Journal of Infant, Child, and Adolescent Psychotherapy ISSN: 1528-9168 (Print) 1940-9214 (Online) Journal homepage: https://www.tandfonline.com/loi/hicp20 Identity Narrative and Its Role in Biological Survival: Implications for Child and Adolescent Psychotherapy Andrei Novac, Margaret C. Tuttle & Barton J. Blinder To cite this article: Andrei Novac, Margaret C. Tuttle & Barton J. Blinder (2019): Identity Narrative and Its Role in Biological Survival: Implications for Child and Adolescent Psychotherapy, Journal of Infant, Child, and Adolescent Psychotherapy, DOI: 10.1080/15289168.2019.1583053 To link to this article: https://doi.org/10.1080/15289168.2019.1583053 Published online: 09 May 2019. Submit your article to this journal Article views: 55 View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=hicp20 JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY https://doi.org/10.1080/15289168.2019.1583053 Identity Narrative and Its Role in Biological Survival: Implications for Child and Adolescent Psychotherapy Andrei Novac, MD, Margaret C. Tuttle, MD, and Barton J. Blinder, MD, Ph.D. ABSTRACT In this article, we propose the term identity narrative (IdN) to define an implicit emotional and cognitive framework that serves as an unconscious scaffolding for the gradual development of autobiographical memory. We distinguish preverbal IdN from narrative identity, a term previously used in the philosophical literature. Unlike narrative identity, which refers to conscious life scripts, IdN is unconscious and constitutes a contemporary neuropsychological conceptualization of the unconscious. Within autobiographical memory, IdN has a stabilizing function providing individual predictability and, hence, social stability. IdN begins prior to language acquisition and has an evolutionary significance. It is consolidated by neurohormonal mechanisms, influences and is influenced by attachment, and molds the manner in which autobiographical memory is recalled. It participates in the emergence of self and identity. IdN is reshaped throughout life by both bottom-up (implicit “predictive cycle” paradigm) and top-down acquisitions that include paradigm shift/sudden new insights, experiences with high emotional valence, repetition and practicing, and prolonged exposure. In this way, IdN, autobiographical memory, and the language brain are parts of a larger biological substrate of human social affiliations. Human history starts with telling of stories. In some languages, the word for the discipline of history and the word for story are interchangeable (“Geschichte” [Ger.], “L’histoire” [Fr.]). Tales, fables, creation myths, and cosmogonic myths are present in all cultures to provide a narrative for the origin of the world (Eliade, 1998). Among the first activities between mother and child are telling of stories. All life lessons are incorporated into our basic assumptions and moral values (McLean, 2005; Piaget, 1965). Development has numerous steps for each individual, which results in a unique singular reflective mode and individual identity (Fonagy & Target, 1996). Inevitably, some of the acquired developmental CONTACT Andrei Novac anovac@uci.edu University of California at Irvine, 400 Newport Center Drive, Suite 309, Newport Beach, CA 92660. Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/hicp. Dr. Andrei Novac is Clinical Professor of Psychiatry and Founding Director of the Traumatic Stress Program at the University of California at Irvine, School of Medicine. He graduated from the Carol Davila School of Medicine in his native Bucharest, Romania in 1978. After a post-MD three year training in Pediatrics, he immigrated to the US and completed his internship, psychiatric residency and a research fellowship at UC Irvine. This was followed by training in neuro-anatomy with Lennart Heimer, M.D. at Zeiss Anatomy Lab in St. Louis, MO. He is the author of more than 50 articles and book chapters, and more recently has published two books of poetry. He is a distinguished fellow of the American Psychiatric Association, and was admitted to the American College of Psychiatrists. He is also an affiliate and a member of the research committee of the New Center for Psychoanalysis, Los Angeles. Margaret C. Tuttle, MD, is an Instructor in Psychiatry at Harvard Medical School and an outpatient psychiatrist at Massachusetts General Hospital. She is Co-Chair of the Massachusetts Psychiatric Society’s Psychotherapy Committee and serves on the Steering Committee of the American Psychiatric Association's Caucus on Psychotherapy. She received her MD degree from the University of Massachusetts School of Medicine. She also holds masters degrees in mathematics from MIT and in music from the New England Conservatory of Music. Barton J. Blinder, M.D., Ph.D. is a Clinical Professor at the Department of Psychiatry and Human Behavior, Samueli College of Health Sciences, University of California, Irvine, as well as Professor in the Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington. He received his MD degree and did his residency training at the University of Pennsylvania School of Medicine. Dr. Blinder is also a Senior Faculty (Adult and Child Psychoanalysis) at the New Center for Psychoanalysis, Los Angeles, and a founding member, College of Research Fellows, American Psychoanalytic Association. © 2019 JICAP Foundation, Inc. 2 A. NOVAC ET AL. steps also include inconsistencies that remain unreconciled as to meaning, which is one of the bases of psychological conflict and defense (Blinder, 2007; Northoff, Bermpohl, Schoeneich, & Boeker, 2007; Pally, 2001).1 They all contribute to the formation of autobiography. These aspects of human consciousness have their origins in an inherent need to make sense of the past and a predictable future. In this contribution, we are proposing IdN as an unconscious form of memory that serves as a support to, and structure for, a meaningful autobiographical memory. Narratives and memory Narratives The word narrative comes from “gna” (Sanskrit), meaning knowledge, and “gnarus” (Latin) and “narrare” (Latin), meaning to tell (Abbott, 2002). Herodotus, the father of history, used biographical narratives, the stories of individual people, to reconstruct events (retroactively), thus creating history.2 The major role of history in society is its participation in both group and individual identity of its members (see Figure 1). External narratives are in essence history. Internal narratives, “memories,” comprise individual experiences, sometimes personal stories, which often are the building blocks of autobiographical memory (Novac, 2013). We propose a differentiation between two types of internal narratives: autobiographical (personal) narratives (AN) and identity narratives (IdN). Sometimes the need to live through and create stories appears in connection with a need to explain and mitigate any uncertainties about the future. This explains the frequent appearance of rumors, gossip, and urban legends, which further suggests a protective/defensive social role of narratives (Baker & Lones, 1996; DiFonzo, Bordia, & Rosnow, 1994; Kowalski, 2001; Novac, McEwan, & Bota, 2014; Sunstein, 2009). Figure 1. Representation of continuity of narrative domains. JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 3 Identity narrative and autobiographical memory To understand how narratives are encoded, it is important to recapitulate some basics about memory. Brain projection of activity is contingent upon the degree of engagement in a task. This is the basis of representational plasticity and map expansion (Kilgard, 2012; Kilgard & Merzenich, 1998). Narratives exist thanks to memory formation of meaningful sequences of events and previous experiences. Explicit memories are pieces of information readily available for voluntary recall; implicit memories are present, but an individual has a limited or vague awareness of them. Humans have a sense of continuity in time, which is possible only due to the existence of AM. Autobiographical memory gradually arises during the preschool years and is a form of declarative (explicit) memory.3 Squire (1995) distinguished between declarative (conscious recollection) and nondeclarative (without a conscious sense of “pastness”). Tulving’s contributions (1972, 2002) on memory have delineated the differences between declarative semantic memories (facts) and declarative episodic memories (events). A subtype of episodic memories is the autobiographical memory (AM). The main features that differentiate AM from episodic memories have been outlined in a large body of research and more recently summarized in contributions by Fivush (2011) and Nelson and Fivush (2004): (1) selfdefinition: AM includes a sense of continuity with an auto-noetic quality (a sense that events happened to oneself) and are intimately related to the self-concept. They connect the past with the present and allow for the planning of the future; (2) AM defines the self in relations to others, for example, in the social context. Memories create a cultural and a social bond with others. Thus, AM varies with culture and gender since it contributes to a person’s social identity and provides for a culturally canonical biography (Bernstein & Rubin, 2004); and (3) self-regulation: the ability