I'm very interested in the process behind the evolution of human minds. How did it happen? How did this incredible creature - us - who see the world as they do, come to experience themselves as they do?
My studies have brought me to this conclusion. The self, or the thing we think about, as us, is a construction built out of a recursive, positive feedback between individual primate minds taking a bigger and deeper interest in one another. What is this 'bigger and deeper interest'? Michael Tomasellos ideas about shared intentionality, and in particular, his analysis of chimp and human communication in his book 'the origins of human communication' settles the body as the primary locus of cognitive development: chimp and bonobo (our closest genetic relatives) minds are 'built' up from the bottom - from the body; it is not their vocal attempts, but their gestural actions, that indicate the presence of a cognitive creature.
Tomasello and the other evolutionary psychologists (scientists and philosophers) I've read are more cognitively oriented, which for me misses a big piece of the puzzle. Tomasello is right about the primacy of the body - and thus in human speech - as the research of George Lakoff and Mark Johnson has shown, large chunks of our language are unconscious metaphorical constructions of a metaphorically biased mind. The world makes sense this way because the brain is always organizing and cross-referencing different types of information. The types of creatures that we are - visually dominant with tool like hands - has to integrate different modalities to form a coherent reality. Sounds and vocalizations, pitches, timbers and other acoustic elements, present themselves 'this way or that way'. Take the devils note, the 'tritone' in music. When people hear that we all naturally react in a similar way. High tones are soft, sensuous, and safe. Words like nipple and tip and blip and sip - it isn't a coincide that these sounds share the same theme: smallness. They sound 'small' because it is high and pitchy. In fact, smaller creatures tend to produce a more high pitch sound while large creatures produce lower pitch sounds.
Integration, consolidation, and increased complexity, all have to operate in the service of coherency - homeostasis for the body - but psychologically speaking, a sense of stability for the mind. Evolution maintains a marvelous balance of forces within the body, so it should not be surprising that the mind is similarly organized.
But before I get ahead of myself, let me lay out three principles that I think operate in the evolution of human consciousness. They are aspects of one process, but because of it's nature, it's difficult, not to mention uncommon, for the human mind to be presented this way:
i) Adaptation
ii) Affect Regulation
iii) Coherency
The first idea is basically the working process of biological evolution. The organism at the cellular level is amazingly complexly organized; in multicellular creatures, each cell is exquisitely intertwined with the activity and function of other cells. But it can be hard, and even tempting, to exclude the very consciousness we use from this similar process.
Thankfully, us humans are hardy - and heartful - creatures equipped with tremendous plasticity. The second idea, affect regulation, is basically what the human mind is designed to do. The way we think, we're unconsciously brought to assume that we are the true deciders of our actions; and even worse, we develop philosophies and ideologies that reify certain ideas about the world (and ourselves) that fly in the face of a much sounder reflection.
Affect regulation is the way an organism self organizes in response to environmental threats and attractions. It is basically automatic (Ledoux, Anxious) but also has a basic consciousness component (what it is like to be aroused or distressed) for every creature with a complex nervous system. Negative experiences that hyper-arouse the organism destabilizes neuroendocrinological systems like the HPA axis. An organism needs to return to a normal equilibrium - or psychological 'homeostasis' - after hypo-arousal, and it appears there is a mechanism that follows severe arousal that allows a 'discharge' from an overly aroused procedural motor circuitry. Peter Levine sees this discharge as the "shake" an animal makes after an affectively traumatic experience.
Coherency is a distinctly human concept that is fundamentally related both to the nature of human consciousness, and the process of affect regulation itself.
Imagine Australopithecus, a creature that seems to be man 4 million years ago. Australopithecus already shows a departure from the great ape morphology, but is still very ape like. It's brain is small - chimp like - and so likely was its behavior. However, it was largely arboreal - living on the ground and so needing to become more aware of the threats below it.
Homo Habilis comes along 2.5 million years later and the head is bigger. What happened during this transition, phenomenologically? What engendered this shift?
Theories abound, but I want to consider one related to the communicative process itself. Working from Michael Tomasellos obvious theory (in light of modern traumatology) the shared-intentionality hypothesis, I am interested in the very nature and structure of modern human conscious itself. That is, the two poles which makes up our mind and even gives us the sense of a "self": Self and Object.
