Attachment and Brain Development
Conceptual syntheses and empirical study' in developmental psychology continue to bridge the fields of neuroscience and psychotherapy. From the perspective of interpersonal neurobiology, as Allan Schore has shown in his integrations of theory, research, and clinical experience, we think of the attachment relationship as the major organizer of brain development. The attachment bond, the dynamics of caretaking experience, and the course of relational life in the social surrounds of infancy and childhood are fundamental in shaping the architecture of the brain, mediating the development of integrative and regulatory functions. Ongoing attunement and patterns of synchrony in interaction and communication between the child and caregivers create neural networks, forming the core structures of the brain, integrating sensory, emotional, cognitive, and behavioral domains of experience.
Over the course of his work Schore has increasingly centered on emotion and the dynamics of unconscious processes in his reformulations of classical attachment theory', shifting the focus from patterns of overt behavior that shaped John Bowlby’s original accounts of the attachment bond to the realm of intersubjectivity, communication, and interactive regulation between the child and caretakers (Schore, 2012, 2019a, 2019b).
The dynamics of synchrony, rupture, and interactive repair shape his reformulations of attachment. By way of overview, the more the caregiver contingently tunes levels of activity to the infant during periods of social engagement, the more the caregiver allows the infant to recover quietly in periods of disengagement, and the more the caregiver attends to the infant’s initiating cues for reengagement, the more synchronized their interaction. Following lapses in attunement and rupture, the caretaker re-regulates negative states and restores synchrony.
In the ongoing dialogue, he proposes, the caretaker and the infant co-construct cycles of “affect synchrony” that up-regulate positive emotion (joy, elation, excitement, interest) and “rupture and repair” that down-regulate negative emotion (fear, sadness, shame, disgust). The regulatory' processes of emotional synchrony, which create states of positive arousal, and interactive repair, which modulates states of negative arousal, are the fundamental elements of attachment. The ongoing dynamics of attunement, rupture, and re-attunement in the relational matrix mediate the development of the emotion-processing limbic circuits of the right hemisphere, shaping the emerging self over critical periods of maturation in the first two years of life (Schore, 2012, 2019a, 2019b).
The right hemisphere is instrumental in the development of capacities for implicit relational knowing, the “nonconscious reception, expression, and communication of emotion and the cognitive and physiological components of emotional processing” (Schore, 2009, p. 6). A growing body' of research supports the crucial functions of the right hemisphere in sense of self and relational life, mediating capacities for self-awareness, empathy, and identification with others (Decety & Chaminade, 2003; Knox, 2011; McGilchrist, 2019; Schore, 2019a, 2019b).
Donald Winnicott describes the experience of embodiment, aliveness, authenticity, creativity, and play' in his accounts of the true self that emerges in the constancy of care over the course of infancy and childhood. Caregivers continue to shape the emerging self in formative ways. As David Wallin explains:
The expressions of the child’s self that evoke the attachment figure’s attuned responsiveness can be integrated, while those that evoke dismissing, unpredictable, or frightening responses (or no responses at all) will be defensively excluded or distorted. What is integrated can then enjoy a healthy maturational trajectory'; what is not tends to remain undeveloped... the difficulties that bring patients to treatment usually' involve unintegrated and underdeveloped capacities to feel, think and relate to others (and to themselves) in ways that “work.”
(2007, p. 100)
Researchers assume that epigenetic programming by' variations in the quality of caretaking strengthens resilience or increases risk for psy'chopathology and physical illness in adulthood and later life (Sroufe, 2016; Sroufe, Coffino & Carlson, 2010; Stevenson, Halliday, Marden & Mason, 2008). A large body of empirical findings shows that neglect, abuse, and trauma in infancy' and early' childhood increase risk for a range of conditions, including post-traumatic stress disorder, borderline personality' disorder, and major depression (Roth, 2017; Roth & Sweatt, 2011; Schore, 2019a, 2019b; Siegel, 2020; Wallin, 2007; Van der Kolk, 2014). Adverse childhood experiences are linked with a range of negative health outcomes in adulthood, including diabetes, hypertension, heart disease, stroke, cancer, and dementia (see Dube, Felitti, Dong, Giles & Anda, 2003 for a review of the findings from the landmark Adverse Childhood Experience study).
