Excerpted from Psychotherapy with Sex-Abuse Victims
True False and Hysterical
©1996 Creative Therapeutics, Inc. All Rights Reserved
My primary purpose in this chapter is to focus on the phenomenon of the seemingly purposeless embedment of mental material into the brain circuitry. Although such material originally may have had some purpose, it appears to persist beyond the time when it has served some purpose. For reasons unknown to the individual, it persists indefinitely, possibly throughout life. Such cognitive material appears to have a life of its own and spins around in the brain circuitry long after it has served some function. Psychologists and psychiatrists have not given this phenomenon the attention it deserves, especially as a contributory factor in the development and perpetuation of psychopathology. This phenomenon also has important therapeutic implications.
I will refer to this process as the Embedment-in-the-Brain-Circuitry Phenomenon (EBCP). I use the word mental to refer to psychological brain processes, which are on a continuum. On one end of the continuum is purely cognitive material, with no associated emotional (affective) concomitants. An example of this would be a "pure thought" without any emotional content such as one would experience when calmly adding up a row of numbers. Of course, if the numbers represent the amount of money one has, then, of course, emotional elements may appear. At the other end of the continuum are pure emotions, with little if any associated emotional cognitive concomitants. An example of this would be a nightmare in which the individual experiences only morbid fear without any knowledge of its source. However, if some kind of cognitive material appears, such as some menacing figure, the experience could not then be viewed as "pure emotion." A panic attack in which the only experience is morbid fear would be another example. However, once cognitive elements are introduced, such as the fear that one is going to have a heart attack, then this would represent some shift (albeit small) down the continuum toward the purely cognitive end. Most mental material is likely to fall in between these two ends of the continuum.
Obviously, the newborn infant is ill equipped to survive without a significant amount of care by older individuals. Obviously, also, if the infant is to survive, it must learn techniques for survival. It must have the capacity to learn, i.e., modify behavior as a result of experience. In order to accomplish this, the infant must be able to store in memory what is learned at any particular time in order to make use of what has been learned at any future time. Learning, then, can be reasonably defined as a change in an organism’s behavior as a result of experience. The younger the child, the more primitive the learning mechanisms are because of the inability of the brain substance to accommodate more complex forms of learning. However, the human brain has the capacity to learn at the very earliest levels of life. There is also a hierarchy with regard to the complexity of the learning process. An amoeba can be "taught" to avoid a noxious stimulus. This is a form of learning in that there appears to be some kind of "memory" that enables the organism to avoid repetition of exposure to a specific noxious stimulus. This is one of the simplest forms of learning, often referred to as conditioned learning. Obviously, the amoeba cannot involve itself in more complex forms of learning because it does not have brain circuitry to accomplish more complex tasks.
Each organism at the time of its "birth" has a capacity for learning, a capacity that, in higher animals, becomes more complex over time, during which the organisms can learn from experience. There must be, however, a certain potential for learning at the time of birth in order to enable the individual to survive. It cannot wait until it "grows up" and then start to use the learning mechanisms.
Another important factor here is the speed of learning. The more complex forms of cognitive learning can only occur over a long period, often many years. Our educational process is probably the best example of this phenomenon. Even conditioned learning often takes time, and the more complex the task, the longer the conditioning process.
Imprinting in Lower Animals
Ethologists use the term imprinting to refer to a response pattern that develops in the earliest hours of life, arises under very specific circumstances, and cannot be extinguished by subsequent experiences. This response pattern occurs during what is referred to as the critical period because it will not develop if the same circumstances are operative significantly before or significantly after this particular segment of time.
Some of the seminal work in this area was done by Lorenz (1937, 1950), who introduced the term imprinting to refer to this phenomenon. Lorenz worked primarily with greylag geese, but the principles of the imprinting process have been verified in many other species by other investigators. For example, the basic principle is well demonstrated by studies on ducklings conducted by Hess (1966). The fertilized egg of a duck is removed from the nest of the biological mother and placed in the nest of a surrogate duck. Once hatched, the duckling is allowed to remain with the surrogate mother during the first two to three days of life, during which time the duckling demonstrates various manifestations of an attachment bond with the surrogate. One of these is the tendency to follow her wherever she goes. If, after the first few days, the duckling is returned to the nest of its biological mother, it shows few if any manifestations of attachment, especially the following response. And no amount of effort on the biological mother’s part to involve the duckling is successful.
If one studies this phenomenon further, one finds that there is a critical period during which this attachment response develops and that involvement with the surrogate before and after this critical period is less likely to result in the formation of an attachment bond. For mallard ducklings the critical period is from 13 to 16 hours. The imprinting response cannot be viewed as an example of a learned reflex in that it cannot be "taught" before or after the critical period, and it cannot be extinguished by traditional punishment or negative reinforcement. Furthermore, imprinting is somewhat indiscriminate in that if the surrogate is a mechanical toy, the bond will develop in association with it and the duckling will follow the mechanical toy throughout its life—no matter how many attempts are made to get it to follow the biological mother. Attempts to suppress the response by such techniques as shocking the duckling each time it touches the mechanical toy often serve instead to strengthen the response. This further demonstrates the point that this phenomenon is not to be considered an example of a learned or conditioned response. If the egg is hatched in a situation in which the newborn duckling is deprived of all contact with any kind of moving figure, animate or inanimate, for a length of time that extends beyond the critical period, then no following response at all can be evoked. Under these circumstances the duckling will not be capable of attaching itself to any caretaking figure, whether it be the biological mother or a human being. It is reasonable to assume that the capacity to form the imprinted response is genetically programmed in that each species has its own critical period for the elicitation of it. Accordingly, I consider it reasonable to refer to it as instinctual.