Shuffling back to Tomasellos theory about chimp communication, I am intrigued by the way he describes great ape minds as "cognition for competition". Tomasello presents chimps as acting imperatively - that is, for themselves - and when relating with humans, although they begin to learn that humans are benevolently disposed towards them, they nevertheless struggle with interpreting human action as concerned about them. When chimps see you pointing for something, after a while of learning that paying attention to the pointing gesture yields nice rewards (a treat), they begin to respond to a human pointing. But lets say one human drop a treat under a bucket, leaves, and another human comes in and points at the treat. The chimp won't get - doesn't have a working model to support - that the other human is similarly disposed. The chimp doesn't know that the pointing gesture is borne of a a concern that is shared between humans.
It seems the way to get to a steady state of Self-Object consciousness is to build into creatures a disposition towards inquiring about the intentional state of other actors, for their benefit (and also your own!). Tomasello does this by tracing human linguistic communication to gestural communication executed through the body. This is all very cognitive. Interesting, no doubt, but missing out on another sphere of communication - the right brain kind - that 'carries' the narrative-structure of a human life.
Intentional state is the end goal, perhaps, but what is that like on the inside? A gestural action, such as those seen in apes, is very affectively alive. The whole body is in it. In the pointing gesture - something chimps can do - the motion from the body to the object parallels the embodied experience of being a self that wants some thing. The pointing action represents that want, and hence, processes like these, inasmuch as they occur in actors biologically the same, will generate perceptual states that 'converge' on similar phenomenological experiences.
In discussion about human evolution, you seldom here mention of shame. And if it's mentioned, it often seems superficial in its descriptiveness. This is odd, because shame may in fact be - and to me, actually is - the phenomenological condition required to maintain states of "shared-intentionality" between human agents.
From the perspective of the human nervous system, the body can be either aroused via sympathetic, HPA networks mediated by ventral tegmental area, or hypoaroused by parasympathetic networks like the lateral tegmental area (PAG) and the dorsal portion of the vagus nerve. These two, oscillating systems keep the organism affectively alert to threats in the environment. This process is being called 'neuroception', and serves as an unconscious system that organizes object-relations with bodily processes like metabolic homeostasis.
But how does this system operate, phenomenologically? The phenomenology, it must be stated, is at first very passive vis-a-vis environmental input. The brain is very small and very unmyelinated at birth to pass through the cervix. Experiences to come will shape the brain and at the same time will shape subsequent experiences. Good experiences will stand out with particular objects, and likewise negative experiences. Those that occur most commonly will fill-out hyper myelinated circuitry with dense synaptic connectivity. Those that occur less will be 'crowded out' by those that occur most.
What really cements the brain-mind dualism is the process of meaning. Self-Object is the mind of a human being. The human being instinctively builds self with reference to the object. Since the object is essentially other human beings (the source of the self to begin with) the brain is constantly cataloging meanings as it works out a state of coherency. To put this differently, the closed system of the brain needs to 'make psychologically coherent' the various meanings the human organism encounters. This, of course, is a bizarre paradox: the closedness of the brain is BUILT by the openness of the mind; furthermore, the input is the activity of other minds, which our brains, instinctively, self-monitor and imitate as we struggle to make sense of the world around us.
Coherency is the phenomenological process of struggling with the affects that social interaction creates in individual actors. Shame occurs because that's what shared-intentionality required to create minds that cared about one another. Joy, laughter, pleasure - these too are dependent on dyadic interactions: they are emergent properties that follow from the complexities of human meanings.
So back to those old species, those homo's who biased our present brain structure. It bears to point out that not only our cortex, but our amygdala and our upper brain stem are disproportionately large in modern human beings. The biological sociologist Jonathan Turner sees this as a co-evolution between emotional and cognitive processes. So what sort of experiences made this possible?
What about the expanding phenomenology that came with a deeper, more recursive awareness of self and other? Self and other co-evolved, as access to the former follows from access to the latter. When ancient ape-lineages became more interested in one another's knowledge, at some point, the affective program (probably mediated by mirror neurons) referenced the other in constructing a present affect state. How does this happen?
Psychoanalytical and developmental research makes it perfectly clear that right-brain processes 'scaffold' attentional states (contents) that align with the past history and the general needs of an individual human organism. But this is something that is occurring from moment to moment; usually quieted and relaxed in moments of solitude, it becomes "conjoined" to the presence of others by simply being around them. Affective information (which would give the organism knowledge of a conspecifics intentional state) is picked up unconsciously in facial expressions, tone of voice, and gestures and other types of movements. These types of information impel feeling states, especially those that occur most often and most often dissociated from: shame, or 'awardness', 'insecurity'; affects that are ubiquitous in relations, yet not spoken of, perhaps, not surprisingly, due to a secondary shame about their constant presence. What else is narcissism but an overcompensation against the self destroying affects of shame?
