Thursday, November 06, 2014

Bernard Brandchaft - Systems of Pathological Accommodation,204,203,200_.jpg

Bernard Brandchaft is one of the early co-founders (with Robert Stolorow and George Atwood) of intersubjective systems theory in psychoanalysis. Brandchaft (who died in 2013) is the co-editor and a contributor to The Intersubjective Perspective (1994, with Stolorow and Atwood), and co-author of Psychoanalytic Treatment: An Intersubjective Approach (2000, with Stolorow and Atwood), and Toward an Emancipatory Psychoanalysis: Brandchaft's Intersubjective Vision (2010, with Shelley Doctors and Dorienne Sorter), the later being a collection of Brandchaft's essays worked into a book format, with a couple of chapters by the co-authors.

One of the great innovations in post-Freudian psychoanalysis was the recognition that early relational experience shapes personality and the sense of self for the remainder of one's life, barring intervention. Attachment theory has demonstrated this and contemporary neuroscience has confirmed, especially the work of Allan Schore.

In Brandchaft's work, he developed an understanding of how children, even in infancy, develop "systems of pathological accommodation" as a self-preservation tactic to survive dysfunctional parents or caregivers.

What is presented below are some passages from this seminal article. This represents the first half or more of the article, while the remainder of the article goes into treatment - which I hope to share here as well.

Note: Brandchaft uses some of the language of the object-relations school, so "object" generally will mean the parent or caregiver, the subjective experience of which becomes an internal object (of the unconscious) later in life.

Systems of Pathological Accommodation and Change in Analysis

Bernard Brandchaft, MD
Los Angeles, CA
From: Psychoanalytic Psychology (2007); 24(4):667-687. DOI: 10.1037/0736-9735.24.4.667

When the child is required preemptively to adhere to an inflexible personality organization that caregivers bring to its needs for psychological distinctness, these earliest attachments exclude or marginalize spontaneous experience and second thought metacognitive processes of self-reflection. The child’s ability to process new information and, accordingly, to self-correct and grow are impaired as its emerging sense of self is usurped. By repetitive process, the child’s first reality becomes patterned into a set of immutable belief systems. These subsequently find their place in retrograde social systems in which authoritative first truths remain absolute. … The ensuing pathological accommodation continues to operate as an entrenched system beyond awareness, to preserve life by imprisoning it in archaic bonds. [668]

The sense of self established within this system is defined and appraised by alien referents, their origins buried in an antiquity that shapes experience by continuing to inform and deform. It is not subject to the rules of ordinary thought. [668]

The transfer from object tie to unconscious and depersonalized organizing principles (“internalization”) retains the quality of those archaic attachments. The structures of pathological accommodation, like the original ties, can be seen to regulate the first and only reliable cohesion that the individual has known. In this manner, they protect against the unbearable terror of early object loss and the dissolution of selfhood whenever fundamental differentiating change might occur. In the process, repetition is inexorably substituted for change while in this addictive-like process self-regulation remains the property of another. [669]

In the disorders I am describing, the reality that dominates is that of the caregiver in her/his impingement on or exclusion of whole domains of the subjective reality of the child. The expanding discipline of child observation in the past half-century has yielded findings that have contradicted prevailing notions about the quality of what had been regarded as average expectable environment. These studies have resulted in an awareness of the widespread extent to which real-life trauma, especially in very early development, is a primary etiological factor in what earlier had been ascribed to instinctual trauma or constitutional defect. In these disorders, the breakdown factors are embedded in the total infant-caregiving system. They are inexorably reactivated within succeeding attachment systems, including the analytic transference, when the child has remained totally dependent upon its ties to an attachment figure in order to sustain a belief in the continuity of his own existence. [669-670]

I have cited clinical examples to argue that the conflict embedded in the compromise formed by the structures of pathological accommodation, a quintessential element in the quality of superego pathology, have their origin in the caregiver-infant contextual domain within which self-differentiation and the ontogeny of the sense of self emerge (Brandchaft, 1988). The child’s development has been fatefully compromised by the compulsively selective inclusion/exclusion and dissociation of information that experience might otherwise provide, when such incremental self-mutilation is regarded as mandatory in order to preserve and protect a tie on which life itself depends. Obsessive–compulsive disorders display most convincingly the operation and imprisoning character of systems of pathological accommodation. [671]

