When we hit an ‘I need you’ moment, what do we do if the person we need doesn’t come through for us? Obviously we can protest and feel angry – if you have ever looked after a baby you will be familiar with that solution. Their reddening face, squirming body and arching back as they scream ‘blue murder’ will be familiar. But what if the person still doesn’t come? Evolution requires us to have a backstop: if you are a human infant screaming in the bush for your Mama, screaming incessantly will make you a tasty snack for any predator wandering by.
So, what does follow ‘protest’? Generally, despair. Once RAGE has been spent, FEAR ensures that we keep quiet (I refer to these emotions in capitals because I am referring to Jaak Panksaap’s 7 basic AFFECTS. For more on this, see him explaining them in a 17-minute Youtube video. Despair can be a silent scream of immobilised terror, also known as sub-dorsal vagal nerve activation which Stephen Porges calls the freeze response. In extremis, this can result in adults losing control of their bowels and/or dissociative, out-of-body experiences.
If infants find themselves experiencing what Attachment Theorist Mary Main has termed ‘fright without solution’ too much and too often, how does this sculpt their predictions about the world? If they cannot turn to their caregiver to cope with their powerful negative emotions when they hit an ‘I need you’ moment, how will their developing brain respond and what consequences might this have for the adults they become? This blogpost explores some possible answers to this crucial question.
We can arrive at ‘fear without solution’ from two origins. Either through the active and frequent abuse of a caregiver (think of the Disorganised attached 1-year old crawling under the chair the mother is sitting on upon reunion in the Strange Situation), or through the pernicious, but harder to spot, behaviour of neglect. In this latter instance, a very depressed mother with plummeting oxytocin and spiking cortisol levels will not catch her baby’s eye when he/she makes a desperate bid for contact or will break off eye contact faster and more frequently than a well mother would (Ruth Feldman’s extraordinary work in this area is painful but fascinating.
Another route to neglect can of course be substance misuse where the caregiver is drunk or high, and thus leaves the baby to cry in distress for long periods of time. We might also note that capitalism’s habit of sequestering parents and infants alone at home (nuclear families where one partner is out at work 9 hours a day) puts enormous pressure on the one parent who stays at home. In the Global South, where allo-parenting is more common, the infant has a wider range of caregivers available more of the time, although poverty can obviously be a powerful negative factor affecting optimal development.
Whatever their environment, all human infants undergo rapid and profound brain development in the first years of life. I like to think of the neurotypical infant’s developing brain as a fabulously complicated piece of putty; poked, prodded and sculpted by how it is loved (or hated) into a form enabling him or her to accurately predict the environment he/she has landed in. Just think how a baby can be born anywhere in the world, from an Inuit igloo to a Shanghai 100-floor condominium, and after a decade and a half he/she can take their place as a becoming-capable member of that society. Which organ of the body is responsible for this remarkable achievement? The brain, of course.
Let’s remember that the brain didn’t evolve to be a precise observer, to be rational, or to be happy. It has one fundamental task – to allocate resources efficiently to allow the animal to grow, protect itself, survive, and reproduce. This resource allocation process is called allostasis. Alongside thinking, feeling, perceiving, or creating emotions, the brain regulates the autonomic nervous system and other physiological systems while being responsible for behaviours that generate resources to be consumed and processed. How can allostasis be most efficient? By predicting physiological needs before they arise. This means the brain must run an internal model of the body in the world. It does this using the principle of active inference (see my blog post on this idea here.
In every moment of wakefulness, the brain uses the totality of past (learned, non-infantile) experiences organized as concepts to guide actions (behaviors) and gives the sensory inputs it is receiving a constantly categorized meaning. So where does the mind fit into this picture? We might say the mind is not just a function of the brain-body but also the brain-bodies of other people, the physical environment, culture, and social reality.
Having introduced the concept of allostasis, let us return to the story of a developing baby’s brain. We know the myelination of the right-frontal lobe happens between 6 and 24 months of age because scans can show it. ‘Myelination’ is important because if the brain is putty, myelination patterns are the pokes and prods which shape the brain through experience. Myelin is the fatty tissue of Omega-3 proteins which accelerates communication in circuits of neurons – think of the plastic coating on an electrical cable. The left-frontal lobe only starts myelinating after 2 years, when infants are learning to communicate with their caregivers through language.
