Download Summary Ch - Dr. Allan N. Schore

Early organization of the nonlinear right brain and development of
a predisposition to psychiatric disorders
Overview
Before I started a review of the paper, I had to give some thought to how I would define
nonlinear system dynamics, or chaos theory, and of course compare it to linear system
dynamics. As I thought of it, our old way of viewing the world was only as linear, one
action leads to another, a chain of causal relationships that was logical, understandable
and predictable. It applied to the science I learned at school, to the physics of sports, to
world politics and to psychology, psychotherapy and psychoanalysis. Freud’s early
theories of psychopathology were bound in the theories of his day. He spoke of forces,
cathexis, the damming up of energies, of resistance and chains of associations. All we
needed were finer measurements to get more accurate answers and make better longrange predictions.
As science began to examine larger and more complex systems such as the universe,
ocean currents, the weather or clouds – or smaller and smaller aspects of our universe the
old rules did not apply. Either the very fact of observation changed the world under study
or the system we were trying to understand was so complex there was no way to
comprehend or measure all the forces at play, let alone their interactions. In the latter
situations we could only accurately make short-term predictions. This state of affairs
grew into complexity theory, chaos theory and nonlinear system dynamics. Here the very
smallest change in any value at the beginning would lead to enormous and unpredictable
changes at the end. Additionally, we had to understand the ways in which increasingly
complex systems develop from simpler ones. In our field we began to speak of
intersubjectivity, co-constructed reality, contingent interactions, critical periods for
attachment, brain development, mylenation, the formation of unconscious scripts, mental
representations and personal narratives. We began to study smaller and smaller fractions
of a reaction or interaction. We could stretch time and measure brain activity in real time.
The concepts of nonlinear system dynamics would be applied to personality
development, attachment and to the right brain, our nonlinear side.
Schore proposes to apply the principles of dynamic [nonlinear] systems theory to normal
and abnormal development and to offer a model of attachment dynamics from this
perspective, including the role of brain chemistry, synaptic development, brain
architecture and experience dependent maturation to the right cortex. These concepts will
be linked to developmental models of resistance against and vulnerability to mental
disorders.
Schore starts with three central concepts of systems theory: state changes, selforganization and the central role of energy flow.
Modeling of patterns of State Change has become a central area of focus in the physical
and biological sciences. We have moved beyond the horizon of changes in behavior,
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cognition and affect into the realm of the ontogenetic appearance of increasingly complex
psychobiologic states and state-dependent functions. Schore will explore the role-played
by the brain systems which biochemically regulate all brain and body states. The concept
of psychobiologic state lies at the common boundary of the psychological and biologic
sciences. The continuously developing mind cannot be understood without reference to
the continuously developing body. Their continuous interaction becomes an important
interface for the organizing self.
Self-organization in the context of nonlinear dynamics refers to the emergence of and
stabilization of novel forms of self-organization from lower order forms. Schore includes
the ways in which the developing brain hierarchically self-organizes. Then the way in
which “lower” autonomic and “higher” central brain systems become capable of
generating and then regulating psychobiologic states. These control mechanisms in the
developing infant are located primarily in the right orbito-frontal region with its rich
connections into the limbic system and to the mechanisms of autonomic and behavioral
arousal. All of these concepts are seen as developing within the context of the mother-self
and the responsive mother- brain.
In systems theory energy is not the static concept of old, it now refers to the moment-tomoment energy needs of a growing and developing brain. It studies the ways in which
energy is consumed, regulated and generated in the growing brain. The metabolic rate of
the child’s brain is significantly higher than the adult’s. By studying metabolism in
different areas of the brain we can map their maturational status and have come to realize
that the brain matures in discontinuous discrete stages. It has been found that, as selforganization increases and becomes more complex the rate of energy consumption and
energy transfer increases. Brain metabolism is regulated by biogenic amines, which are
delivered by ascending and descending neural tracts. We are also familiar with the
finding that these bio-amines are regulated by the interaction between infant and
caregiver. The study of how these early interactions induce the bio-energetic changes that
support increasingly complex brain interconnections and therefore increasingly complex
functions is a study in the application of dynamic systems theory to normal and atypical
development. In the final section of the paper Schore will speculate on the ways in which
early forming micro-structural pathology and disturbed energy utilization of specific
brain systems will predispose to later appearing psychiatric disorders. This work is a
continuation of his study of the ways in which less than optimal genetic-environmental
interactions during critical periods produce an orbito-fronto-limbic organization that
leaves the individual vulnerable to a host of psychopathologies.
