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Case Study

Breaking Free: A Mind-Body Approach to Retraining the Brain

By Janina Fisher and Pat Ogden

Carrie, 67—a mother and grandmother—came into therapy because of increasing difficulties in her marriage of 40-odd years to her childhood sweetheart, a Vietnam vet. Ever since Vietnam, he'd been moody and easily irritated, but in the past year or so, she reported, he'd developed health problems, and his moods had gotten worse.

"Out of nowhere, he starts screaming at me or putting me down—ridiculing me for being useless and inadequate," she said. "When he does that, I just freeze; it feels as if I'm rooted to the floor and can't move. He'll scream at me to 'say something!' but I can't; no words come. Then I try to think how to make him happy: what does he need? When I can talk, I ask him what I can do. Does he need to know I love him? I try to say something nice, but that just makes him madder."

Carrie vividly remembered growing up with parents who'd been moody, unpredictable, and quick to anger. Alcohol had fueled their hair-trigger reactivity, making them even more volatile and frightening. When she heard certain tones in their voices or saw particular facial expressions, her young body would freeze and become quiet and still—her eyes tracking their movements and expressions intently. She'd then automatically shift into a calmer, compliant state, in which she'd try to soothe them and minimize the abuse. Sometimes, she'd try to placate them by giving each a hug, smiling brightly, and telling them how much she loved them and how pretty her mother looked. These were a child's adaptive responses to alcoholic parents, designed to diffuse their rage. Frequently, her next response would be shame and submission: her shoulders slumped, her head came down, her chest collapsed, and her body shrank in and away. Over time, these reactions became automatic, thanks to what's called procedural learning—our memory system for learning habits and habitual functions. Carrie's young brain was organizing itself for survival in an alcoholic family environment, and her body was developing patterns of response that became as automatic as the ability to ride a bike.

The same childhood-survival strategy was being activated whenever her husband lashed out at her. The problem, of course, was that the pattern of freezing and placating—meant for another time and place—was no longer adaptive. Thanks to years of therapy, Carrie understood this, but her insight was having no effect on her automatic reactions.

Why hadn't years of talk therapy worked? Could it be because these patterns were so encoded in her body and brain that insight and emotional expression alone couldn't change them? Until the end of the 20th century, neuroscientists believed that the brain's structure was largely unchanging and unchangeable after certain "critical periods" in infancy and childhood. They'd have assumed that the survival skills that Carrie learned as a child couldn't be unlearned in adulthood: those neural pathways were fixed for life. The only likely major changes in the brain would be negative—neural degradation or destruction caused by injury, disease, or old age.

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