Wednesday, May 13, 2015

Integration and Connection in Well-Being and Recovery from Trauma


This blog is Part Two of 'The Need for Integration'. 


The American Psychiatrist and Neurobiologist Daniel Siegel (2006) claims,

“The central idea of interpersonal neurobiology is that integration is at the heart of well-being.”

In this blog, I am going to explore the relationship between integration and connection.  The relationship is critical to health and well-being.  This is the case in ordinary human development and also in the recovery from developmental disturbances, such as those caused by trauma in childhood.  Siegel and Solomon (2003) state that effective therapy for trauma involves the facilitation of neural integration.     

In part one of this blog, I referred back to the original use of the term integration in relation to child development, by Donald Winnicott, the British child psychoanalyst and pediatrician.  According to him (1962) the infant is born ‘unintegrated’.  Through the process of his fragmented experiences being held together by the ‘good enough’ parent, he achieves integration and a distinct sense of being a whole person.  This normally happens by the end of the first year or so. 

Child development is centred on the integration of emotional and physical aspects of relating.  For this to be achieved the primary caregiver must be integrated as a person, but also connected within a wider environment.  Ideally, there are positive connections with partner, family, and community.  These connections provide the holding environment within which the caregiver and infant connect physically and emotionally.      

While the uses of the word integration by Siegel and Winnicott, come from different perspectives and with 50 years in-between, the essence is the same.  A healthy person is an integrated person.  If we think of the developing brain we can think of neurons connecting and forming integrated neural pathways.  Or we can think of different parts of the brain, connecting and functioning together in an integrated way.  We can think of mind body integration.  Integration of our senses with our mind and conscious awareness.  Integration with the world around us. 

From the beginning of life integration is interwoven with attachment.  Referring to the importance of attachment in relation to the process of integration, Stien and Kendall (2004, p.7) state,

“Moreover, it has received influential support in the last two decades from neurobiological research which has found that secure attachments produce a growth-facilitating environment that builds neuronal connections and integrates brain systems.”

What enables an infant’s mind, body and brain to develop is connection with others.  Throughout our lives development takes place within a relational context.  As Bessel van der Kolk (2014) says, 

“Most of our energy is devoted to connecting with others.”  And, “We are profoundly social creatures; our lives consist of finding our place within the community of human beings.”

During infancy the attunement and emotional regulation of the caregiver is central to the developmental process.  Mirror neurons in the caregiver and infant connect with the detail of each other’s feelings and behaviour.  The infant's neurons fire, connect and become wired.  This kind of connected being 'in tune' with the other is called attunement.  Just as attunement facilitates development, a chronic lack of attunement prevents connections developing and disconnects those that have.  Neuroscience has confirmed how vital attunement is to this process, and Bessel van der Kolk (2014) states that “Donald Winnicott, is the father of modern studies of attunement”. This integrative statement helpfully connects the fields of psychoanalysis and neuroscience and also the past with the present.

It could be said that connection is the glue that enables integration to take place.  Different parts become integrated because they are connected together.  For example, a person with an integrated sense of their identity can connect the different parts of their life.  An integrated and coherent autobiographical narrative, which is such an important indication of mental health is one that is connected.  Like a story with a beginning, middle and end, the different parts are joined together coherently.

Where there is a lack of such connection during infancy, development is disrupted.  As a result, the infant might not reach the developmental stage of integration.  He could be described as unintegrated or unconnected.  The unintegrated traumatized brain is not functioning together as a connected whole.  Parts are fragmented, split off, closed down, not developed, dissociated, etc.  Dissociation, which is a central feature of trauma, literally disconnects a person from himself and the world around him.  The disconnection is a form of protection and it usually happens in terrifying situations from which there is no physical escape. Traumatized people are often disconnected from their bodies.  The body is a source of pain rather than pleasure.  It also let the person down by not aiding his escape from trauma. 

Among many negative impacts on the brain-body system, trauma interferes with the integration of left and right hemisphere brain functioning.  Rational thought cannot be accessed in the face of overwhelming emotion.  Emotional and social disconnection can begin a spiral that leads to further isolation and alienation.  On the other hand, emotional and relational connection creates a positive spiral.  It leads to the conditions that bring more connection.   

An unintegrated person can’t disintegrate because there is nothing to disintegrate from.  In the same way an unconnected person cannot become disconnected.   However, an integrated person can disintegrate and a connected person can disconnect.   If a person is traumatized, it is important to determine the point that recovery must begin from.  For example, is it necessary to build connections for the first time or to heal those that have been broken?  The answer can be reached through an assessment and understanding of attachment relationships and developmental milestones.

The reality of trauma means that the traumatic experience is not integrated into the personality, regardless of the person’s stage of development.  The trauma is disconnected from consciousness but remains present through disturbing and frightening physical sensations, flashbacks and nightmares.  One of the aims of treatment is to enable connections to be made between these sensations and the events they are related to.

“Individuals who lack emotional awareness are able, with practice, to connect their physical sensations to psychological events.  Then they can slowly reconnect with themselves.”  (van der Kolk, 2014).

The building of connections is central to recovery.  This work can be considered on different levels.  The individual’s connection with himself, his own body, his thoughts, sensations and emotions.  His connection with others and the world around him.  Connections between the different parts of his history and identity. 

I am highlighting the importance of connection though the complexity of this work cannot be done justice to here.  Before connections can be achieved, safety must be established.  Only when the disconnected or unconnected person begins to feel safe will he be able to take the risks involved in connecting. Once the process of connecting begins the person is moving towards integration.  The foundations of well-being can be considered as safety, connection and integration. 

The third part of this blog will consider the need for integrated and connected systems and environments for trauma recovery.

References

Siegel, D.J. (2006) Series Editor’s Foreword, in, Ogden, P., Minton, K. and Pain, C. Trauma and the Body, New York: Norton

Siegel, D. J. and Solomon, M. T. (2003) Healing Trauma: Attachment, Mind, Body and Brain, New York: Norton

Stien, P.T. and Kendall, J. (2004) Psychological Trauma and the Developing Brain: Neurologically Based Interventions for Troubled Children New York, London, Oxford: The Haworth Maltreatment and Trauma Press

Van der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Viking: New York

Winnicott, D.W. (1962) “Ego Integration in Child Development”, in, The Maturational Process and the Facilitating Environment, Hogarth Press and the Institute of Psychoanalysis: London (1972)