brain, the greater the ability to effectively manage stress and disease. Rat pups deprived of mothers had few glucocorticoid receptors and were consequently unable to tolerate mild stress. They were also likely to develop chronic illnesses later in life.
Future adult rat behavior was also shaped by early pup experiences. Decreased maternal availability was correlated with decreased exploration and novelty seeking in adult rats. Pups with poor mothering were less likely to search their surroundings and less likely to seek novel forms of stimulation as adults. They remained stuck in solvable mazes or engaged in repetitive self-soothing behaviors. Lastly, early childhood mothering was directly influential on future mothering behavior. If rats had absent mothers as pups they were likely to demonstrate poor attachment and care of their own pups later in life.
Number of neuronal cells effected by mother-pup separation. The white column shows the amount of neurons present in normal, non-deprived rats while the orange and blue columns represent neurons in rats deprived of maternal contact from post-natal day 3 or day 10, respectively. Evidence that separation from mothers at a young age is detrimental and the earlier the separation the worse the outcome.
"I'm not a rat!" It's true, your comprehension of this article up to this point verifies you are not a rat. But you have a brain like a rat and that's enough to lead Cozolino and other researchers to believe that having a good mother (or parental figure) that shows obvious signs of affection and attachment correlates with future mental and immunological health.
Adverse Childhood Experiences
Bolstering this argument are the Adverse Childhood Experiences (ACE) studies conducted by Kaiser-Permanente. Beginning in 1995, about 17,000 adults in the San Diego area were recruited into a study seeking to measure negative childhood experiences against adulthood issues with mental, physical, and relational health. The researchers were hoping to gather quantifiable data to back-up the assertions of the ‘soft-science’ of psychologists and psychotherapists. To answer the question: does your childhood really determine the quality of your adulthood? Amongst other questions, adults were assessed for their childhood exposure to neglect (emotional or physical), abuse (verbal, physical, sexual), and household challenges (poverty, hunger, homelessness, divorce, death, addiction, etc.). The higher the number of negative experiences, the higher the ACE score.
Findings of the ACE studies. Some have criticized the ACE study for lack of diversity and inclusion as all of the participants surveyed were insured through Kaiser-Permanente. One can imagine that those without health insurance probably have higher ACE scores than those with insurance. Meaning the trends reflected in the ACE studies are probably healthier than the general population.
In a remarkably direct fashion, higher Adverse Childhood Experiences scores have translated into higher rates of depression, anxiety and suicide attempts during adulthood. There is also a direct relationship with higher rates of smoking, obesity, coronary and liver disease. And those with high ACE scores are more likely to have unexplained negative medical symptoms and more likely to have trouble getting and keeping work.
Essentially, negative early childhood experiences result in negative adult experiences. These studies are correlative not causative – meaning the findings imply a difficult childhood probably contributes to having a difficult adulthood rather is the cause of it. Because of the sheer size and high-quality of the study, the ACE studies stand as a landmark in the field of mental health and epidemiology.
Since 95, there has been continual research into ACE and their prevalence amongst different populations. Not surprisingly, those from lower socioeconomic classes and non-white communities are disproportionately effected by adverse experiences. The ACE studies will continue to be an important reminder of the far-reaching effects of poverty, racism, and trauma on the lives of individual children.
Cozolino's analysis of the ACE studies translated early childhood negative experiences to later physical and psychological problems for adults. Continuing with this theme, Cozolino described core shame – a negative psychological feature of many adults that begins in childhood. Cozolino describes core shame as "a fundamental sense of being defective as a person, accompanied by fear of exposure and self-protective rage." Those that live with core shame typically suffer from depression, anxiety, addiction, or other mental health issues. The physiological and behavioral components of core shame are:
“Rapid and dramatic shift from sympathetic to parasympathetic dominance (emergency shutdown) and behavioral shift from escalating energy, approach, and connection to deflation, submission, and withdrawal.”
Cycles of Violence and Poverty. Billy Bragg's 'Levi Stubb's Tears' tells the story of a young woman fleeing from a broken home only to end up in an abusive relationship.
"Sympathetic and parasympathetic dominance" refers to the two branches of our autonomic nervous system, the mostly unconscious part of our peripheral nervous system that regulates our heart rate, arousal, digestion, and the fight-or-flight response. A healthy nervous system has an equal balance of both branches: the sympathetic branch allowing us to exert ourselves and handle daily stress; and, the parasympathetic branch allowing us to relax and connect with other people. A healthy life may be thought of like the daily balancing of activation with relaxation – sympathetic with parasympathetic. Core shame develops when our body's ability to deal with transitory stress is continually triggered and overburdened.