Shame is often regarded by emotion theorists and psychoanalysts as "destroying' the self and as well it should be. If the self is a construction made by a brain BUILT UP from an evolutionary process of deeper phenomenological awareness of the other - or object - than when the primary object, or the activity of another self, expresses disapproval, naturally, the self as "self-object" falls apart because the object is looking upon the self with disapproval. This could hardly be harder evidence that the self was made in the furnace of interaction - communication - and that the affects we feel from moment to moment are the 'carrots' and 'sticks' that promote Tomasello's shared intentionality in the evolutionary process.
Human minds are also dissociative, which gives us a microscope into the nature and purpose of moment-to-moment phenomenology.
Trauma breaks a part the mind simply because cortisol has neurotoxic effects on neurons. In a state of trauma, the neurons involved with working memory (hippocampus and surrounding structures) are damaged, which phenemonologically is experienced as not being able to think clearly or recall aspects of the traumatic event. To offset this neurotoxic effect, the brains periaquaductal grey region releases copious amounts of endogenous opiates, apparently for the purpose of blunting awareness of the 'object' out there in the environment that is causing such stress. The autonomic response to stress of this sort is to decouple the two systems - cognitive and affective - which may be useful in the short term, but long term creates havoc for the personality.
The cerebellum and brain stem seem to play a big part in keeping the affective elements alive in the procedural outputs of nervous system. The body doesn't feel right, which means affects don't feel right, which, if something is known to have gone wrong (the trauma) fills the mind with an endless focus on the negative experience.
Humans have no doubt responded to trauma in different and myriad ways, but I imagine that huddling closer together, and coming "closer to the object" played a significant role in the development and evolution of compassion and love. Pain served love by making awareness of self - and ones own vulnerability - vitally apparent to the organism. The organism then reached out to the other - other humans - as a way to soothe the self and its fears.
Trauma de-couples neurologically because neurons have been damaged and working memory has been deeply dysregulated, paradoxically, because of the continuity of affects that consciousness cannot give meaning to. A normal memory when made works its way from short term areas in the hippocampus, to more widely distributed areas throughout the temporal lobes. Traumatic memory seems not to have made that journey; furthermore, it is lodged in the mind still as affective inputs into ones normal stream of awareness.
I mentioned earlier the "discharge" that animals execute after a traumatic experience. Humans have something similar to this, but, being highly cognitive creatures, our affective systems and homeostatic systems "organize" trauma top-down, by instinct, with reference to the meanings and events we ascribe to it.
When people die, we grieve and mourn them. This process occurs because of a powerful buildup of affects. We cry. We share meaning. We make coherent. The brain, to it's credit, seems more able to 'open up' working memory and store the loss in long term memory following a grieving process of existential reflection.
Saturday, 29 August 2015
Thursday, 20 August 2015
BIID:Body Integrity Identity Disorder
As recently presented in the book "The Man Who Wasn't There" by Anil Ananthaswamy, is not real.
First, let me explain by "not real". We got to go down a philosophical pathway first and note a distinction between two types of pathology. There are pathology's (or diseases) that are genetic and exhibit irreversibility. And then there are diseases that exist because of some underlying condition that the person isn't aware of (i.e blood pressure, diet, stress) that can otherwise be changed.
Anil Anathaswamy and others who claim that BIID is a "neurological disorder" and thus requires a medical treatment (removal of the body part the person wants to remove) are advocating what seems to me to be an insanely extreme position - and ironically enough (from an Indian writer) Anathaswamy doesn't seem to recognize the influence MIND - that is, how the experiences human beings have in their everyday interactions with other human beings can influence the neurobiology of the brain and the homeostatic balance between "self in relation" (the states we enact when we communicate with others) which is situated in the frontal and dorsal temporal areas, and the areas of the brain stem which regulate homeostatic processes (i.e the various factors influencing blood flow, breathing, etc) - can have on the body; and, I might add, ones sense of relation towards a body part is not at all different from the other ways the mind can go wrong.
Lets explore some of these other ways: anorexia nervosa, spasmodic dysphonia and gender dysmorphia
The first one is a disorder of how someone experiences their own body. The cause, of course, is the overwhelming influence (as experienced by the anorexic) of the significance society ascribes to body image. Causally speaking, some aspect in the anorexic's early relational environment (as between mother and her, father and her, individual siblings and her, and the emergent properties at higher levels) makes her vulnerable to succumbing to the influence society places on body image. I want to make clear that I am speaking probabilistically: when certain combinations of relational circumstances come together (say a gene for being high reactive and a mother who yells and screams) the likelihood of a certain phenotype (or consequence in behavior) is made either high or low.
