“Why do infants, indeed all people, so strongly seek states of connectedness, and why does the failure to achieve connectedness wreak such damage on their mental and physical health?” asks Tronick (2007, p.488). Connection is the formation of dyadic states of consciousness which increase coherence and complexity. When connection is established with another person there is a sense of growth and exuberance. With disconnection there is an experience of shrinking and loss of continuity. Feeling disconnected is painful and at the extreme end there may be “terrifying feelings of annihilation” (Tronick, 2007, p. 476). The Dyadic states of consciousness model assumes that humans are complex and open psychobiological systems. To increase organisation and complexity, and reduce entropy, we must garner energy from the environment.
The still-face is an experimental paradigm of ‘traumatic abuse, specifically neglect’ (Schore, 2012). In this experiment, the infant is exposed to a ‘severe relational stressor’ – the mother holds eye contact but inhibits vocalisation and spontaneous emotional facial expressiveness or gesture. This is a loss of dyadic regulation which triggers an increase in interactive behaviour and arousal in the infant. The infant is confused and fearful at first as the break in connection is understood as threatening. Then a sad facial expression follows with gaze aversion, withdrawal, self-comforting, loss of posture and bodily collapse. This is accompanied by a ‘dissipation of the infant’s state of consciousness’, a loss of self-organising ability, reflecting the disorganisation of lower psychobiological states (Schore, 2012). Infants who experience chronic breaks in connection show an ‘extremely pathological state’, of emotional apathy, similar to Spitz hospitalism effects and Romanian orphans who do not grow and develop. These infants develop a communication style that says ‘stay away, don’t connect’ – chronic pathological dissociation. The still-face illustrates the infant’s intense need for connection and the large investment of human time and attention that is required to support their optimal development through ensuring that they are consistently met with ‘emotional availability’.
Young mammals have a powerful emotional system to indicate that they are in need of care – the panic/ grief/ separation distress system (Panksepp, 2013). This becomes activated when they are lost or left alone and alerts caregivers to seek out and attend to the needs of the child. The system that motivates social closeness creates the psychic pain of separation distress. If a baby is left to cry for a long time a number of detrimental outcomes occur (Noble et al., 2018). The brain is flooded with stress hormones that kill neuronal connections. Pain circuits become activated and opioids, which produce feelings of well-being, are diminished. With nonresponsive care the baby may shut down emotions, appearing fine, when in reality his cortisol readings are very high. Animal studies show on-going experiences of grief set up mood disorders. Unrelieved stress in early life leads to anxiety and depression later in life as well as using alcohol for relief. Stress response systems can become permanently wired to oversensitivity from early stress leading to all sorts of negative health outcomes including accelerated aging and mortality.
When children are presented with ‘manageable, graded emotional challenges’ they can increase their resilience but not when they are overwhelmed – severe attachment stressors decrease adaptive capacities (Schore, 2012). ‘Mild early stressful experiences’ that challenge but do not overwhelm increase myelination in the ventromedial prefrontal cortex which controls arousal regulation and resilience. The legacy of a secure attachment is an ‘efficient right brain’ that can cope resiliently with stressors in human interaction (Schore, 2019a). Intense stresses can interfere with right-brain processing and if a critical point is reached will eventually damage it. It has been established that psychological factors ‘prune’ and sculpt’ neural networks and excessive pruning of ‘cortical-subcortical limbic-autonomic’ circuits occurs with early abuse and neglect. This acts as a ‘severe growth impairment’ and “represents the mechanism of the genesis of a developmental structural defect” (Schore, 2019a, p.49).
In pathogenic environments the child’s strong emotions evoke discomfort in the caregiver when their own histories are activated and they respond with ‘errors of omission’ (withdrawal, distancing, neglect, denial) or ‘errors of commission’ (blaming, shaming, punishing, attacking) (Fosha, 2021). These signal the beginning of a pathogenic path. To maintain the attachment relationship the child must defensively exclude those affects that are intolerable to the attachment figure. Bower and Trowell (2002) argues that the stressful challenge of parenting is having the ability to be in direct contact with raw, powerful emotions that babies express. The impact of this is particularly challenging on parents that lack social support. A well-supported caregiver has a much greater capacity to be receptive and responsive to the baby’s feelings.