So what might be happening in this first 24-month period of life as the infant’s right-frontal lobe develops? In adult patients with brain injuries in this area (Mark Solms’ anosognosic patients come to mind) they have deficits in reliably distinguishing between what belongs to them and what belongs to others, suggesting that this part of the brain is important for what I am going to call a somatosensory, non-declarative, non-verbal and embodied sense of self. That is pretty technical language, so in plain English: the ideal developmental process by 24 months would have produced a securely-attached, little person able to negotiate tricky moments in life by enlisting the help of their caregiver to effectively scaffold their experience.
Let us imagine such a ‘happy’ 18-month year old running into the kitchen and tripping over the slight ridge on the floor in the doorway, whereupon they fall flat on their face and start crying. Their wiring has led to them to predict that their caregiver will accurately and sensitively respond to their problem. So they are easily soothed when their caregiver quickly picks them up, kisses better their Ow knee, cuddles them and tells them how brave they have been and what a ‘naughty’ ridge it was in the floor that felled them! In a technical sense, their caregiver’s brain has absorbed their upset thanks to the infant’s successful bid for co-regulation of their neurobiological distress. Soon enough, they are wriggling down to get on with the important job of playing…
But let us return to our baby who has been suffering ‘fear without solution’ too much of the time over their first 24 months. What might their experience of a similar upset be? Their little brain will not predict a timely response from their caregiver to their distress. In fact, if they have experienced active abuse from the caregiver, they might predict that their parent would only add to their distress by shouting at them for being so stupid and falling over in the first place. They would have learnt that being in close proximity to such a person at such a time will not go well. Since an angry parent is likely to be a hurt-y parent, they would not readily seek out a cuddle to manage their pain. And, if they have suffered neglect rather than abuse, they will have learnt that their parent may likely not notice their distress, and thus not be able to soothe it. So how will their brains cope with the shock at falling over and the pain sustained when they fell? And what happens when they grow up and their pain transforms from a bruised knee to a setback at work, a bully at school or worse of all, a broken heart?
In another blog post, I have outlined my image of a well-looked after baby growing up to be a person who bounces about on a well-strung trampoline under their feet, utterly oblivious to the abyss below them. Not so our little toddler and adult-to-be, who knows thanks to the sculpting of their right-frontal lobe by 24 months, that the Other will not hear their cry, or if they do, then they had better shut up pretty quick or else. So when we’ve learnt that turning to the Other in times of distress is dangerous, what consequences does this have for our emerging sense of Self?
Perhaps answers lie in the Neuropsychoanalysis Congress in Trieste which I attended in July, 2024, entitled ‘When The Body Speaks: Beyond Conversion Disorder’. World-leading researchers examined how an embodied sense of self is generated in the brain, and what alters its normal expression.
From Swiss neurologist, Olaf Blanke, I learnt that he could elicit a sense of a benevolent ‘presence’ in a third of his normal subjects by stimulating part of their Temporal-Parietal Junction (TPJ) using trans-magnetic stimulation. Antarctic and Himalayan explorers frequently describe experiencing this phenomenon. Ernest Shackleton, for instance, described the uncanny awareness of someone just behind him and slightly to his right, who disappeared when he turned to look at them, but felt to him like an encouraging and loving presence in the most desperate moments of his final month lost on the Antartic ice sheet in 1917.
Blanke demonstrated to his spellbound audience of 500+ neuroscientists, neuropsychiatrists, psychoanalysts and psychotherapists how he had used some ingenious robotics to elicit this identical experience of ‘presence’ in normal subjects he brought to his lab. He showed how manipulating the electrical firing of neurons in the TPJ can distorts one’s embodied sense of Self. Interestingly, it is precisely this region which is activated when people have epileptic fits, take hallucinogens and/or experience a religious sense of ‘Oneness’ with the Universe. At these times, whether for good or for ill, the boundaries of the Self seem to flicker and fray.