Adversity' compromises the regulatory’ functions of the body, influencing the course of synaptic growth, gene expression, and reactions to stress. “If children grow up with dominant experiences of separation, distress, fear, and rage,” D. F. Watt writes, “then they will go down a bad pathogenic developmental pathway, and it’s not just a bad psychological pathway but a bad neurological pathway” (2003, p. 109, cited in Schore, 2019b, p. 24).
We have come to think of our experience of attachment as an ongoing process rather than a fixed property', evolving across the course of development as we negotiate the dynamics of relational life. In accord with current understandings of neuroplasticity', we assume that the core conditions of the therapeutic relationship and enriching forms of experiential learning over the course of treatment carry' the potential to reinstate developmental processes that have been compromised in earlier caretaking, reorganizing the deeper neural structures that mediate attachment, strengthening capacities to process and integrate subjective experience, regulate emotion, and negotiate the dynamics of relational life. As Schore and Wallin emphasize in their accounts, we can think of the integration of the core structures and functions of the brain as the neural corollary' to the psychological integration we foster over the course of psychotherapy, connecting the body, states of mind, and behavior.
“If our view of memory is correct,” Gerald Edelman and Giulio Tononi proposed at the turn of the century’, . .every act of perception is, to some degree, an act of creation, and every act of memory' is, to some degree, an act of imagination” (2000, p. 101). Over the last half century' converging lines of study in the fields of cognitive psychology and neuroscience have documented two domains of memory, most broadly categorized as implicit and explicit. Researchers describe fundamental differences in the maturation, architecture, and dynamics of these forms of memory, and findings promise to deepen our understanding of vulnerability, problems in functioning, and basic tasks in psychotherapy.
We can trace the origins of modern memory' research to the work of Brenda Milner, a British neuropsychologist who began her studies of cognition and learning at the Montreal Neurological Institute in the 1950s. In her case study' of Henry' Molaison, known as H.M., published in 1957, she described his profound loss of memory' following an experimental surgical procedure intended to control his intractable epileptic seizures. After the removal of the medial temporal lobe, which contains the hippocampus, Molaison developed a pervasive loss of memory' for people, places, and objects. His perceptual and intellectual functions remained intact.
In the course of her research, Milner found that Molaison was able to learn new motor skills though repetition, even though he was not conscious of the skills he was developing. He had lost his capacity' for explicit memory'— memory of people, places, and objects, based on conscious recall, dependent on the medial temporal lobe and the hippocampus. Yet he had preserved his capacity' for implicit memory—the unconscious recall of motor skills, perceptual skills, and emotional experience, dependent on the amygdala. Milner’s research documented the crucial role of the hippocampus in memory', showing that memory' is a distinct set of mental functions located in particular structures of the brain. In time, researchers would demonstrate that memory' is not a unitary faculty' of mind (Milner, Squire & Kandel, 1998; Sacks, 2017).
Over the first year of life we register our experience as unconscious, pre-symbolic memories in the amygdala. The structures of implicit memory, functional before birth, organize unconscious patterns of learning across sensory', motor, and emotional networks as associative memories, encoded in layers of neural processing out of awareness.
When implicit memories are activated, the “instantiations” engage circuits in the brain that mediate fundamental aspects of experience in everyday life—the sensations, emotions, images, thoughts, and behaviors that constitute our sense of self, our perceptions of relational life, and our assumptive world—what we think of as “me,” “my experience,” “my world.” In this sense we can think of our early states of mind as implicit forms of memory' that influence the
Orienting Perspectives in Neuroscience 47 organization of the self and the development of traits that we understand as defining features of personality. Researchers assume that implicit memories shape the development of attachment schemas and working models of relational life that influence patterns of interpersonal behavior. Implicit memory operates in the experience of “priming,” where contextual cues activate particular features of earlier experience in preparation for action (Schore, 2019a; Siegel, 2020; Van der Kolk, 2014).
