New York: WW Norton & Company, Inc; (2003). ISBN: 0-393-70407-6.
363 pages; $45 |
Affect
Regulation and The Repair of the Self
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By
Allan N Schore
Review by Milton Richlin, PhD
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In this
most recent volume in his series, Allan Schore of the University of
California at Los Angeles describes an extensive body of research and
clinical observations supporting the idea that early development of
the brain's right hemisphere plays a critical role in an infant's attachment
to its primary caregiver. During the first three years of life, the
centers in the prefrontal cortex of the infant's right hemisphere respond
to the interaction with the mother's emotions in guiding the infant's
own emotional development.
In the
preface, Schore explains the purpose and plan of the current book in
the context of earlier volumes1,2 in the series:
In this
book ... I offer further exposition in the fields of developmentally-oriented
psychotherapy and developmental neuropsychoanalysis .... The rich body
of data that emerged from basic brain research, as well as from psychobiology
and psychophysiology was now, perhaps more so than any time before,
relevant to clinicians.3:pxiii
An important
theme of the book is that many aspects of Freud's original theoretical
and clinical models have been substantially updated and, in some cases,
even radically altered. Schore places great emphasis on Attachment Theory
(as set forth and developed by Bowlby) and its use of the concept of
nonconscious internal working models. Schore seems to believe that any
biases held by his readers must be measured against the ever-growing
neurobiological evidence that Freudian theory and our understanding
of brain function are no longer incompatible. As a nonpsychoanalytic
psychotherapist, I appreciated learning of the great efforts being made
to scrutinize and revise psychoanalysis in neuroscientific terms--an
effort that supplements the experimental approach within psychoanalysis
itself.5,6 Also interesting is the fact that a new journal,
Neuro-Psychoanalysis (which began publication in 1999) lists
an impressive editorial board, including psychoanalysts Schore, Otto
Kernberg, and Arnold Modell as well as neuroscientists Antonio Damasio,
Joseph LeDoux, Eric Kandel, Karl Pribram, and Oliver Sachs.
Another
important theme is the neurobiological development of the self. On this
topic, Schore presents a nearly overwhelming volume of research findings.
From these findings, two particularly important subthemes emerged. The
first is the greater role of the right prefrontal cortex as compared
with the left during the first three years of life--with regard to influencing
development of a sound emotional base:
This prefrontal
region comes to act in the capacity of an executive control function
for the entire right cortex, the hemisphere that modulates affect, nonverbal
communication and unconscious processes ... . In this manner, the child's
first relationship, the one with the mother, acts as a template for
the imprinting of circuits in the child's emotion-processing right brain,
thereby permanently shaping the individual's adaptive or maladaptive
capacities to enter into all later emotional relationships .... Indeed,
the right brain is thought to contain the essential elements of the
self system (Mesulam and Geschwind, 1978; Schore, 1994).3p18-19
A second
major subtheme is the key role of the mother's face and emotional expressions
in determining the emotional development of the infant. The mother's
face--particularly her eyes--is the most potent stimulus in the infant's
environment. Schore quotes studies by Hoffman (1987) and Panksepp, et
al (1985), which show that interactive mutual gazes between the mother
and her infant trigger high levels of endogenous opiates in the child's
growing brain. These findings are related to Schore's Regulation Theory,
which emphasizes that attachment is essentially the right brain regulation
of biological synchronicity between organisms.
Another
theme discussed in the book addresses the relation between the right
hemisphere and the lower brain centers, particularly the autonomic nervous
system (ANS). Physicians whose patients have an illness with a strong
psychosomatic component will be especially interested. The following
quotation is representative of Shore's presentation:
... the
infant's psychobiological response to trauma is comprised of two separate
response patterns, hyperarousal and dissociation ... In the initial
stage of threat an alarm reaction is initiated, in which the sympathetic
component of the ANS is suddenly and significantly activated, resulting
in increased heart rate, blood pressure, and respiration. Distress is
expressed in crying and then screaming ... This state of fear-terror
is mediated by sympathetic hyperarousal, and it reflects increased levels
of the major stress hormone corticotrophin releasing factor, which in
turn regulates noradrenaline and adrenaline activity ....
But a
second, later-forming, longer-lasting traumatic reaction is seen in
dissociation, in which the child disengages from stimuli in the external
world and attends to an "internal" world .... Traumatized
infants are observed to be staring off into space with a glazed look.
This parasympathetic dominant state of conservation-withdrawal occurs
in helpless and hopeless stressful situations in which the individual
becomes inhibited and strives to avoid attention in order to become
"unseen." ...
This primary
regulatory process for maintaining organismic homeostasis ... is characterized
by a metabolic shutdown ... and low levels of activity .... It is used
throughout the lifespan when the stressed individual disengages in order
"to conserve energies ... to foster survival by the risky posture
of feigning death, to allow healing of wounds and restitution of depleted
resources by immobility" (Powles, 1992, p 213).3p124
In evaluating
the potential value of Schore's book for readers of The Permanente
Journal, I would like to compare the book to A General Theory
of Love by Lewis, Amini, and Lannon,7 a book reviewed
favorably here recently by Vincent J Felitti, MD.8 Both books
cover the same basic material: the human infant's development of a self
on the basis of brain development; and interactions with the primary
caregiver. But Shore's book can be seen as the full text, whereas A
General Theory of Love is more like a good abstract of the scientific
materials. For many purposes (eg, saving time), the abstract may be
sufficient. However, there are several deficiencies in the Lewis et
al book that might incline an interested reader to spend the extra time
required to read Schore's book. The latter is more scholarly, far more
fully referenced,9,10 and represents a more complete attempt
to explain how evolving psychodynamic ideas are integrating with the
field of neuroscience. To paraphrase an old expression, "You pays
your money [$39 vs $24] and your time [363 pages vs 274], and you takes
your choice."