to create coherent narratives of one’s emotional experience has an emotionally healing effect. As we will see below, awareness of past events and the construction of elaborate narratives of personal events creates meaning and promotes processing of adverse experiences. Children who participate in adult-guided reminiscing show a higher level of understanding and self-regulation (Laible, 2004a, 2004b). The different types of memory must be examined in light of our knowledge about consciousness. Episodic memory (and its subtype, autobiographical memory) is specific to humans. It is a manifestation of auto-noetic consciousness and allows for self-knowledge and “time travel”; therefore, it allows for a sense of past, present, and future (Schachter, Addis, & Buckner, 2008). Semantic memory refers to facts and events and is linked to noetic consciousness. In general, mammals are capable of some semantic memory and exhibit semantic consciousness. An individual has knowledge and awareness of semantic memorized material (facts and events). In contrast, procedural memory arises out of anoetic consciousness. Here, an individual possesses the “recorded material” but has no explicit awareness of it. Anoetic consciousness is present in vertebrate animals. More recently, a functional connection between anoetic (procedural) consciousness and autonoetic (autobiographical) consciousness has been proposed. Who we are is a fundamental state of self-experience that cannot be put into words. “It forms a background of experience with a higher form of consciousness in the foreground” (Feinberg & Mallatt, 2016; Leffert, 2018; Tulving, 1983, 2003; Vanderkerkhoven & Panksepp, 2009). Identity narrative. We propose that preverbal IdN, as an unconscious prerequisite (a scaffolding) of autobiographical memory, is encoded information based on early experiences that are gradually retained as implicit memories. It provides AM with implicitly encoded predictable patterns of reactions to the environment, which first developed in a dyadic relationship with caregivers. Despite its unconscious nature, we have chosen the term “narrative” in IdN because it refers to an adaptationally scripted set of reactions and responses. In this sense, “narrative” is consistent with “gna” (Sanskrit) and “gnarus” (Latin), meaning “knowledge.” The term identity narrative is a clinically derived concept. It resembles an earlier term, “narrative identity” (Adler, Wagner, McAdams, 2007; Josselson & Ruthellen, 2004; McAdams, 2001, 2013; McLean & Breen, 2009; Fivush & Graci, 2017), which has emerged in the philosophical and psychological literature. French phenomenologist Paul Ricoeur (1975, 1978, 1984, 4 A. NOVAC ET AL. 1985, 1988) pointed to the fact that humans tend to draw past events together into a meaningful story, a process he called “emplotment.” Unlike IdN, which is unconscious, narrative identity refers to a life story an individual develops, which is conscious and part of explicit memory. In clinical terms, narrative identity would be akin to autobiographical memory and an autobiographical narrative. Conversely, IdN creates an early preverbal unconscious narrative (a script), “a way of being” rather than “a way of remembering.” This way of being is created by parental interactions, attachment, cultural environments, and life experience. There is evidence that life events, especially interactive experiences from ages 0 to 3, are in fact stored and influence a person’s development and future personality (Kernberg, 2015). Unlike autobiographical memory, IdN emerges in animals. Animal studies (Poulos et al., 2014) have demonstrated that exposure to adverse experiences in very early age results in changes in the rats’ reactivity in adult life without an apparent direct recollection (by observable behavior) of the events. However, as we will see below, IdN reshapes itself throughout life, and there is an ongoing reciprocal exchange between IdN and AM (Novac, Bota, & Blinder, 2017). IdN is evolutionarily necessary because it facilitates the gradual rewriting of memories into a stable autobiography during and after preschool years. Once formed, IdN, an unconscious personal script created by early experiences and socio-cultural factors, becomes an attractor for selected life events to be retained as autobiography. Life events and their memories then become lasting personal memories and characteristics. Autobiography and autobiographical narratives would hardly be possible without a preestablished neuro-cognitive scaffolding. Otherwise, explicit memory does not naturally become “self” or “the way a person is” (a first-person experience). We propose that early implicit links are distinct from AM. Thus, IdN incorporates the early preverbal, match/mismatch/repair paradigm during mother/infant interaction (Cavelzani & Tronick, 2016), which also mirrors the known “predictive cycle” paradigm of procedural learning (Tadlock, 2005). This early implicit information remains automatic with little access to awareness. After the preschool years, IdN also includes the acquisition of self-related skills, previously described within the “acquisition of skills” paradigm of procedural learning (Fitts, 1954), which is dominant after verbal acquisition and throughout life. Through the acquisition of skills implicit learning paradigm, newly acquired explicit memories of life events are incorporated into the implicit memory pool, that is, the IdN. It is obvious from clinical observation that these are not simply forms of procedural memory but have an exclusive autobiographical role (e.g., mismatch/match/repair skills, acquired in infancy). The fact that these have a highly personalized pattern, specific to each individual, gives them a signature feature, hence, our proposed term of “identity narrative.” Thus IdN is different from the classic concept of AM and related autobiographical narratives because it appears as a procedural type of memory with automatic, implicit features, either beyond awareness (like the match/mismatch/repair function) or procedural memories of the “acquisition of skill” type that are partially accessible by recall. The main role of IdN is the organization and holding of autobiographical information. Its priority is information-storage and retrieval that is congenial and predictable to each individual. It allows for the storing of autobiography in the form of a meaningful, “logical story.” IdN provides a personal point of reference toward that narrative, common sense, and personal meaning for a story. Without it, the numerous elements comprising a personal autobiographical narrative would not be kept in mind in an organized and consistent manner. IdN is also an original record of one’s early experiences and patterns of interaction, on which incoming information is recruited, implanted, and built to create an autobiography. In this way, an autobiography becomes deeply rooted as part of identity. We hypothesize that IdN is composed of many sequences of implicit memories, or implicit scripts, that connect through key points to a variety of explicit memories of life events (see Figure 2). Such key points have a role in allowing for the creation of autobiographical stories, conscious autobiographical narratives, or “narrative identity.” Thus, IdN is a necessary feature of a person’s development through which some aspects of the self develop earlier to prepare the process of maturation through language and AM. Due to its implicit, automatic-like nature, IdN makes the acquisition of the features of AM possible. It participates in the auto-noetic quality of AM, a specific human quality, by a) “remembering that it happened to me,” JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 5 Figure 2. Autobiographical memory. the auto-noetic experience (Tulving, 2002); b) the linking of past experiences to the present and the ability to “own” the changes in one’s own self (McLean, Pasupathi, & Pals, 2007); and c) the ability to create a personal timeline and observe an organized manner in creating a personal chronology (Habermas, 2007; Habermas & Bluck, 2000).4 Childhood amnesia, the first three to five years of life for which most people have little or no recollection, is the period during which IdN first develops by a gradual acquisition of implicit, experiential memories. The literature on childhood amnesia and its link to AM is vast and points to the specific factors that favor an earlier onset of autobiographical memory in some cases and thus a shortening of the amnestic period. Cultural factors and gender differences5 (Fivush & Buckner, 2003; Wang, 2001, 2013; Wang & Ross, 2007); emotional factors, including increased emotional awareness (Wang, 2001; Wang & Fivush, 2005; Welch-Ross, 1997); acquisition of cognitive self with emphasis on details and distant memory6 (Nelson & Ross, 1980); interactive style and verbal exchange with caretakers7 (Jack, MacDonald, Reese, & Hayne, 2009); event segmentation, the division of events into smaller episodes (Zacks & Swallow, 2007); and mothers’ reminiscing style (Eisenberg, 1985; Fivush, 2001a, 2001b; Reese, Haden, & Fivush, 1993; Fivush & Graci, 2017) have all been found to influence childhood amnesia and the extent of autobiographical memory. All these further create fluidity and