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This blog is to critically introduce, and contextualise, new research findings from developmental research, neuroscience, attachment theory  and other areas of psychology that are topical or are likely to whet the appetite of  anyone interested. The aim is to discuss research which will feel relevant and which might even, if lucky, make a...

This blog is to critically introduce, and contextualise, new research findings from developmental research, neuroscience, attachment theory  and other areas of psychology that are topical or are likely to whet the appetite of  anyone interested. The aim is to discuss research which will feel relevant and which might even, if lucky, make a difference to how we approach our work or other areas of our lives.

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Coronavirus, moral panic, psychic and physical threat, danger and social immunity

 

We are in the grip of huge physical and psychological threat from the coronavirus. Like all species, humans have clearly evolved mechanisms for both responding to, and avoiding, pathogens. There are similarities between the fear response, as seen for example when there is danger of being confronted by an aggressor or predator, and the fear of pathogens. Both give rise to distrust, anxiety, fear of the ‘other’, ‘disgust’, and autoimmune inflammatory reactions.

I have been watching my own and others’ reactions on the streets. Fear, anxiety and distrust are powerfully present. It feels strange to shirk proximity, move away from strangers and avoid close contact. I particularly feel for children now, as they, as potential ‘spreaders’, are eliciting fear and disgust reactions in many which could have a psychic effect. The brain circuits involved in physical pain are equally active in social ostracism, and children particularly tend to interpret the world through adult eyes, and as Winnicott said, gain their sense of self that way. Who wants to be viewed as a social leper, a dangerous potential pathogen inducer to be avoided?

Avoiding danger is of course is what most species do,  moving away from pathogens, whether avoiding infected foods, forming colonies near plants that pathogens don’t like, or developing internal group hygiene, such as bees clearing out worrying larvae and ants at times doing the equivalent of ‘deep-cleaning’.  Many species do what we are doing now, and actively become more isolated.

When we smell something putrid or ‘off’ we tend to feel, and indeed signal, disgust, and whole areas of the brain, particularly the insula, are activated. Smell is possibly the most powerful sense-organ, but sight (eg awareness of other’s worrying bodily  such as boils or pox) and touch also are used to detect threat. Indeed, trauma victims so often seem to have highly developed sense of smell, especially when the abuse happens at a very young age. Decisions such as what to eat, who to mate with, are influenced by such subtle non-conscious factors.

What we know is that when in a state of stress or when sensing danger, we all tend to be more suspicious and less welcoming of others generally, in psychoanalytic language we have heightened paranoid-schizoid responses. Humans anyway have an innately constituted fear of  those we see as ‘other’. Even babies prefer others who look like them, talk like them, and act like the trusted adults in their circles, but that exacerbates in times of fear and danger, when borders are all but closed.

Social safeness and safeness from pathogens are linked. A classic example is grooming within groups of conspecifics, like primates., Those who are groomed and groom have been shown to harbour less infection-inducing tics and parasites. The additional benefit is feeling good. Higher status chimps get groomed more, especially by low status ones, for example, and grooming fosters a sense of social harmony in which neurochemicals such as oxytocin are released. In humans we have other mechanisms which foster the same things. Singing, dancing, social and family gatherings, which all heighten oxytocin and immune responses, lower inflammatory ones, and are linked with feeling good. Social outcasts, whether primates or humans, tend to have lower serotonin, for example, and higher cortisol. This is a  real danger at the moment when isolation and lack of community is a threat to mental health and especially the psychologically vulnerable..

I had always assumed that in-group loyalty and out-group suspicion, even in babies,  had a good evolutionary rationale as a main predator of infants and children was often males from another social group who might, for example, kill offspring spawned by other men and indeed, kill those other men too. What I had not sufficiently considered is the powerful fear of the ‘other’ carrying genuinely dangerous pathogens. We know this all too well from the accounts of the genocide of indigenous populations in Australia and the Americas, decimated by viruses carried by Europeans.