It wouldn’t be ethical, but I bet if you measured the TPJ activation of a psychotic person in the grip of delusion, it would also be activated in an unusual way. Or what about someone who is seeing a ghost? Would their TPJ also show a similar pattern of activation? Up to 50% of people who have been recently bereaved report feeling the ‘presence’ of their deceased loved one. Distortions of the embodied Self also abound in anorexia, as well as in depersonalisation and derealisation disorders. These deeply human and often spiritual experiences have long puzzled our great writers – let us consider Old Hamlet and Banquo’s ghostly entrances into Shakespeare’s tragedies, or the surreal and erratic growth spurts of Lewis Carroll’s Alice.
Perhaps an important takeaway from Blanke’s discoveries should be that one’s sense of Self – where we start and where we end – is far from immutable and is far more dependent on our relationship to others than we might realise. We might even say that a stable sense of self is the sophisticated end point of the brain’s complicated developmental trajectory – which abounds with pitfalls, many of which were examined by the Trieste Congress’ other speakers.
Edinburgh’s Neurology Professor, Jon Stone (who has spent his career helping sufferers of Functional Neurological Disorders, or FNDs) outlined some specific examples of embodied Self-disturbance. In Freud’s day, these people were labelled Hysterics (think of Anna O’s partial paralysis and Dora’s voice loss). Their problems were later grouped under the term ‘Conversion Disorders’: the idea being that the patient ‘converted’ emotional turmoil into a psychosomatic problem which neurologists then claimed they couldn’t treat due to the absence of an ‘organic’ problem. This would not be a comforting diagnosis if you woke up one day and discovered that your whole left side was paralysed. Or if you were suddenly blind, deaf, or victim to intermittent tremors, stammers, tics, or seizures. Up to 100,000 people suffer with FNDs in the UK, and Professor Stone’s videos demonstrated how powerfully debilitating their symptoms can be. You know you are not malingering or pretending when you fall to the ground, overcome by uncontrollable shakes; when your symptoms can last decades and even worsen with time. How on earth does this happen?
Professor Stone revealed some extraordinary cases: people who stammered in their language of origin so badly that they couldn’t be understood but communicated without hesitation in their second language; people who couldn’t speak at all but could sing; others who could run but not walk. The variations were mind-boggling and confounding, yet all were true cases he had treated (often successfully). FNDs are by no means rare – every year 10-15% of children presenting to Neurology departments in France are suffering from FNDs. So, what exactly is going on?
FNDs have perplexed physicians for a long time. James Paget wrote in 1873: “The patient says ‘I cannot’, the Doctor says, ‘You will not’. The truth is the patient ‘cannot will’”. FNDs are not transitory phenomenon. Some patients suffer for 30+ years; after 14 years, 80% of patients still had symptoms, some of which had worsened. When Professor Stone started in FNDs, the patient would be told what wasn’t wrong with them (‘Your scan is normal’) and were then sent to the Psychiatry department which understandably made them feel angry and misunderstood. Just imagine: you wake up paralysed and are taken to the doctor only to be told that it is ‘in your head’ and you are thus on your own (and ‘mad’). You would be furious!
What Jon Stone instead tells his patients is: ‘You have FND, your nervous system is not damaged, but it’s not functioning properly’. Treatment involves several different options: occupational therapy, speech and language therapy, physiotherapy, and psychotherapy. Professor Stone certainly agrees with Freud that some FND symptoms are brought on by emotional difficulties (many of his patients have histories of trauma and neglect) but he asserts for 30-70%, this is not the case.
He gave us the following analogy to comprehend this. Imagine a piano: you open the lid, and everything looks fine, but when you try to play, it is wildly out of tune. Stone likens FND to a brain software problem (like the piano tuning) but scanners only pick up a hardware problem (a broken string or ill-fitting hammer). So what can we say about how FND sufferers’ brains are different? In one experiment, participants were shown two jars: one jar had a majority of red balls with a few blue ones; the other had the opposite formation. The jars were then hidden from view and a mix of red and blue balls were presented to the participants, who were asked to guess which jar they were from. On average, FND patients saw only 2 balls before asserting which jar the ball had come from, while Control subjects waited until they had seen 8 balls before making their guess. Professor Stone suggested the haste of the FND patients’ decision-making might be reflecting their propensity to privilege their top-down predictions over bottom-up sensory inputs (a bit like in phantom limb syndrome where the mind map of the body has not updated properly to reflect the fact that they have lost a limb). Stone used this inference to design a FND-inflected physiotherapy and CBT program aimed at helping patients slow down and test their top-down assumptions more frequently. This proved more effective than the standard treatment for FNDs, implying his hypothesis is correct.