Functional Properties of Self-Organizing Developmental Systems
Schore starts with the simple idea that in order for an individual to mature flexibly and to
develop increasingly complex self-organizational patterns it must be an “open” system.
That is, it has to be open to reciprocal interactions with the mother. These reciprocal
interactions result in a dynamic equilibrium with the self and with the caregiver. These
interactions can be seen in terms of energy-matter import-export and degradation moving
toward entropy.
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A more developed self-organization system develops through cycles of stability and
instability. Each cycle, successfully navigated, leaves the child more organized and
flexible. Each individual has a personal range of ability to tolerate instability before
needing to return to a stable and familiar organizational structure before venturing forth
again. Eventually the cycles of instability and return lead to plateaus of developmental
equilibrium that can be seen as developmental stages. From these developmental plateaus
“points of developmental bifurcation” occur when the infant has the opportunity to
irreversibly alter its trajectory of development. At these “bifurcation points” very small
environmental influences can result in major developmental changes. If the developing
infant has the good fortune to have an attuned mother at these “points of bifurcation”
major developmental achievements are possible. These changes are nonlinear breaks in
development a perfect example of chaos theory in action.
Chaos…arises at a point of phase transitions, when systems are “choosing”
between different process structures. What occurs at these points is that random
fluctuations in energy can be amplified throughout the entire system so that a new
process structure is formed. Chaos in dynamical systems is thus a product of the
same forces that create process structures and give rise to self-organization
Evolutionally speaking the ability to incorporate chaotic systems into our ontology allows
for small inputs to advance and stabilize or unfortunately to derail and destabilize
development. It enables the infant to achieve increasing system flexibility and adaptive
self-organizational capabilities in response to changing internal or external environments.
Energy is crucial in dynamic systems theory, when applied to development it can be
thought of as cellular metabolism or energy transfers at synapses. At a higher level one
could think of it as the state of sympathetic arousal or conservation of energy in the
parasympathetic state. When applied to developmental psychology the analogy of energy
input to information has a lot appeal. To continue this analogy the amount of energy
attached to a bit of information can be measured by the emotional valance accompanying
the input. Emotion is the prime amplifier of feeling – making good things much better
and bad things much worse. Emotion elongates time allowing for the laying down of
memory. Emotion propels development, learning and puts valence on working models
and expectations. The cycle of feedback loops between mother and infant when in tune,
filled with positive energy and contingent reciprocity lead to secure attachment patterns,
positive working models and sets the course of an individual’s behavioral style and
emotional disposition.
Nonlinear State Changes and Organization of Attachment Dynamics
In this section of the paper Schore deals with attachment dynamics in the first year of life.
The infant’s need for “contingent, attuned, reciprocal dyadic transactions” the
prerequisite building blocks of a developing secure attachment is recast in terms of
energy and non-linear dynamics. As we know the first year is one of rapid brain growth
with sensitive periods for anatomic development as well as for the laying down of
interactive models of what the world is like. These crucial times are ones in which the
mother’s ability to read the infant’s face and the infant’s developing ability to read and
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respond to the mother’s face is crucial for the infant’s ability to regulate it’s level of
arousal. When this resonance occurs there is an amplification of positive feeling in both
partners. As we know these moment-to-moment transactions take place out of awareness.
The ability to match in rhythm, intensity and trajectory across sensory modalities allows
the infant to reach and sustain new and higher levels of contained arousal. This is a
situation in which the slightest change in either mother or infant can result in a
disproportionate response in the other. When this system is truly “open” there is an eyeto-eye direct link between the right brains of mother and infant. The resultant positive
feeling are felt as bodily states mediated through controlled and synchronized arousal of
the infant’s autonomic system. This particularly important as the infant’s core sense of
self is initially bodily based. As we already know, “the affective regulation of brain
growth” is embedded in the context of an intimate relationship.
Central Role of Bioamines in Regulation of Energy Metabolism of the
Developing Brain
We know in an open system, the developing brain is strongly impacted by experience, in
particular by face-to-face interactions with a responsive caregiver. The question posed is:
how is the growing brain molded by experience?
