Sunday, July 24, 2011

Self Awareness

Amazing as it is to believe, scientists have identified which regions of the brain are associated with self awareness. Self awareness starts with awareness of bodily sensations, such as hunger, thirst, tiredness, and pain. It includes being able to think about the self, form ideas of the self, notice patterns, and assign attributes. These functions seem to be set in the anterior medial prefrontal cortex. Not surprisingly, self awareness develops through interactions with an attuned other. The caretaker names experiences, assigns words to feelings, connects sensation with action and need with fulfillment. Through these interactions this part of the brain is built, and its connections with other regions developed. Therefore, it is understandable that psychological trauma, including attachment traumas, in the first year of life has been observed to negatively impact on the experience-dependent maturation of the circuits of the anterior cortex.

The children and families we serve who have experienced early trauma have an under-developed ability for self reflection. This means that it is hard to recognize one ’s self. It includes poor awareness of internal stimuli, including the inability to locate the source of internal pain and figure out what to do about it. Imagine that you feel hungry, but you do not recognize the feeling as hunger and therefore eat. You have not been taught by a caring other that this feeling is hunger, and can be satisfied. You are just aware of distress, and become increasingly cranky. In more complex interactions, you cannot identify how your own responses caused reactions from others. Remember, this is an actual inadequacy of one part of the brain. It can be seen in fMRI images and other brain tests. It’s not that you are refusing to understand yourself, its that you can’t, just as a blind person cannot see.

This deficit could be seen in a child not moving away from pain quickly, or appearing not to notice heat or cold. It could result in elimination issues, as the child doesn’t connect his bodily sensations with the need to find a bathroom. It could be a part of eating problems.

It seems to me that understanding this has implications for our constant desire that our children “take responsibility for their actions.” What if the child just does not have the requisite brain structures to be this self aware? Are we insisting he do something he is not capable of?

Luckily, the concept of brain plasticity reassures us that the self reflection part of the brain can be strengthened at any age. How can we help our children in this area? We can do what an earlier caretaker did not do. We can be alert to any signs of need on their part (hunger, pain, toileting, cold) and put it into words and help them immediately satisfy the need. We can avoid being judgmental about this, instead consider teaching much as we would teach them to read if they had never been taught.

An important way of helping is the use of narrative. We can help the children step back and formulate the story of their lives. This can be as simple as a quiet time at night re-telling the story of that day’s activities, or as complicated as a life book. A DBT chain analysis can be a way of creating a narrative of an event. A “Me Book” which illustrates my favorite colors, my favorite games, etc. etc with many facts about me is a way to create a self that can be observed by the self. We can be sure to take pictures, and say “remember when we went to the zoo, and you loved those monkeys?” Any time an adult creates a story about a child’s life she is helping him develop his self-reflective capabilities.

Like every other change we try to make, this change will be slow and involve many, many repetitions. And like every other change we make, it happens only in the context of attuned, engaged, enthusiastic relationships.

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