Professor Stone seems to be saying that FND patients suffer from poor top-down predictions about their ability to control their motor systems (i.e. they believe and therefore perceive that they have less control over their body than in fact they do). Their bodies are doing things they do not will, yet we know that their brain is causing their symptoms, a part which is unconscious to them (hello Freud!).
Bodies doing things we do not will is a common source of human suffering. Think of auto-immune disorders, IBS, fibromyalgia, migraines and skin complaints of all kinds, as well as FNDs. If psychosomatic complaints are brain software problems and the software is sculpted by early interpersonal relationships, what might be happening under the bonnet, so to speak? A baby uses the emotional apparatus they are born with, in the form of crying, to elicit care. This is another way of saying emotions are the brain’s earliest way of saying to the world: ‘Solve this problem!’ But the developing abused/neglected baby is honing a top-down prediction that another mind will not solve their distress because of the too-many times their RAGE/FEAR and PANIC/GRIEF did not get processed by their caregiver. These experiences over the first two years of life are translated into myelination patterns in the brain to form their top-down predictions which their brain then uses for allostatic regulation. An example of this sculpting would be how when the HPA axis is endlessly triggered, the stress response turns from hyperactive to hypoactive. This is one of the reasons depressed people often feel so bad in the morning, as they should start the day with a cortisol spike to get them up and at it, but their HPA axis has been wired by early experience to generate despairing moods instead of proactive ones.
So, to recap, our baby does not grow up trusting their m(Other). Their top-down prediction about the m(Other) is that they will not be empathetically received if they are in an ‘I need you’ moment. Now we know a baby is utterly dependant on their caregiver and cannot afford to rupture this bond. So, a parent who responds to their baby’s distress with FEAR or RAGE is installing software in the baby’s brain (stored unconsciously because of infantile amnesia) which might make their neuronal circuitry effect the following: ‘My emotion won’t make my caregiver solve the problem. And my distress mustn’t drive my parent to abandon me. So I must find another place to inscribe my distress. I know! It can go into the body.’ Bingo! Affect is converted to somatic symptom = psycho-somatic complaint. Professor Stone acknowledged that FND symptoms can sometimes begin in response to an unsuccessful ‘I need you’ moment and this could be reactivating the earlier predictive pathway. Then, in an awful example of the repetition compulsion, FND patients might meet a response in their doctor identical to that of their parent originally: ‘Move along please, you’re inconveniencing me and there’s nothing wrong with you’.
But another way the neglected and/or abused baby might solve this problem is by re-drawing the boundaries of their psychic skin meaning their top-down predictions about themselves end up a little kooky. Then, instead of developing a psycho-somatic complaint, they might develop a personality disorder (PD), which is a psychic configuration whereby the Self has very porous boundaries. For example, the narcissistic PD patient hits an ‘I need you’ moment and responds with a top-down prediction that the Other will fail them so they unconsciously control the Other to get what they want. You could say they ‘acquire’ the Other, changing ‘I need you’ into ‘I need I‘ thus wiping out the Other’s agency and/or separateness. This would produce the behaviour of a coercively-controlling partner who can never be wrong. Or conversely, the echoistic PD patient hits an ‘I need you’ moment and responds with a top-down prediction that their needs are always subordinate to the Other, so much so they cannot even be voiced, so they unconsciously bend themselves to the Other’s will (like Echo who loses her voice in the myth). In this version, they ‘attribute’ the Other, changing ‘I need you’ into ‘You need you’. This is why a Narcissus so often takes up with an Echo (Savery, D. 2018). For more on acquisitive and attributive borderline personality disorder, see Ron Britton’s paper, The Unconscious in Practice which is Chapter 5 in Sex, Death and the Superego (2003, Karnac Books).