Schore, in this section, works from the top down. That is from attachment experiences to
the intracellular environment. Attuned caregiver experiences regulate arousal levels
through the regulation and production of neurohormones and catecholaminergic
neuromodulators. Face-to-face experiences trigger the production of corticotrophin
releasing factor (CRF) in the infant’s paraventricular hypothalamus it, in turn, raises
plasma concentrations of noradrenalin, activates the sympathetic nervous system,
increases oxygen consumption and generates a state of emotional excitement. CRF
controls endorphin and ACTH production in the pituitary and activates the ventral
tegmental system. This takes place during a phase of intense neuronal and dendrite
growth, it is also the time of proliferation of the catacholaminergic receptors, especially
the D1 dopamine receptors in the prefrontal cortex and limbic system associated with
memory, affective and cognitive learning. These biogenic amines are the same ones that
regulate emotion and motivation throughout the life span. They activate the metabolism
of glucose during activity, modulate cerebral blood flow, and regulate the blood-brain
barrier. All of this is another way of saying; these amines regulate energy utilization of
the brain, which in turn regulates growth and later pruning.
During growth phases, the brain requires great amounts of energy. At such times the
brain can shift from anaerobic to aerobic metabolism. Glucose is combined with oxygen
to produce carbon dioxide, water and energy. Part of the free energy is stored as
adenosine triphosphate (ATP). The breakdown ATP is the main source of energy at the
cell walls and in the mitochondria, reflecting the activity of the enzyme cytochrome
oxidase. These processes are most highly concentrated in the areas of syaptogenesis and
dendrite growth.
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As we have already learned, the size and complexity of the dendrite tree is experience
dependent. It has been shown that there are modifications of the dendrite spines within
minutes of a stimulus, which may last only a fraction of a second.
In summary working our way down, we see how the infant’s experience of face-to-face
attuned experiences are translated into cell growth, regulation of energy utilization, levels
of arousal, the proliferation of dendrites and finally to metabolism in the mitochondria.
Energy-Dependent Imprinting of Neural Circuits During Critical Periods of
Infancy
From another perspective, Schore starts this section of the paper with a central tenet of
dynamic systems theory concerning critical moments in complex self-organizing systems.
Times at which small additional flows of energy cause the system to become increasingly
interconnected and causes the system to crystallize in a new and permanent form. When
applied to infant development, it refers to those moments of imprinting when the
emotionally expressive face initiates a chain of events including higher levels of arousal,
increased blood flow, increased metabolism, the release of catacholamines and
subsequent neural restructuring.
The early neonate’s cerebral metabolic rate is very low. This rate gradually, but in
phases, increases as postnatal development proceeds until by early childhood overall
cerebral metabolism consumes one half of the child’s total oxygen consumption. A
similar metabolic picture is reflected in the cytochrome rich mitochondria of the cortex.
These specific phases of neural development in differing brain regions, as they begin
programmed growth, is accompanied by a sudden switch from anaerobic to aerobic
metabolism. This shift is essential, as maturing neurons requires a great deal more
energy than immature ones. The level of cytochrome is an important indicator of neural
metabolism and metabolic need; cytochrome oxidase is part of oxidative phosphorylation
produces 18 times as much energy as glycolysis alone.
A maturation phase has three parts; an accelerating edge that reflects a changing state in
that brain region; a peak that reflects the attainment of the maturational state and a
decelerating edge that reflects a stable equilibrium within the state. This three-phase
model correlates with the energy requirements of a brain area; it is also proposed that the
leading edge correlates with the maturation of excitatory innervations [the sympathetic
neurons] and the trailing edge with the maturation of the inhibitory innervations [the
parasympathetic neurons]. While interesting I do not understand the relevance of the
second law of thermodynamics: which states that systems are not 100% efficient and
energy flows from higher states to lesser states – tending toward entropy and toward
chaos since the extra energy can change local dynamics; [the first law states that energy
can change form but is neither created or lost; the third, that we can never get to absolute
zero –273C].
Clearly, when systems are in a state of flux either in the accelerating or decelerating
phase they are highly unstable and therefore very susceptible to the effects of small
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changes in input. The phase of accelerating growth would be that of maximum dendrite
proliferation and that of decelerating growth that of apoptotic death or parcellation.
Parcellation is responsible for the selective loss of synapses that determine an areas final
micro architecture, analogous to Darwinian natural selection. Again, a testament to the
power and importance of the primary care giver during the process of attachment and
emotional learning.
In dynamic systems language, this model holds that a condition of chaos exists when a
system must move from an ordered but obsolete state to a more flexible and adaptive one.
Schore puts the misnomer of self-organization is a nice way: it is not a self but a dyadic
unit and these not uniform incremental changes but basic and radical changes in the
organizational state.