Anytime anorexia appears, it can be said to have these certain relational conditions "scaffolding" the appearance of the phenomena in question. The end phenomenological (or the psychologically experienced) state is the sensation that ones body looks fat. I don't know what that's like and neither do you: it requires the presence of certain preconditions to 'make apparent' the "reality" that one is overweight, even though one may in fact be desperately underweight.
The second condition is one I myself once dealt with. I suffered a severe relational trauma at 13 which occurred again at 15 and 16. The result was post-traumatic stress disorder which, since it was caused by bullying, is better described as "developmental trauma", also known by other theorists as "complex trauma".
The issue of psychological or emotional trauma is perhaps best understood in terms of energy flow through the nervous system. Our nervous system is built to process a certain rate of information. When were relaxed and yet focused - a necessary mental state for effective socializing - information passes between humans with very high fidelity. On the other hand, when we feel threatened, our brain switches from what the neurophysiologist Stephen Porges calls the "social engagement system" to the "fight-flight" system. In neuroendrincology, this system is better known as the hypothalamic-pituitary-adrenal axis.
Whenever were shocked into defensive reaction, our brain releases a chemical from the hypothalamus (CRH) which causes the pituitary gland to release adrenocorticotropin into the blood stream; this then causes the adrenal glands (which sit atop the kidneys) to release adrenaline and cortisol. Cortisol, in turn, breaks down glucose which is then used to power mitochondria in cells; cell activity for the energy required to mount an effective defense response. This is basically what's happening when were "stressed" by the world.
When being bullied, I realized early on that I couldn't speak. What I heard whenever I attempted to speak was the presence of anxiety; an unconscious effort, compulsively enacted, to 'fix', or control, or do something that would make the bullying end. Repetition. The longer the threat lasts, the more consequential the effects on brain cells and the architecture of inter-cellular activity. Eventually, you brought to a state of mind of compulsive alertness to the now generalized relational threat: alert to the cues of others, in face, voice, of movement, that indicates disapproval. I found myself operating as if 'from without', seeing myself as a "shameful object", deserving disdain; the external viewpoint is what happens under relational trauma; the other party, the other perspective, begins to dominate your attention. In evolutionary logic, this is precisely what we should expect from examples in lower phyla: organisms adapt by modifying their internal organization. In complex multicellular organisms, these changes are coordinated to correspond to the information coming in from the visual system. Such as running away, fighting, or freezing when the two other responses aren't available or aren't possible. This, also, is basically what the simplest cells do: they pull away from noxious chemicals; likewise, they draw closer to useful chemicals.
Spasmodic Dyphonia is the belief that the raspy, stressful effort to speak is caused by an unrecognized neurological disorder; I, as well as many other psychologists and neuroscientists (such as Robert Scaer) believe a "disease" such as this is a consequence of relational trauma that occurred in the early years of development. I see early years because the belief that spasmodic dysphonia is a real thing (brain, or even larynx related) gains its force from a lack of episodic memory to make sense of it's presence. Because I suffered bullying, I know the contexts that brought this state out of me. Neurologically, the voice - the organ that felt the stress when one felt the need to protest the abuse - remains tentative and withdrawn.
Should we infer from a brain scan that the brain is causing a voice issue? Or should we instead trace the dots backwards and recognize the obvious contingency between social reality and the effect it can cause in neurobiology.
Finally, lets get back to body integrity identity disorder, with reference, this time, to what I've explained about the way emotional trauma builds anxiety and over-reactivity into brain processes. This occurs because, again, in a normal evolutionary context, the body is meant to 'burn' off the energy being provided by the stress response system (which, it bears mentioning, is inherited from evolutionary older species); but in our very unusual evolutionary environment, we often find ourselves stuck, in a job, without a context that can help us process our emotions without feeding them through, again and again, as rumination and paranoia about the self and it's world.
Here's an example. Imagine being 3 years old and witnessing a car accident. All around you people are screaming;loud noises all around you activate the stress response system. A women cries for help. Scared, you instinctively turn to where you last saw your mother, but she isn't there. You can't see here. You look and look. You breathe heavy, you start crying, wailing, mommmmmmmmy, wherrreeeee arrrrrrrreeeeee yooooouuuuuu. You quickly turn around and trip on the curb in front of you, you fall down and bang your knee on the cement. Your legs bleeding and you begin to cry harder.