The Question of Imprinting in Human Beings
I believe that human infants exhibit a similar phenomenon during the earliest months of life. I do not believe, however, that it is so specific that one can measure accurately an exact critical period, as one can in lower animals. One of the ways in which human beings differ from lower animals is the flexibility of the instinctual response and its capacity to be modified to varying degrees by the individuals themselves and the social environment. Certain birds, for example, are compelled to perform specific ritualistic mating dances during the mating season. They have no choice but to do so. The capacity for the particular response is programmed into their genes and is elicited by certain environmental stimuli that occur at specific times of the year. Although we human beings have procreative urges that produce the desire to mate, we are not compelled to act on these instinctual responses in a reflex manner. We have a certain degree of conscious control over them, and our social environment can play a significant role in modifying these instinctive responses.
Like the duckling, the human infant forms an attachment bond with its mother or her surrogate. If the human infant is not provided tender loving care during infancy, the child may literally waste away and die. In less extreme situations—in which the caretaker simply does not provide significant affection, tenderness, cuddling, protection, and so on—the infant is not likely to form this bond and, I believe, may never form it. Like the duckling who does not develop a following response if it has been deprived of contact with moving figures for a time that extends beyond the critical period, humans who have been significantly deprived during their critical periods for imprinting will similarly be unable to form an attachment bond—regardless of how benevolent, devoted, dedicated, and loving the caretaking individual. Although I cannot specify a particular segment of time—such as one can with a duckling and other lower species—I believe that this kind of critical period exists in humans within the first few months of life. I cannot be more specific. However, the time span in humans is probably broader and more variable than that of lower animals. And, as is true of lower species, if a human infant does not form this bond during the critical period, I do not believe that it can ever be formed . Such individuals may very well become psychotic or psychopathic, or develop other forms of severe psychopathology. Elsewhere (Gardner, 1988b, 1994a), I have elaborated on some of these.
Of pertinence to my discussion here is the capacity of the human brain to learn quickly under certain circumstances, circumstances that involve threat to survival. As I will elaborate upon below, I believe that the human brain has the capacity for quick learning, similar to the kind of learning seen in imprinting. Although this may have survival value, the imprinted mental material may remain spinning around in the brain long after it has served its purpose.
"PSYCHOPATHOLOGY OF EVERYDAY LIFE"
To the best of my knowledge, the term psychopathology of everyday life was introduced by Sigmund Freud to refer to the utilization of psychoanalytic insights for explaining a variety of common forms of thinking and behaving. Whereas Freud and his followers would give attention to the psychodynamic factors (both Freudian and non-Freudian), they have not given proper attention to the EBCP as an important contributing factor to such mental and behavioral manifestations.
The EBCP is basically known to all of us. We all have mental material floating around in our brains that periodically intrudes itself into conscious awareness, material that once served some purpose and no longer does so. A common example, well known to individuals who have spent years involved in very demanding academic pursuits, is the dream of being back in school and anticipating, often with terror, a forthcoming examination for which one is ill prepared. Commonly, the dream ends with the individual waking up with a sigh of relief that it was "only a dream." I personally have such a dream once or twice a year. Many years ago, I mentioned this to a colleague and his response to me was: "Doesn’t every Jewish boy who went to medical school have that dream?"
Another example from my own personal experience. I was born in 1931. In 1941 the United States formally entered World War II. (It was informally involved for at least two or three years before that.) At that time, the predictions were that the war would last seven to ten years, which meant that I myself might have to go into the military service in my late teens. The prospect of being drafted into the infantry (the most likely course as I understood it at that time) was a bleak one and my hopes were that somehow, some way, the war would end sooner—before my eighteenth birthday in 1949. Although I did not think about it daily, the specter of my being drafted into the infantry hovered over me during those years, epitomized by the fantasy of receiving a letter in the mail from my draft board informing me that I would now have to enter the Army. As is well known, in 1945, after dropping two atom bombs on Japan (not one but two), the Japanese prematurely surrendered.
One would think that my sigh of relief at age 14 would have resulted in the complete evaporation of my anticipation of receiving that dreaded letter from my draft board. It did not. In 1950 the Korean War began. I was then 19 and in college. Although "a perfect age" for being drafted, college students who achieved a high score on a national examination were deferred. (If there was one thing that Jewish boys from the Bronx High School of Science relished, it was national competitive examinations!) Not surprisingly, I achieved the required score and was deferred. (I recognize now the inequity and possibly even the immorality of that policy, but in 1950 such considerations did not enter my mind.) Yet, even after passing that exam, thoughts of receiving that letter from my draft board did not leave my mind. I am not claiming that I walked around obsessed with these concerns; I am only stating that they came to mind from time to time for no apparent reason.
In 1952, upon entrance to medical school, I signed up with "The Berry Plan" (named, I believe, after the general who originated it), a program in which I committed myself to military service following the completion of my residency (approximately eight to nine years hence). Now, there would be no reason for me to be concerned about any letter from my draft board. I was already formally in the service, only my day of entry would be in 1960. Furthermore, I was not going to serve as Kanonenfutter (cannon fodder) in the infantry; rather, I was going to be a doctor and an officer. Yet, I still had occasional thoughts about receiving a letter from the draft board.
From 1960 to 1962 I served as a psychiatrist at the primary U.S. Army hospital in Frankfurt-am-Main, Germany. When I left the service at age 31, I learned that under the "doctor draft," the program under which I was serving, my military obligation would last until age 52! There was no imminent danger of my being drafted again. I was merely being put on notice that people who were deferred for medical training had that obligation. I was reassured, again, that because I had already served I would be very low priority for reinduction. Yet thoughts of receiving that letter from the draft board would occasionally enter my mind, perhaps once a month or so. Again, I was not plagued by them, nor have I ever been.
Most people do not dance with glee when reaching the age of 52. To me, obviously, it was a special event in that now the Army could no longer "get me." The fantasy then turned to one like this: The postman comes and gives me this special delivery certified letter. I open it up. It’s from the draft board, informing me that I have been drafted. "Ha, ha! I have already served," say I as I wave my honorable discharge papers under the nose of some guy in the draft board. "You can’t have me now! Besides, I’m over 52. Here’s my birth certificate to prove it!" As I write this, I am 64. Yet, I still have occasional thoughts of receiving that letter from the draft board. Although I know intellectually that they are not drafting 64-year-old men (in fact, they are not drafting anyone at this point), I still have occasional thoughts of that letter coming.