continuity between early experiences, the creation of the IdN, a proto-narrative, and the ensuing emergence of AM. IdN is a network of relatively stable coordinates onto which conscious autobiography is mapped. On the one hand, IdN continues to act as a selecting and discriminating mechanism for further progression of autobiographical memory throughout life. Yet on the other, autobiographical experiences, which are partially rerouted (by, among other factors, an emotional valence) into implicit memory, reshape IdN. Many experiences or skills adaptively developed, practiced, or retained through an emotionally laden experience (e.g., hyper-consolidation of memories related to trauma) become IdN. Such experiences are perceived as “owned” (they are part of autobiography) because they become IdN8 and thus part of the self. Following is a summary of the functions of IdN as they relate to AM, which include: (1) information encoded based on early experiences that are retained as implicit memories. As will be covered later in this article, there is evidence that even prenatal stimulations are A. NOVAC ET AL. 6 (2) (3) (4) (5) (6) (7) encoded in the fetus’s brain (DeCasper & Fifer, 1980; DeCasper & Spence, 1986). In the same vein, a voluminous literature on intergenerational transmission of trauma has emerged over the past several decades (Danieli, 1998); implicitly encoded, predictable patterns of reaction to the environment which first develop in a dyadic relationship with caregivers; encoded information during childhood amnesia, which continues to expand and reshape throughout life; creation of an early narrative (a script) as “a way of being” rather than “ a way of remembering”; “implicit scripts,” a term we are proposing to describe the key points of implicitly encoded memories. They may constitute “attractors” (see dynamic systems theory) that allow for the anchoring and spontaneous recall of elements of declarative stories of AM. In this sense, implicit memory, as such, may have as one of its major evolutionary roles, the maintenance of a stable AM and self; facilitation of the re-routing of some but not all memories of life events into an autobiography which is perceived as “self” (a first-person experience); and organization of the autobiographical information into a relative and meaningful narrative throughout life, which promotes a drive to live and survive. Earlier contributions from psychology and psychoanalysis Identity narrative is a form of unconscious memory, but it does not fully overlap with the psychoanalytical unconscious. Eagle’s (2018) recent treatise on core concepts in psychoanalysis points to the nature of the “psychodynamic” unconscious. In essence, the Freudian psychodynamic unconscious is all-encompassing, the “seething cauldron” of drives, impulses, and defenses. IdN is closer to the contemporary concepts of the “descriptive/cognitive unconscious,” arising out of caregiver/infant relationships and interaction to create an affective exchange that has a reparatory function. Freudian and post-Freudian schools (1911/1989) discussed “Versohnung” (reconciliation) and “Wiedergutmachung” (reparation) to refer to acceptance of one’s own drives and fantasies. James (1892) described “habit” as an unconscious memory and described the “total self” as “duplex” in nature, with one aspect being awareness (“knower”) and the other, experience (“known”). Among relevant psychological concepts are Bowlby’s (1969) internal working model as mental representations for understanding the world, self, and others; Hartmann’s (1950) “selfrepresentation” as an experiential memory that defines a person’s identity; and Hartmann’s (1958) roles of ego defenses as adaptations to the external world. Such adaptations are cultural and rooted in internal neural systems. These adaptations reflect a continuous attempt of the ego to create balance between intra- and inter-systemic (environmental) tension, hence a narrative of the self; the work of Russell Meares (1995) and Brandchaft and Stolorow (1990) referring to “invariant organizing principle,” describing an implicit, automatic narrative of the self; the stepwise acquisition of values and logic (Carlo, Koller, Eisenberg, Da Silva, & Frohlich, 1996; Haidt, Koller, & Dias, 1993); Stern (2000) encoding of experiences into short sequences of events9; the “working model” (Stern, 2000); and the undifferentiated matrix that evolves into differentiation (Jacobson, 1964; Mahler, 1967; Stern, 2000). Pre-existing biological and evolutionary determinants that facilitate these ontogenetic acquisitions of early internal organization are an integral part of several schools of psychology and have been mirrored by animal studies (Bowlby, 1969, 1973, 1980; Panksepp, 1998a, 1998b; Stern, 1977; Stern, 2000; Leffert, 2010, 2018; Blinder, 2004, 2007; Dowling, 1977; Jacobson, 1964; Suomi, 1997; Poulos et al., 2014). Finally, there is a large body of literature on narrative identity as a theoretical concept with clinical implications related to culture, the sense of time, and personality (Josselson, 2004; McAdams, 2001, 2013; McLean & Breen, 2009). Ricoeur (1975, 1978, 1984, 1985, 1988) recognizes the existence of a “prenarrative” or “prefiguration.” Prenarratives include engrams that JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 7 stem from the fact that an individual consciousness is inhabited by its culture as a “symbolic whole.” Prenarrative is the concept closest to IdN in the literature. In the same vein, as part of a comprehensive text on the philosophy of memory Fivush and Graci (2017), presented an integrated review on autobiography and narrative identity and its role in the forming of social identity. A more recent research study on narratives collected in the immediate aftermath of trauma revealed that narrative content after trauma occurs in individualized patterns. Such patterns predict the severity of symptoms at a 12-month follow-up (Booker et al., 2018). The presence of specific patterns of explicit narratives may be an indication that such individualization of response is tied to a deeper procedural-type narrative, further supporting our proposal. The neuroscience of narratives as memory Explicit and implicit memories were, in general, believed to function in a partitioned manner. A clear example is the famous patient HM, who underwent a bilateral medial temporal lobe ablation in the 1950s with permanent anterograde amnesia. Despite that, implicit, independently acquired memory acquisitions continued to occur (Milner, 2005). A body of literature suggests there is, in fact, the continuous exchange between explicit and implicit learning (Berry, Shanks, Speekenbrink, & Henson, 2012; Lotze, Scheler, Tan H-R, Braun, & Birbaumer, 2003). Explicit memories include the subtypes of episodic (historical) and semantic (facts) memories, while autobiographical memory is a form of historical memory. Implicit memory includes automatic/procedural memory often used in specific skills and priming, which includes the skewing of response upon subliminal recognition. Thus, implicit memories influence episodic memory and decision making (Berkowitz, Laney, Morris, Garry, & Loftus, 2008; Cradd & Dark, 2003; Loftus, 2010). Among the many stages in the formation of explicit memories, two processes, consolidation and reconsolidation, have a particular role in the processing and reuse of previous experiences. By means of consolidation of memories, retained information is transformed into long-term memories. This process requires protein synthesis (Alberini, 2005, 2009) and long-term potentiation (LTP), at the synaptic level as well (Lynch, Rex, & Gall, 2007).10 Reconsolidation is another memory mechanism by which each memory, when recalled, is reshaped and modified according to new informational input from the time of recollection (Duvarci & Nader, 2004). Thus, the memory of past events can be modified, re-actualized, and distorted based on current (contemporary, in time) experiences. This function of memory is empirically familiar to psychotherapists. Further, reconsolidation may be the basis of the human capacity to revisit, elaborate, and change one’s awareness of the past. Each time a memory is retrieved, it is reworked through protein reconfiguration, but not with de novo protein synthesis. In summary, new memorization (Alberini, 2005, 2009, 2010; Alberini, Milekic, & Tronel, 2006) requires the participation of the hippocampus and amygdala, and it requires protein synthesis. Reconsolidation does not, however, require de novo protein synthesis. If protein synthesis is chemically blocked, no new memory can be developed, but reconsolidation (reworking) is preserved (Taubenfeld, Milekic, Monti, & Alberini, 2001). One could argue the continuous process of memorization and reconsolidation can be seen in the restless human tendency to deconstruct old forms and find new meanings (Badiou, 2011; Derrida, 1984; DiNicola, 2011, 2012). The neuroanatomical substrate for implicit and autobiographical memory A closer examination of the recent literature shows a significant separation between the anatomical activation linked to autobiographical memory in comparison to procedural memory. Neuroanatomy of implicit/procedural memory. The neuroanatomical substrate of