Organization of Regulatory System in Orbitofrontal Cortex That Manifests
Chaotic Dynamics
This section of the paper starts by noting the inherent vulnerability of reverberating
circuits, as during attachment periods, to major alterations from small energy inputs as
the system cycles round and round. Important feedback loops link external social
perceptions with internal bodily states. It is very important for such systems to reach
stability.
In a restatement of our familiar chart of the three levels of hierarchical control; before the
cortex is myelinated the Amygdala then the Cingulate areas process emotionally
important information. By the end of the first year the orbito-insular area of the prefrontal
cortex processes the emotional face and regulates states of arousal. As development
proceeds into the second half of the second year the orbitofrontal areas develop and
become central to the processing of emotionally important information and responsible
for the infant’s ability to self-regulate. Schore remind us that the orbitofrontal cortex is
anatomically unique having access to information about any activity of mind or body. It
receives input from the sensory posterior cortex and outputs to the motor areas, the limbic
system, both branches of the autonomic nervous system, down into the midbrain and
through the vagal complex into the brain stem and body.
The orbital corticolimbic system, along with the amygdala, insular cortex, and anterior
Cingulate are the components of the “rostral limbic system” which is the apex of the
energy expending and energy conserving aspects of the ANS, controlling the nonlinear
mechanisms of somatic arousal.
As we know, the orbitofrontal cortex, below the level of awareness, scans the emotionally
expressive face for important visual and auditory information. Because of the extensive
connections to both limbic systems, this valence tagging matching function and can result
in explosive bursts of activity and discontinuous jumps in state with only slight input
changes. As a correlate, dopamine neurons can shift almost instantaneously from spike
firing to burst firing. A hallmark of chaos theory; tiny changes in input can result in a
massive output changes within moments. For example, a facial expression to brief to
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register consciously can be amplified to explosive proportions in half a minute and can
take hour, days or even weeks for the person to return to a “normal” state. While
explosive behavior is a necessary function of the orbitofrontal system, optimally the
shifts from one state to another are experienced as rhythmic and fluid.
The activity of the prefrontal system is responsible for the regulation of motivational
states and the adjustment or correction of emotional responses. The prefrontal system
also generates and stores internal working models. These working models contain vital
information about the details of social interactions and the emotional responses to these
interactions. Working models allow for smooth transitions and provide a means of
feedback, which can provide for change and learning in cognitive emotional interactions.
Right Brain as Nonlinear System
Schore now outlines the differences between the left and right brain. As we know the
right brain is more metabolically active for the first 18 months of life, during those
critical periods concerned with attachment and the early intense right-brain-to-right-brain
facial communications with the mother. This communication is thought to account for the
enlarged orbital prefrontal area on the right as compared to the left. On the other hand,
the later maturing nonlimbic dorsolateral prefrontal area is larger on the left. This is
thought to correlate with the left-brain becoming more metabolically active after 18
months.
Schore goes on to review the ways in which the right orbito-frontal region serves as the
control center for emotional learning, emotional control, emotional storage and emotional
responsiveness. These activities are mediated though controlling the production
biologically powerful amines and hormones. These compounds control the level of
arousal and through the emotional assessment of the situation prepare the body for either
“fight or flight” or energy conservation, mediated by stimulation or inhibition of either
branch of the autonomic nervous system; the ventral tegmental tracts for autonomic
stimulation and the lateral tegmental tracts for autonomic inhibition.
It has been shown that under situations of intense emotional input there is a shift from
left-brain control to right-brain control. There is some controversy as to whether the right
controls all emotions or just the negative ones. It seems clear that the right is the seat for
control of the nonverbal-verbal systems. It also seems clear that the right poster cortex is
essential for assessment of all emotional information. It has been shown that children
with right posterior damage have persistent difficulties in the expression of positive
affect.
Schore believes very strongly that the right modulates all the nonverbal “primary”
emotions, regardless of valence. These are the emotions that require a high expenditure of
energy and arousal, terror, elation or excitement or a very low level of arousal with
energy conservation such as shame. There seems to be some division of labor between
sides of the brain, in the expression of the verbal “social” emotions: anxiety, interest,
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enjoyment and guilt, which seem to be left hemisphere driven. In short, the right can be
seen as nonlinear while the left is seen as much more logical and linear.
Critical Period Gene-Environment Interactions and the Development of a
Vulnerability to Psychopathology
As a clinician, I found this section of the paper particularly important and sweeping in its
implications. Schore links what is known of genetic development with what is known
about the anatomical and biological aspects of development during critical attachment
periods. He then joins these two areas of investigation and speculates as how what is
psychological and psychopathological are be influenced by genetic endowment and
attachment experiences, this is the interface between nature and nurture.