Fascinatingly of course oxytocin fosters not only in-group trust and cohesion but also distrust of those in out-groups. I again had always assumed this also to be linked to the dangers of attacks from rival groups, but it makes sense that fear of viruses and pathogens is central here too.

It is no coincidence that Trump, in characteristic xenophobic fashion, attacks a ‘foreign’ virus. Pathogens of course are always ‘foreign’ but this conflation of fear of a pathogen and fear of the other is worryingly common. Certainly, anecdotally it is my non-white clients, particularly Asian ones, who have felt most shunned in the last few weeks. We know from social neuroscience that we can non-consciously demonise certain others, such as the homeless and drug-addicts,  and despite what we consciously avow, often our brains, when looking at drug--addicts, or even those of other ethnicities, show less activity in networks involved in empathy and recognising the other as human, such as areas in the medial prefrontal cortex. Instead we often see increase activity in areas of the insula which are linked with disgust signals as well as in amygdala-linked fear and aggressive reactions. Both also are often activated with a threat of pathogens. The worry is that dehumanisation can kick in, the other (e.g the infected, but also the rival shopper) becoming ‘subhuman’. Similar brain mechanisms are thus involved in both Trump-like xenophobia, and in fear of pathogens.

A major health concern is the rise in inflammatory conditions. Inflammation of course is an appropriate response to heal an injury, wound or danger. We need inflammation when we have an injury or when eating toxic food. Our immune antibody army then generally does a great job sending inflammatory cytokines like IL-6, TNF-alpha, CRP, and multiple macrophages etc  in to fight dangerous intruders. However, such immune responses go into overdrive in disorders such as lupus, fibromyalgia and so much more, and cannot tell the difference between the benign and the dangerous. The same happens with trauma, high levels of stress and competition threats, including this virus. It is no coincidence that stress, trauma in childhood is linked to higher levels of most pro-inflammatory cytokines in adulthood. 

High inflammation is also central in depression, and inflammation might have had a specific evolutionarily important role in managing pathogens and disease, fevers and hot temperatures often vital for dealing with viruses and other diseases. High inflammation is also linked to social aversion as well as stress, depressive symptomatology, anhedonia, lethargy, possibly because social isolation decreases infection risk. High cytokine activity comes with threat responses, hypervigilance and much else seen in stress, anxiety and psychological trauma. The same genes are involved in both depression and defence against pathogens, genes that are less present in societies where there is less risk of physical infection, and where there is also less depression.

What we seem to be uncovering is an extraordinary synergy between fear of the other, fear of pathogens, expectation of danger or threat and links with the rise of xenophobia, racism and ‘othering’, and links also between these and depressive and other metal health symptomatology.

Anyway of course, in danger and major stress brain circuits involved in empathy and rational thought go into abeyance as survival-based responses kick in, including panic and aversion, and that is in large part what we are seeing in the panic-buying and hoarding. It is interesting that in more socialised  European countries, those less in the grip of neoliberal competitive ideologies,  there is plentiful food on shelves, unlike in our increasingly competitive one with decimated services, massively cut hospital beds and our main drivers increasingly being individualism, profit and greed.

Assuming that lock-down, isolation and banning foreigners is the right approach for covid-19 ,  we still need to recognise that this comes with dangers to us as a society, such as discrimination, vigilant distrust, depression and much more. There are also real risks in social isolation, and taking away the main sources of emotional wellbeing, which are community and cherished others. In response we need to keep alive influences that combat this, whether friendships, family, forms of self-care. I have noticed myself giving really nice looking people a wide birth, and but if I catch myself I can take a deep breath,  thank them for moving away from me rather than feeling threatened, and while keeping a distance, make sure I have a slightly more open face, smile (heart) as I walk through the places I can still walk.

We can and should, for our own and others’ good, keep alive our capacity to reach out compassionately and kindly to others at a time when such pathways are endangered by heightened threat, fear and disgust reactions, alongside social withdrawal. So, if we need to self-isolate to protect self or others, or if we have to work on the front-line, at the risk of being Polyanna-ish, let’s try to keep hold of compassion, for ourselves and others.