procedural memory is linked to the striatum, the basal ganglia and the cerebellum. There are two types of procedural memory: predictive cycle learning/memory, by which skill is acquired unconsciously and perfected in time (Tadlock, 2005), and the acquisition of skills, procedural learning/memory, 8 A. NOVAC ET AL. which is a gradual conversion of a conscious, explicit memory into procedural implicit memory by extensive repetition (Fitts, 1954). The dorsal striatum has been associated with implicit acquisitions. Two separate parallel pathways allow association with other functional structures. They travel to and from the striatum and contain in their structure striatal medium spiny neurons, which contain a variety of receptors including dopamine (D1), muscarinic (M4), and adenosine (A2A) receptors. They also communicate via interneurons to other neuronal areas, creating a complex multilevel coordination of procedural learning (Kreitzer, 2009). These pathways connect to the ventral striatum (reward system), the limbic cortex with its emotional functions, and motor regions of the brain. They make up the cortico-basal ganglia-thalamus-cortical loop (Haber, Fudge, & McFarland, 2000; Parent, 1990). In addition, Heimer, Harlan, Alheid, Garcia, and de Olmos (1997) and Alheid and Heimer (1988) demonstrated that lesions in the olfactory tubercles (cortical tract) project into the substantial innominate,11 which project into the accumbens and the striatal areas of the basal ganglia (the forebrain). In turn, the latter projects back into different areas of the cortex. Heimer (2003) refers to this loop as cortico-subcortical reentrant circuits. The cerebellum is a crucial structure involved in learning. It has been known to be the main neural station in fine-tuning and correcting of movement and in motor agility related to procedural learning. Currently, however, the cerebellum is seen as a crucial component in memory function. Initial memory traces are believed to form at the level of the Purkinje cells and then expand to other areas of the cerebellum (Nagao & Kitazawa, 2008; Saywell & Taylor, 2008). The limbic system and the structures of the medial temporal lobe provide an affective and motivation component to implicit learning (Shu, Bao, Li, Chan, & Yew, 2000; Shu, Bao, Wu, Wang, & Leonard, 2003). Affective processes have a determining role in recruitment and consolidation of implicit procedural memories in IdN. Finally a variety of factors, including genetics (identical twins versus fraternal twins) (Fox, Hershberger, & Bouchard, 1996); physiological states, for example, sleep (Gais, Plihal, Wagner, & Born, 2000; Karni, Tanne, Rubenstein, Askenasy, & Sagi, 1994); outside interferences, for example, pharmacological agents (Kumari et al., 1997); and psychopathology, for example, obsessive compulsive disorder (Roth, Baribeau, Milovan, O’Connor, & Todorov, 2004), have all been shown to affect procedural learning. More recently reported fundamental changes in attitude toward life in terminally ill patients after a few sessions of psilocybin-enhanced psychotherapy (Grob et al., 2011) are likely to be secondary to a reshaping of procedural memory components. In addition, a wide variety of functions, including language production and grammar, is dependent on procedural memory (Clark & Lum, 2017). The functional anatomy associated with autobiographical memory (AM). The functional anatomy of autobiographical memory includes a variety of brain regions that are distinct from the anatomic substrate of procedural functions and IdN. AM activates brain regions characteristic for episodic memory and, to a lesser degree, areas associated with semantic memory. In addition, there are concomitant activation areas associated with emotional responses (Svoboda, Mckinnon, & Levine, 2006). In AM, twice as many coordinates on brain imaging are located in the left cerebral hemisphere. This was followed by medial and lateral areas of the amygdala, hippocampal complex, and the basal ganglia. Cerebellar activations were predominantly right sided. Svoboda et al. (2002) and Maguire (2001) found a “core” AM network comprising medial and ventrolateral prefrontal cortex, the medial and lateral temporal cortex and the temporoparietal junction, the retrosplenial area and posterior cingulate, and the cerebellum.12 By using prospectively collected autobiographical stimuli, Levine, Turner, Tisserand, and Hevenor (2004) identified a dissociation among regions related to the episodic (i.e., life events) component within AM compared to those recruited by semantic (general knowledge) component within AM. JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 9 The episodic component engaged the medial temporal, the posterior cingulate, the diencephalic regions (related to memory recovery), the right temporoparietal cortex for spatial reconstruction, and the suppression of the emotional paralimbic areas. The semantic component included the left temporoparietal and parieto-frontal regions for “egocentric” spatial recollection. The literature on brain activation in AM memory is vast and differentiates factors related to age of memories. There are additional findings of studies relevant to AM: 1) there is left lateralization of the ventrolateral PFC for strategic retrieval and verification (Fletcher & Henson, 2001; Henson, Shallice, & Dolan, 1999; Petrides, 2002); and 2) the dorsolateral PFC, the dorsal component of the anterior cingulate, and the fronto-polar cortex are recruited in memory reconstruction (Cabeza & Nyberg, 2000; Duncan & Owen, 2000; Fletcher & Henson, 2001). Thus, based on anatomic activation, the AM (memory reconstruction) is distinct from the automatic retrieval and verification of memories. In psychotherapy, unique insights are gained via reconstruction of explicit memory and are repeated throughout the therapy process, ultimately becoming procedurally mediated skills (developed through the “acquisition of skills” procedural paradigm). This process is associated primarily with the activation of the striatum, the basal ganglia, and the cerebellum. In summary, a large body of knowledge has accumulated regarding the recruitment of different brain regions in autobiographical memory activation. These findings demonstrate autobiographical memory and implicit procedural memory are distinct brain functions. The two types of memory have different brain activations as well as common areas of activity, confirming the clinically demonstrated link and interchange between these two memory functions. Different subtypes of AM (episodic, semantic components) have been identified as well as a variability in recruited brain regions, depending on retrieval of contextual details versus spatial memory and navigations (left, respectively right hippocampus) and information transfer (temporo-polar cortex) (Levine et al., 1998; Markowitsch, 1995). Thus neurologically, AM is a complex, multidimensional memory with a likely close link to implicit memory. Neuroimaging studies have also confirmed a pattern of activation during different phases of memory expression of newly learned skills (Lotze et al., 2003). As new skills are learned and perfected, the locus of maximum brain activation shifted to less extensive sub-cortical and cerebellar areas, a pattern observed in the mastery of a musical instrument by repeated practice. Dynamic systems theory and development of brain and the self Under dynamic systems theory, terms such as self-organizing, dynamic systems, and chaotic systems are used synonymously to refer to the study of complex biological systems, including the brain and underlying behavior (Stolorow, 1997; Thelen & Smith, 1994). Dynamic systems theory stands in contrast to concepts of predetermined, preprogrammed end states of development. Dynamic systems theory posits that self-organizing processes interact continuously in active living systems, in a nonlinear manner, without any particular structure. The solution emerged from relations and not from specific design. This principle applies to child-mother interaction in mutual regulation, which is continuously molded in the process of development (Beebe & Lachmann, 1988; Sander, 1985; Stolorow & Atwood, 1992). In nonlinear self-organization of the brain, information is a form of energy that plays a crucial role in the development of the brain and mind (Harold, 1986; Lewis, 1995; Schore, 1997a). Further, dynamic systems theory views attractors as semi-stable or preferred configuration for which the self-organizing activity of the system has an affinity. Attractors are transient with a different degree of stability but at times promote new adaptive forms. Seen from the point of view of dynamic systems theory, psychological processes, psychodynamics, brain development, and even changes in psychoanalysis follow the same patterns of nonlinearity (Stolorow, 1997). The implicit scripts (memory units) of IdN may function as attractors in incorporating some and not other life events into AM. Brain development has an inherent nonlinear characteristic. The brain undergoes continuous selforganization, which is characterized by the emergence and stabilization of new forms that originate 10 A. NOVAC ET AL. from the interaction of lower-order components. The end result is a