CHAPTER 1
How We Remember: Experience Shapes Who We Are
INTRODUCTION
When we become a parent, we bring with us issues from our own past that influence the way we parent our children. Experiences that are not fully processed may create unresolved and leftover issues that influence how we react to our children. These issues can easily get triggered in the parent-child relationship. When this happens our responses toward our children often take the form of strong emotional reactions, impulsive behaviors, distortions in our perceptions, or sensations in our bodies. These intense states of mind impair our ability to think clearly and remain flexible and affect our interactions and relationships with our children. At these times, we’re not acting like the parent we want to be and are often left wondering why this role of parenting sometimes seems to “bring out the worst in us.” Issues that are rooted in our past impact our present reality and directly affect the way we experience and interact with our children even when we’re not aware of their origins.
To our role of parenting we bring our own emotional baggage, which can unpredictably interfere in our relationship with our children. Leftover issues or unresolved trauma and loss involve significant themes from the past that stem from repeated experiences early in life that were difficult and emotionally significant. These issues, especially if we have not reflected on them and integrated them into our self-understanding, can continue to affect us in the present. For example, if your mother often left the house without saying good-bye because she didn’t want to hear you cry, your sense of trust would be broken, especially at times of possible separation. You’d feel insecure and uncertain. After she’d leave without your awareness, you’d look for her and get upset at her absence. The situation would be made more stressful if the adult who was caring for you insisted that you not cry. Not only would you feel betrayed and distressed at the loss of your mother, but because no caring adult gave you comfort by listening to you, empathizing with your feelings, and giving you some sense of being connected and understood, there would be no way for you to process your emotional distress. If this were your history, after you became a parent yourself separation experiences might be an issue for you that could evoke a range of emotional responses. They might trigger your own sense of abandonment and make you feel uneasy about leaving your child. Such a discomfort would be perceived by your own child and create a sense of insecurity in him, increasing his distress, and then heightening further your own sense of discomfort in leaving him. In this manner, a cascade of emotions would be released in a chain reaction of responses that reflect your own early history. Of course, without reflection and your own self-understanding, this cascade of reactions would just be experienced in the here and now as “normal” aspects of the difficulty of separation. Self-understanding can pave the way to resolve these leftover issues.
Leftover issues often affect our parenting and cause us and our children needless frustration and conflict. Here’s an issue from Mary’s experience as both a mother and a child.
SHOPPING FOR SHOES
As a parent, I discovered various leftover issues from my own childhood that were affecting my relationship with my children and robbing us of what could have been enjoyable experiences. Shopping for shoes was one of them. I found that I dreaded seeing their tennis shoes wearing out because it meant that I would have to take my two sons to the shoe store. They loved getting new shoes and initially looked forward to this excursion with excitement, as most children do. This had the possibility to be a delightful outing, since choosing new shoes is something children usually like to do, but it never turned out that way.
My sons would choose the shoes they wanted, which I verbally encouraged them to do. Even though they were quite enthusiastic about their choice, I began to spoil the experience with my doubts about the color, the price, the size of the shoes, or whatever tangible aspect I could wrap my mind around. Their excitement about their choice began to fade and an accommodating attitude of “Whatever you want, Mom, is okay with me” took its place. I’d vacillate and reconsider the advantages of one pair of shoes over the other and after a great deal of hassle we’d leave the store with our purchases. We were all exhausted. The excitement of getting new shoes became buried in the unpleasant memories of the experience.
I didn’t want to act the way I did but repeated the experience many times, often apologizing to my children as we left the store. I always ended up in emotional conflict. “Over shoes,” I’d reprimand myself. “How ridiculous.” Why did I keep repeating a pattern that I clearly wanted to change?
One day, after another disappointing shopping trip, my six-year-old son, obviously feeling deflated, asked, “Didn’t you like to get new shoes as a kid?” An overwhelming “No” flooded through my body as I remembered the frustration-filled days of my own childhood shoe-shopping outings.
I was one of nine children. With so many shoes to buy, my mother always went when there was a sale, preferably a big one, and the stores were crowded with shoppers and the prices were to her liking. I never went shopping alone with my mother, since there were always three or four of us who were in need of shoes at the same time. So at a crowded sale, with mixed emotions I’d seek my next pair of shoes. I knew that I was unlikely to get what I wanted. I was unlucky enough to have a perfectly average-sized foot, for which the pickings were always very slim by sale time. My choices were minimal and I usually fell in love with something new that wasn’t on sale. This choice was sure to be nixed by my mother.