A vast literature has begun to stress the role of trauma, incurring from the dawning of consciousness itself (Bowlby, 1969, 1973, 1980; Cicchetti & Greenberg, 1991; Crittenden, 1994, 1995; Main, 1995; Meares, 1998; Stolorow, 1999) that initiates the cocreation of complex systems of pathological accommodation (Brandchaft, 1991). These come to crystallize and occupy central experiential pathways in personality formation. The course and goals of a psychoanalytic treatment of developmental disorders must be based on bringing these Traumatic Attachment Systems to light and addressing them therapeutically. An understanding, in depth, of the effect of unresolved trauma requires a recognition of the ways it is contextually constituted…. [672]

It has come to be widely recognized that real life trauma constitutes an assault on nuclear formations of the personality at their onset. Winnicott defined trauma as an impingement from the environment and from the individual’s reaction to the environment that occurs prior to the individual’s development of the mechanisms that make the unpredictable predictable. He maintained that trauma at the beginning of life relates to the threat of annihilation. Subsequently, attachment studies show that its effect is felt on biological and behavioral systems at many levels and that the child’s ability to negotiate developmental tasks is severely challenged. [672-673]

Where such developmental trauma has become the average expectable environment, it has a pervasive impact on the primary relationship, playing a determining role in the subsequent course of development (Crittenden, 1994; Fonagy, 2001; Main, 1995). Here, the child’s first efforts are turned toward the task of dealing with pain and the encroaching experience of the extinction of life, commensurate in its massive impact with the infant’s total dependence upon its objects [caregivers]. An attachment system of complex interweaving between self and object occupies the center of the child’s attention and shapes initiative. Occurring at the dawning of consciousness, processes of pathological accommodation become the context within which translocation (“internalization”) occurs in the automatic processing of experience. From a bedrock position, they continue to exert an enduring influence on the formation of the child’s personality, the complex relationships of its experiential world, basic feelings about itself and life, and its expectations and subsequent relationship with objects. Systems of pathological accommodation, as prototypical forms of self and object reciprocal attachment, operate powerfully at preverbal and procedural levels. [673]

A radically different self-object system, however, has been created, and this system plays a greater, not a lesser, central and constitutive role than a responsive caregiving attachment might have played. This new system remains exquisitely context-sensitive and context-dependent with traumatic memory traces and ever-present proximity of life-threatening trauma at the core of the reality it attempts to organize. The harsh set of tasks involves preoccupation with strategies for maintaining attachment to the object, while simultaneously coping with the complex effects of relational trauma as development proceeds. The preoccupying mental state may well attain the proportions of an “attention deficit” disorder, especially when the caregiver’s attention continues in its fixation on what is “missing” in the child while that of the child remains focused on the lack of the object’s aware/responsiveness to the toxic state that is preoccupying child. [673]

Trauma such as that which accompanies a serious mismatch of the caregiver’s experience and response with that of the infant can be observed to result in a shock-like “toxic” state. In the instantaneous tsunami-like reaction, the time-space dimension of experience undergoes collapse while the fragile structures supporting a continuing sense of self are crushed. Trauma such as that which accompanies a serious mismatch of the caregiver’s experience and response with that of the infant can be observed to result in a shock-like “toxic” state. In the instantaneous tsunami-like reaction, the time-space dimension of experience undergoes collapse while the fragile structures supporting a continuing sense of self are crushed. The state, as it can be observed in the therapeutic interaction, brings together a cognitive/affective montage in which are indissolubly fused unconscious memories of life-endangering archaic experience and the shroud-like expectation of future threats of extinction. In this process, damage keeps being inflicted on the quality of one’s personal experience and entire spectrum of one’s relationships. The hole created will be filled in by a combination of compensatory enactments and distancing structures together with those of pathological accommodation, which “heal” the breach. [673]

A rigid template is formed through which all experience comes to be filtered. A patient so traumatized will frequently display a knowledge of the analyst’s unconscious intentions before the analyst knows about them (however reductionistic or distorted from the analyst’s point of view). [673-674]

Also in place in such experience is the patient’s unquestioned belief that the analyst’s appraisal of her, and of himself, will be based at every stage on how well or poorly she is able to please and affirm the analyst by showing progress in the program on which he rests his claims for progress and the patient’s well-being. [674]

