Integration of Self and Transcendence in Recovery

It is important to understand how the term integration relates to brain functioning and well-being. Utilizing complexity theory from quantum physics might be most helpful. “Systems that are able to move toward maximal complexity are healthy systems. They are the most stable, adaptive, and flexible. What a wonderfully concise definition of well-being. Mental health can thus be defined as a self-organizational process that enables the system-be it a person, relationship, family, school, community, or society-to continually move toward maximal complexity” (Siegel, 2003). In other words, the more integrated the brain, the more complex it is. The more complex the brain, the more mentally healthy it is.

Transcendence can be a byproduct of self-integration. As an alcoholic and/or addict grows as a person secondary to integration during their recovery, at a certain point or energy they will transcend. This process allows the person to reach a higher level of self-knowledge, as well as, knowledge about the world around them. This moving beyond creates a different perspective of one's life. The following story of Marcus describes experiences in his early recovery that significantly change his awareness. His new awareness not only reduces the probability of relapse but also allows for growth in interpersonal relationships.

Marcus grew up in a home with an abusive alcoholic father who beat Marcus with a leather belt when he was drunk. At age 12 Marcus decided that he would never let anyone hurt him again and from that point declared, “If anyone gets in my face I will kick their ass.” Although he had many drinking buddies, Marcus continually had problems with male authority figures such as supervisors, teachers, policemen and male therapists. He once pushed a police officer leading to a night in jail. A fight with a supervisor cost him a job. When he first met his male therapist he threatened him with bodily harm. As his alcoholism progressed, he became less able to control his rage. When asked he said, “It's like there is another person inside of me that takes over – I have no control.” While in treatment, Marcus had a hard time getting in touch with his feelings and could not seem to find words to express his feelings. He described his rage as “All or nothing – I either don't feel anything or feel too much.”

Research on relapse indicates that anger/rage is just below people, places, and things when investigating factors associated with return to use. In Marcus's case he seemed to have little or no control of this emotion when around male authority figures. One perspective of his problem is to view it as a lack of vertical integration in his brain. His prefrontal cortex doesn't appear to be able to override his brain stem leading to impulsive acting out. As Marcus says, “It's like another person inside of me that takes over – I have no control.”

In treatment Marcus could not get in touch with his feelings and lacked words to describe them. The language of the brain is feelings mediated by the monoamines (norepinephrine, dopamine, and serotonin). His “mirror of memory” tarnished his objectivity especially in transference situations (situations that reminded him of his abusive father). This difficulty can be perceived as a problem of horizontal integration. In other words, the left hemisphere of his brain is not well integrated with the right hemisphere.

There are a number of techniques that can be utilized to assist Marcus. One technique involves the creation of contingent communication within his mind. Contingent communication involves a perception, making sense of the perception and responding in a timely and effective fashion. Secondly, mindfulness meditation can help change brain function. “Mindfulness promotes the integrative function of the prefrontal cortex,” Siegel says. “It allows brain circuits to fire that have perhaps never fired before, giving people a sensation of inner awareness that they may never have had before” (Siegel, 2003). This inner awareness creates the potential to transcend.

Achieving Vertical Integration

Vertical integration involves contingent communication from the prefrontal cortex through the limbic system, brain stem and down to the body. When the brain is vertically integrated, the prefrontal cortex has inhibitory control over lower brain functions, giving it the ability to process, inhibit and organize reflexes, impulses and emotions generated by the brain stem and limbic system. The prefrontal cortex allows us to learn from our mistakes and correct behavior that is self-detrimental (Amen, 2002).

A child – like Marcus – growing up in a traumatic environment, will develop an exceedingly active brain stem. The majority of stress response systems reside in this area, and increased excitation in the lower brain can lead to anxiety, anger, rage and impulsivity. Forms of trauma can lead to an underdevelopment of the prefrontal cortical area. This can lead to problems with empathy, problem solving and the ability to abstract and conceptualize. Furthermore, patients like Marcus can overestimate the degree of threat or misread visual cues such as facial expressions. The outcome is an inability to modulate affective response. In fact the hallmark feature found in many trauma survivors is failure to regulate the degree and duration of an emotional response.

Marcus may have learned a number of cognitive-behavioral coping strategies while in treatment. Imagine what will happen when he experiences a situation in early recovery that reminds him of the old trauma (for example, his supervisor at work gets angry with him). His brain has learned to go into an excitation mode and a “hyperarousal” pattern. His brain stem overrides the prefrontal cortex. In the aftermath of another angry failure, he returns to alcohol/drug use.

