ASTSS/NCPTSD Annual Conference
March 2001, Canberra, Australia
We all have some idea about the right and left brains having different functions. The left brain deals with verbal logical matters, the right with emotional ones. But if we look in more detail at the different hemispheric functions, we realise as the eminent neurologist Rhawn Joseph said, we live simultaneously in two separate complex mental worlds. The right and left brains exist, literally side by side using unique strategies for perceiving, processing, and expressing information. Further, these separate mental worlds may know little about each other. This corresponds to the fact that even in young adults 40% of the corpus callosum is still unmyelinated.
We may be more willing to accept our mental split if we note a corresponding physical split. Our voluntary nervous system consciously directs our external muscles in the environment and is analogous to the left brain. The involuntary nervous system directs internal muscles and organs unconsciously, is associated with emotion and is analogous to the right brain. Just as we are unaware of our internal organs except when they are stressed or injured, we may not be aware of our right brains if all goes well.
The right brain is fully dominant until the age of three when the eviscerali child first starts to think. Communication between hemispheres is exceedingly poor before the age of 3, and limited till the age of 5. Verbal dominance of information and awareness is established only after 7.
At this age the left brain speech area can organise and categorise information into linguistic codes and narrative units within linear time.
Before that time including during the period of attachment as Schore has indicated, the right brain utilises the limbic system and the right orbitofrontal cortex. Both have close connections with the autonomic nervous system and visceral responses. The right brain reads faces, inflection, nuances, pitch, melody, empathises and intuits what persons feel about what they say, why and in what context. In time it provides gestalt, morals, motives, inferences and meanings. These develop silently throughout life. The right brain remains dominant in regard to most, if not all, aspects of social-emotional functioning. When it is disturbed a myriad of affective psychosomatic and behavioral disturbances may result. For instance, when an ambivalent mother says "I love you." a child's left brain hears the words while the right brain discerns hate. The two parts cannot be assimilated. Later on hearing "I love you." the adult may cringe without knowing why.
With increasing myelination we develop an ever more stereoscoping and coherent view of ourselves and our history. However, in traumatic dissociation a functional split recurs or intensifies between the hemispheres. The lack of self- awareness of the right brain is now used to protect the left brain and its linguistic consciousness from being overwhelmed. This is done by dissociation of traumatic information and storing it in nonverbal codes in the right brain. Joseph says, ".. our traumas [and] fears.. are mediated .. by the limbic system, [and] the non-linguistic, social-emotional right brain. And.. these experiences are stored in the memory banks of the right cerebrum."
I will now indicate how this translates clinically.
Beverley a 37 year old woman presented with symptoms of anxiety, depression, unexplained outbursts of anger and inability to enjoy life. She had a sense that these symptoms were connected with her father's abuse. She remembered clearly that at the age of 14 he had fondled her breasts. Her girlfriend remembered, but she did not, that when they were seven her father got them to hold his penis during urination. She was convinced that more happened with her father which was connected with her eternal terror of him. When speaking uninhibitedly she would say with respect to events at age 12 "When he raped me.." but when attention was drawn to what she had just said she would go blank and not remember what she had said a minute previously.
At other times she said, "I know that my father did more to me. Things intrude into my mind at nights or when I have sex. But when I try to think about it, a kind of voice (which she traced back to her father) says things like, "You can't prove it, you have no evidence." And "If you tell your mother she won't love you and she will leave you. The family will finish and you will be alone." Or, "You will kill me." My mind is in conflict every night. The knowing there is more [right side], the lack of evidence [left side]."
"To this day when I am in his presence, something happens to my mind, like I enter a trance, it is a different world, like a daytime and night time world, a logical and an illogical world." Saying this she alternately cupped the left and right sides of her head.
We traced derivative symptoms back to her father. They included her father exploiting her in his business and her protecting his secret bankruptcy, and excessive anger with males who imposed their opinions. Beverley felt that parts she always knew about somehow were revealed to her in a new way as she could put them into words. This allowed her to feel more whole and in control. Eventually her father's sexual abuse was similarly revealed and put into words. The safety of therapy neutralized her father's intimidatory voices to not reveal, to not know, to split her knowledge. Her symptoms disappeared.