Obviously, such thoughts serve no useful purpose. I believe that this experience—spanning a half-century—demonstrates well the EBCP. Furthermore, my very writing now about this occasional fantasy embeds the material even more deeply into my brain circuitry. The idea that talking (or writing) about it gets it out of my system is not valid for this phenomenon. In fact, it may not be valid for any phenomenon. Rather, talking about it does just the opposite, namely, it embeds it even more deeply into the brain circuitry. One could argue that psychodynamic factors are operative in my periodic recollections, factors that are fueling their perpetuation. I cannot deny this, especially because it is impossible to disprove entirely any speculation regarding psychodynamic processes. It is also not possible to prove them valid. For myself, with regard to these recollections, I do not believe that psychodynamic factors are playing an important role, if any role at all. I believe that the EBCP explanation is the more likely one.
Another example: About 25 years ago, while writing one of my earlier articles, I asked an editor about the proper placement of commas before and after "e.g." She told me that the preferred procedure, in most situations, is to put commas on either side. For some strange reason, when writing or dictating an e.g., I automatically think of her telling me to put commas on either side. I really do not need that extra thought. It serves no useful purpose. I got her message and utilized it. One could argue that this too has some psychological meaning, perhaps that I was interested in her, for purposes far beyond learning the placement of commas, and that recalling her in association with the comma instructions also provides me with a mental image of her. Well, she was 25 years older than I. One could argue then that she was a mother figure for me. I cannot deny any of these explanations. And even if one or both of these psychodynamic explanations are operative, I do not believe that they provide for the full explanation as to why I have hooked her in with my recollection of the punctuation principle. Of course, the learning-by-association principle is operative here, but also, I believe, is the EBCP.
Traumatic experiences are very likely to result in the EBCP. Take divorce as an example. A couple is married X number of years and has Y number of children. They then go through a very painful child-custody dispute, which lasts three years. Their funds are depleted and they both end up "basket cases," both the "winner" and the "loser." Five years later both are remarried, allegedly happily. They each have new spouses with whom they have good relationships, nothing like the old ones. Yet, unwelcome and painful thoughts related to their earlier divorce experiences still spin around in their brains. I do not believe that any amount of psychotherapy is going to reduce such recollections. In fact, such therapy might even increase the frequency of such thoughts because of the inevitable muckraking that is involved in the therapeutic process. Moreover, the "deeper," more prolonged, and more extensive the psychotherapy, the greater the likelihood these recollections will increase in frequency. I do not deny the potential benefits of such treatment; I focus here only on its inevitable untoward effects.
The EBCP is probably the best explanation for the universal observation that we learn best from our own experiences, especially painful ones. The wise men of the ages have passed down to us advice derived from their experiences. Their hope is that their descendents will learn from their mistakes and avail themselves of the wisdom they derived from their own experiences, often painful. The great works of philosophy and literature, especially the Bible, are testament to this legacy. Yet, most of us learn little from these sages. Rather, we learn most from the experiences that we have had, especially those that were painful. I am not saying that we do not repeat our mistakes; I am only saying that we are less likely to repeat them if we have suffered pain in association with them. An experience associated with high levels of emotion is more likely to become deeply embedded in the brain circuitry. In addition to the higher embedding potential of an emotionally charged experience is the fact that a highly emotional experience is likely to be repeated more than one that is more neutral or that is free of emotions, and this too increases the likelihood that it will become entrenched into the psychic structure.
The analogy with the formation of a river may be applicable here. A river may begin as a small, narrow stream of water, perhaps only a few feet wide. As this little stream flows, it pulls earth, pebbles, and small rocks along with it and gradually forms a crevice. As this deepens and widens, a stream gradually develops. As the stream progressively deepens and widens, it may ultimately warrant the term rivulet, then river. Other streams may enter into it, causing ever more widening and deepening. The same phenomenon, I believe, takes place in the brain—but, obviously, at far more complex levels.
THE POSTTRAUMATIC STRESS DISORDER
The Posttraumatic Stress Disorder (PTSD) provides an excellent example of the EBCP. In order to justify the diagnosis, according to DSM-IV:
A. The person has been exposed to a traumatic event in which both of the following were present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person’s response involved intense fear, helplessness, or horror.
In order to make the diagnosis, a multiplicity of symptoms must be present for at least one month and cause significant clinical distress or impairment. Some of the symptoms commonly seen are:
Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions . . . recurrent distressing dreams of the event . . . acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes . . . intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event . . . physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event . . . efforts to avoid thoughts, feelings, or conversations associated with the trauma . . . hypervigilance . . . exaggerated startle response.
The PTSD may be the only disorder in DSM-IV in which the symptoms may play a role in the therapeutic process. The trauma has resulted in a flooding of stimuli into the brain circuitry. One could argue that their remaining there serves important purposes. One would be to desensitize the person to the psychologically traumatic effects of the trauma. It is as if each time the person reexperiences the event, it becomes a little more tolerable. It is reasonable to view the PTSD, then, as nature’s form of systematic desensitization. Furthermore, one could argue that PTSD symptoms may be useful for introducing coping mechanisms (especially fight or flight) that could be useful for helping the patient avoid recurrence of the same traumatic experience. When a trauma is so severe that a PTSD develops, the flooding of stimuli into the brain is so rapid that ECBP occurs very quickly. Furthermore, it is highly likely that the processes of systematic desensitization and EBCP, although therapeutic, also lessen the likelihood that the individual will be able to forget the traumatic experience. At the same time that the patient is deriving the benefits of the desensitization process, he (she) is entrenching the mental material ever more deeply into the brain circuitry via the EBCP. The benefits of the EBCP are that the individual is less likely to forget the coping mechanisms (fight or flight) that might be useful for preventing a recurrence. But there is a price to be paid for this deepening of memory, namely, the inability to forget. The more one remembers, the less capacity to forget. The more one desensitizes, the more EBCP, and the less capacity to forget about the experience. An analogy can be made here to taking a potent drug with a powerful, untoward side effect. It appears to be the psychological price that the patient pays for the curative process. There are implications here for the therapeutic process, especially a therapeutic process that encourages the person to think about the trauma.