While in treatment, Marcus said to his therapist, “If I wanted to I could kick your ass.” The following dialogue took place between Marcus and his therapist:

• Marcus: “ If I wanted to I could kick your ass.”
• Therapist: “Whatever you do, don't stop behaving the way you are right now because you know and I know that it saved your life, didn't it?
• Therapist: “I'd like to talk to that part of you that made a conscious decision to never let anyone hurt you again.”
• Marcus: Nonverbal aggressive cues diminish and he starts to cry.

The therapist has established congruent communication with Marcus and he has responded by deescalating. In the past, male authority figures have told him they would kick him out of treatment, fire him, put him in jail or punish him in other fashions. These responses only reinforced Marcus's perception that when he allowed these types of people to get close, they hurt him. Marcus's therapist has broken this old non-productive pattern of failure.

The therapist now can use psychoeducation to help Marcus understand the history and pattern of his problem with anger. A good place to start is to teach him about a neural circuit called the “checker system.”

• Therapist: “Do you know that your brain has a circuit that helps protect you and that it is called the ‘checker system'.”
• Marcus: “I have never heard of that.”
• Therapist: “The ‘checker system's' job is to keep you safe. (Looking at a picture of the brain) It involves areas in your brain – the amygdale, basal ganglia, and in Marcus's case, the brain stem. The job of the checker system is to keep you out of harm's way and it is doing the best that it can. This is how it works:
• It SCANS (vigilance)
• It Alerts (fear when danger is perceived)
• It Motivates (causes practical behavior)
• Therapist: “Marcus do you think the police officer you pushed was out to do you bodily harm.”
• Therapist: “Marcus do you think the supervisor you got into a fight with was really going to physically hurt you.”
• Therapist: “And Marcus do you think that the first time we met I was a physical danger to you.”
• Therapist explains to Marcus that his “checker system” is doing the best it can, but when it gets in situations that remind you of your father, it gets very hyper and your brain stem and other areas of the lower brain interpret the situation as a “fight or flight” survival dilemma. This is a hardwired, somewhat out-of-date survival system that was very effective when the caveman had to decide whether to run or fight the saber-toothed tiger. It may have helped you when you were young but now there are different demands. Your anger is interfering with your relationships, hindering your promotability, and disturbing your attachment to your children.

The therapist is helping Marcus to have a different type of relationship with his brain. With this understanding – presented in a nonpathological fashion – he can start to learn to self-regulate. Self-regulation takes place secondary to neural integration. As disparate parts of his brain become integrated, complexity increases. With increases in complexity comes an increase in personal stability and adaptation. What was once lost in the non-verbal right brain where trauma is stored in the paralimbic area, comes verbal awareness in the left brain of history and pattern leading to acceptance and change.

• Therapist: “For the next week I want you to observe what is happening in your brain.” This is called discernment. Marcus is also taught self-regulation strategies such as breathing meditation.
• Therapist: (second session) “Marcus, I want you to start to have contingent communication within your own brain. Your prefrontal cortex can have a dialogue with the lower parts of your brain. Thank your “checker system” for keeping you safe and let it know that it is your friend. Also, let it know that you need to speak with the lower parts of your brain about being safe. Tell your “checker system” that when someone reminds you of your father, it does not mean that you are in physical danger. Tell it that we have to quit acting like this and that you are tired of being in trouble and constantly relapsing. Let your lower brain and your prefrontal cortex become a team instead of adversaries.”

This type of dialogue promotes neural integration. It allows the past events in Marcus's life to stay in the past. He can now distinguish something that happened in the past from something that is happening in the present. When he is around male authority figures he can look at the situation through the eyes of an adult rather than the eyes of a child. This has been called “moving from there to here” or “going from subjectivity to objectivity.” Mary Sykes Wylie describes this increase in neural integration as “the consolidation of memory via the hippocampus into the neocortex, and the synthesis of left-brain logic and right-brain emotion, so that the past event becomes no more and no less than an aspect of your conscious autobiographical story” (Wylie, 2004). As the old self-destructive patterns are brought into consciousness and understood by the logical cause-effect left hemisphere, Marcus begins the process of change. He is prepared to learn behavioral coping strategies to augment the meditation techniques.