In the brain at these same exact moments, the stress elicited by the context at hand spurred the HPA Axis into activity. It's revolution in the brain, each moment of fear and anxiety, is fed through and magnified from moment to moment. The brain is on maximal "high alert", feeling threatened and enacting a defense behavior that may elicit help attention from helpful adults. In particular, I want to highlight the 'social' parts of the brain as well as the parts that deal with meaning and narrative. "Mommy" is missing, and the loss is felt by the child as terrible: felt with such totality because psychological individuation has yet to happen.
The hitting the knee at the same sequence of time brought into the chorus of activity the area of the sensory cortex that processes knee sensations. The knee - in pain - is being 'incorporated' into a sequence of neurological events that's presently processing an existential sensation of emptiness of self; the mother - the source of identity for a child this age - is missing, and so in a sense, is the child. Hitting the knee brings the 'knee' into the experience of existential absence.
The read psychosomatic disorders exists is perhaps ultimately a manifestation of homeostatic balance. The brain may seek to "unload" certain experiences in different and sometimes anomalous ways. Normally, psychological trauma is processed and the person is able to return to balance without much residue on present functioning. But very often, when the intensity crosses a certain threshold, psychological trauma exerts disastrous effects on consciousness via the deleterious influence of cortisol on neurons. The self is instantly made disordered in some way. For some, it can be the voice (as it was for me); for others, their body (gender dysmorphia). But trauma is apparently very diffusive. A trauma can be 'linked' and contained, as it were, by the fact that a simple thing like a knee bang occurred at the same time one experienced trauma. Just as in other traumatic experiences (this is a science, called 'traumatology') episodic memory is 'deleted' by the power of cortisol, but procedural, or implicit memory, often stays. This is the core feature of post-traumatic stress disorder and there is very good reason to believe that a body part mapped by the brain which was experiencing trauma may 'retain' the existential, embodied sensation of being 'alien' from the body.
This is hard to understand for us because the idea of someone not 'owning' a body part seems strange, so it must, of course, be real, in this day and age of brain science. But we shouldn't rush to such a conclusion when a relational event (trauma) can provide a core 'basis' for the evolution - key word here, the perceptual state of the adult is the not same as the 4 year old, 5 year old, etc; perceptions change as our brain evolves more complex ways of analyzing an experience: for the adults Anathaswamy describes, they spent many years deluding themselves about an experience, which, understandably, they couldn't give narrative sense to (and thus resolve the anxiety: traumatic stress follows because of a lack of episodic clarity,) and thus grew more and more estranged from.
Now, of course, there is the question: so if not amputation, psychotherapy?
Yes psychotherapy. But also, not just any psychotherapy. You need a therapist who can pay attention to the global and systematic effects of interpersonal communicative displays in interaction, and also gain a sense of the individuals history to 'flesh out' out a narrative structure that can go along with this procedural symptom
This, I hope, will one day become a rule in a neurobiologically based psychotherapy: when a person is relating to some aspect of their experience in a dissociated way, assume trauma. As mentioned above, traumatic experiences are recorded differently than normal experiences. Because of the large amounts of circulating cortisol (possibly other stress chemicals as well may have toxic effects on cellular structures) and the particular role the hippocampus and adjacent structures play in 'working memory', what is felt phenomenologically by the traumatized person as 'dissociation', may well be the mental manifestation of neurons being destroyed by too much of a certain chemical.
What does this mean? It means the entire experience as neurologically coded is imperfectly processed. The physiological and affective feelings seem to persist, but without much memory of an event. In particular, I'm thinking of those children who are abused or neglected who fail to develop coherent self-schemas, and thus fail to experience themselves in any normal or healthy way.
Therapy would seek to locate some plausible "building" block from the persons past, and from that past, construct a coherent self narrative that can "take in" and absorb the meanings associated with the body part.
On another note, in this day and age of brain 'mapping', I find it unbelievable that brain scientists don't pay attention to the psychodynamic processes psychoanalysts pay attention to. It's ridiculous. The thoughts and feelings we ascribe to events and the meanings they hold about our past relationships, these are brain events; not only that, as many neuroscientists already acknowledge, a coherent sense of self, a sense of "I know where I am" in one's conceptual self-space, is very important to the whole idea of the self narrative.
Anxiety is tamed when we are able to contextualize or given meanings to our experiences. But when an experience seems nebulous (without an episodic memory) the procedural experience (a sense of numbness, or distance) can generate thoughts that canvass every aspect of the experience, until, over time, a relationship with the body-part has been formed - and also very much 'enbrained' - by countless instances of brooding, ruminating, and suffering from the thoughts and feelings you're having.