specialization of different structures (Lewis, 1995; Schore, 1997a). The research of nonlinear development has drawn on elements of chaos theory. Systems that involve chaos achieve greater flexibility in performance. During times of instability, a developing system has the flexibility to select adaptive capabilities (Schore, 1997a; Thelen, 1995). Self-organizing systems are capable of generating new internal representations in response to changing environmental conditions. In dynamic physical systems, energy is the essential factor that produces change. In chaos, at the point of phase transition, systems choose between different process structures (Schore, 1997b; Schwalbe, 1991). In the case of brain development, information is a form of energy, and information includes amplitude of emotion. Such information acts toward self-organization. It is common knowledge among clinicians that infant development occurs in spurts within the interaction of attachment and states of both attunement and disengagement between infant and caregiver (Beebe & Lachmann, 1988; Tronick, 2007). These interactive processes and learning begin during fetal development. After birth, homeostatic states of caregiver and infant are open, semipermeable to regulation from others, but linked together (Hofer, 1990; Kalin, Shelton, & Lynn, 1995). There is evidence that attachment and the alternation between attunement and disengagement are also mechanisms in which the caregiver modulates changes in the infant’s arousal level and thus creates fluctuations in energy release. This was well documented by Schore (1997a) in a comprehensive review. For instance, face-to-face interactions generate the release of corticotropinreleasing factor (CRF) in the infant’s paraventricular hypothalamus, which results in the release of plasma norepinephrine and the activation of the sympathetic nervous system. This, in turn, increases oxygen consumption and energy levels and arousal in the brain. In turn, arousal and mood elevation are propagated by the ascending reticular system, which, in turn, further enhances brain activity (Foote & Morrison, 1987). The release of catecholamines also allows for imprinting of memories of certain states and perceptions (Schore, 1997a). Imprinted memories are irreversible stamps of an early experience upon the development of the nervous systems, which mediates attachment bond formation. Here, information, a form of energy, makes brain development and growth in a nonlinear process. Here are some of the sequences in brain development (Schore, 1997b): During the first six months, when energy consumption of the brain increases, the amygdala is the dominant structure activated in emotional response. By six months of age, the temporal limbic and cortical association areas become active in emotional processing. By the age of one year, the orbitoinsular and prefrontal cortex, which together with the amygdala, are activated by facial images, become prominent (Kolb & Wishaw, 1990). During this stage (approximately 12 months of age), the amygdala, the orbitoinsular region and the prefrontal cortex mediate interpersonal regulation and attachment. Regulation of mood is also provided by attachment function. By 18–24 months, the orbitofrontal cortex (OFC) becomes functional. This results in early, more consistent, self-regulatory behavior (Dawson, 1994). The OFC has been referred to as “homeostatic, self-regulating structures of the mind” (Cicchetti & Tucker, 1994; Schore, 1997a). It is at the interface of the cortex and subcortical region and has been referred to by Damasio (1994) as a “convergence zone.” It virtually connects any activity among brain, mind, and body at any given time. Once relatively mature, at 24 months of age, the OFC connects to the amygdala, the insula, the anterior cingulate, and “rostral limbic system” (Devinsky, Morrell, & Vogt, 1995). These are known regulatory brain structures. The OFC constitutes the highest structure of control of the autonomic nervous system (ANS), both sympathetic and parasympathetic. Thus, emotional regulating systems and emotional response areas (amygdala) connect to the control of the ANS, with its energy-regulating mechanisms and visceral functional roles. As we will show below, this stage of brain development also coincides with the emergence of the self around 18 months of age. The development of the hemispheres also shows a nonlinear pattern. The orbitofrontal area of the right hemisphere develops first (White, Lucas, Richards, & Purves, 1994). During the first two years of age, the right hemisphere is dominant, as most of the functions necessary for development are bonding and attachment (Henry, 1993). The right-to-right hemispheric communication has been JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 11 described as the arousal-regulating energy transmission between primary caregiver and infant. The ventromedial region of the right hemisphere (amygdala, orbitofrontal areas) remains crucially involved in face recognition and bonding throughout the life-span (Sergent, Ohta, & MacDonald, 1992). In addition, the right hemispheric ventromedial regions of regulation are closely linked to the nucleus of the solitary tract, one of the main origins of the vagal nervous system (Porges, 1995) with a broad stress adaptation and survival role throughout life. Further, the maturation of different brain areas is driven by evolutionary acquisitions. Higherorder association areas, which are also later evolutionary acquisitions, develop later in comparison to lower-order association areas. The frontal lobe develops from back to front, as the ventral portion of the frontal lobe is the latest evolutionary acquisition (Gogtay et al., 2004). Regarding the entire brain development, with age maturation, there is a gradual loss of gray matter, and in parallel, gradual acquisition of myelin in the white matter. Cerebral white matter increases in the first four decades because of ongoing axonal myelination (Bartzokis et al., 2001). Loss of gray matter starts in adolescence. The myelination process that extends into adulthood, which includes myelination and maturation of the corpus callosum may explain emotional and relational maturation characteristics for the later decades of life (Grotstein, 1988). The nonlinear development further applies to specific brain regions and structures. In a study with intrahemispheric electrode pairs placed in brains of 253 children, Thatcher (1992) demonstrated growth spurts in EEG coherence that were approximately six months to one year in duration. These were cyclical processes involving sequential lengthening of intracortical connections in the left hemispheres and a sequential contraction of intracortical connections in the right hemisphere. Each growth spurt cycle lasted two to five years and involved both rostral-caudal expansions and contractions. At the same time, a process of lateral to medial rotation took place. A nonlinear trajectory of amygdala and hippocampus development has also been revealed. Uematsu et al. (2012) demonstrated by means of morphometric MRI studies in 109 healthy individuals ranging from one month to 25 years of age, peak age of amygdalar and hippocampal volumes in preadolescents (9–11 years old). The female amygdala reached peak age about 1.5 years earlier than did the male amygdala. Both displayed rightward laterality in the hippocampus, but only males showed such rightward laterality in the amygdala. This may explain gender differences in emotional processing. Myelination in the hippocampal subicular and presubicular regions continue until adulthood. The right hemispheric human face perception also follows a nonlinear developmental pattern. The right hemispheric specialization in human face perception has been demonstrated as present since infancy, and in one study was also linked to learning letter recognition (Lochy, de Heering, & Rossion, 2017). This finding supports a link between the development of social (face) and informational (letters) input. Development of the self While the emergence of the self is generally accepted to occur around 18 months of age, this process is a result of complex nonlinear individual and interactive development. Interaction between the developing fetus and the mother’s body are continuous and constitute a form of information considered energy in nonlinear system development of brain and self. As evidenced by ultrasound studies (Ianniruberto & Tajani, 1981), the fetal activity seems to reflect the acquisition of response patterns that parallels the evolution of cerebral synaptogenesis. Mancia (1982) has referred to elements of the self in utero as an “experiential self,” a set of mental functions that can be regarded as “protofunctions” and emerge out of an undifferentiated state. The postnatal development into awareness of “another” and the “mutual regulation model,” and attunement (Beebe & Lachmann, 1988) is preceded by an entire array of developmental processes that also occur in an interactive manner. Stern (1985) has referred to similar processes of consciousness as “perceptive amodality,” and the term “bodily self” was used by Jacobson (1974), Gaddini (1982), and Mancia (1982). 