Then there was my older sister, who had a very “special” narrow foot and was always allowed to purchase whatever she wanted because her size was seldom on sale anyway. I felt angry and neglected but I was told to be grateful that I was easy to fit. By the time my mother had fitted all of us, she was extremely exhausted and very irritated. Her indecision about making choices, as well as her anxiety about spending money, became full blown and I worried about her behavior. I was lost in a sea of emotions and just wanted to go home and avoid the whole shopping scene. What could have been an adventure in choosing something of my very own was spoiled.
Here I was, years later, with a mental model of shoe shopping that was bringing to my own children the same anxiety I had felt as a child. My mother was too busy getting all of us, along with our purchases, to the car to listen to or even notice my distress at the shoe shop. Because it was brought to my conscious attention by my son’s question, I was able to recall my own early experiences and anxiety, which were now affecting my behavior with my children and keeping me from making this an enjoyable experience. It wasn’t the shoe-shopping experience I was having in the present but the many that I’d had in the past that were influencing my behavior. I was responding to leftover issues.
Unresolved issues are similar to leftover issues, but they are more extreme, involving a more disorganizing influence on both our internal lives and our interpersonal relationships. Experiences that were profoundly overwhelming and may have involved a deep sense of helplessness, despair, loss, terror, and perhaps betrayal are often at the root of unresolved conditions. As an example, we can again use the issue of separation, but this time under a more extreme circumstance. If a young child’s mother is hospitalized for an extended period of time for depression and the child is shuffled from one caregiver to another, the child will experience a deep sense of loss and despair. Separation may continue to create anxiety and affect the child’s ability to have a healthy separation from her own child later in life. As a parent she may also have difficulty connecting to her child, since her own attachment was broken abruptly and she received no support. When the child becomes a parent without the opportunity to process these events and make sense of these frightening early experiences, emotional, behavioral, perceptual, and bodily memories may continue to intrude on her life. These unresolved issues can profoundly impair the parent-child relationship.
As parents we are especially vulnerable to responding on the basis of our past issues during times of stress. Here is a story of an unresolved issue that Dan became aware of shortly after he became a father.
STOP THE CRYING!
I used to feel a strange sensation when my son was an infant and he would be inconsolable in his crying. I was surprised at the panic that would come over me as I became filled with a sense of dread and terror. Instead of being a calm center of patience and insight, I became fearful and impatient.
I tried to look within myself to understand these sensations. I thought about the possibility that I might have been allowed to cry for long periods in my own infancy. I couldn’t recall this directly, but knew that the normal process of early childhood amnesia would prevent me from having a consciously accessible autobiographical recollection of such an early experience. I couldn’t come up with any other plausible interpretation for this panic.
I tried it on as a narrative: “Yes, I must have been terrified of my own crying as a child. I must have had to adapt to the feeling that I was being abandoned. When my son cries now, it reactivates my emotions of fear and I experience the associated panic.” I thought about it long and hard. I had no feelings about the accuracy of the story. No images. No sensations. No emotions. No behavioral impulses. In other words, this narrative elicited no nonverbal memories. The explanation also did absolutely nothing to change the panic. I felt that this did not mean that it was necessarily untrue—just that it was not helpful at that point in my journey to understand.
I was with my infant son one day when he began to cry. I felt helpless to console him and I began to have that strange panicky feeling of needing to flee. Then an image came to my mind first as a sensation of fullness in my head. The panic began to feel centered, less widespread. Then I began to see something internally which competed with what I was seeing externally. I say internal and external now, but then they felt similar: like seeing videotape with a double exposure. I closed my eyes. The external view disappeared and the internal one became clear.
I saw a child on an examining table, screaming, with a look of terror on his scrunched-up reddened face. My pediatrics internship partner was holding down his body. I had to not hear the child’s screams. I had to not see his face. I could see the room. It was the treatment room of the pediatrics ward of the hospital where we had to take the kids who needed their blood drawn. It was the middle of the night and we were on call and had been awakened to figure out why this little boy had a fever. He was burning up and we had to draw his blood to rule out an infection.
The kids at the UCLA Medical Center, as in any teaching hospital, were very ill. Many of them were veterans of hospital life, but that didn’t lessen their fear—the frequent blood draws just perpetuated it, and in the process destroyed their veins. My partner and I had to draw blood every night that we were on call. Now it was my turn to draw.