I must also stress how unethical it was for Anil Anathaswamy not to pay attention to the difference between psychotherapy's; even more so, to not know about all the progress being made in the field of psychotraumatology, which for example, allows us to study the symptoms of the present (a feeling towards a limb) with reference to catayzing events in the persons relational past.
Lastly, since the self is made in relation, it can only be remade, or remolded, by relationships. Intensive psychotherapy would be the only means to "create" new relational self states as, in terms of systems theory, existing 'ways of being' practiced thousands of times form deeper "troughs" than activities only performed a few times. So, psychotherapy, weekly, can help CREATE A NEW RELATIONSHIP (does the foundationless nature of the mind bother you?) between a person and his affectively infused body part.
But why don't we know this? Enter insurance companies, who want "quick and effective" solutions that work more on 6 week schedules, rather than the more necessary "as long as possible" schedule. This is what skews results.
And on an even more final note, claiming tihs to be a real condition that warrants surgery is a dangerous idea to throw out there, as people, especially anxious people, are liable to be suckered in by the gravity of the statement, and brood upon it, until they too develop the conviction that they have "always felt this way".
The mind is inherently dissociative. Each new revolution of consciousness codes differently, but often follows predictable pathways. At our core is a defensiveness, because dissociation is all about paying attention to things that are relevant to survival; in our abstract minds, this also means ignoring feelings that generate shame or anxiety: homeostasis works 'throughout', physically and psychodynamically.
First, let me explain by "not real". We got to go down a philosophical pathway first and note a distinction between two types of pathology. There are pathology's (or diseases) that are genetic and exhibit irreversibility. And then there are diseases that exist because of some underlying condition that the person isn't aware of (i.e blood pressure, diet, stress) that can otherwise be changed.
Anil Anathaswamy and others who claim that BIID is a "neurological disorder" and thus requires a medical treatment (removal of the body part the person wants to remove) are advocating what seems to me to be an insanely extreme position - and ironically enough (from an Indian writer) Anathaswamy doesn't seem to recognize the influence MIND - that is, how the experiences human beings have in their everyday interactions with other human beings can influence the neurobiology of the brain and the homeostatic balance between "self in relation" (the states we enact when we communicate with others) which is situated in the frontal and dorsal temporal areas, and the areas of the brain stem which regulate homeostatic processes (i.e the various factors influencing blood flow, breathing, etc) - can have on the body; and, I might add, ones sense of relation towards a body part is not at all different from the other ways the mind can go wrong.
Lets explore some of these other ways: anorexia nervosa, spasmodic dysphonia and gender dysmorphia
The first one is a disorder of how someone experiences their own body. The cause, of course, is the overwhelming influence (as experienced by the anorexic) of the significance society ascribes to body image. Causally speaking, some aspect in the anorexic's early relational environment (as between mother and her, father and her, individual siblings and her, and the emergent properties at higher levels) makes her vulnerable to succumbing to the influence society places on body image. I want to make clear that I am speaking probabilistically: when certain combinations of relational circumstances come together (say a gene for being high reactive and a mother who yells and screams) the likelihood of a certain phenotype (or consequence in behavior) is made either high or low.
Anytime anorexia appears, it can be said to have these certain relational conditions "scaffolding" the appearance of the phenomena in question. The end phenomenological (or the psychologically experienced) state is the sensation that ones body looks fat. I don't know what that's like and neither do you: it requires the presence of certain preconditions to 'make apparent' the "reality" that one is overweight, even though one may in fact be desperately underweight.
The second condition is one I myself once dealt with. I suffered a severe relational trauma at 13 which occurred again at 15 and 16. The result was post-traumatic stress disorder which, since it was caused by bullying, is better described as "developmental trauma", also known by other theorists as "complex trauma".
The issue of psychological or emotional trauma is perhaps best understood in terms of energy flow through the nervous system. Our nervous system is built to process a certain rate of information. When were relaxed and yet focused - a necessary mental state for effective socializing - information passes between humans with very high fidelity. On the other hand, when we feel threatened, our brain switches from what the neurophysiologist Stephen Porges calls the "social engagement system" to the "fight-flight" system. In neuroendrincology, this system is better known as the hypothalamic-pituitary-adrenal axis.
Whenever were shocked into defensive reaction, our brain releases a chemical from the hypothalamus (CRH) which causes the pituitary gland to release adrenocorticotropin into the blood stream; this then causes the adrenal glands (which sit atop the kidneys) to release adrenaline and cortisol. Cortisol, in turn, breaks down glucose which is then used to power mitochondria in cells; cell activity for the energy required to mount an effective defense response. This is basically what's happening when were "stressed" by the world.