12 A. NOVAC ET AL. Human ontogenesis includes early motor sensory autonomic and integrative functions in utero (Mancia, 1989). This includes prolonged periods of active sleep (similar to REM sleep), which is linked to learning processes (Curzi-Dascalova et al., 1993; Li, Ma, Yang, & Gan, 2017; Okai, Kozuman, Shinozuka, Kuwabara, & Mizuno, 1992; Scher, Johnson, & Holditch-Davis, 2005). The periods of active sleep suggest the fetus is gradually acquiring implicit knowledge about the environment. Ultrasound studies further evidenced the motor-development that reaches well-coordinated movements between the 10th and 20th weeks of gestation (Milani-Comparetti, 1981). Initially, movements are sporadic and reactive and eventually become integrated, coordinated, and aim-oriented (TimorTritsch, Hertz, & Rosen, 1976). Recordings of fetal monitoring have revealed bending and stretching; exertion of pressure on the wall of the uterus; turning of the head; twists, yawns, and scratches of the body; and sucking of the thumb and reflex motor responses to somesthesic, auditory, vestibular, acoustic, and visual stimulations (Piontelli, 1987). These are early signs of interaction with the immediate intrauterine environment and a derived learning process with the development of response patterns. Ocular movements begin between the 28th and 30th weeks of gestation and seem to be associated with rapid nystagmiform movements related to REM-type active sleep (Mancia, 1981, 1982). Further, the sensorimotor interaction between mother and fetus develop. Through this, respiratory, cardiocirculatory, gastrointestinal, and endocrine systems of the fetus coordinate with maternal functions. Further, the fetus’s response to the mother’s voice and to external stimuli becomes noticeable. Maternal-fetal interaction is characterized by a relative constancy and rhythmicity of response to stimuli (Rascovsky, 1977). The newborn baby has the ability to transfer information from one sensory system to another. This capacity, referred to as “amodal perception” (Stern, 1985), is crucial for interactions with caregivers from the moment of birth. Affective responses in the postpartum period have at least some roots in prenatal capacity. This is suggested by the fact that a fetus has the capacity to experience certain affective reactions, as recognized, for example, from facial expressions after exposed to sweet or bitter substances in the amniotic fluid. Prolonged REM sleep in utero during the last few weeks of gestation, probably due to reticular nuclei (formation reticularis pontis), may be related to early learning processes. In this regard, the reticular nuclei are known to mature very early and known to control cardiocirculatory, respiratory functions, and REM sleep; guide ocular movements and posture; organize patterns of movement; and may influence the synaptogenic activity of the cortex. Yet some hereditary REM sleep and ocular movement patterns have also been revealed (Valatx, 1977). There is continuous learning of body sensation and stimulation, as familiarity with intrauterine stimuli has been revealed after birth (DeCasper & Fifer, 1980). Emde (1983) and Stern (1985) have proposed the presence of a pre-representational self that has a continuity of affective experience (which they refer to as “the affective nucleus”), related mainly to pleasure and displeasure. Based on the wealth of experimental findings, Mancia (1989) concluded the acquisition of numerous functions, including REM (and learning), allows the fetus access to “amodal” perception and memory, which is transformed into different internal sensations of pleasure and displeasure. From here on, self-awareness is a process that also develops in a nonlinear fashion but culminates with full integration at approximately 4–5 years of age (Bertenthal & Fisher, 1978; Goffman, 1959; Kagan, 1984; Lewis, 1992; Lewis & Brooks-Gunn, 1979; Rochat, 2003; Rochat & Striano, 1999).13 Rochat (2003) summarized the gradual, step-wise additions in self-awareness. Immediately at birth, infants are able to have a sense of their own body as a different entity from the environment. At the end of the second month, infants not only have a sense of self-world differentiation but also a sense of how their body is situated in relation to other elements of the environment. By 4 months old, infants become “touch all” as they have systematic hand-eye coordination (Rochat, Goubet, & Senders, 1999). During these stages, infants have an “implicit” self-awareness. At about 18 months, infants reach for specific marks on their own bodies to remove them. This was demonstrated by the “Post-It” experiment where the infant sees, in the mirror, the Post-It stuck to his/her forehead and reaches to remove it (Bertenthal & Fisher, 1978). After being able to identify “Me” in the mirror at 18 months, infants continue to oscillate between seeing their image as a first person JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 13 versus a third person. This was described by Piaget (1962) as he observed his own daughter, Jacqueline, age 23 months, who referred to herself in a photograph, sometimes as “Me” and other times as “Jacqueline.” In conclusion, while a full account of the numerous tests regarding the birth of the self at around 18 months is beyond the scope of this article, the above-described contributions support a pre- and postnatal contiguous process of development that follows features of dynamic systems and chaos theory (Schwalbe, 1991). The birth of the “Me” and self-awareness constitute the basis of autobiographical memory. Neurobiology of the self and narrative functions Damasio (2010) has summarized his own previous contributions and those of other investigators about the organization of self. The self has been classified into three major levels: (1) The proto-self, which represents the neural aspects of mental life, localized mainly in the brain stem. Similar to what Panksepp (1998a, 1998b) previously concluded based on animal studies, the proto-self constitutes the origins of “drives.” Damasio refers to the proto-self as the embodiment of the self. (2) The core self, which includes elaborate feelings and emotional reactions, engages with the outside world or its objects (as in “object relations”). This aspect of the self has been traced to midline brain structures and includes the processing of emotions (Panksepp & Northoff, 2009). (3) The autobiographical self includes the encoding of events in a person’s life in a specific sequence. The individual sequencing of autobiographical memory provides time-specific relevance to memory, a function attributed to the medial prefrontal cortex. Neuronatomically, all three levels of the self are traced to extensive midline brain structures (Craig, 2002, 2003; Damasio, 1999; Denton, 2006; Holstege, Bandler, & Saper, 1996; Panksepp, 1998a, 1998b, 2003, 2005a, 2005b; Parvizi & Damasio, 2001; Strehler, 1991). In animal studies, these midline areas have been referred to as the subcortical-cortical midline structures (SCMS), described in theoretical contributions (Panksepp, 1998b; Panksepp & Northoff, 2009; Qin & Northoff, 2011); similar areas are included in the neuroimaging-derived concept of the default system (“mode”) (Raichle et al., 2001). The latter refers to the activation of midline brain structures evidenced by functional neuroimaging during a state of relative mental inactivity. The default mode deactivates during states of brain activity. Finally, a network of neurons that are highly interconnected and distinguished from lower order neurons has been described in the human brain. This network, also referred to as “rich-club” neurons, may constitute part of an anatomical basis for procedural narratives (Colizza, Flammini, Serrano, & Vespignani, 2006). In summary, independent animal studies, human neuroimaging findings, and theoretical contributions have all pointed to a brain midline location associated with emotional processing, baseline functions of the self, and, hence, individual identity. Discussion Reshaping of the identity narrative in child, adolescent and adult From an evolutionary perspective, the main task of mental activity is to facilitate survival and meet our needs in the world (Panksepp, 1998b; Solms, 2018). In this sense, numerous events interact with and reshape autobiographical and identity narratives throughout an individual’s lifespan.14 The precise mechanism by which IdN is modified, as a result of life experiences, remains unclear. However, as we will see below, IdN formation includes both a primary nonlinear process, that is, predictive cycle paradigm and characteristic of infancy, and a secondary process of memory, that is, 14 A. NOVAC ET AL. acquisition of skills paradigm, which includes language. Below we examine five instances that have been associated with human change. The language brain, attachment and IdN A large body of literature points to the functional relationship between attachment and the molding of reactivity to the environment throughout development. In animals, maternal absence from the nest increases cortical desynchrony in pup rats (Sarro, Wilson, & Sullivan, 2014). Maternal presence produces amygdalar deactivation (equivalent to what is seen in human down-regulation of emotions) in pups (Moriceau & Sullivan, 2006). In rats, social relationships have been