When a child’s arm veins are so scarred that you can’t draw blood from them, you have to find another vein. Sometimes it took many tries at different locations. We would trade off between who was holding the syringe and who was holding the child. We had to shut off our ears, and harden our hearts. We had to look away from the fear on the child’s face, not feel the tears rolling down over our hands, and not hear the cries echoing in our ears.
But now I could hear the screams. No blood came. I had to find another site. “Just one more time,” I’d tell the child, who couldn’t hear me or if he could hear, he couldn’t understand. He was feverish and sick, frightened, thrashing, screaming and inconsolable.
I opened my eyes. I was sweating. My hands were trembling. My six-month-old son was still crying. And so was I.
I was shocked by the flashback. I hadn’t thought much of that pediatrics internship years ago except that it was a “good year,” and I was glad when it was over. Over the days that followed the flashback, I thought a lot about those images. I spoke with a few close friends and colleagues about my experience. When I would begin to talk about the on-call nights, I’d feel a queasy sensation in my stomach. My hands would ache and I’d feel as if I was getting the flu. As the images came out, I would feel desperate and frightened and flooded with the scene of those young kids. I would sink into the memory: “I can’t look at the child, I have to get the blood sample.” I’d try to avert my gaze, in both the memory and in talking with my friends. I felt ashamed and guilty for inflicting pain. I remembered having a sensation of panic I’d have to squelch when the beeper went off at night. There was no time to talk about how much pain these children were in or how frightened of us they were. There were no opportunities to reflect on how overwhelmed and scared we were. We had to keep on going; pausing to reflect would have made it too painful to continue.
Why didn’t this “trauma” from years earlier surface as a flashback, emotion, behavior, or sensation before the birth of my son? This question raises issues about memory retrieval and the unique configuration of unresolved traumatic memory. Several factors make the retrieval of a certain memory more likely. These include the associations linked to the memory, the theme or gist of the experience, the phase of life of the person who is remembering, and the interpersonal context and the individual’s state of mind at the time of encoding and at recall.
I am the youngest in my family and I had no young children in my life before the birth of my son, and therefore I was never in the presence of an inconsolably crying child after my pediatrics internship. Once I found myself with a persistently crying child, I began to have an emotional response of panic. The panic can be seen as a nonverbal emotional memory activated by the context of being with a crying child. Once the panic came, my mind’s recollection process initially searched for an autobiographical memory and found nothing. At the time, there was no thematic narrative memory in which the pediatrics year could have been woven. The year was “fun and over” and I did not consciously reflect on it. Then the flashback occurred.
There is often a reason why traumatic experiences are not processed in a way that makes them readily available for later retrieval. During the trauma, an adaptation to survive can include the focusing of attention away from the horrifying aspects of an experience. Also, it may be that excessive stress and hormonal secretion during a trauma directly impair the functioning of parts of the brain necessary for autobiographical memories to be stored. After the trauma, recollection of those details encoded in only nonverbal form will likely evoke distressful emotions that can be deeply disturbing.
My empathic connection with the children’s terror in the hospital was overwhelming. The year was so intense, the work so demanding, the number of patients so high, the turnover so quick, and the illnesses so severe that my coping skills were put on high alert. I had distressing feelings of shame and guilt about having been the source of the children’s pain and fear. Once my internship was done, I suppose I could have said, “Okay, let me now try to remember all the pain I had to cause those very sick children.” Instead, I didn’t reflect on that year of pediatrics and I moved on to study trauma.
As interns we attempted to avoid the overwhelming awareness of the patients’ passive, helpless, and vulnerable experience by identifying ourselves only as active, empowered, and invulnerable medical workers. The child’s vulnerability became a threat to our active but nonconscious effort to avoid our feelings of vulnerability and helplessness. In retrospect, the children’s vulnerability became the enemy. There was often little we could do to cure their devastating illnesses, and our inability to help them added to the overwhelming sense of sadness and despair that we felt.
We were fighting against disease, fighting the existential reality of death and despair during that relentless and sleepless year. Helplessness had to become the furthest thing from our conscious minds or we would have collapsed. Vulnerability became the target of our anger toward the villain of disease we could not conquer.