Most people who suffer with PTSD have fairly clear memories of the major events associated with their trauma. There are some individuals, however, who dissociate the trauma, and this is especially likely to occur when the trauma is very severe, e.g., military combat, earthquakes, tornadoes, floods, rape, and attempted murder. There is a massive flooding of stimuli into the brain circuitry. The unity of consciousness is disrupted. There is a disintegration of consciousness and certain segments of the personality may operate autonomously. Continuity and consistency of thoughts are disconnected from one another. Identity confusion and identity alteration may occur. There is a loss of sense of the passage of time. The person may experience perceptual distortions, illusions, or feelings that the surrounding world is strange or unreal (derealization). Sometimes there is complete amnesia for the event (psychogenic amnesia) or the individual enters into an altered state of consciousness in the context of which complex behaviors are exhibited that are subsequently unknown to the patient (psychogenic fugue). The phenomenon may be associated with psychic numbing, which also serves to protect the individual from full appreciation of the trauma. (The reader interested in a more detailed description of the dissociative phenomena does well to refer to Steinberg’s contribution ). Dissociation is well compared to the overloaded computer that short circuits and stops functioning because it cannot deal with the massive amount of information being poured in.
In chronic abuse this pattern may become deeply entrenched to the point where the process becomes automatic: each time the person is abused, he (she) automatically dissociates and thereby protects himself (herself) from the pain of the experience. The result may be (in a small percentage of cases) no conscious recall of the traumatic events.
Such dissociative episodes may then occur in situations in which the person is reminded of the abuse by cues that are similar to those that existed at the time of the original abuse. It is as if the traumatic experience and its derivative dissociative states, not in conscious awareness, are very much embedded in the brain circuitry. Exposure to a similar situation triggers some dim and possibly unconscious recollection of these events, a recollection that may be associated with powerful emotional concomitants similar to those experienced at the time of the original trauma. Such triggers then produce the disorganization of thinking typical of dissociation. Under such circumstances, there are likely to be other manifestations of dissociation in which the person may be amnesic for certain time blocks during which events that transpired are totally obliterated from the person’s memory but have been clearly observed by others. This is not simply a matter of forgetting certain events, which all people do, but there is total obliteration of conscious memory of such events and confusion when confronted by observers of the individual’s involvement in such events.
Dissociation is very controversial at this point, even regarding whether or not it actually exists. This is especially the case with regard to the multiple personality disorder (more recently renamed in DSM-IV the dissociative identity disorder). I myself consider it quite rare, far less common than the PTSD (the far more likely reaction to trauma). Overzealous examiners often frivolously apply the concept of dissociation to even the most transient episodes of inattentiveness and "spacing out." This may be done in circumstances in which there was absolutely no evidence for bona fide dissociation at the time of the original alleged abuse. This is most commonly done by examiners who want to justify sexual abuse as the trauma when the patient does not have any conscious recollection of having been so traumatized. In the course of "therapy" for such dissociated traumas and residual effects, the patient cannot only be led to believe that she was sexually traumatized, but the belief becomes deeply embedded in the brain circuitry to the point where it becomes a fixed delusion (Gardner, 1992a, 1994a, 1995a).
Obsessive-Compulsive Disorder (OCD) provides another good example of the ECBP. Throughout most of this century, primarily under the influence of psychoanalytic teaching, OCD was generally considered to be a purely psychological disorder. More recently, the pendulum has shifted significantly toward the organic etiological explanation. This biological explanation has been given significant support by the findings that certain drugs such as Anafranil (clomipramine) and Prozac (fluoxetine) often bring about alleviation of OCD symptoms. However, when patients discontinue such medications, symptoms usually return.
Traditionally, patients with OCD suffer with obsessions (repeated thoughts) and compulsions (the repeated need to enact certain behaviors). Obsessive preoccupations are intrusive and inappropriate and cause marked tension or distress. Compulsive acts are often referred to as rituals and appear to be meaningless or serve no useful purpose; yet the individual is almost powerless to prevent himself (herself) from performing them. Although a particular individual may suffer more with obsessions or compulsions, generally there is a combination.
Typical obsessions are: repeated fear that food and dishes are contaminated with disease-engendering agents, obsessive desires to shout obscenities in public situations, and repeated and undesirable sexual imagery that is unacceptable to the individual. Common repetitive behaviors seen in the compulsions include: handwashing, putting things in specific order, repeated checking (lights on or off, TV on or off), and counting rituals (the goal of which is to prevent or reduce anxiety).
There may very well be a genetic loading or predisposition to the development of the OCD. However, I believe that the original OCD symptoms (which usually appear in childhood) generally served some psychological purpose. Then, after they have become deeply entrenched in the brain circuitry, they continue circulating there and may have "a life of their own" when they no longer serve any purpose. For example, the OCD symptoms may have originated in childhood as a mechanism for magically reducing guilt over hostility. Then, after this guilt-assuaging mechanism has been used for many months and years, it continues to spin around in the brain circuitry even though the person has matured enough to recognize that such magical ways of assuaging guilt are not really necessary. The person may have progressed to a more mature level with regard to comfort with socially unacceptable hostile thoughts and feelings, but may still be plagued by the earlier guilt-reducing mechanisms that "just don’t seem to go away." The OCD symptoms thereby become ego-alien, yet the person is helpless to put the thoughts out of his (her) mind or stop himself (herself) from acting out the OCD compulsions.