The timing of the on-set and off-set of critical periods of development is seen as
genetically programmed, occurring through the activation of a family of genes, rather
than a single one. Gene control is exerted though productions of powerful enzymes, they
in turn allow for selective brain development. When we couple this with our
understanding of the powerful impact of emotionally charged face-to-face interactions
with the early caregiver a new world of understanding emerges.
Since the right brain in the dominant growth phase early, disorders of the emotions and of
emotional regulation that would be the hallmark of inadequate attachment experiences in
the first 18 months. The mother is seen as the “hidden regulator” of the infant’s neurogenetic, neuro-regulatory, neuro-anatomical and neuro-endocrine systems.
It is now believed that that the underlying genetic defect in psychiatric disorders are
defects in the systems involved in the synthesis and breakdown of biogenic amines.
These compounds regulate both the growth, and responsiveness of the brain, before and
after birth. Disruptions in very early life would result in mitochondrial abnormalities.
Such abnormalities can be seen early in life as in Rett’s Disorder or as faulty wiring of a
less serious nature, a defect that will exert its influence later in life. Rett’s Disorder is rare
affecting only females. It is characterized by normal development in the first few months
followed by decreased head growth, abnormalities of movement and profound mental
retardation. In autism there may be a year or more of normal early development while in
childhood schizophrenia there may be several normal appearing years– lesser illnesses
will have their typical time frame of normality.
The genetic system encoded in mitochondrial DNA is maternally inherited and has a
mutation rate ten times that of nuclear DNA. Once a critical level of mutant mitochondria
DNA is reached there is rapid change in cellular phenotype from normal to abnormal,
resulting in an impairment of oxidative phosphorylation and ATP production. This
radically disrupts cell metabolism and leads to the expression of emotional illness. We
are familiar with the understanding that a traumatizing physical environment can lead to
genetic damage – we are less familiar with notion that a traumatizing emotional
environment can also lead to genetic damage and amplify a genetic predisposition to
emotional illness. This can occur in the “nonshared” environment, environmental signals
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provided by the mother in the uterus and later to the environmental clues provided by the
mother’s body.
We have already discussed the ways in which stress, particularly during critical periods,
results in dysregulated levels of catacholamines and that genetic and structural
abnormality can follow. For example, normal dopamine levels start a chain reaction that
turn on genes within the cell that ultimately lead to the structural changes associated with
adequate imprinting experiences. But high levels of stress related dopamine could induce
neurotoxic inhibition of mitochondrial metabolism, wide spread mutations in brain tissue
may follow. In fact, animal studies show that early postnatal stress, such as maternal
deprivation, produces permanent changes in dopamine receptor function, both in cortical
areas and in the ventral tegmental area, resulting in long lasting “abnormalities of social
and affective function” and a reduced capacity to respond to stress in adulthood.
Mammalian studies show that early social stress induces changes in noradrenalin levels,
which can become permanent, certainly a “risk” factor for the development of despair,
anxiety and affective disorders later in life. Human studies show that exposure to neglect
will modify the development of a child’s noradrenalin system.
Excessive Developmental Parcellation and the Pathomorphogenis of
Frontolimbic Circuits
This is another unusually interesting section of the paper, with clinical implications. As
we would expect, Schore considers the early mother-infant interactions, pre or post natal,
to be the first confrontation between nature and nurture. Postnatal stress is inevitable. It is
the mother’s ability to modulate and repair the stress reaction in her infant that sets up the
child’s expectations about the future. An infant, who has experienced attuned responses,
will show lower levels of corticoid output and a more rapid return to pre-stress levels
than an infant who has experienced chronically stressful dyadic interactions. Stressed
infants have been shown to develop into adults who show exaggerated and prolonged
levels of stress hormones upon exposure to novel situations.
Dysregulated levels of stress hormones during critical growth inhibit cell metabolism, a
condition that enhances the toxicity of excitatory neurotransmitters producing
mitochondria abnormalities. Infants who experience frequent intense attachment
disruptions in the first year and shame transactions in the second year will experience
sudden and unregulated shifts from sympathetic dominant states to parasympathetic
dominant states and will experience prolonged elevated cortisol levels. Eventually both
autonomic systems are in a state of hyper-arousal in response to traumatic disruptions, a
condition leading to synaptic death in the “affective centers” and permanent functional
impairments in the affect regulatory systems. This interaction between cortico-steroids
and excitatory transmitters is thought to mediate programmed pruning at appropriate
times. An individual with genetically programmed underproduction of synapses and then
experiences a traumatic environmentally driven over-pruning of synapses is thought to
experience the primary mechanism for such “neurodevelopmental” disorders as autism
and schizophrenia. Normal pruning occurs in “parallel cortical circuits” while abnormal
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pruning is thought to involve pruning hierarchically in the cortical-subcortical circuits,
including loss of long axon collaterals, cell death and dendritic regression in both
branches of the ANS. Hierarchical pruning results in the defects that underlie
vulnerability to psychopathology.