This unresolved issue presented itself to me as a vulnerable first-time parent, and I had intense and shameful emotional responses to my son’s crying and his vulnerability—almost finding it intolerable—and to my sense of helplessness to soothe him. Fortunately, through painful self-reflection, I was able to see this as an unresolved issue in myself and not as a deficit in my son. And this understanding allows me to easily imagine how having an emotional intolerance for helplessness can lead to parental behaviors that target that helplessness in children and attack them for it. Even with love and the best of intentions, we may be filled with old defenses that make our children’s experiences intolerable to us. This may be the origin of “parental ambivalence.” When their lives provoke the intolerable emotion in us, our inability to be aware of it consciously and to make sense of it in our own lives leaves us at risk of being unable to tolerate it in our children. This intolerance can take the form of becoming blind to or ignoring our children’s emotions, which gives them a sense of unreality and disconnects them from their own feelings. Or our intolerance may lead to a more assertive act such as irritability or an outright though not consciously intended attack on the child’s emotional state of vulnerability and helplessness. Then, the unsuspecting child becomes the recipient of hostile responses that become woven into his internal sense of identity and directly impair his ability to tolerate those very same emotions in himself.
If we have leftover or unresolved issues, it is crucial that we take the time to pause and reflect on our emotional responses to our children. By understanding ourselves we give our children the chance to develop their own sense of vitality and the freedom to experience their own emotional worlds without restrictions and fear.
FORMS OF MEMORY
Why do we have unresolved and leftover issues? Why do events from the past influence the present? How does experience actually have an impact on our minds? Why do past events continue to influence our present perceptions and shape how we construct the future?
The study of memory provides exciting answers to these fundamental questions. From the beginning of life, our brains are able to respond to experience by altering the connections among neurons, the basic building blocks of the brain. These connections constitute the structure of the brain, and are believed to be a powerful way in which the brain comes to remember experience. Brain structure shapes brain function. In turn, brain function creates the mind. Although genetic information also determines fundamental aspects of brain anatomy, our experiences are what create the unique connections and mold the basic structure of each individual’s brain. In this manner, our experiences directly shape the structure of the brain and thus create the mind that defines who we are.
Memory is the way the brain responds to experience and creates new brain connections. The two major ways connections are made are the two forms of memory: implicit and explicit. Implicit memory results in the creation of the particular circuits of the brain that are responsible for generating emotions, behavioral responses, perception, and probably the encoding of bodily sensations. Implicit memory is a form of early nonverbal memory that is present at birth and continues throughout the life span. Another important aspect of implicit memory is something called mental models. Through mental models our minds create generalizations of repeated experiences. For example, if a baby feels consoled and comforted when her mother responds to her distress, she will generalize the experience so that the presence of her mother gives her a sense of well-being and security. When distressed in the future, her mental model of her relationship with her mother will become activated and lead her to seek her out in order to be calmed. Our attachment relationships affect how we see others and how we see ourselves. Through repeated experiences with our attachment figures, our mind creates models that affect our view of both others and ourselves. In the example above, the child views her mother as safe and responsive and views herself as capable of impacting her environment and getting her needs met. These models create a filter that patterns the way we channel our perceptions and construct our responses to the world. Through these filtering models we develop characteristic ways of seeing and being.
The fascinating feature of implicit memory is that when it is retrieved it lacks an internal sensation that something is being “recalled” and the individual is not even aware that this internal experience is being generated from something from the past. Thus, emotions, behaviors, bodily sensations, perceptual interpretations, and the bias of particular nonconscious mental models may influence our present experience (both perception and behavior) without our having any realization that we are being shaped by the past. What is particularly amazing is that our brains can encode implicit memory without the route of conscious attention. This means that we can encode elements into implicit memory without ever needing to consciously attend to them.
After the first birthday the development of a part of the brain called the hippocampus establishes a new set of circuitry that makes possible the beginning of the second major form of memory, explicit memory. There are two components of explicit memory: semantic, or factual, memory, which becomes available at around a year and a half of age, and autobiographical memory, which begins to develop sometime after the second birthday. The period before autobiographical memory is available is called childhood amnesia and is a developmentally universal phenomenon occurring across cultures; it has nothing to do with trauma but instead appears to be dependent on the fact that maturation of particular structures in the brain has not commenced. In contrast to implicit memory, when explicit memory is recalled it does have the internal sensation of recollection. For both forms of explicit memory, conscious attention is required for the encoding process.