 

 

 

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Guest — Sarah Hartley
Thank you for this Graham!
Saturday, 14 March 2020 13:31
Guest — Gabriela
Thank you graham! So well spoken! Kindly Gabriela Jones
Sunday, 15 March 2020 08:55
Guest — KeiraLianne
Very interesting- thank you for sharing!
Monday, 16 March 2020 23:04
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Neglecting Neglect: Why Therapists Do It & How We Can Break the Cycle 

A version of this blog recently appeared on the Psychotherapy Execellence Website  here  

 

Why Neglect?

In Nurturing Children I use clinical stories to illustrate essential elements of good therapeutic work. Ultimately therapeutic success depends on a good alliance, empathy, compassion and mutual resonance, alongside carefully gleaned skills and understanding. Yet some patients leave us feeling de-skilled, hopeless, even dreading sessions. I find this especially when working with people with histories of neglect, who have experienced insufficient growth-inducing experiences. This is different to those who are victims of, for example overt abuse or violence, who tend to be more reactive and challenging,

 

The feelings stirred up in us can be hard to own up to if our personal narratives include being ‘caring’, ’interested’ and ‘empathic’.

  • With such clients we often feel flat, bored and dulled-down.
  • They appear 'empty', inhibited, passive, self-contained, with minimal capacity for mentalizing.
  • They show little pleasure, rarely inspiring hope, affection or passion.
  • They can be thought of as 'under-looked' or 'unenjoyed', or after Alvarez, ‘undrawn’ rather than ‘withdrawn’.
  • They slip out of minds, stirring up little interest or worry.

 

Spectrum of neglect

  • from extremely deprived orphans to milder forms,
  • such as those with very emotionally avoidant, or depressed parents.

True I risk conflating symptoms and causes, as similar histories do not necessarily lead to the same symptoms, but there are sufficient commonalities to describe a common clinical experience.

 

Double deprivation

Neglected children initially receive scant attention, and later further deprive themselves by barely recognising life-enhancing relationship opportunities. While born with the same preconceptions of lively interpersonal exchanges as anyone, the lack of good experiences leads to lifeless internal objects, with little hope of introjecting anything good. They seem to project little too, having surprisingly little effect on others.

 

Nervous systems and brains

Inadequate early experience leads to ‘dampened down' nervous systems, the opposite of hyperactive aroused people. Emotional deprivation profoundly affects brain architecture, and programs our neurochemical system. (eg releasing less oxytocin).  Many develop autistic-like symptoms, lacking empathy and avoiding intimacy. We see deficits in right orbitalfrontal region, central to attachment patterns and emotional regulation, and less prefrontal left brain activation, central to agency and pleasure.

 

Countertransference

Such people evoke less interest than those with better developed autobiographical and emotional capacities. Our words and gestures, given with meaning, can feel denuded of life. It is in one’s countertransference that one really learns about these clients, and what it is like to be them, but our attuned resonance can lead us to feel as dead as them. We can say things in therapy just to escape their lifeless worlds.

 

Clinical technique

We must sustain an empathic stance without being drawn too far into such lifelessness, to stay psychologically animated enough to breathe life back into their psyches, while avoiding the trap of a 'going-through-the-motions'  faux  psychotherapy. Research even shows that anyone interacting with avoidant people becomes less interested in people generally!

 

With such patients we need a more ‘active’ technique. They often know little about positive emotional experiences such as enjoyment, excitement, attunement, playfulness or joy. To develop an interest in oneself and others, someone must have been interested in us. In therapy we tend to work a lot with clients’ defensive and fear systems, helping to manage difficult feelings. However, with these patients we also need to build their ‘appetitive’ seeking systems, via mutually enjoyable interactions, allowing aliveness to flourish.