Fotopoulou & Tsakiris (2017) have argued that the earliest indication of selfhood, the feeling of being an embodied subject, is shaped by embodied interactions with others (during and beyond early infancy). Their research suggests that an infant’s bodily self-perception emerges from the dynamic interplay between signals arising from inside the body and from interpersonal, affective exchanges with their caregiver. Homeostasis depends on the mother’s CARE (a baby cannot regulate their temperature at birth, and for their first five months, cannot even turn over by themselves). Fotopoulou and Tsakiris argue that the ability to accurately intuit what is happening inside your body depends on having experienced good quality interpersonal touch earlier on (having been soothed with gentle touch, fed, held and changed with sensitivity). To learn more about this, Fotopoulou has done a video on her work you can watch here.
What is a healthy psychic skin? It is a coherent, reliable, sensed, physical boundary of Self inscribed into circuits of the brain, especially in the neuronal networks of the insula and anterior cingulate gyrus. One way this may happen is that slow nerve fibres which are responsible for processing intense long-lasting pain, temperature, and pleasant touch are unmyelinated at birth, while fast nerve fibres which convey information concerning pressure, vibration, pin prick and spatial localisation are myelinated from birth. So could we intuit that an infant who lacked a caregiver to gently touch them, might be predisposed to developing chronic pain syndromes later on, due to the way their slow nerve fibres myelinated in an adverse way due to the absence of gentle touch in their earliest years?
Cristina Alberini’s fascinating research on memory feels pertinent to this discussion. She set out to explore whether infantile amnesia obscures from view experiences which are retained somewhere else in the brain’s memory system. Her studies show that juvenile and adult rats have context-dependent memories of an aversive experience from infancy, even though as pups they did not avoid the site of the aversive experience (even 30 minutes after exposure to it). She calls these latent memory traces and, through TRAP cell analysis, she demonstrated that they are retained as neuronal networks well into adulthood.
Some of the questions Alberini asked (and answered for us) were:
Is the hippocampus involved with these latent memory traces?
Yes, the hippocampus is required, and performs an increasingly important function as it matures with experience.
Is the biological makeup of memories formed in infants distinct to later memories?
Yes, early experiences have a physical impact on brain development (they form the prods and pokes which sculpt the putty). For example, they might increase the number of synapses or promote the maturation of both excitatory and inhibitory synapses in particular parts of the cortex. Alberini’s research showed that if the infant rats were denied appropriate experiences, a number of synapses critical to later memory development die. This proves the existence of critical time periods in the development of memory systems – just as there are for vision and language.
These windows of plasticity only occur in infancy, and they really matter. For example, we may be able to learn new languages after age 12, but we will have missed the critical window in language development where we can learn to speak without an accent. For rats, and presumably for us too, there is a precise temporal window where hippocampus-dependent learning requires specific types of experience.
So, why are memories formed in infancy stored long-term, but not available for conscious recall?
Alberini hypothesises that in infancy our memory systems are underdeveloped and unrefined, like blurry lenses which later develop into clear vision. It seems that congruent learning matures the system, shaping our identities and our actions – especially our automatic, implicit, unconscious responses. So, the episodic memories of infancy are stored in a latent, implicit form for all time, forming the substrate out of which the more sophisticated memory apparatus develops. Therefore our ability to recall long-term memories matures through repetition of congruent learning during infancy. In sum, this is a critical period for memory system development and has lifelong consequences for the brain.
This might all feel rather abstract, so let’s explore a clinical example which demonstrates the pernicious effects of these latent memory traces on the mind of an adult person. Mr. B, a patient of mine now in his 50s, grew up with a very intrusive and exacting mother. He has conscious memories of being slapped, often and painfully, on the backs of his calves if he made mistakes and has recounted his horrified dread at school if he ever received a test mark below 100%. Recently, he brought to a session the following experience: “I had to call HMRC (Her Majesty’s Revenue and Customs) to ask about a tax rebate my accountant told me I was owed. During the whole time I was on hold (about 20 minutes) I noticed I was incredibly anxious and full of dread. When I finally got through to the HMRC Officer, they couldn’t have been nicer, but I was shaking and crying by the time I put the phone down. I tell you because I can see how bizarre this is, given how nice the person was and how they gave me the information I was expecting. I should have been happy! But I was a mess.”