Relational trauma is imprinted through right brain to right brain interactions in which the child resonates with the ‘rhythmic structures of a mother’s dysregulated states’ (Schore, 2019a, p.238). The infant is presented with an aggressive/ fearful face and this image and the ‘chaotic alterations’ in the infant’s bodily state are ‘indelibly imprinted’ into limbic circuits as ‘flashbulb memory’ which is stored in ‘imagistic procedural memory’ in the right hemisphere. Studies of mothers of 4-month-old infants who later show disorganised attachment describe how these caregivers use intrusive touch and engage in ‘dyadic dysregulating’ interactions involving ‘mother-chase-infant dodge’ and ‘mother positive/ surprised while infant distressed’ (Schore, 2019a, p.46). Note the extreme asynchrony of these interactions. The conclusion drawn was the mothers were overwhelmed with their pasts of unresolved abuse or trauma and so cannot bear interacting with their infant’s distress.
Children’s attachment systems are activated when they become distressed (Bureau et al., 2010). Adults have caregiving systems that become activated when the child signals distress and triggers sensitive behaviours towards the child. However, this system can be compromised in its functioning by parental stress like poverty, depression or past trauma, resulting in unresponsive care-giving. Lack of maternal sensitivity and maternal depression are linked with dysregulated cortisol patterns in infancy. Parents who do not meet the child’s needs, even if they are not judged to be abusive or neglectful by society’s standards, may lead to their child developing greater stress reactivity and lack organised strategies for seeking comfort from attachment figures to modulate their arousal.
Trauma is the sudden rupture of attachment bonds (De Zulueta, 2006); or, according to Bowlby, events that significantly threaten the attachment relationship (Szjanberg et al., 2010); Porges describes trauma as a chronic disruption of connectedness (Dana, 2021). Infants are ‘pre-adapted’ to rely on the availability of responsive parental care for protection and for regulation of emotions and biology (Bureau et al., 2010). In infancy a ‘hidden trauma’ can occur from the unavailability of a responsive attachment figure to comfort and regulate stress and fear that are part of the infant’s daily experience. Schore agrees that parental affective unresponsiveness is a hidden trauma specific to infancy which can hyperactivate the infant’s stress response over time (2019a). Longitudinal evidence suggests that this trauma may have an equal or greater impact on development than maltreatment which is more easily observed (Bureau et al., 2010).
References
Bower, M., & Trowell, J. (2002). The emotional needs of young children and their families: Using psychoanalytic ideas in the community. Routledge.
Bowlby, J. (1969). Attachment and loss: Attachment.
Bureau, J-F., Martin, J. Lyons-Ruth, K. Attachment dysregulation as hidden trauma in infancy: early stress, maternal buffering and psychiatric morbidity in young adulthood. In Lanius, R. A., Vermetten, E., & Pain, C. The impact of early life trauma on health and disease: The hidden epidemic. Cambridge University Press.
Fosha, D. (2021). Undoing aloneness and the transformation of suffering into flourishing: AEDP 2.0. American Psychological Association.
Dana, D. (2021). Anchored: How to befriend your nervous system using Polyvagal theory. Sounds True.
Noble, R., Kurth, A., and Narvaez, D. (2018). Measuring Basic Needs Fulfilment and Its Relation to Health and Wellbeing. In Narvaez, D. (2018). Basic needs, wellbeing and morality: Fulfilling human potential. Springer.
Panksepp, J. (2013). How primary-process emotional systems guide child development: Ancestral regulators of human happiness, thriving and suffering. In Narváez D, Panksepp, J., Gleason, T., & Schore, A. Evolution, early experience and human development: From research to practice and policy. essay, Oxford University Press.
Schore, A. N. (2019a). The development of the unconscious mind (Norton series on interpersonal neurobiology). W. W. Norton & Company.
Schore, A. N. (2019b). Right brain psychotherapy (Norton series on interpersonal neurobiology). W. W. Norton & Company.
Szajnberg, N., Goldenberg, A., Harari U. (2010). Early trauma, later outcome: Results from longitudinal studies and clinical observations. In Lanius, R. A., Vermetten, E., & Pain, C. The impact of early life trauma on health and disease: The hidden epidemic. Cambridge University Press.
Tronick, E. (2007). The Neurobehavioral and social-emotional development of infants and children (Norton series on interpersonal neurobiology). W. W. Norton & Company.
Zulueta, F. D. (2006). From pain to violence: The traumatic roots of destructiveness. John Wiley & Sons.