When the Body Says No: The Cost of Hidden Stress (32 page)

Interactions with the world program our physiological and psychological development. Emotional contact is as important as physical contact. The two are quite analogous, as we recognize when we speak of the emotional experience of feeling
touched
. Our sensory organs and brains provide the interface through which relationships shape our evolution from infancy to adulthood. Social-emotional interactions decisively influence the development of the human brain. From the moment of birth, they regulate the tone, activity and development of the psychoneuroimmunoendocrine (PNI) super-system. Our characteristic modes of handling psychic and physical stress are set in our earliest years.

Neuroscientists at Harvard University studied the cortisol levels of orphans who were raised in the dreadfully neglected child-care institutions established in Romania during the Ceausescu regime. In these facilities the caregiver/child ratio was one to twenty. Except for the rudiments of care, the children were seldom physically picked up or touched. They displayed the self-hugging motions and depressed demeanour typical of abandoned young, human or primate. On saliva tests, their cortisol levels were abnormal, indicating that their hypothalamic-pituitary-adrenal axes were already impaired.
⁵
As we have seen, disruptions of the HPA axis have been noted in autoimmune disease, cancer and other conditions.

It is intuitively easy to understand why abuse, trauma or extreme neglect in childhood would have negative consequences. But why do many people develop stress-related illness
without
having been abused or traumatized? These persons suffer not because something negative was inflicted on them but because something positive was withheld. As Dr. Myron Hofer, director of the Division of Developmental Psychobiology
at Columbia University, wrote in a special editon of the journal
Psychosomatic Medicine
in 1996, “The paradox remains, how could the
absence
of something or somebody create such disturbances….
There must be a biology of loss, and we must find it.”
⁶

How the absence of something or someone creates physiological disturbances becomes clearer if we recall our discussion of stress. All stressors represent the absence, threatened or real, of essential features in the environment, features that the organism perceives as necessary for survival. In “What Is Stress,” S. Levine and H. Ursin write that, “Stress stimuli … indicate that something is missing or about to disappear and that this something is highly relevant and desirable to the organism.”
⁷

For any young warm-blooded creature, life is impossible without the parent. The young human depends on adults much longer than the offspring of any other species, for reasons that go well beyond immediate physical needs. Parental caregivers are more than providers of food, shelter, lifeskills information, and protection against predators. As the sad example of the Romanian orphans showed, parents are also the biological regulators of the child’s immature physiological and emotional systems. Parental love is not simply a warm and pleasant emotional experience, it is a biological condition essential for healthy physiological and psychological development. Parental love and attention drive the optimal maturation of the circuitry of the brain, of the PNI system and of the HPA axis.

The brain of the human newborn is smaller and less mature, in relation to the adult brain, than that of any other mammal. A horse, by comparison, can run on the first day of life—an activity for which we lack the required nerve circuitry, visual-spatial skills and muscle coordination for another year and a half or more. The straightforward anatomical reason for entering the world so neurologically challenged is the size of our head. Already at birth, the head of the human child is the biggest diameter of the body. It is the part most likely to become stuck in the birth canal. At the same time as the human head grew to accommodate the increasingly complex intellectual and manual-control capacities of the brain, the human pelvis narrowed to permit more balanced two-legged locomotion. One cannot walk two-legged with the pelvis of a horse. Thus, increase in head size co-evolved with the narrowed pelvis; were our brains much larger at the end of gestation, no one would ever be born.

Three-quarters of brain growth and almost 90 per cent of brain development take place following birth, mostly in the first three years of life. Immediately after birth, the human brain, alone among mammalian brains, continues to grow at the same rate outside the uterus as it did inside. In the first months and beyond, there is an astoundingly rapid and complex development of nerve connections, or synapses. We form millions of new synapses a second during some periods.

The unfolding of any developmental process depends not only on inherited genetic potential but also on environmental conditions. The finest and hardiest strain of wheat will fail to grow in barren and dry soil. Decades of neuroscientific research have established that an indispensable requirement of human brain development is nurturing emotional interactions with the parent. Emotional interactions stimulate or inhibit the growth of nerve cells and circuits by complicated processes that involve the release of natural chemicals. To give a somewhat simplified example, when “happy” events are experienced by the infant, endorphins—“reward chemicals,” the brain’s natural opioids—are released. Endorphins encourage the growth and connections of nerve cells. Conversely, in animal studies, chronically high levels of stress hormones such as cortisol have been shown to cause important brain centres to shrink.

The neural circuits and neurochemistry of the brain develop in response to input from the environment. An infant with perfectly good eyes at birth would become irreversibly blind if he were confined to a dark room for five years, because the circuitry of vision needs the stimulation of light waves for its development. A “Darwinian” competition decides the survival of neurons and their synapses: those that get used survive and grow. Those deprived of the appropriate environmental stimulation atrophy or die, or fail to develop optimally.

A fundamental goal of human development is the emergence of a self-sustaining, self-regulated human being who can live in concert with fellow human beings in a social context. Vital for the healthy development of the neurobiology of self-regulation in the child is a relationship with the parent in which the latter sees and understands the child’s feelings and can respond with attuned empathy to the child’s emotional cues. Emotions are states of physiological arousal, either positive—“I want more of this”—or negative—“I want less of this.” Infants and small children do not have the capacity to regulate their own
emotional states, and hence are physiologically at risk for exhaustion and even death if not regulated by the interaction with the parent. Closeness with the parent, therefore, serves to preserve the infant’s biological regulation.