This explanation for the OCD is well demonstrated by Tom, age 45, who told me in his first interview that he suffered with OCD from the age of about seven or eight. I told Tom of my belief that although OCD might have a constitutional/biological basis, I still consider environmental factors to be contributory, especially at the time of the origin of the symptoms. Accordingly, because I could do nothing about the biological factors, the only help I could possibly provide him was to address ourselves to the environmental. I then explored with Tom what might have been the environmental factors that could have contributed to the development of his OCD. As a result of such inquiry, I learned that as long as Tom could remember, his mother was continually warning him not to upset his father and especially not to express anger toward him. She told Tom that if he did engage in such behavior, his father might die of a heart attack. Throughout the course of Tom’s childhood, his father was perfectly healthy and there was never any real medical reason for his mother’s concerns. Tom recalled, as early as age four, developing a ritual in which he would touch a table four times, with the belief that this procedure would protect his father from dying of a heart attack. In the course of my inquiry, Tom gained insight into the fact that this ritual served as a magical protection against the fulfillment of hostile wishes that he inwardly harbored toward his father. He came to appreciate that he was taught to feel very guilty about the normal hostility that all people feel in all relationships and that this ritual protected him from his fantasized consequences of anger expression.
Another one of Tom’s mother’s favorite themes was to say to Tom, "Don’t make me choose between you and your father, because I’ll always choose him." Tom had never asked his mother to make this choice; in fact, the notion never even entered his mind until the time his mother introduced it. In the course of our discussion, Tom came to appreciate that this message also engendered in him great hostility, which he felt guilty about expressing.
Two weeks after this interview, Tom claimed that he was enjoying a significant alleviation of his OCD and attributed it to the insights he had gained in his session. He complimented me on my expertise and thanked me profusely for the help I had provided him. I am not easily flattered by such professions of cure and have always been somewhat suspicious of them. This was especially the case because such preoccupations had been entrenched in Tom’s brain circuitry for almost forty years. I told Tom that I was pleased that our conversation had such good results, but that it was difficult for me to believe that after all these years his symptoms would completely evaporate. Furthermore, even if they had, there was no question that Tom’s anger-inhibition problem still persisted and was not simply confined to the OCD symptoms, but manifested itself in other areas. I told him, what was already obvious, that even though his mother was no longer alive, his father was old and senile, and the anger-inhibiting messages that his mother was communicating at that time should no longer be operative, yet, residua of that anger inhibition were still present in his life. I pointed out to him how this problem was causing difficulties in his relationships with his wife and son. This suggested strongly that his mother’s dictates were still floating around in his brain via the EBCP. Thus, my dubiety about his "cure."
As therapy progressed, it became increasingly clear that the primary cause was the EBCP situation that prevailed at that time. I advised him that until he was more comfortable expressing his resentment in other areas, it was likely that there would be an exacerbation of the OCD. And this is what came to pass. When there was a return of symptoms, I prescribed Prozac, which proved somewhat efficacious. We also worked on his anger-inhibition problem. It became increasingly clear to me that he was no longer the guilt-ridden person that he was at age five, but that his mother’s dictates were still entrenched in his mind via the EBCP. He became less beholden to them and could more easily ignore them. But therapy was not successful in obliterating these thoughts from his mind. He just felt less of a need to obey them. Prozac helped, I believe, because it interferes with the transmission in the brain circuitry of the unacceptable psychological material that manifests itself symptomologically as the OCD.
SEXUAL FANTASIES AND PROCLIVITIES
All of us have a repertoire of personal sexual fantasies and proclivities. Usually, these are the accumulated result of our earlier sexual experiences, some often dating back to early childhood. It may very well be that the variety of such preferred sexual fantasies and activities is so great that no two people are identical. The EBCP is very much operative here in that sexual experiences that are repeated and/or associated with very high emotional tone are more likely to be embedded in the brain circuitry. I am not addressing myself here to whether or not one puts the label of psychopathology on any of these sexual fantasies or activities; I am only addressing myself to the way the EBCP plays a role in determining one’s preferred sexual fantasies and activities.
One’s "First True Love"
The adolescent’s first romantic encounter serves well as a good example of the EBCP. Romantic, loving feelings can be extremely powerful. In many cases they can be an obsession and become the all-consuming preoccupation of the youngster (and even older people). When such feelings are associated with the first sexual experiences, especially the first orgastic experiences, the emotional impact can be profound. Under such circumstances, even a relatively short experience can become deeply embedded in the psychic structure. This first encounter is likely to become a model for all subsequent amorous encounters. Often, the loved person is idealized, and the obvious deficiencies of the individual are completely ignored. This idealized relationship then becomes the model for all subsequent relationships, sometimes with disastrous results throughout the course of the individual’s life. Whereas in adolescence the individual’s cognitive immaturity enables the person "in love" to harbor obvious distortions of reality, residua of this illogicality may blur reason throughout the course of one’s life. The individual seeks to find a substitute for the original loved one, a substitute that will bring about the same state of elation. This too may require a "willing suspension of disbelief." The delusional world so created may ultimately bring about an enormous amount of grief for both parties. (Of course, many other factors are operative in the romantic love phenomenon, and I have discussed these elsewhere [Gardner, 1991b,c]). Here I focus on the EBCP as an important element. It is a partial explanation for people who, throughout life, involve themselves in what are obviously improper and even destructive relationships in association with which they create delusions about each other that are in direct contradiction to what is the reality of the situation.
Less dramatically, EBCP plays an important role in the choice of one’s sexual partners. It is not surprising that most people tend to gravitate toward partners from their own ethnic background. This, in part, relates to the fact that one’s first love relationship is with one’s parents, who then become the models for their substitutes, the subsequent lovers in one’s life. If a boy has a good relationship with his mother, she will become the model for the girls he will gravitate toward, his adolescent professions of rejection and even scorn of his mother notwithstanding. And the same principle holds for girls with regard to their relationships with their fathers and his subsequent substitutes. What I am saying here has absolutely nothing to do with the existence (or lack of existence) of the Oedipus complex. I am addressing myself here only to the EBCP as an important determinant of these choices. It determines the qualities that one is going to be attracted to because these are qualities that were associated with high emotional charge in early childhood and were frequently introduced into the brain circuitry via the fact that the parenting figures are the main ones the child encounters in the early years of life. The principle is epitomized by the old song, "I Want a Girl Just Like the Girl Who Married Dear Old Dad." (Referring to this phenomenon as "oedipal" does not, I believe, provide additional information—especially if one studiously separates fact from fantasy.)