[. . . ]
CHAPTER 1
How We Remember: Experience Shapes Who We Are
INTRODUCTION
When we become a parent, we bring with us issues from our own past that influence the way we parent our children. Experiences that are not fully processed may create unresolved and leftover issues that influence how we react to our children. These issues can easily get triggered in the parent-child relationship. When this happens our responses toward our children often take the form of strong emotional reactions, impulsive behaviors, distortions in our perceptions, or sensations in our bodies. These intense states of mind impair our ability to think clearly and remain flexible and affect our interactions and relationships with our children. At these times, we’re not acting like the parent we want to be and are often left wondering why this role of parenting sometimes seems to “bring out the worst in us.” Issues that are rooted in our past impact our present reality and directly affect the way we experience and interact with our children even when we’re not aware of their origins.
To our role of parenting we bring our own emotional baggage, which can unpredictably interfere in our relationship with our children. Leftover issues or unresolved trauma and loss involve significant themes from the past that stem from repeated experiences early in life that were difficult and emotionally significant. These issues, especially if we have not reflected on them and integrated them into our self-understanding, can continue to affect us in the present. For example, if your mother often left the house without saying good-bye because she didn’t want to hear you cry, your sense of trust would be broken, especially at times of possible separation. You’d feel insecure and uncertain. After she’d leave without your awareness, you’d look for her and get upset at her absence. The situation would be made more stressful if the adult who was caring for you insisted that you not cry. Not only would you feel betrayed and distressed at the loss of your mother, but because no caring adult gave you comfort by listening to you, empathizing with your feelings, and giving you some sense of being connected and understood, there would be no way for you to process your emotional distress. If this were your history, after you became a parent yourself separation experiences might be an issue for you that could evoke a range of emotional responses. They might trigger your own sense of abandonment and make you feel uneasy about leaving your child. Such a discomfort would be perceived by your own child and create a sense of insecurity in him, increasing his distress, and then heightening further your own sense of discomfort in leaving him. In this manner, a cascade of emotions would be released in a chain reaction of responses that reflect your own early history. Of course, without reflection and your own self-understanding, this cascade of reactions would just be experienced in the here and now as “normal” aspects of the difficulty of separation. Self-understanding can pave the way to resolve these leftover issues.
Leftover issues often affect our parenting and cause us and our children needless frustration and conflict. Here’s an issue from Mary’s experience as both a mother and a child.
SHOPPING FOR SHOES
As a parent, I discovered various leftover issues from my own childhood that were affecting my relationship with my children and robbing us of what could have been enjoyable experiences. Shopping for shoes was one of them. I found that I dreaded seeing their tennis shoes wearing out because it meant that I would have to take my two sons to the shoe store. They loved getting new shoes and initially looked forward to this excursion with excitement, as most children do. This had the possibility to be a delightful outing, since choosing new shoes is something children usually like to do, but it never turned out that way.
My sons would choose the shoes they wanted, which I verbally encouraged them to do. Even though they were quite enthusiastic about their choice, I began to spoil the experience with my doubts about the color, the price, the size of the shoes, or whatever tangible aspect I could wrap my mind around. Their excitement about their choice began to fade and an accommodating attitude of “Whatever you want, Mom, is okay with me” took its place. I’d vacillate and reconsider the advantages of one pair of shoes over the other and after a great deal of hassle we’d leave the store with our purchases. We were all exhausted. The excitement of getting new shoes became buried in the unpleasant memories of the experience.
I didn’t want to act the way I did but repeated the experience many times, often apologizing to my children as we left the store. I always ended up in emotional conflict. “Over shoes,” I’d reprimand myself. “How ridiculous.” Why did I keep repeating a pattern that I clearly wanted to change?
One day, after another disappointing shopping trip, my six-year-old son, obviously feeling deflated, asked, “Didn’t you like to get new shoes as a kid?” An overwhelming “No” flooded through my body as I remembered the frustration-filled days of my own childhood shoe-shopping outings.
I was one of nine children. With so many shoes to buy, my mother always went when there was a sale, preferably a big one, and the stores were crowded with shoppers and the prices were to her liking. I never went shopping alone with my mother, since there were always three or four of us who were in need of shoes at the same time. So at a crowded sale, with mixed emotions I’d seek my next pair of shoes. I knew that I was unlikely to get what I wanted. I was unlucky enough to have a perfectly average-sized foot, for which the pickings were always very slim by sale time. My choices were minimal and I usually fell in love with something new that wasn’t on sale. This choice was sure to be nixed by my mother.