Self-regulation requires the coordinated activities of anatomically separate brain areas, along with the benign dominance of the upper, more recently evolved regions of the brain over the lower ones. The oldest part of the brain—and the most essential for life—is the
brain stem
, where the primitive survival impulses of the “reptilian brain” arise and where basic autonomic functions are controlled, including—among others—hunger, thirst, cardiovascular and respiratory drives, and body temperature. The newest part of the human brain is the
neocortex
in the front of the brain.
Cortex
means “bark,” as in the bark of a tree, and refers to the thin rim of grey matter enveloping the white matter of the brain. Made up largely of the cell bodies of nerve cells, or neurons, the cortex processes the most highly evolved activities of the human brain. This
prefrontal cortex
modulates our responses to the world not in terms of primitive drives but in terms of learned information about what is friendly, neutral or hostile and what is socially useful and what is not. Its functions include impulse control, social-emotional intelligence and motivation. Much of the regulating work of the cortex involves not the
initiation
of actions but the
inhibition
of impulses arising in the lower brain centres.

Mediating between the regulatory processes of the cortex and the basic survival functions of the brain stem is the
limbic
emotional apparatus. The limbic system includes structures located between the cortex and brain stem but also encompasses some parts of the cortex. The limbic system is essential for survival. Without it the regulatory and thinking capacities of the cortex would function like the brain of an idiot savant: intellectual knowledge would be disconnected from real knowledge of the world.

Emotions interpret the world for us. They have a signal function, telling us about our internal states as they are affected by input from the outside. Emotions are responses to present stimuli as filtered through the memory of past experience, and they anticipate the future based on our perception of the past.

The brain structures responsible for the experience and modulation of emotions, whether in the cortex or the midbrain, develop in
response to parental input, just as visual circuitry develops in response to light. The limbic system matures by “reading” and incorporating the emotional messages of the parent. The centres of memory, both conscious and unconscious, rely on the interaction with the parent for their consolidation and for their future interpretations of the world. The circuits responsible for the secretion of important neurotransmitters like serotonin, norepinephrine and dopamine—essential for mood stability, arousal, motivation and attention—are stimulated and become coordinated in the context of the child’s relationship with his caregivers. In the brains of infant monkeys, serious imbalances of these various neurochemicals have been measured after only a few days of separation from their mothers.

In the parent-child interaction is established the child’s sense of the world: whether this is a world of love and acceptance, a world of neglectful indifference in which one must root and scratch to have one’s needs satisfied or, worse, a world of hostility where one must forever maintain an anxious hypervigilance. Future relationships will have as their templates nerve circuits laid down in our relationships with our earliest caregivers. We will understand ourselves as we have felt understood, love ourselves as we perceived being loved on the deepest unconscious levels, care for ourselves with as much compassion as, at our core, we perceived as young children.

The disruption of attachment relationships in infancy and childhood may have long-term consequences for the brain’s stress-response apparatus and for the immune system. A large number of animal experiments have established a powerful connection between early attachment disturbances and unbalanced stress-response capacities in the adult. The crux of this research is that disrupted attachment in infancy leads to exaggerated physiological stress responses in the adult. Obversely, nurturing attachment interactions in infancy provide for better modulated biological stress reactions in the adult.

For the satisfaction of attachment needs in human beings, more than physical proximity and touching is required. Equally essential is a nourishing emotional connection, in particular the quality of
attunement
. Attunement, a process in which the parent is “tuned in” to the child’s emotional needs, is a subtle process. It is deeply instinctive but easily subverted when the parent is stressed or distracted emotionally,
financially or for any other reason. Attunement may also be absent if the parent never received it in his or her childhood. Strong attachment and love exist in many parent-child relationships but without attunement. Children in non-attuned relationships may feel loved but on a deeper level do not experience themselves as appreciated for who they really are. They learn to present only their “acceptable” side to the parent, repressing emotional responses the parent rejects and learning to reject themselves for even having such responses.

Infants whose caregivers were too stressed, for whatever reason, to give them the necessary attunement contact will grow up with a chronic tendency to feel alone with their emotions, to have a sense—rightly or wrongly—that no one can share how they feel, that no one can “understand.” We are speaking here not of a lack of parental love, nor of physical separation between parent and child, but of a void in the child’s perception of being seen, understood, empathized with and “got” on the emotional level. The phenomenon of physical closeness but emotional separation has been called
proximate separation
. Proximate separation happens when attuned contact between parent and child is lacking or is interrupted due to stresses on the parent that draw her away from the interaction.

An example of such an attunement break occurs when the parent looks away first from the child during one of their intensely pleasurable eye-to-eye gaze interactions. Another attunement break occurs if the parent insists on stimulating a resting child because he (the parent) desires the mutual engagement, even if the child at that moment needs some respite from the intensity of their interaction.

“Primate experiments show that infants can undergo severe separation reactions even though their mothers are visually, but not psychologically, available,” writes the UCLA psychologist, theorist and researcher Allan Schore.
“I suggest that proximate separations are a common and potent phenomenon in early personality development.”
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In
proximate separations
the parents are physically present but emotionally absent. Such parent-child interactions are increasingly the norm in our hyperstressed society. The levels of physiological stress experienced by the child during proximate separation approaches the levels experienced during physical separation. Proximate separation affects the young child on the unconscious physiological levels rather than on
the conscious thought-feeling levels. It will not be recalled later as the adult looks back on his childhood experience, but it is entrenched as the biology of loss.