In correlating attachment categories to symptoms and neuro-pathology Schore gives us
the following outline. Infants showing a disorganized-disoriented form of attachment
have a high rate of exposure to abuse. Their threatening interpersonal environment
induces states of hyperarousal which in turn induce long-lasting elevations of
sympathetic catacholamines and long-lasting states of parasympathetic vagal-associated
dissociation associated with hypoarousal and increased cortisol production. This
attachment group is found to have the highest cortisol levels of all the other attachment
groups. Their chaotic environment induces rapid and extreme alterations in sympathetic
and parasympathetic arousal. This in turn, induces chaotic biochemical alterations in the
infant’s brain, which is extremely damaging because it toxically induces apoptotic
cellular death. These infants suffer a permanent deficit in the ability to read the emotional
face. Since there is cell death in both asides of the ANS as well as in the fronto-limbic
areas their sympathetic and parasympathetic systems are not able to operate in a
reciprocal manner. It has been established that, structural damage to the hypothalamicpituitary-adrenal system leaves infants vulnerable to psychopathology later in life. Their
fragility would make them susceptible to extremes of labiality even with moderate stress.
Their right hemisphere damage would make such infants vulnerable to post traumatic
stress disorders, later in life. Since the right hemisphere is dominant for the regulation
and secretion of cortisol, these infants become susceptible to overwhelming and
uncontrollable panic states marked by terror and intense somatic symptoms during
traumatic recall.
Different attachment patterns indelibly influence the dual limbic system. An insecureresistant [avoidant] attachment pattern reflects in an experience dependent expansion of
the excitatory ventral tegmental circuit and extensive parcellation of the inhibitory lateral
tegmental circuit. Children with this type of wiring are sympathetically biased towards
states of high sympathetic arousal and emotionality without sufficient” vagal restraint”.
This reduced capacity to stimulate the parasympathetic, impairs the ability to help
regulate the sympathetic over arousal. This organizational pattern tends toward
externalizing psychopathology. They show difficulty in repressing negative affects and
have easy access to negative memories, and an inability to inhibit emotional spreading.
Insecure-avoidant attachment histories shape an expansion of thee inhibitory lateral
tegmental areas and excessive parcellation of the excitatory ventral tegmental circuits.
This organization is biased toward parasympathetic states of energy conserving low
arousal and reduced overt emotionality. Under stress they are inefficient in regulating
high arousal states, are vulnerable to over regulation and to internalizing
psychopathologies. These personalities show defensiveness and low accessibility to
negative memories, as well as high levels of “deactivating strategies”.
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There are recent findings of gender-based differences in right orbital functioning by the
2nd year that seem to persist throughout life. These wiring differences in the limbic
system may account for the susceptibility of males toward externalizing and females
toward internalizing disorders.
In line with chaos theory, the time may have come to focus on individual differences in
personality development rather than on large diagnostic groupings. Environmental stress
affects those with preexisting vulnerability the most. We know that the right orbital
frontolimbic circuits are most vulnerable during critical attachment periods, particularly
for those with a genetic predisposition toward non-standard architecture.
Early Forming Structural Pathology of Nonlinear Right Hemisphere and
Origins of Predisposition to Psychiatric Disorders
This section presents an overview and a concise reconciliation of the masses of earlier
material. Shore starts back at the beginning with the interesting formulation; that
nonlinear synchronized energy interchanges between the infant and the attuned caregiver
are the matrix out of which increasingly complex self-organizations develop. In this
frame, information and emotion are considered to be forms of energy. This evolutionarily
derived open system provides the opportunity for the infant to develop the needed
stability to self-regulate and self-soothe during stress and provides the flexibility to
develop a hierarchical set of new systems enabling him to adapt to increasingly complex
environments. At the center of this developmental schema is the right orbitofrontal cortex
with its connections to all parts of the cortex, midbrain, brain stem and endocrine glands.