 

Summary

Humans are born ‘experience expectant’, primed for interpersonal interaction, but emotional development is stymied without growth-inducing relationships. In therapy we need to find a way to encourage agency and positive affect, and the paradoxically, step back from lifeless encounters to empathically be in touch with such lifelessness. With them we walk a delicate tightrope between amplifying aliveness, agency and enjoyment while not being too intrusive, manic or seductive.

 

This blog describes children and adults I feel particularly worried about, who rarely inspire passion and therapeutic zeal, who have been neglected emotionally in their early lives, and often then evoke further neglect. The long-term sequelae of such neglect can be 'deadly' serious, probably more harmful, yet less noticed, than more visible trauma. Neglected children and adults I have worked with often ‘warm up’, get livelier and more real, given sufficient adaptation to our practice, and the courage of emotional honesty.

 

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Joining forces; Telomeres, social, psychological and political challenges

 

In the last few days I came across yet another interesting article [1] showing that prenatal stress is linked with  shorter telomeres. Telomeres are those caps on the end of chromosomes that can fray and shorten with stress and age [3], are a classic biomarker for health. Shorter telomeres are bad news, heralding ill health, and indeed, early death, or in other words early stress might program the body to develop a faster metabolism, which also leads to faster ageing and more physical and mental illness. One recent meta-analysis looking at over 40 papers corroborated how early adversity, such as abuse or neglect, links with shorter telomere length [2].

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Death penalty for being abused? The price is too high for society and disadvantaged young people

 

Young people who had been in the care system are far more likely to die in early adulthood than their peers, a report showed last week; indeed they are at least 7 times more likely to die prematurely, before the age of 21. The BBC story about this highlighted poor access to mental health services, the lack of general support available, and the consequent over-use of drugs, alcohol and other forms of unhealthy self-medication and attempts to manage stressors.

I have worked with children in the care system for over 30 years and at least the research is showing what we have always known clinically. Bad early experiences lead young people to use drugs, alcohol, take risks in sexual and other behaviours, but also to struggle academically, socially and in their emotional wellbeing generally. Most of my most worrying cases in the NHS have been in the care system, and major crises often occur at the age when they are supposed to become ‘independent’ at the age when most well-adjusted children from loving families in fact rely on their families more than ever.

 

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Guest — Michael J Reiss
Very convincing.
Tuesday, 28 February 2017 14:52
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Obesity, unhappiness, and poverty: the urgent need to avoid simplistic solutions

A version of this blog can also be found on the Tavistock and Portman NHS Foundation Trust website here, 

An NHS Trust in Yorkshire recently decided to deny non-urgent treatment to obese patients and also to smokers. A recent guardian article called this a form of discrimination similar to racism. It is true that we are facing an epidemic of obesity and linked health issues including diabetes and heart conditions. The solution is not to discriminate against or blame people who in many ways are already victims. There is a danger that our discourses about food and obesity become another way of blaming the poor for their poverty and its effects. People are criticised for being lazy, greedy, lacking control or selfish, yet often what drives eating is far outside consciousness and has sensible explanations.

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Brexit, project fear, brains, racism inequality and the other

Many of us are shocked to the core by the referendum result, and even more so by the campaign and the way it was conducted, especially its racist undertones. In many ways this was a protest vote, and whatever his weaknesses Corbyn has understood that inequality, uncertainty and the increasing power of smaller elites has impacted powerfully. What the left seem not to have learnt from its history lessons is how at times of serious crisis people become inward and conservative and indeed, often xenophobic and distrustful of the other. This makes more sense when we understand just what fear, anxiety and anger does to the brain.

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Guest — Valérie Mortin
Spot on Graham. What shocked me was the total fragmentation this referendum has created...young vs old, poor vs rich, educated vs ... Read More
Sunday, 03 July 2016 21:00
Guest — Francesca Spagnoli
Reading your article it seems possible to hope for a better future for us, but more importantly, our future generations.
Sunday, 03 July 2016 22:17
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