Although homosexuality may certainly have a genetic/biological substratum, environmental factors may also be operative in bringing about this sexual orientation. I focus here on the EBCP as a factor operative in the development of homosexuality of some individuals.
Fred, a 12-year-old boy, was, by all known criteria, moving down the heterosexual track. He had already expressed some interest in girls and had already had heterosexual fantasies. Fred’s life pattern, then, had been typically heterosexual. He had engaged in the rough-and-tumble play in earlier years, play that is one of the most important predictors of whether a youngster is going to go down the heterosexual or homosexual track (Green, 1985, 1987). Fred’s involvements in competitive sports was typically age-appropriate and heterosexual, and he had good heterosexual models in his father, teachers, and male relatives. At age 12, before he had ever experienced an orgasm, Fred was sexually seduced by a homosexual male. However, the seduction was not an isolated rape; rather, it was the culmination of an ongoing seductive (often referred to as "grooming") process by a scoutmaster. During the two years prior to the seduction, Fred had deeply admired this man, who had been his confidant and had bestowed upon him continual praise and admiration. In the course of the sexual encounters, Fred not only experienced his first orgasms but was provided with "love" and "affection" at such a high rate of intensity that, from Fred’s point of view, he had never experienced pleasures compared to those that he enjoyed with his scoutmaster. Fred became obsessed with this man, who in turn was obsessed with him. The man became his "first love" and Fred believed at that time that this experience was not only the greatest he had ever had, but that nothing in the future would ever be able to compare with it. After six months, the man lost interest, rejected the boy, and then moved on to another "lover." The boy continued to move along the homosexual track and, as an adult, continued to believe that had he not had this experience at age 12, he probably would have become heterosexual.
Some, but certainly not all, boys who have this experience shift from the heterosexual to the homosexual track. This is especially the case in situations in which the pursuit of heterosexual partners frequently results in rejection, the most common outcome in early adolescence. Homosexual overtures, however, are far less likely to be spurned, especially when young boys are involved. This kind of an experience, not uncommon among men who ultimately become homosexual, can be explained readily by the EBCP. I am not denying a possible (and even probable) genetic/biological predisposition for many homosexuals. I am only describing here another route to that pattern, a route for which the basic genetic substratum may very well have been heterosexual, but the EBCP superimposed itself onto that foundation and brought about a pattern of homosexual orientation.
Pedophilia may very well have a genetic substratum, but I believe also that environmental factors are likely to play a role in whether an individual will select pedophilia as the primary mode of sexual orientation. Here I focus on the EBCP as a factor that may be operative in bringing about pedophilia.
I once interviewed a 42-year-old man, Glen, who told me that he was a pedophile and that he has always been a pedophile. He said that he had never acted out on his pedophilic impulses because of his fear of disclosure, social stigmatization, and even imprisonment. Glen had never married and he gratified his pedophilic impulses by masturbation, especially in association with child pornographic materials. I asked him the traditional question I ask all patients who have atypical sexual orientations, namely, what their theory is regarding how they got that way. Glen believed that his sexual orientation would have been typically heterosexual if not for a certain experience he had when he was five years old. He and two girls his age were in the woods behind his house playing the exploratory game, "You Show Me Yours and I’ll Show You Mine." However, it had not reached the point of genital exposure; rather, the two girls pulled up their dresses and showed him their panties. And he pulled down his pants and showed them his underpants. In the course of the third such encounter, the children were discovered by Glen’s mother, a strongly religious woman who immediately broke out into a tirade of rage against all three children and then sent the two little girls home. She called the girls’ mothers, informed them of what had occurred, and all mothers agreed to place upon the children stringent restrictions. During the next few weeks, Glen’s mother was obsessed with what she had seen. Her rage outbursts to Glen were ongoing and often lasted an hour or two. She constantly invoked religious proscriptions against such behavior, exhorted Glen on how sinful he and the other children had been, and repeatedly made him promise that he would never do such a terrible thing again. Glen said to me, "Her shit-fits lasted at least three weeks and she never let up."
During the ensuing years, with a certain amount of fascination, he intermittently thought about his experiences with the two girls. At the age of 14 he first experienced very strong sexual urges and began to masturbate. However, when he compared notes with his friends, he found that he was not particularly interested in utilizing pinup magazines in that he did not find himself particularly attracted to adult women, especially those who were fully developed. And this was true also with regard to girls in his class, who he also came to learn were common sources of masturbatory stimuli for his boyfriends. Rather, he found himself on occasion thinking sensuously about those girls who were less well developed physically. His most stimulating masturbatory fantasy, however, was the two little girls in their panties, with whom he had his first "sexual" encounter at age five. Although when masturbating he tried strongly to think about the pinup girls in the magazines and the girls in his class, it just "didn’t work" for him. At 15 he tried dating a few classmates in the hope that he might overcome his problem. Again, this just "didn’t work," even though he chose the youngest looking and the least well developed girls. Finally, by 16, he gave up entirely the attempt to become a normal heterosexual boy and resigned himself to the fact that he was a pedophile, even though he did not use that term at the time.