Within a secure developmental attachment system, sensitive caregiver responses form harmonious sequences with the child’s distinctive experience. Where repeated trauma prevails, the child’s natural rhythms and psychological states do not initiate harmonious interaction responses. Instead, the attachments serve as pathways for responses centered in the caregiver’s own insecure attachment patterns. In place of letting the child take the lead in the playful interaction, for example, the anxious mother, like the anxious therapist later, will direct the child, thus beginning the extinction of any center of initiative in the child. The obsessive caregiver will keep scrutinizing the child for flaws and defects, and they then become enmeshed into a ritualistic system of “fixing.” The center of the developmental stage is shifted from the child’s vitalizing expressions to the caregiver’s deadening, impinging, frightened, or abusive mismatch. Ever afterward, this sequencing will occur automatically beyond the influence of self-reflective awareness. Occurring at split-second intervals, the process results cumulatively in an “overburdening” exhaustion. If its triggering contextual origins go unnoticed, it may seem unexplainable and intractable as a characterological “volatility” in the patient, impervious to cognitive learning…. [674]

Well-being and happiness cannot be sustained within this system. Feelings of attractiveness come systematically to be extinguished and replaced by those of repulsiveness, aliveness by malaise. The repetitive sequencing of such states of mind takes the form of obsessive brooding and self-reproach from which patients cannot free themselves when they are alone. These states are frequently not clearly recognized as discrete states of mind and as reactive to psychologically complex triggering interactions. … Terror has been unleashed in the subjective world, and, as on the larger geopolitical stage of our contemporary world so dramatically, terror requires immediate preventive or preemptive intervention. [674]

Within traumatic attachment systems, the child develops a lasting hatred of reality and may spend a lifetime attempting to evade it or, “born again,” to superimpose a more acceptable substitute upon it. The hated reality is one has been imposed and has come to crush spontaneity and individual joyfulness. At its center, the traumatized child has come to feel itself as bad. Its experience has been interlaced with threats and episodes of abandonment, physical and psychological, and first belief in causality establishes that it has done something egregiously, malignantly, and selfishly “wrong.” The child has been forced to adopt or embrace, this alien impinging referent as not-to-be questioned Truth because such threats leave it helpless. Intense anxiety is aroused, and the anger generated is the only means the child possesses to attempt to prevent the caregiver from carrying out or continuing the threat. … Chronic rage and revenge follow, laying the foundation for sadomasochistic character formations. This child carries the stigma of badness driven into his selfhood and will never able to put the torment to rest: “Like damn little men pounding at my brain with picks and axes and chisels” (Stevenson, 1998, p. 36). [674-675]

In this context of repetitive/cumulative trauma, the child’s acute sensitivity will serve as an advance warning system, and his development will have to be patterned around a program of matching the caregiver’s mental state with a system of “shoulds” and “shouldn’ts.” An enduring template comes into being under wide areas of the child’s cognitive, emotional, behavioral and neurophysiological functioning, just as similarly had happened in the caregiver’s own childhood. This metasystem is established before symbolization has developed, and it will continue to operate largely beyond the corrective influence of subsequent relational experience or self-reflective awareness. Acting like a DNA-inherited pattern into which subsequent experience will be silently synthesized, it serves as a conveyer belt for future transgenerational transmission. Once established, “it filters experience in such a way that minimizes the likelihood of spontaneous change” (Sroufe, 1996). [675]

At the very foundations of personality formation, traumatic sequences (“schemata-of-a-way-of-being-with” Stern, 1985) are established in which the child’s connections with self and caregiver are repeatedly broken into by mismatching. [675]

The state of distress is brought to an end with the compulsive rematching of the child’s mental organization to that of the caregiver. The process takes place in milliseconds. Its hierarchical position is rooted in the procedural level of experience before the capacity for the representation of internal working models has developed. It is subsequently incorporated into such models acting as a compulsion in statu nascendi [in the state of being born]. Attachment observation yields conclusive evidence that infants attached to maltreating figures are not less attached - indeed they are likely to remain the more rigidly so by reason of their continuing insecurity and that of their attachment objects. Winnicott has traced the adult fear of a future mental breakdown to one that has already occurred so early in life that it cannot be remembered. [676]

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