It additionally serves as the apex of both sides of the limbic system and serves as the
central point of energy regulation and balance between the internal and external worlds.
This is the schema for a growth-enhancing environment.
Growth inhibiting-environments negatively impact the development of attachment
systems and of self-regulatory systems. To me it is an interesting formulation that; such
infants are poorly equipped to partake in open environmental systems because of their
lowered limbic threshold causing an exaggerated stress response to novel experiences.
Such infants continue to fall further behind since they are unable to expose themselves to
a full compliment of social-emotional experiences. Additionally, infants from poorly
attuned or misattuned environments are not provided internal models of interactive repair.
In fact, their procedural memory prepares them for failure rather than success in
navigating the stress of life.
When early attachment experiences are conceived of as direct maternal-right-brain-toinfant-right-brain communications it becomes possible to conceive of the intergenerational transfer of mental health or illness, of adaptive or maladaptive ways of
relating and of developing internal coping mechanisms.
It is important to remember that deficits in affect regulation are only manifest when the
infant is under stress, at those times there is an exaggerated hormonal response in both
time and intensity with an amplification of the negative state.
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Since the right brain is in a state of maximal growth during the first year and half it
exhibits a “preferential vulnerability” to developmental mishaps. Orbito-frontal metabolic
dysfunction has become increasingly implicated in autism, schizophrenia, bipolar
disorder, unipolar depression, post-traumatic stress disorder, drug addiction, alcoholism
and psychopathic, borderline and narcissistic personality disorders.
The remainder of this section was very exciting, as Schore, in working forward and
backward from: a fundamental postulate of clinical psychiatry which holds that the major
source of stress precipitating psychiatric disorders involves the affective response to a
rupture or loss of a significant relationship. It is now thought an environmental event,
appraised to be emotionally meaningful, may be the direct cause of a neurochemical
change which then becomes the psycho-pathogenic mechanism of the illness. This results
in a neural patterning of responses that renders the person unable to respond adaptively to
stress; resulting in an inappropriate internal activation or inhibition to an environmental
situation. Modern neuro-biochemical-psychiatric thinking sees defective neuromodulators as the causal agent in mental illness. Clinically we see that patients are unable
to return to the baseline state for extended periods of time, they also rely upon an
inadequate set of response patterns to adapt to stress, lacking the flexibility to develop
new response patterns.
Recent research in biochemical psychiatry is focusing on the relationship between
disturbed emotions and neurotransmitter dysfunctions, emphasizing the role of
monoaminergic neuromodulators in psychiatric disorders. The limbic receptors of these
bioamines are the primary target of the psycho-pharmacological drugs used currently in
use. This again implicates the role of right brain dysfunction in the development and
expression of the severest of the psychiatric disorders along with dysregulation of the two
forebrain-midbrain limbic circuits.
A deeper understanding of the earliest ontological substrates of psychiatric illness and the
interplay between genetics and environment resulting in a vulnerability to stress-induced
disorders of adaptive functions is occupying center of current research. This research
points directly to the early rapid growth and maturation of the right brain and
accompanying biogenic aminergic systems that regulate the growth of the limbic system
as causative agents. If this line of speculation holds there should altered patterns of right
brain bioamines evident in high-risk infants. Indeed current research shows that
prenatally stressed infants, soon after birth, show alterations in the right brain dopamine
levels and alterations in emotionality. Children designated as at high risk for
schizophrenia exhibit early neurointegrative deficits, reflecting dysregulation of
hypothalamic and reticular activating systems. When challenged these infants show leftsided postural and movement abnormalities, reflecting over activity of ascending
dopamine systems in the right hemisphere. High-risk infants of schizophrenic parents
show right and not left sided EEG abnormalities. Disturbances in facial expressions are
seen in pre-schizophrenic infants in the first year. It is assumed that these early
“traumatic” events play the critical role in the “developmental disconnection of the
temporolimbic prefrontal cortices” seen in the hypometabolic prefrontal areas of the
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schizophrenic brain and relate to the negative symptoms of that disorder. Negative
symptoms include social withdrawal, isolation, paucity of affect and inability to read
social clues.
More evidence of early right brain deficits come from 3-6 month old infants of depressed
mothers who show a right frontal EEG asymmetry. At 10 months, infants who express
more intense distress to maternal separation display a greater right than left frontal
activation. This asymmetry has been related to emotional reactivity and vulnerability to
psychopathology in both infants and adults. Individuals with extreme right frontal
activation show a hyper-reactivity to mildly negative situations, both in the degree and
duration of their response. It has been reported that children with both internalizing and
externalizing problems show a greater right than left frontal EEG activation, suggesting
that this EEG pattern reflects difficulties in affect regulation, whether the affect is
positive or negative.