Our short term strategy for stress begins with the sympathetic branch. When a dramatic and perceived life-threatening challenge occurs, our sympathetic system spikes our heart rates, elevates our blood pressure, tenses our muscles to fight the problem or run away from it a.ka. fight-or-flight. If we can neither flee or bully our way to safety, our last defense lies with the parasympathetic branch and its "emergency shutdown" or freeze response to which Cozolino links to core shame. Limbs go limb, blood pressure and heart rate drop, and the mind dissociates or goes blank. We play possum. Many predators are only interested in live prey, so feigning death may have thwarted enough attacks of our ancestors to be included in our body's repertoire of survival strategies.
Deploying this 'freeze' strategy once or twice in our lifetime may ensure our survival, but it becomes problematic when freeze and collapse becomes a regular part of our life. Cozolino posits that the parasympathetic freeze response turns to core shame when it is repeatedly triggered by our early relationships and environment. As small, needy beings we are extraordinarily sensitive to the quality of our relationship with our parents. A threat to those relationships is a threat to our survival. Being shamed a handful of times in the heat-of-the-moment may not be particularly damaging, but a parenting style that is built on anger, intimidation, or punishment inclines us to frequently fall into collapse. The mind is adaptive and predictive, it predicts future conditions based on past experiences. So if our childhood was full of shame-inducing experiences we would expect to feel depressed, deflated, and withdrawn from life as an adult a.k.a. core shame.
Cozolino highlights the importance of our early childhood relationships in our developing sense of self-worth. That we develop a shameful or compassionate relationship with ourselves through our early family system is also bolstered by the research with rat families. Cozolino takes this exploration a bit deeper by looking at how the nuclear family system is part of the larger system of a society-as-a whole and its effect on shame.
Chimpanzees, our closest animal relatives, have complex and patriarchal social systems with a few male alpha chimps leading bands of 15-150 beta chimps. Alpha chimps use intimidation and physical violence to maintain their position in the frequently shifting social order. Due to disputes over mates or foraging territory, Cozolino posits that beta chimps display all the signs of shame/parasympathetic collapse when they are dominated/corrected by alpha chimps: submission, social withdrawal, lowered eye gaze, and a physical deflation or hunkering. While we can never ask a beta chimp if they believe they are ‘just the worst chimp ever,' we can imagine that the behavior markers and social consequences of their transgressions induce something like shame within them. Cozolino's observation is that this sense of shame is essential to maintaining chimp social order and survival. Shame is an acknowledgment of hierarchy and power.
As humans, our social hierarchies are vastly more complex than chimps, from families to communities to cities to states to global-alliances. Our experience of shame depends on the group of individuals and values in which we find ourselves rather than on how many mates are available or mango trees in our foraging territory. A person raised strictly evangelical may believe their homosexual flashes of desire are an abomination. Meanwhile, a young man in Chelsea, Manhattan celebrates his gay sexuality in the streets on June 20th of every year. In either of these communities, there is an agreed upon set of behaviors and beliefs that are either shameful or not – an intersubjective reality. That is, an agreed upon 'truth' that only exists because people agree it exists. For example, money is only valuable because we all agree that it is valuable. It has no intrinsic worth other than as a fire starter or as a sheet for scribbling. Shame is no different. While it was once disgraceful to divorce, it is now more common than staying married. Our society's values have changed over time and consequently, our families' sense of shame has morphed from the time we were children.
Unfortunately, for those with core shame, it's not just a matter of deciding one day to stop feeling bad about ourselves. Our core shame is usually an unconscious part of our personality – not a value by which we choose to live. Oftentimes, it is such a prominent feature of our existence that we have no awareness that there's an alternative way-of-being. This problem speaks to the deep roots of childhood shame and the largely unconscious nature of our minds. Also, to the importance of the mental and emotional health of the architects of our minds – our parents.
Healing core shame is a long and arduous task – the repeated making conscious of the unconscious. To link present-day symptoms like anxiety and depression, to distant memories or feelings. In essence, psychotherapy is re-parenting and the allowing of emotion to be expressed that was, long ago, made to be hidden. Because we learned during childhood that those closest to us also most deeply wound us – therapy is a lesson in learning to trust and in utilizing relationships to heal.
My ongoing exploration into therapy related topics.