demonstrated to create stress buffering via the HPA axis (Hostinar, Sullivan, & Gunnar, 2014; Shionoya, Moriceau, Bradstock, & Sullivan, 2007). Learning processes in rats are part of the acquired attachment patterns, which occur via the olfactory system and arise within a developmental schedule (Sullivan, Landers, Yeaman, & Wilson, 2000), highly suggesting a contribution to enduring personality features. Such learning creates enduring individualized behavioral patterns and, hence, an animal model for the development of IdN. In humans, the study of attachment, by means of the adult attachment interview (AAI), relies on eliciting composite memories, parts of autobiographical memory, and earlier life narratives (Hesse, Main, Abrams, & Rifkin, 2003). This is accomplished by analyzing the coherence and cooperation of speech and communication patterns, which have been shown to be accurate markers of attachment. For instance, unresolved/disorganized attachment (U/d) produces speech that becomes temporarily disorganized and disoriented in discourse or reasoning while recollecting traumatic events. Such lapses in monitoring have been described as speech equivalents of dissociations.15 Included below are further details of the functional brain anatomy of language. In previous contributions, we reviewed the extensive, bilateral brain projections of language function and their relationship to attachment (Novac & Bota, 2013; Novac, Tuttle, Bota, Yau, & Blinder, 2017). We further summarized the numerous contributions in the area of language brain (Anderson et al., 1999; Gandour et al., 2003, 2000; Gandour, Wong, & Hutchins, 1998; Gandour et al., 2002; Hickok & Poppel, 2004, 2007; Indefrey & Levelt, 2004; Klein, Zatorre, Milner, & Zhao, 2001; Wong, Parsons, Martinez, & Diehl, 2004; Wong, Perrachione, & Parrish, 2007; Xu et al., 2006; Zatorre, Evans, & Meyer, 1994; Zatorre, Evans, Meyer, & Gjedde, 1992) (see Figure 3) and propose the designation of a communication beltway of brain activation (Novac & Bota, 2013) (see Figure 4).16 Midline brain structures (the equivalent of the “default mode”) associated with the function of the self, and lateral regions of the language brain (the “communication beltway”) may, in fact, create an extended connectivity network that becomes active in memory and emotional processing (Novac & Bota, 2013). These findings show attachment, language, the creation of meaning, and identity in reference to others (via attachment) are all deeply linked to early experiences. In turn, communication functions are molded by the development of reactivity to the environment, which facilitates attachment and adult interpersonal patterns, all of which are implicitly based memory functions. In this sense, they are all relevant in the reshaping of IdN. Traumatic stress Traumatic stress is one area in which changes of IdN are among the most observable. Adverse life events and trauma have a disruptive effect on a person’s narratives. Traumatic events result in hyper-consolidated traumatic memories. Such hyper-consolidation has an evolutionary role in danger recall as a survival mechanism (Cahill & McGaugh, 1995; Davis, Walker, & Lee, 1997; Dębiec, Bush, & LeDoux, 2011; Kensinger & Schacter, 2006). Traumatic memories become default implicit memories and are the first to be recalled. Neurobiologically, this is a byproduct of stressrelated hypersecretion of catecholamines, which have a memory-consolidating effect (McGaugh, 1983). This results in a premature fixation of traumatic memories that are unprocessed. These memories also have a high emotional valence and tend to be reactivated beyond an individual’s JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 15 Figure 3. Source: (Anderson et al., 1999) (reprinted with permission). Functional neuroimaging of extensive bilateral cortical activations of language brain during interactive speech. We proposed the term “communication beltway.” (This contrasts to midline structure activation, the “Default Mode” associated with structures of the self, which remain active during reflective and rest states. Repeated alternation in activation between these two patterns, may stimulate new circuitry for procedural learning and changes in IdN, associated with long-term psychotherapy: The implicit re-routing hypothesis.) control. In turn, spontaneous and retriggered memories of the trauma reactivate the catecholamine system. This leads to further hyper-consolidation of the same traumatic memories (Cahill et al., 1996), which explains the re-experiencing (e.g., uncontrolled obsessive recollection, nightmares) of traumatic events, one of the most painful symptoms in individuals with posttraumatic stress disorder (PTSD). Neurobiologically, traumatic re-experiencing is accompanied by a right hemispheric dominance and increased activation of the subcortical areas (striatum, basal ganglia), which explains the implicit quality of traumatic re-experiencing (Rauch, Shin, & Pitman, 1998). Right-sided hemispheric hyper-consolidation of traumatic memories and right-sided dominance lead to nonverbal, emotive, and motoric sensations. Due to a relatively low activity of the left-sided brain regions charged with discrimination (Frewen et al., 2008; Levin, Lazrove, & van der Kolk, 1999), traumatized brains react to re-triggering reminders of trauma as if the past trauma is occurring in the present. For individuals with PTSD, the traumatic narrative dominates the IdN. 16 A. NOVAC ET AL. Figure 4. Schematic presentation of communication beltway. Childhood and adult play Play has been described as a proto-emotion (Panksepp, 1998a; Panksepp & Biven, 2012; Panksepp & Northoff, 2009) that emanates from the “core self,” which seems to originate in the animal brain stem. It transcends species, and by means of interactive play with parents and peers, young animals acquire and practice new life skills (Brown & Vaughan, 2009). Play also models social hierarchies as well as in-group and out-group boundary maintenance (Solms, 2018). Creative pursuits may have similar evolutionary roles as play (Novac, 2011). In essence, play may reshape IdN throughout life. Life experience Like play, exposure to real life also promotes adaptation and survival. Unlike play, exposure to reallife adversity can also potentially threaten existence. To survive in the long run, humans have an inherent biological need for peace of mind. The need for early optimal environments to create the sense of stability (which contributes to long-term peace of mind) has been previously documented in the psychoanalytical literature (Hartmann, 1958; Winnicott/Ed. by Caldwell; Winnicott, 2011). Psychological repair is, in fact, a process by which humans naturally tend to gravitate toward peace of mind. Such peace of mind may have an evolutionary value because it supports a desire to live and procreate. This is accomplished in part by the acquisition of narratives (stories) about life from one generation to another (Wang & Fivush, 2005) and a reshaping of self-awareness. Thus, human development is accomplished by the internalization of external events through social experience (see Figure 1). Life experience also has an adaptive role in predicting danger and, thus, has a survival role. This brings the reshaping of narratives into the realm of a fundamental adaptive and evolutionary role. One instance where this is noticed is in the way humans recollect events. Awareness of the environment gravitates between two poles of adaptation: On the one hand, it is the preferential recollection of danger for future survival. This is exemplified by the fact that traumatic memories are the first to be recollected in the form of intrusive memory. This provides an early mechanism for physical escape from danger and thus physical survival. At the opposite end is the ability to distort reality by means of an adaptive narrative to survive emotional torment, a form of JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 17 psychological survival. In fact, a large body of literature supports the continuous reshaping of memory according to emotional content. This includes defense mechanism, distortions, and the creation of rumors as part of a drive of social preservation (Freud, 1937, 1993; Berkowitz et al., 2008; DiFonzo et al., 1994; Mazzoni, Loftus, & Kirsch, 2001; van Es, 2002). Seen in the context of psychopathology, IdN is of particular significance in the study of ego-defense mechanisms. By doing so, an individual develops a sense of control, self-worth, and competence (Baumeister & Newman, 1994). Memory consolidation is influenced by the emotional gradients and associated activation of the catecholamine system (Parker, Cahill, & McGaugh, 2006). Such activation during a specific experience is favorable to the memory retention of that event into the identity narrative.17 In addition, reconsolidation is a mechanism by which a memory is continuously reshaped according to present experiences. By virtue of its preferential replay, IdN may influence personal traits and pervasive behavioral patterns. The field of behavioral epigenetics (Weaver et al., 2004) has examined how repeated exposures to psychological environments and life experiences produce neurobiological changes by activating or deactivating certain