It now seems clear that the right brain deficits of very early trauma persist into childhood.
This loss of frontal lobe interconnection, secondary to excessive parcellation, is
associated with impaired social perception and puts the child at high risk for developing
nonverbal learning disabilities. These symptom complexes can be called “developmental
right hemisphere syndromes” or a “developmental and social-emotional processing
disorders”. While these symptom complexes are present early they are not recognized or
activated until the child experiences the stress of the school environment. At that time we
begin to see the classic maladaptation to new situations, difficulties in maintaining
friendships, withdrawn and excessively shy behaviors and avoidance of eye contact.
Later in life these right hemisphere abnormalities are expressed as introversion, poor
social perception, chronic emotional difficulties, an inability to display affect and
impairment in visuospacial representation.
Longitudinal studies show, these deficits endure into adulthood and predict adult
psychiatric disturbance. In adults “greater right hemisphericity” is associated with a
history of more frequent negative affects, lower self-esteem and chronic difficulties in
affect regulation. Again, early traumatic relational environments generate an unstable
right frontal cortical ability to evaluate and guide behavior. The right brain is
metabolically inefficient and under stress is easily replaced by lower inflexible
subcortical control mechanisms. The uncoupling of the two right brain limbic circuits
occurs in response to interactive stress, in episodes of “expressed emotion”, intense levels
of humiliation, criticism, hostility and emotional over-involvement within a close
relationship. This uncoupling is a uniquely potent psychobiologic stressor for the
induction of all classes of psychiatric disorders triggering extremely high levels of
sympathetic ergotrophic and parasympathetic trophotrophic arousal that are beyond the
individual’s regulatory ability. To me, most importantly, this “transient frontolimbic
imbalance” elicits subcortical limbic kindling, subjectively experienced as a sudden
transition into rapidly shifting and intense affective states, which is “emotional chaos”. I
have heard about kindling and I need to know more.
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The right hemisphere is preferentially activated in stress, and is specialized in processing
negatives states such as those aroused by traumatic memories. PET scan shows right
paralimbic activity with the activation of traumatic memories is similar to those seen
when a phobic state is evoked. Schore believes these studies of the cerebral dysregulated
states are of particular importance since they do more than just tell us the cerebral
localization of a disorder but helps us localize the developmental time when the
disordered state was crystallized. When in the attachment process the failure occurred.
Dynamic Systems Theory and Ongoing Right Hemispheric Development
This final section of the paper is a beautifully worded overview; I will only shorten it
some. Sroufe, attachment is “the apex of dyadic emotional regulation, a culmination of all
development in the first year and a harbinger of the self-regulation that is to come”. The
attachment dynamic continues throughout the life span as an unconscious mechanism that
mediates the interpersonal and intrapsychic events of all relationships especially intimate
relationships. Bauer and Fink, “by the 2nd year, the infant can construct accurate
representations of events that endure and are accessible over time, and these experiences
are imprinted into the right hemispheric networks that store autobiographical memory.
The ability to access an internal working model of relationships that encode strategies of
affect regulation and expectations of future interactions with meaningful others, to
develop a theory of the intentions of others, and to be psycho-biologically attuned and
thereby empathic to the internal states of another are the fundamental prerequisites of an
adaptive capacity to enter into satisfactory relationships with others. Affect regulating
interactions are essential for the infant to develop coping skills, later in our development
they continue to be needed to develop increasingly complex social and internal states.
Well into the second year of life the nonlinear right brain begins to end its rapid growth
phase just as the linear left starts its rapid growth phase. Importantly later in life during
additional critical periods, the right brain will again enter a phase of growth dominance,
which allows the process of attachment to continue and permits a reorganization of the
emotion processing right brain, making it one of the more plastic parts of the brain. This
also gives us another chance to get it right.
If an infant because of experience and or a genetic vulnerability does not have adequate
experiences of being part of an open dynamic system with an emotionally responsive
adult, its corticolimbic organization will be poorly equipped to cope with the chaotic
dynamics inherent in all human relationships. Such a system tends to be static and closed,
geared toward defensive structures guarding against interactive assaults that may trigger
disorganizing and painful states. Such a person would tend to avoid new and novel
situations and the social-emotional growth that such experience-dependent experiences
can have on the organization of the right brain, tending toward a static or inwardly
spiraling self-organization.