Allan N. Schore, PhD

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Relational Trauma and the Developing Right Brain: An Interface of Psychoanalytic Self Psychology and Neuroscience

Allan N. Schore, PhD
UCLA David Geffen School of Medicine

Right Brain Pathological Dissociation and Self Psychological Deficits

Workers in the field of developmental traumatology now assert that the overwhelming stress of maltreatment in childhood is associated with adverse influences on more than just behavior, but on brain development.54 During the intergenerational transmission of attachment trauma the infant is matching the rhythmic structures of the mother’s dysregulated arousal states. This synchronization is registered in the firing patterns of the stress-sensitive corticolimbic regions of the right brain, dominant for coping with negative affects.55 Describing the essential survival functions of this lateralized system Schutz notes The right hemisphere operates a distributed network for rapid responding to danger and other urgent problems. It preferentially processes environmental challenge, stress and pain and manages self-protective responses such as avoidance and escape.”56 The right brain is fundamentally involved in an avoidant-defensive mechanism for coping with emotional stress, including the passive survival strategy of dissociation.

Current neurobiological data can be utilized to create models of the mechanism by which attachment trauma negatively impacts the right brain. Adamec and colleagues report experimental data that “implicate neuroplasticity in right hemispheric limbic circuitry in mediating long-lasting changes in negative affect following brief but severe stress.”57 According to Gadea mild to moderate negative affective experiences activate the right hemisphere, but an intense experience “might interfere with right hemisphere processing, with eventual damage if some critical point is reached.”58 This damage is specifically hyperarousal-induced apoptotic cell death in the hypermetabolic right brain. Thus, via a switch into a hypoarousal, a hypometabolic state allows for cell survival at times of intense excitotoxic stress.18,48,49,59

Recall that right cortical areas and their connections with right subcortical structures are in a critical period of growth during early human development. The massive psychobiological stress associated with attachment trauma sets the stage for the characterological use of right brain pathological dissociation when encountering later stressors. Converging evidence indicates that early abuse negatively impacts limbic system maturation, producing enduring neurobiological alterations that underlie affective instability, inefficient stress tolerance, memory impairment, and dissociative disturbances. In this manner, traumatic stress in childhood leads to self-modulation of painful affect by directing attention away from internal emotional states.60 The right brain, dominant for attention61 and pain processing62 thus generates dissociation, a defense by which intense negative affects associated with emotional pain are blocked from consciousness.

Congruent with developmental and clinical models Spitzer et al. report a transcranial magnetic stimulation study of adults and conclude, “In dissociation-prone individuals, a trauma that is perceived and processed by the right hemisphere will lead to a ‘disruption in the usually integrated functions of consciousness.’”63 In functional magnetic resonance imaging research Lanius et al.64 show predominantly right hemispheric activation in psychiatric patients while they are dissociating, and conclude that dissociation, an escape from the overwhelming emotions associated with the traumatic memory, can be interpreted as representing a nonverbal response to the traumatic memory.

These studies are exploring the evolution of a developmentally impaired regulatory system and provide evidence that prefrontal cortical and limbic areas of the right hemisphere are centrally involved in the deficits in mind and body associated with a pathological dissociative response.47 This hemisphere, more so than the left, is densely reciprocally interconnected with emotion processing limbic regions, as well as with subcortical areas that generate both the arousal and autonomic bodily-based aspect of emotions. Sympathetic nervous system activity is manifest in tight engagement with the external environment and high level of energy mobilization, while the parasympathetic component drives disengagement from the external environment and utilizes low levels of internal energy.65 These ANS components are uncoupled in relational trauma.

In a recent psychoanalytic formulation that echoes Kohut’s “uncurbed spreading of anxiety or other emotions,” Bromberg links right brain trauma to autonomic hyperarousal, “a chaotic and terrifying flooding of affect that can threaten to overwhelm sanity and imperil psychological survival.”66 Dissociation is then automatically and immediately triggered as the fundamental defense to the arousal dysregulation of overwhelming affective states. And in the psychiatric literature Nijenhuis67 asserts that “somatoform dissociation” is an outcome of early onset traumatization expressed as a lack of integration of sensorimotor experiences, reactions, and functions of the individual’s self-representation. Dissociatively detached individuals are not only detached from the environment, but also from the self -their body, their actions, and their sense of identity.68 Crucian et al. describe “a dissociation between the emotional evaluation of an event and the physiological reaction to that event, with the process being dependent on intact right hemisphere function.”69

Pathological dissociation thus reflects the chronic dis-integration of a right brain system and a resultant adaptive failure of its capacity to rapidly and nonconsciously detect, process, and cope with unbearable emotional information and overwhelming survival threat. A poorly developed right cortical-subcortical implicit self system is inefficient at recognizing and processing external stimuli (exteroceptive information coming from the relational environment) and on a moment-to-moment basis integrating them with internal stimuli (interoceptive information from the body). This too frequent failure of integration of the higher right hemisphere with the lower right brain induces an instant collapse of both subjectivity and intersubjectivity, even at lower levels of interpersonal stress.

In summary, the developing brain imprints not only the overwhelming affective states that are at the core of attachment trauma, but also the primitive defense used against these affects—the regulatory strategy of dissociation. It is now established that maternal care influences both the infant’s reactivity70 and the transmission of individual differences in defensive responses.71 A large body of psychiatric, psychological, and neurological studies supports the link between childhood trauma and pathological dissociation. 72,73,74,75,76