Then there was my older sister, who had a very “special” narrow foot and was always allowed to purchase whatever she wanted because her size was seldom on sale anyway. I felt angry and neglected but I was told to be grateful that I was easy to fit. By the time my mother had fitted all of us, she was extremely exhausted and very irritated. Her indecision about making choices, as well as her anxiety about spending money, became full blown and I worried about her behavior. I was lost in a sea of emotions and just wanted to go home and avoid the whole shopping scene. What could have been an adventure in choosing something of my very own was spoiled.
Here I was, years later, with a mental model of shoe shopping that was bringing to my own children the same anxiety I had felt as a child. My mother was too busy getting all of us, along with our purchases, to the car to listen to or even notice my distress at the shoe shop. Because it was brought to my conscious attention by my son’s question, I was able to recall my own early experiences and anxiety, which were now affecting my behavior with my children and keeping me from making this an enjoyable experience. It wasn’t the shoe-shopping experience I was having in the present but the many that I’d had in the past that were influencing my behavior. I was responding to leftover issues.
Unresolved issues are similar to leftover issues, but they are more extreme, involving a more disorganizing influence on both our internal lives and our interpersonal relationships. Experiences that were profoundly overwhelming and may have involved a deep sense of helplessness, despair, loss, terror, and perhaps betrayal are often at the root of unresolved conditions. As an example, we can again use the issue of separation, but this time under a more extreme circumstance. If a young child’s mother is hospitalized for an extended period of time for depression and the child is shuffled from one caregiver to another, the child will experience a deep sense of loss and despair. Separation may continue to create anxiety and affect the child’s ability to have a healthy separation from her own child later in life. As a parent she may also have difficulty connecting to her child, since her own attachment was broken abruptly and she received no support. When the child becomes a parent without the opportunity to process these events and make sense of these frightening early experiences, emotional, behavioral, perceptual, and bodily memories may continue to intrude on her life. These unresolved issues can profoundly impair the parent-child relationship.
As parents we are especially vulnerable to responding on the basis of our past issues during times of stress. Here is a story of an unresolved issue that Dan became aware of shortly after he became a father.
STOP THE CRYING!
I used to feel a strange sensation when my son was an infant and he would be inconsolable in his crying. I was surprised at the panic that would come over me as I became filled with a sense of dread and terror. Instead of being a calm center of patience and insight, I became fearful and impatient.
I tried to look within myself to understand these sensations. I thought about the possibility that I might have been allowed to cry for long periods in my own infancy. I couldn’t recall this directly, but knew that the normal process of early childhood amnesia would prevent me from having a consciously accessible autobiographical recollection of such an early experience. I couldn’t come up with any other plausible interpretation for this panic.
I tried it on as a narrative: “Yes, I must have been terrified of my own crying as a child. I must have had to adapt to the feeling that I was being abandoned. When my son cries now, it reactivates my emotions of fear and I experience the associated panic.” I thought about it long and hard. I had no feelings about the accuracy of the story. No images. No sensations. No emotions. No behavioral impulses. In other words, this narrative elicited no nonverbal memories. The explanation also did absolutely nothing to change the panic. I felt that this did not mean that it was necessarily untrue—just that it was not helpful at that point in my journey to understand.
I was with my infant son one day when he began to cry. I felt helpless to console him and I began to have that strange panicky feeling of needing to flee. Then an image came to my mind first as a sensation of fullness in my head. The panic began to feel centered, less widespread. Then I began to see something internally which competed with what I was seeing externally. I say internal and external now, but then they felt similar: like seeing videotape with a double exposure. I closed my eyes. The external view disappeared and the internal one became clear.
I saw a child on an examining table, screaming, with a look of terror on his scrunched-up reddened face. My pediatrics internship partner was holding down his body. I had to not hear the child’s screams. I had to not see his face. I could see the room. It was the treatment room of the pediatrics ward of the hospital where we had to take the kids who needed their blood drawn. It was the middle of the night and we were on call and had been awakened to figure out why this little boy had a fever. He was burning up and we had to draw his blood to rule out an infection.
The kids at the UCLA Medical Center, as in any teaching hospital, were very ill. Many of them were veterans of hospital life, but that didn’t lessen their fear—the frequent blood draws just perpetuated it, and in the process destroyed their veins. My partner and I had to draw blood every night that we were on call. Now it was my turn to draw.