I pointed out that his FEAR and PANIC response occurred when needing something from an authority figure (information about a tax rebate). Did he link these feelings to anywhere else? It didn’t take him much reflection before replying: ‘It’s my mother, isn’t it?’ I said he appeared to be in the grip of implicit, unconscious predictions about what follows when he needs something from a person more powerful than him. I wondered whether seeing how deeply the traces of his early experience affected him as a grown man might allow him to feel more compassion for his younger self, who had suffered so much when he was little and needed everything from his mother. He was tearful, and we sat in silence a while.
He then said, rather forlornly, “How will I ever stop feeling this way?” I replied: “Every week you come to me with things that have upset you?” He nodded. “And every week I don’t respond by hurting you or ridiculing you, but I am sensitive to your distress and help you understand why you are feeling this way?” Again, he nodded. “So, by being in a state of need with me, and finding that it feels OK, you are re-programming your brain – changing your predictions – so that, eventually, you won’t assume that everyone in authority is going to punish you. Then the dread won’t come.” He became tearful again, but the atmosphere felt calmer.
On reflection, in that session, we were uncovering his belief that everyone in authority will overwhelm and distress him. Together, we worked out this is untrue: although having to call HMRC had elicited dread from him, he could observe that talking to me did not. He was changing. Believing IS perceiving.
For those of us whose infancies were dominated by FEAR, RAGE, and PANIC/GRIEF – hurt by the very people who brought us into the world – the cues and sequences that were initially laid down have structured our memory systems in adverse ways to produce unhelpful top-down predictions about how we will be received by the world. This is why we may sabotage our own progress, abuse substances, self-harm, and/or form relationships with people who provoke great FEAR, RAGE, and PANIC/GRIEF.
We can also struggle to feel at home in our bodies because this is where unconscious infant memories reside: feeling embodied at all can trigger waves of FEAR, RAGE, and PANIC/GRIEF. These feel aversive, so we avoid them. But then we never get to feel grounded, and so remain trapped in flight and anxiety – trees with weak and fragile root systems are vulnerable to being unearthed by storms. Mental illness and some FNDs could be seen as natural outgrowths of minds forced to live in a world where trust is fleeting and needing others predicts emotional calamity.
So, what can be done to heal our minds? The poet Mary Oliver writes: ‘Attention is the beginning of devotion’. Obviously, you could find yourself the attention of a good therapist. But there are also things you can do for yourself. You might consult Stephen Porges on how to build an inner sense of safety. Simple exercises can be incredibly effective. Practice grounding yourself. Notice your feet on the floor and how your body is touching the earth. Bring your thumb and ring finger together and sit quietly. Breathe, in and out, concentrating on the small movements of your body, which is working so hard for you, pulling in the oxygen and life force you need, pushing out the carbon dioxide and everything you don’t. Repeat to yourself in a kind and loving tone: ‘I am a child of God/Nature. I am loved. I matter.’ You do.
And remember, no matter how rooted and happy another person may seem to you, no-one escapes the travails of subjectivity. Life is always hard for everyone (sometimes). It seems to me that American author Marilynne Robinson, in her novel Gilead, puts it well:
“In every important way we are such secrets from each other, and I do believe that there is a separate language in each of us, also a separate aesthetics and a separate jurisprudence. Every single one of us is a little civilisation built on the ruins of any number of preceding civilisations, but with our own variant notions of what is beautiful and what is acceptable – which, I hasten to add, we generally do not satisfy and by which we struggle to live. We take fortuitous resemblances among us to be actual likeness, because those around us have also fallen heir to the same customs, trade in the same coin, acknowledge, more or less, the same notions of decency and sanity. But all that really does is just allow us to coexist with the inviolable, untraversable, and utterly vast spaces between us.”
(p.225, Gilead, London: Virago 2005).
We may translate these intimate, undeclared languages into shared tongues, but they are only ever signifiers for the limitless and indecipherable abyss within us. Shining moments of understanding and care are therefore nothing short of miraculous – possessing the power to transform the very composition of our minds. I, for one, am thankful for them.
Psychoanalysis in other stories 
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