When being bullied, I realized early on that I couldn't speak. What I heard whenever I attempted to speak was the presence of anxiety; an unconscious effort, compulsively enacted, to 'fix', or control, or do something that would make the bullying end. Repetition. The longer the threat lasts, the more consequential the effects on brain cells and the architecture of inter-cellular activity. Eventually, you brought to a state of mind of compulsive alertness to the now generalized relational threat: alert to the cues of others, in face, voice, of movement, that indicates disapproval. I found myself operating as if 'from without', seeing myself as a "shameful object", deserving disdain; the external viewpoint is what happens under relational trauma; the other party, the other perspective, begins to dominate your attention. In evolutionary logic, this is precisely what we should expect from examples in lower phyla: organisms adapt by modifying their internal organization. In complex multicellular organisms, these changes are coordinated to correspond to the information coming in from the visual system. Such as running away, fighting, or freezing when the two other responses aren't available or aren't possible. This, also, is basically what the simplest cells do: they pull away from noxious chemicals; likewise, they draw closer to useful chemicals.
Spasmodic Dyphonia is the belief that the raspy, stressful effort to speak is caused by an unrecognized neurological disorder; I, as well as many other psychologists and neuroscientists (such as Robert Scaer) believe a "disease" such as this is a consequence of relational trauma that occurred in the early years of development. I see early years because the belief that spasmodic dysphonia is a real thing (brain, or even larynx related) gains its force from a lack of episodic memory to make sense of it's presence. Because I suffered bullying, I know the contexts that brought this state out of me. Neurologically, the voice - the organ that felt the stress when one felt the need to protest the abuse - remains tentative and withdrawn.
Should we infer from a brain scan that the brain is causing a voice issue? Or should we instead trace the dots backwards and recognize the obvious contingency between social reality and the effect it can cause in neurobiology.
Finally, lets get back to body integrity identity disorder, with reference, this time, to what I've explained about the way emotional trauma builds anxiety and over-reactivity into brain processes. This occurs because, again, in a normal evolutionary context, the body is meant to 'burn' off the energy being provided by the stress response system (which, it bears mentioning, is inherited from evolutionary older species); but in our very unusual evolutionary environment, we often find ourselves stuck, in a job, without a context that can help us process our emotions without feeding them through, again and again, as rumination and paranoia about the self and it's world.
Here's an example. Imagine being 3 years old and witnessing a car accident. All around you people are screaming;loud noises all around you activate the stress response system. A women cries for help. Scared, you instinctively turn to where you last saw your mother, but she isn't there. You can't see here. You look and look. You breathe heavy, you start crying, wailing, mommmmmmmmy, wherrreeeee arrrrrrrreeeeee yooooouuuuuu. You quickly turn around and trip on the curb in front of you, you fall down and bang your knee on the cement. Your legs bleeding and you begin to cry harder.
In the brain at these same exact moments, the stress elicited by the context at hand spurred the HPA Axis into activity. It's revolution in the brain, each moment of fear and anxiety, is fed through and magnified from moment to moment. The brain is on maximal "high alert", feeling threatened and enacting a defense behavior that may elicit help attention from helpful adults. In particular, I want to highlight the 'social' parts of the brain as well as the parts that deal with meaning and narrative. "Mommy" is missing, and the loss is felt by the child as terrible: felt with such totality because psychological individuation has yet to happen.
The hitting the knee at the same sequence of time brought into the chorus of activity the area of the sensory cortex that processes knee sensations. The knee - in pain - is being 'incorporated' into a sequence of neurological events that's presently processing an existential sensation of emptiness of self; the mother - the source of identity for a child this age - is missing, and so in a sense, is the child. Hitting the knee brings the 'knee' into the experience of existential absence.
The read psychosomatic disorders exists is perhaps ultimately a manifestation of homeostatic balance. The brain may seek to "unload" certain experiences in different and sometimes anomalous ways. Normally, psychological trauma is processed and the person is able to return to balance without much residue on present functioning. But very often, when the intensity crosses a certain threshold, psychological trauma exerts disastrous effects on consciousness via the deleterious influence of cortisol on neurons. The self is instantly made disordered in some way. For some, it can be the voice (as it was for me); for others, their body (gender dysmorphia). But trauma is apparently very diffusive. A trauma can be 'linked' and contained, as it were, by the fact that a simple thing like a knee bang occurred at the same time one experienced trauma. Just as in other traumatic experiences (this is a science, called 'traumatology') episodic memory is 'deleted' by the power of cortisol, but procedural, or implicit memory, often stays. This is the core feature of post-traumatic stress disorder and there is very good reason to believe that a body part mapped by the brain which was experiencing trauma may 'retain' the existential, embodied sensation of being 'alien' from the body.