When a child’s arm veins are so scarred that you can’t draw blood from them, you have to find another vein. Sometimes it took many tries at different locations. We would trade off between who was holding the syringe and who was holding the child. We had to shut off our ears, and harden our hearts. We had to look away from the fear on the child’s face, not feel the tears rolling down over our hands, and not hear the cries echoing in our ears.
But now I could hear the screams. No blood came. I had to find another site. “Just one more time,” I’d tell the child, who couldn’t hear me or if he could hear, he couldn’t understand. He was feverish and sick, frightened, thrashing, screaming and inconsolable.
I opened my eyes. I was sweating. My hands were trembling. My six-month-old son was still crying. And so was I.
I was shocked by the flashback. I hadn’t thought much of that pediatrics internship years ago except that it was a “good year,” and I was glad when it was over. Over the days that followed the flashback, I thought a lot about those images. I spoke with a few close friends and colleagues about my experience. When I would begin to talk about the on-call nights, I’d feel a queasy sensation in my stomach. My hands would ache and I’d feel as if I was getting the flu. As the images came out, I would feel desperate and frightened and flooded with the scene of those young kids. I would sink into the memory: “I can’t look at the child, I have to get the blood sample.” I’d try to avert my gaze, in both the memory and in talking with my friends. I felt ashamed and guilty for inflicting pain. I remembered having a sensation of panic I’d have to squelch when the beeper went off at night. There was no time to talk about how much pain these children were in or how frightened of us they were. There were no opportunities to reflect on how overwhelmed and scared we were. We had to keep on going; pausing to reflect would have made it too painful to continue.
Why didn’t this “trauma” from years earlier surface as a flashback, emotion, behavior, or sensation before the birth of my son? This question raises issues about memory retrieval and the unique configuration of unresolved traumatic memory. Several factors make the retrieval of a certain memory more likely. These include the associations linked to the memory, the theme or gist of the experience, the phase of life of the person who is remembering, and the interpersonal context and the individual’s state of mind at the time of encoding and at recall.
I am the youngest in my family and I had no young children in my life before the birth of my son, and therefore I was never in the presence of an inconsolably crying child after my pediatrics internship. Once I found myself with a persistently crying child, I began to have an emotional response of panic. The panic can be seen as a nonverbal emotional memory activated by the context of being with a crying child. Once the panic came, my mind’s recollection process initially searched for an autobiographical memory and found nothing. At the time, there was no thematic narrative memory in which the pediatrics year could have been woven. The year was “fun and over” and I did not consciously reflect on it. Then the flashback occurred.
There is often a reason why traumatic experiences are not processed in a way that makes them readily available for later retrieval. During the trauma, an adaptation to survive can include the focusing of attention away from the horrifying aspects of an experience. Also, it may be that excessive stress and hormonal secretion during a trauma directly impair the functioning of parts of the brain necessary for autobiographical memories to be stored. After the trauma, recollection of those details encoded in only nonverbal form will likely evoke distressful emotions that can be deeply disturbing.
My empathic connection with the children’s terror in the hospital was overwhelming. The year was so intense, the work so demanding, the number of patients so high, the turnover so quick, and the illnesses so severe that my coping skills were put on high alert. I had distressing feelings of shame and guilt about having been the source of the children’s pain and fear. Once my internship was done, I suppose I could have said, “Okay, let me now try to remember all the pain I had to cause those very sick children.” Instead, I didn’t reflect on that year of pediatrics and I moved on to study trauma.
As interns we attempted to avoid the overwhelming awareness of the patients’ passive, helpless, and vulnerable experience by identifying ourselves only as active, empowered, and invulnerable medical workers. The child’s vulnerability became a threat to our active but nonconscious effort to avoid our feelings of vulnerability and helplessness. In retrospect, the children’s vulnerability became the enemy. There was often little we could do to cure their devastating illnesses, and our inability to help them added to the overwhelming sense of sadness and despair that we felt.
We were fighting against disease, fighting the existential reality of death and despair during that relentless and sleepless year. Helplessness had to become the furthest thing from our conscious minds or we would have collapsed. Vulnerability became the target of our anger toward the villain of disease we could not conquer.