I believe that the most likely explanation for Glen’s pedophilia relates to the EBCP. Had his mother responded in the more common and healthier way, he might not have developed along the pedophilic track. One might even say that he might not have been fixated at the pedophilic level. Had his mother, with compassion, understanding, and benevolence, told the children that this behavior was not acceptable and that when they were older, they would be freer to engage themselves in such behavior, he might not have become a pedophile. I believe it was the mother’s three weeks of "shit-fits" that was the primary (if not exclusive) determinant of Glen’s pedophilia. The mother "never let up" and, in the course of her harangues, deeply entrenched into her son’s brain circuitry the fantasies and thoughts of the sexual encounters with the girls. Each time she screamed at him, he could not but think about these encounters. As mentioned, high emotional tone is an important determinant as to whether psychic material is embedded into the brain circuitry, and such high emotional tone is more likely to be associated with trauma. The trauma in this case was Glen’s mother. She converted a normal childhood encounter into a sexual trauma. If she had just mildly reprimanded Glen and then exercised reasonable precautions, the imagery might not have been entrenched so deeply, if at all, into his brain circuitry. The powerful emotions that then became associated with these encounters, emotions that the mother engendered, played a role in the entrenchment process. In addition, her harangues repeatedly brought the imagery of these encounters into mental awareness and, by extension, embedded them more deeply into Glen’s brain circuitry. I often thought it would be of interest to find out how many pedophiles had experiences of this kind in early childhood in that it might be a possible explanation for some with this orientation.
Residua of Childhood Sexual Experiences in Adult Sexual Life
Women who have been sexually abused in childhood will sometimes incorporate (consciously or unconsciously) residua of their early sexual experiences into their adult sexual fantasies and activities. Sometimes these are unwanted elements, but they persist nevertheless. For example, a woman who stared at a design on the wallpaper to distract herself from her childhood sexual encounters with her stepfather may find that she needs such stimuli in order to become sexually aroused. One man once told me that while he was dating his wife, she told him that she had been sexually abused by her father during childhood. Specifically, from age 7 through 11, he had come into her room at night for sexual encounters. In the early years, there was fondling and masturbation. But starting at age 9, she was having sexual intercourse with him.
Subsequently, when my patient and his fiancée became more intimate, she somewhat apologetically asked him if he would enact a particular ritual as part of their foreplay. Specifically, she asked him to enter the bedroom from the hall and, while approaching the bed, to first take off his pajama bottoms and then his pajama top. All this was to be done while walking toward the bed. Then, while she was lying on her left side, she wanted him to lie behind her on his left side as well. She somewhat ashamedly told him that this was exactly what her father did prior to having sex with her and that she needed a lover to perform this particular ritual if she was to become sexually aroused. She wished that she did not need these preliminary steps, but hoped that he would understand. I do not believe that this is an isolated example. Just as desired early sexual activities become incorporated into brain circuitry, so do the undesired. Both may be associated with strong emotions, thereby increasing the likelihood of embedment in the brain circuitry. Both are likely to be thought about frequently, thereby also increasing the likelihood of embedment in the brain circuitry. Although intellectually undesired, such residua may become necessary for sexual arousal. This need for adult reenactment of a childhood sexual trauma provides an excellent example of the EBCP.
Carl, at the age of 14, was seduced into believing that anal intercourse with his minister was an important prelude to his subsequent sexual encounters with girls and that these experiences would make him more successful in such pursuits. He engaged in these homosexual activities over an 18-month period, at the end of which time the minister was jailed. In the years following, visual images of his sexual experiences with his abuser intruded themselves into his traditionally heterosexual masturbatory fantasies—in spite of his attempts to exclude them. We see here an excellent example of the EBCP. The sexual experiences were associated with a high level of emotion and became repeatedly embedded in Carl’s brain circuitry, so much so that he could not exclude them from his masturbatory fantasies, in spite of his very strong desire that they would "just evaporate."
At 18, while having sexual intercourse with his first girlfriend, she asked him not to thrust so vigorously because he was causing her pain. In spite of his intellectual recognition that her request was reasonable, he felt compelled to thrust even more vigorously, causing her severe pain and bleeding. Afterward, he realized that her comments were identical to those he himself had made to his minister when he was being anally penetrated. Specifically, when he told his minister that the anal penetration was hurting him, the minister ignored him and merely continued thrusting. We see here not only an excellent example of the way in which residua of earlier sexual experiences become incorporated into future sexual fantasies and activities, but also the identification-with-the-aggressor phenomenon so often seen in those who have been sexually abused. The EBCP provides a viable explanation for such incorporation and identification.
Hindman (1991) describes this phenomenon of subsequent incorporation of the childhood experiences as a common sequela among those who have been severely traumatized in the course of their abuse. He states of these patients:
Sexual responsiveness during the sexual abuse scenarios did not seem to dissolve or discontinue in adulthood. What seems to be a tragic effect of the most severely traumatized patient is that because of their sexual responsiveness, many patients manifested signs of continual arousal toward either the perpetrator or to the kinds of activities taking place during the sexual abuse. It seems to be an especially traumatic combination for the horrors of abuse and sexual arousal to be remembered.
We see then that not only pleasant but unpleasant sexual experiences can be incorporated into the brain circuitry. Apparently, the cognitive element is not the most important determinant as to whether such material will be incorporated into the psychic structure; rather, it is the degree to which the cognitive material is associated with high emotional charge and the frequency with which the thoughts and feelings are repeated. High pleasure (such as was the situation for Fred, the 12-year-old boy who became homosexual) and intense pain (as it was for Carl, the 14-year-old boy abused by his minister) both have the potential for deep embedment in the brain circuitry.
False Sex-Abuse Accusers
The EBCP can also shed light on the experience some women have when they make an accusation of sex abuse when there is little if any evidence for such. The accusation may begin with a suspicion that may have absolutely no basis in reality. The suspicion exists only in the mind of the accuser, and there is no evidence that the child has been abused and no evidence that the accused party has pedophilic tendencies. The suspicion may have been planted in an era of sex-abuse hysteria, when such suspicions are widespread (Gardner, 1991a). Next, the mother brings the child to an "expert," who, with anatomical dolls and leading questions, elicits from the child some comments that are then considered confirmatory of sexual abuse. The expert, then, is required to report this "abuse" to the proper investigatory authorities, including a child protection service and often the police. Once "gangbusters" descend upon this child, there is a high likelihood that he (she) will spin off ever more elaborate descriptions of the alleged sexual abuses. In the course of all this, lawyers may then be brought in for civil and/or criminal lawsuits. Over the next few years (a not uncommon duration), the mother’s suspicion becomes a preoccupation, then a hysterical manifestation that spreads to others, and finally a delusion in which there is the fixed belief that the abuse occurred. The delusion here is supported by the overzealous experts and "validators" who convince the mother that her decision was valid. Most often, it is supported by a coterie of friends, relatives, and other "enablers." If she is in a group of mothers of abused children, the belief may be even more deeply entrenched.