The content of implicit memory, accordingly, is carried in our experience of sensations, emotions, perceptions, thoughts, and behaviors that remain unintegrated and unformulated, operating out of awareness. We do not experience the subjective sense of remembering in the realm of implicit memory; we feel, imagine, think, and act without any awareness of the influence of past events on present experience, not having access to the associative processes that underlie our experience. The effects of earlier events are present, here and now, without any sense of conscious memory (Westen & Gabbard, 2002 p. 68; see Siegel, 2020, for expanded accounts of memory).
We can think of patterns of attachment, transference reactions, defensive processes, and fundamental attitudes toward the self, others, and the world that originate in early states of mind as forms of implicit memory. A fundamental task of psychotherapy is to deepen understanding of the ways in which early experiences have shaped implicit memories that perpetuate problems in functioning.
The structures of explicit memory organize conscious forms of learning that require focal attention, reflected in recall of facts, ideas, and episodes. Endel Tulving, a cognitive neuroscientist and experimental psychologist at the University of Toronto, has advanced our understanding of explicit memory over the course of his research. He first made the distinction between memory of factual information and memory of personal experience in a report published in 1972, coming to classify explicit memory as semantic (referring to general knowledge of facts) or as episodic (referring to memory for specific episodes in time or autobiographical events) (Tulving, 2013).
As the medial temporal lobe matures in the second year of life we develop capacities for explicit memory, allowing us to register our experience of relational life, place, and time, organizing information according to context and sequence. In contrast to implicit memory, we can formulate our experience of learning, rendering it into words, fostering the development of autobiographical narratives and knowledge of self. The hippocampus plays a central role in the organization of explicit memory, as Milner had shown in her accounts of Henry Molaison.
The functional relationship between the amygdala and the hippocampus is thought to be a crucial determinant of top-down and right-left forms of neural integration, as we will see in the following chapter, influencing our capacities for perception, emotional regulation and learning. The amygdala is closely linked to “right” and “down” systems that govern somatic and emotional experience, while the hippocampus is instrumental in “left” and “top” systems that mediate conscious awareness and capacities to formulate and reflect on experience (Cozolino, 2017; Siegel, 2020).
Researchers assume that implicit memories of trauma carried in the networks of the amygdala and the right hemisphere potentially precipitate a range of problems in functioning. Bessel Van der Kolk provides a careful discussion of research documenting the ways in which recollections of emotional events from the past can activate the visceral sensations associated with the original event, disrupting basic bodily functions (2014). The experience of acute and prolonged stress generates the release of glucocorticoids thought to compromise the functioning of the hippocampus, leading to atrophy and memory' deficits (Davidson & McEwen, 2012). Patients with post-traumatic stress disorder secondary to childhood trauma or combat exposure, chronic depression, and schizophrenia show hippocampal cell loss correlated with memory deficits (Cozolino 2017; Siegel, 2020; Van der Kolk, 2014). Louis Cozolino proposes that compromise in hippocampal functioning may increase the role of the amygdala in mediating memory', emotion, and behavior.
From the perspective of neuroscience, the therapeutic process carries the potential to strengthen the integration of networks linking unconscious and conscious domains of memory', helping patients bring implicit memories into awareness as they render experience into words, taking account of earlier events in reshaping narrative accounts of their lives. In psychodynamic concepts of therapeutic action, associative methods and processing of interactive experience in the therapeutic relationship are thought to engage the realm of implicit memory', helping patients reorganize unconscious associations! networks that precipitate emotional reactions, defensive behavior, and patterns of interpersonal behavior that perpetuate problems in living. A range of approaches and techniques across the foundational schools of thought help patients engage and reorganize conscious patterns of feeling, thought, and behavior operating in the domain of explicit memory’.