This unresolved issue presented itself to me as a vulnerable first-time parent, and I had intense and shameful emotional responses to my son’s crying and his vulnerability—almost finding it intolerable—and to my sense of helplessness to soothe him. Fortunately, through painful self-reflection, I was able to see this as an unresolved issue in myself and not as a deficit in my son. And this understanding allows me to easily imagine how having an emotional intolerance for helplessness can lead to parental behaviors that target that helplessness in children and attack them for it. Even with love and the best of intentions, we may be filled with old defenses that make our children’s experiences intolerable to us. This may be the origin of “parental ambivalence.” When their lives provoke the intolerable emotion in us, our inability to be aware of it consciously and to make sense of it in our own lives leaves us at risk of being unable to tolerate it in our children. This intolerance can take the form of becoming blind to or ignoring our children’s emotions, which gives them a sense of unreality and disconnects them from their own feelings. Or our intolerance may lead to a more assertive act such as irritability or an outright though not consciously intended attack on the child’s emotional state of vulnerability and helplessness. Then, the unsuspecting child becomes the recipient of hostile responses that become woven into his internal sense of identity and directly impair his ability to tolerate those very same emotions in himself.
If we have leftover or unresolved issues, it is crucial that we take the time to pause and reflect on our emotional responses to our children. By understanding ourselves we give our children the chance to develop their own sense of vitality and the freedom to experience their own emotional worlds without restrictions and fear.
FORMS OF MEMORY
Why do we have unresolved and leftover issues? Why do events from the past influence the present? How does experience actually have an impact on our minds? Why do past events continue to influence our present perceptions and shape how we construct the future?
The study of memory provides exciting answers to these fundamental questions. From the beginning of life, our brains are able to respond to experience by altering the connections among neurons, the basic building blocks of the brain. These connections constitute the structure of the brain, and are believed to be a powerful way in which the brain comes to remember experience. Brain structure shapes brain function. In turn, brain function creates the mind. Although genetic information also determines fundamental aspects of brain anatomy, our experiences are what create the unique connections and mold the basic structure of each individual’s brain. In this manner, our experiences directly shape the structure of the brain and thus create the mind that defines who we are.
Memory is the way the brain responds to experience and creates new brain connections. The two major ways connections are made are the two forms of memory: implicit and explicit. Implicit memory results in the creation of the particular circuits of the brain that are responsible for generating emotions, behavioral responses, perception, and probably the encoding of bodily sensations. Implicit memory is a form of early nonverbal memory that is present at birth and continues throughout the life span. Another important aspect of implicit memory is something called mental models. Through mental models our minds create generalizations of repeated experiences. For example, if a baby feels consoled and comforted when her mother responds to her distress, she will generalize the experience so that the presence of her mother gives her a sense of well-being and security. When distressed in the future, her mental model of her relationship with her mother will become activated and lead her to seek her out in order to be calmed. Our attachment relationships affect how we see others and how we see ourselves. Through repeated experiences with our attachment figures, our mind creates models that affect our view of both others and ourselves. In the example above, the child views her mother as safe and responsive and views herself as capable of impacting her environment and getting her needs met. These models create a filter that patterns the way we channel our perceptions and construct our responses to the world. Through these filtering models we develop characteristic ways of seeing and being.
The fascinating feature of implicit memory is that when it is retrieved it lacks an internal sensation that something is being “recalled” and the individual is not even aware that this internal experience is being generated from something from the past. Thus, emotions, behaviors, bodily sensations, perceptual interpretations, and the bias of particular nonconscious mental models may influence our present experience (both perception and behavior) without our having any realization that we are being shaped by the past. What is particularly amazing is that our brains can encode implicit memory without the route of conscious attention. This means that we can encode elements into implicit memory without ever needing to consciously attend to them.
After the first birthday the development of a part of the brain called the hippocampus establishes a new set of circuitry that makes possible the beginning of the second major form of memory, explicit memory. There are two components of explicit memory: semantic, or factual, memory, which becomes available at around a year and a half of age, and autobiographical memory, which begins to develop sometime after the second birthday. The period before autobiographical memory is available is called childhood amnesia and is a developmentally universal phenomenon occurring across cultures; it has nothing to do with trauma but instead appears to be dependent on the fact that maturation of particular structures in the brain has not commenced. In contrast to implicit memory, when explicit memory is recalled it does have the internal sensation of recollection. For both forms of explicit memory, conscious attention is required for the encoding process.
[. . . ]