An element operative in the development of this induced delusion is the ECBP. The more the notion of sex abuse spins around in the mother’s brain, the more deeply it becomes entrenched in the brain circuitry, and the more likely it is to become a fixed belief. The child too may develop the same delusion, especially after years of "therapy," the purpose of which is to encourage ongoing hostility toward the alleged perpetrator (hitting dolls, drawing pictures of him in jail, etc.) and extracting ever more details about the abuses. Ultimately, a folie-à-deux is produced in which both the mother and the child have developed a delusion that may persist throughout life, so powerful is the ECBP.
My experience has been that women who have gone down the track to developing such delusions are incurable in that by that point there is absolutely no insight into the process that has taken place. Their children, however, may be put into treatment. These children have also been abused by the promulgator as well as the therapist and legal health professionals who may have entrenched their delusion. In subsequent chapters I will focus on the importance of the therapist’s appreciating the EBCP when treating these children, those who have been sexually abused, and those who have been swept up in the sex-abuse hysteria of our times.
The therapeutic implications of the EBCP are formidable. If I am correct, then psychotherapeutic attempts to change the behaviors generated from EBCP material may be very difficult, if not impossible. Courts routinely order psychotherapy for sexual offenders, and there are those who present themselves as providing such treatment. I am basically dubious about the efficacy of treatment for sex offenders. The older the individual, the longer the particular pattern has been spinning around in the person’s brain and the less the likelihood of its being changed by a psychotherapeutic technique. Even aversive behavioral techniques are not likely to be efficacious in that they cannot introduce in a short time frame stimuli that are going to effectively compete with those that have been spinning around and entrenching themselves in the person’s brain circuitry for many years.
In mid-century, Kinsey was very critical of those psychotherapists (especially psychoanalysts) who claimed that they could "cure" homosexuality with psychodynamic and psychoanalytic techniques. The story goes (and I do not have this firsthand) that Kinsey informally spread the word that he would like to see one exclusively homosexual person who had been successfully converted to heterosexuality by psychotherapeutic techniques. For many years, no one stepped forward. The story goes that, while off on a lecture tour, the phone rang in his hotel room. The caller announced to Kinsey that he was the person whom Kinsey had been looking for, that he had been a homosexual and had been "cured" by psychodynamic psychoanalysis. The man was ready to come to Kinsey’s hotel and meet him there at the earliest possible mutual convenience. Right then was not too soon. Kinsey, so the story goes, told the man that before he came to the hotel, he would like to ask him one question. The man agreed and this was the alleged interchange:
Kinsey: What do you think about when you masturbate?
Caller: Well, I still think about men.
Kinsey: Don’t waste your time coming here. You’re not the person I’m looking for.
Increasingly, in recent years, child abuse by clergymen has been brought to the attention of the public. A common response on the part of the churches so accused is that these clergymen are going into "treatment." Some of them are in their 50s, 60s, and even older. Perhaps some of these spokespeople do indeed believe that these clergymen are going to be cured. Others, I suspect, know very well that this is generally impossible and that they are merely perpetrating a fraud upon the public. In either case, it is improper and even deceptive to promulgate the notion that treatment can change the sexual orientation of an adult. The chance of changing an adult homosexual to an adult heterosexual is the same as changing an adult heterosexual to an adult homosexual. And attempts to change a pedophile into a person whose sexual interests will be exclusively toward adults is also likely to prove futile.
The ECBP also has important relevance for the treatment of patients who have been traumatized. The therapy of such patients must be embarked upon cautiously, with full appreciation of the natural desensitization process. The therapist should not muckrake and dredge up recollections of the trauma in compliance with some therapeutic principle that to do so is salutary. This is especially the case if the therapist subscribes to the notion that it is first important to "get everything out before the `healing’ process can begin." Rather, the therapist should respect the normal desensitization process and its concomitant reduction in the frequency with which the individual thinks about the trauma. The muckraking process may do the individual more harm than good in that it can have the effect of more deeply entrenching thoughts about the trauma, thereby perpetuating the patient’s preoccupation with it. And this is what happens in "survivor groups" and those who may involve themselves in political-action groups related to their trauma. Whatever benefits they may derive from these activities, a heavy price is paid with regard to the more deepening entrenchment of the traumatic thoughts and feelings in the patient’s brain circuitry.
This point is well demonstrated by an old Laurel and Hardy movie. As I recall it, Oliver Hardy falls deeply in love with a young woman, a woman who has absolutely no interest in him and repeatedly spurns his overtures. The more he is rebuffed, the more deeply "in love" he falls and the more obsessed he is with this woman. Finally, the two decide to join the French Foreign Legion in an attempt to remove Oliver from this woman and thereby help him forget her. And so they join the Legion and go off to the North African desert. Soon thereafter Stan asks Oliver, "Well, did you forget her?" Immediately, Oliver angrily responds, "Stop asking me that. The more you ask me that, the harder it will be to forget her!" Predictably, Stan continues to ask Oliver whether he has forgotten her, and, more predictably, Oliver goes into zany fits of frustration and rage during which he beseeches Stan to stop asking this question and threatens terrible retaliations if he continues to do so. Therapists who work with PTSD patients and other disorders in which the EBCP is operative do well to keep this vignette in mind.Excerpted from Psychotherapy with Sex-Abuse Victims