Achieving Horizontal Integration

According to Louis Cozolino, “the primary focus of psychotherapy appears to be the integration of affect and cognition. Intellectual understanding of a psychological problem in the absence of increased integration with emotion, sensation, and behavior does not result in change. All forms of treatment recognize the need for stress, from the subtle disruption of defenses created by the compassion of Carl Rogers, to the exposure to feared stimuli in cognitive therapies. There is a recognition that the evocation of emotion coupled with conscious awareness is most likely to result in symptom reduction and personal growth” (Cozolino, 2002).

The following gives an overview of the functions of the left and right cortical hemispheres.

Marcus had difficulty getting in touch with his feelings and also could not find words to express his feelings. Horizontal left- to right-brain integration can help him in multiple ways. Left-right integration allows for feelings to be brought into conscious awareness where they can be understood. The goal is to balance the left and right hemispheres. The left hemisphere is more closely identified with cortical (intellectual functioning) while the right hemisphere is more closely connected to the body via the brainstem and limbic system. The question becomes, what type of approach might best be used to promote integration?

For more than 40,000 years stories have been the favored format for passing on multi-level information. A story has the elements of the intellect, as well as emotions and body sensations. Neural growth and integration is enhanced by the integration of conceptual knowledge with emotional and body experiences using a narrative format that is co-created with a therapist. If Marcus can tell a congruent story about his life, not only will he break through old defense systems installed as protection against the early life abuse that disallowed integration, but he can improve as a parent. For example, such congruent narratives can break multigenerational patterns of disorganized attachment. “The process of listening to and telling stories brings together behavior, affect, sensation, and conscious awareness in a way that maximizes the integration of a wide variety of neural networks. Through stories we connect with others, share the words, thoughts, and feelings of the characters, and provide the opportunity for moral lesions, catharsis and self-reflection” (Cozolino, 2002).

One way of approaching the story is through the development of what is called a spiritual autobiography. “The pilgrimage to look for the source of one's faith and see one's experience in relation to that search is not limited to artists and writers, but is shared by a growing number of people of many different backgrounds, interests and ages” (Wakefield, 1990).

Integration brings new insight. Neurons that have never connected are now working together. You may have experienced this phenomenon many times in your life. Remember a time when you could not quite come up with the answer and as hard as you tried nothing happened. After time and contemplation, it suddenly came to you – an “ah ha” experience – sometimes, as a little voice in your head. You suddenly gained new insight. Your brain integrated in a new way. New neural connections were established and awareness was enhanced.

Transcendence in Recovery 

Through the process of neural integration, Marcus now understands the history and pattern leading to past relapses. He understands how his relationship with his abusive father lead to problems with other male authority figures (authority themes). When confronted with a similar problem, he should now be able to have a more mature, enlightened understanding of the situation. Marcus understands how these patterns lead to numerous self-destructive instances.

Marcus is now free from old patterns and can clearly see what in the past was without explanation. He has now moved to a different level of awareness about himself and his world. Marcus has transcended his past. Recovery involves many levels of transcendence-some worldly and some spiritual in nature. Transcendence frees one to connect with others and to a higher power of choice. Each connection leads to possibilities of greater awareness. The joy of recovery involves these connections.

Cardwell C. Nuckols, MA, PhD is an Expert, Consultant, and Trainer, Behavioral Medicine and Addictions Treatment, Apopka, FL. He is the President, Cardwell C. Nuckhols and Associates, LLC. He is also the author of: Healing an Angry Heart, Chalk Talk on Drugs (with Father Joseph Martin), and  Cocaine: Dependency to Recovery.

REFERENCES 

Amen, Daniel G. Healing the Hardware of the Soul. The Free Press. New York , 2002.

Cloninger, Robert C. (2004). Feeling Good: The Science of Well-Being Oxford . New York .

Cozolino, Louis. (2002). The Neuroscience of Psychotherapy. WW Norton , New York .

Siegel, Daniel J. (2003). An Interpersonal Neurobiology of Psychotherapy: The Developing Mind and Resolution of Trauma (In: Healing Trauma, Edited by Solomon, Marion F. and Siegel, Daniel J.). WW Norton. New York .

Wakefield, Dan. (1990). The Story of Your Life. Beacon Press, Boston .

Wylie, Mary S. Mindsight. Psychotherapy Networker. September/October, 2004, 37.