This is hard to understand for us because the idea of someone not 'owning' a body part seems strange, so it must, of course, be real, in this day and age of brain science. But we shouldn't rush to such a conclusion when a relational event (trauma) can provide a core 'basis' for the evolution - key word here, the perceptual state of the adult is the not same as the 4 year old, 5 year old, etc; perceptions change as our brain evolves more complex ways of analyzing an experience: for the adults Anathaswamy describes, they spent many years deluding themselves about an experience, which, understandably, they couldn't give narrative sense to (and thus resolve the anxiety: traumatic stress follows because of a lack of episodic clarity,) and thus grew more and more estranged from.
Now, of course, there is the question: so if not amputation, psychotherapy?
Yes psychotherapy. But also, not just any psychotherapy. You need a therapist who can pay attention to the global and systematic effects of interpersonal communicative displays in interaction, and also gain a sense of the individuals history to 'flesh out' out a narrative structure that can go along with this procedural symptom
This, I hope, will one day become a rule in a neurobiologically based psychotherapy: when a person is relating to some aspect of their experience in a dissociated way, assume trauma. As mentioned above, traumatic experiences are recorded differently than normal experiences. Because of the large amounts of circulating cortisol (possibly other stress chemicals as well may have toxic effects on cellular structures) and the particular role the hippocampus and adjacent structures play in 'working memory', what is felt phenomenologically by the traumatized person as 'dissociation', may well be the mental manifestation of neurons being destroyed by too much of a certain chemical.
What does this mean? It means the entire experience as neurologically coded is imperfectly processed. The physiological and affective feelings seem to persist, but without much memory of an event. In particular, I'm thinking of those children who are abused or neglected who fail to develop coherent self-schemas, and thus fail to experience themselves in any normal or healthy way.
Therapy would seek to locate some plausible "building" block from the persons past, and from that past, construct a coherent self narrative that can "take in" and absorb the meanings associated with the body part.
On another note, in this day and age of brain 'mapping', I find it unbelievable that brain scientists don't pay attention to the psychodynamic processes psychoanalysts pay attention to. It's ridiculous. The thoughts and feelings we ascribe to events and the meanings they hold about our past relationships, these are brain events; not only that, as many neuroscientists already acknowledge, a coherent sense of self, a sense of "I know where I am" in one's conceptual self-space, is very important to the whole idea of the self narrative.
Anxiety is tamed when we are able to contextualize or given meanings to our experiences. But when an experience seems nebulous (without an episodic memory) the procedural experience (a sense of numbness, or distance) can generate thoughts that canvass every aspect of the experience, until, over time, a relationship with the body-part has been formed - and also very much 'enbrained' - by countless instances of brooding, ruminating, and suffering from the thoughts and feelings you're having.
I must also stress how unethical it was for Anil Anathaswamy not to pay attention to the difference between psychotherapy's; even more so, to not know about all the progress being made in the field of psychotraumatology, which for example, allows us to study the symptoms of the present (a feeling towards a limb) with reference to catayzing events in the persons relational past.
Lastly, since the self is made in relation, it can only be remade, or remolded, by relationships. Intensive psychotherapy would be the only means to "create" new relational self states as, in terms of systems theory, existing 'ways of being' practiced thousands of times form deeper "troughs" than activities only performed a few times. So, psychotherapy, weekly, can help CREATE A NEW RELATIONSHIP (does the foundationless nature of the mind bother you?) between a person and his affectively infused body part.
But why don't we know this? Enter insurance companies, who want "quick and effective" solutions that work more on 6 week schedules, rather than the more necessary "as long as possible" schedule. This is what skews results.
And on an even more final note, claiming tihs to be a real condition that warrants surgery is a dangerous idea to throw out there, as people, especially anxious people, are liable to be suckered in by the gravity of the statement, and brood upon it, until they too develop the conviction that they have "always felt this way".
The mind is inherently dissociative. Each new revolution of consciousness codes differently, but often follows predictable pathways. At our core is a defensiveness, because dissociation is all about paying attention to things that are relevant to survival; in our abstract minds, this also means ignoring feelings that generate shame or anxiety: homeostasis works 'throughout', physically and psychodynamically.
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