Right and left brain functions and splits help with some clinical dilemmas.
1. Memories. The peculiarities of early childhood and traumatic memories relate to their right brain storage. They are unconscious, emotional, somatic and timeless because of their nonverbal code storage in the right brain.
2. Conscious and unconscious. Nature seems to have evolved a dual brain in order to provide two simultaneous types of information. Perhaps the right hemisphere is phylogenetically related to reading and surviving the environment and unselfconsciously singing back into it. It resonates with naturally occurring ratios and biorhythms and expresses itself in pleasing music and architecture. The left brain consciously peruses and objectifies what is of interest to the right brain.
In trauma the unconscious right brain is used to store the kernels of threat, and unacceptable judgements and meanings. It may inevitably connect with unconscious elements from early childhood when the right brain was dominant. This may be one reason why exploration of traumas leads eventually back to early childhood.
The benefit of splitting the two brains is to protect the phylogenetically new verbal civilized humans to go about their everyday business. The cost is feeling and doing things without knowing why, suffering psychic conflict, and being subject to blanks and manufactured explanations.
3. The fear of madness. When functioning well, the right brain is a source of inspirations, intuition, and creativity. When it strains to make meaning of the fearful and meaningless, it becomes the source of apparently illogical emotions, illusions, and delusions.
The fear of madness and loss of control stem from a sense of being overwhelmed by right brain traumatic images. Logical left brain function and the self which identifies with it are threatened.
4. Reading the right brain. The right brain has its own language, and like nature and music it can be read through the right codes. Psychoanalysis has taught that means to read the unconscious include tracing emotions, dreams, slips of the tongue, nonverbal behavior, patterns of activity, psychosomatic symptoms, and use of transference and countertransference empathy.
The deciphering of the structure and function of the right brain and bringing it into the mainstream of scientific consciousness is the next major task in psychotraumatology.
Elsewhere (Valent, 1998) I suggest that eight survival strategies (such as fight and flight and attachment) are the templates of surviving and singing back into the environment. Survival strategies are like an octave of physiological, emotional and behavioral notes producing a symphony of human aspirations and their disruptions.
5. Healing the right brain and its split from the left brain. Both psychoanalysis and traumatology attempt to make the dissociated contents of the right hemisphere congruent and acceptable to a meaningful view of oneself which becomes conscious to the left hemisphere. Words and labels are the tools which unify traumatic fragments in the right hemisphere with a conscious acceptable, linear narrative in the left.
Where traumas were multiple and/or occurred early in life a long-term therapeutic relationship may be necessary to recreate or even create an acceptable and meaningful view of oneself and the world.
6. Right brain - left brain splits in traumatology. Our science like our brains is also split.
The so called scientific paradigm favours left brain rational linear categorization and measurement of tangible events such as chemicals. Left brain scientists are denigratory of what cannot be seen, measured and categorized. They may equate right brain phenomena with prescientific thinking and its healers as practising suggestion or a modern form of witchcraft.
The right brain paradigm in the past exemplified by psychoanalysis discerns unconscious patterns and is impatient of narrow categorizations such as in DSM. It wonders at the wisdom of trying to measure nonlinear phenomena with linear means. It sees left brain science lacking clinical relevance, a biopsychosocial gestalt, and soul.
Initially Freud described both childhood development and trauma, and hoped to eventually find a rational neuropsychology for both. It seems that the right brain may be a key to fulfilling his hopes.
One of the tasks of traumatology in this century is for it to be able to read the right brain and integrate its own scientific narrative.
Joseph, R. (1996). Neuropsychiatry, Neuropsychology, and Clinical Neuroscience. New York: Lippincott, Williams & Wilkins.
Schore, A. (1994). Affect Regulation and the Origin of the Self. Hillsdale, NJ: Lawrence Erlbaum.
Valent, P. (1998). From Survival to Fulfillment: a framework for the life-trauma dialectic. Philadelphia: Brunner/Mazel.