sequences of DNA. Early life trauma has been associated with a large meta-analysis study with a polygenic risk for depression (Peyrot et al., 2017). Psychotherapy Psychotherapy has evolved from ancient shamanic, religious (e.g., confession, dream interpretation), and social practices. Since it is evolutionarily, it uses pre-existing pathways of adaptation and change. In this sense, IdN can be gradually enriched with new health-promoting experiences and events. The discrepancy between historical truth and personal narrative truth has been previously covered (Eagle, 1984; Shengold, 1985; Spence, 1983, 1989). The discrepancy becomes particularly significant in the progress of psychotherapy, with different competing narratives evolving (Spence, 1983). In psychotherapy, a new narrative “truth” is created which overrides the trauma identity of an individual. In this way, the discrepancy between the historical truth (the trauma) and the new narrative truth (rebuilt IdN) provides one aspect of healing over time. In essence, the curative effect of psychotherapy is ultimately a change in autobiographical narrative with a necessary, more profound reshaping of the IdN18 (Kilgard, 2012; Quirk, 2002; Schiller et al., 2008).19 One of the most poignant instances of narrative change is the process of trauma recovery during prolonged exposure psychotherapy. Patients are instructed to verbalize their traumatic events. Through numerous repetitions of describing the trauma, the memories are processed with a progressive dissipation of the emotional pain (Foa, Hembree, & Rothbaum, 2007; Rothbaum, Foa, & Hembree, 2007). In essence, implicit scripts with high emotional valence undergo a neutralizing process and are integrated into a person’s IdN, emerging as functional parts of autobiographical memory. This is consistent with a literature that proposes a variety of brain changes that occur in the process of psychotherapy, including psychological defense mechanisms (Blinder, 2007; Etkin, Pittenger, Polan, & Kandel, 2005; Pally, 2000) and processing of experiences (Novac, 2008; Novac & Bota, 2013). Psychotherapy is, therefore, a model through which new narratives become part of a person’s IdN. We hypothesize that the alternation in activation between the default mode (midline structures) of the brain (previously associated with self) and the language brain creates a platform that encodes crucial components of IdN throughout life. The implicit rerouting and cumulative transformation hypothesis Procedural learning has been classified into two different subtypes: a “predictive cycle” procedural learning (Tadlock, 2005) in which the skill is acquired unconsciously, including an initial attempt, failing, and retesting by practice until gradually mistakes are eliminated, and an “acquisition of skills, which starts with a conscious, explicit, declarative phase that is practiced and becomes procedural in time (Fitts, 1954). 18 A. NOVAC ET AL. We are proposing IdN, as a form of implicit/procedural memory, arises through two separate pathways: a bottom-up mechanism, which includes a “predictive cycle” procedural model, and a topdown mechanism, which includes the “acquisition of skills,” used predominantly after language acquisition. The bottom-up mechanism includes early, nonverbal development of IdN through a predictive cycle of learning. It is relevant to the “mutual regulation model” (MRM) described by Tronick (1980, 1982, 2007) and the Boston Process of Change Study Group (Beebe & Lachmann, 1988). In examining frame-by-frame video recording of mother-infant interactions, states of matching (attunement and synchrony) are interspersed with “mismatching” (emotional nonattunement) and states of repair (re-establishment of emotional connection). The study also revealed that during 70 percent of interaction time, mother and child are in a “mismatched” state. Thus, most of the MRM comprises learning how to return to a matching state, hence the similarity to the predictive cycle model described by Tadlock (2005) in the procedural learning literature. The top-down mechanism includes the formation of IdN after language development and throughout adult life. The predominant model of procedural learning is “acquisition of skills” (Fitts, 1954). Many explicit experiences can be transformed into implicit memory as part of IdN and thus anchored into AM. However, both predictive cycle and acquisition of skills may persist throughout life in regulating IdN. Narrative rerouting and reshaping may be further accomplished for the top-down mechanism in a variety of manners (Novac, Bota, & Blinder, 2017; Novac, Tuttle, Bota, Yau, & Blinder, 2017), including: ● A paradigm shift in narrative is the acquisition of sudden, new insights and knowledge as it occurs in the “Eureka” or “Aha!” moment. ● The corrective emotional experience, that is, life events with high emotional valence and that provide significance, has a lasting effect on memory and is known to promote personal change (Alexander, 1963). ● Through repetition and practice throughout life, a number of new memories become part of implicit scripts (see Figure 2). Formalized education leads to both acquisition of skills and longlasting changes in attitude, self-awareness, and even behavior, most likely by creating new implicit scripts, reshaping IdN. ● Prolonged exposure: Long-term relationships with people, groups (facilitated likely by mirroring), and places lead to a gradual incorporation of experiences as implicit and explicit memories into the IdN and autobiography. Figure 2 illustrates the relationship among autobiographical memory, IdN, and implicit scripts. Sometimes evocation of a sensory memory (e.g., taste, smell), an explicit memory, may activate an implicit script which triggers an entire sequence of AM (Novac, Tuttle, Bota, Yau, & Blinder, 2017). The rerouting and transformation hypothesis is consistent with neurobiological findings. High emotional valence and catecholamine system activation may also occur in intense emotional experience without trauma. An inverted U-shaped pattern of catecholamine-related memory consolidation exists. At low and high levels of norepinephrine activity, there is a negative interference (suboptimal) with memory storage. Within a midrange level of adrenergic activation, a linear relationship between emotional valence and memory storage exists (McGaugh, 1989; McGaugh, Weinberger, Lynch, & Granger, 1985; Sapolsky, 2015), possibly favoring memory retention of a life event into the IdN.20 Experience and skills adaptively developed, practiced, or retained through an emotionally laden experience become IdN. In addition, emotional valence may be one of the recruiting mechanisms for IdN. Such experiences are perceived as “owned” (they are part of autobiography) as they become IdN. Depending on the degree of emotional valence, some life experiences become part of the autobiography while others are retained as routine episodic memories. In other contributions, composite memories are described as concomitantly holding cognitive, affective, and behavioral JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 19 information (Novac & Bota, 2014). Such memories, through their emotional valence, can also become part of implicit scripts. Sometimes the experiences of others (through their emotional intensity) can be incorporated into IdN (Brown & Lee, 2010). Finally, through reconsolidation, memories are reshaped according to the state of mind experienced each time they are recalled. As part of the IdN, implicit scripts (units of implicit memory) also have a biasing effect on explicit memory and the decision-making process. In conclusion, as illustrated in Figure 2, the cumulative transformation in a person’s IdN occurs by a variety of mechanisms that have a final modifying effect on autobiography (including auto-noetic consciousness), hence, the designation of implicit rerouting. Implications for child and adolescent psychotherapy The concept of identity narrative serves as a working model for providing a change in psychotherapy. This article acknowledges lasting transformation is accomplished through changes in implicit memory function. Such transformation may include a variety of variables, such as behavior, reactivity to stress, attachment, and self-regulation. Changes in such variables can be lasting only if implicit (unconscious) functions are consolidated, as indicated in both the psychological and neurobiological literature. Regardless of the nature of psychopathology, such consolidation requires specific guidelines in the treatment of children and adolescents: (1) Psychotherapy has to be sufficiently prolonged to follow the “prolonged exposure” rule for modifying IdN and autobiography. In addition, prolonged therapeutic interaction allows for the emergence of new implicit scripts as part of the therapist-patient relationship. Such scripts are played out in transference and counter-transference, which all have to consolidate effects on the implicit memory. (2) Psychotherapy has to involve affective mobilization of a client or patient, which follows our proposition of “high emotional valence” as a vehicle in implicit memory consolidation. In general, when covering a history of trauma, such high emotional valence is almost always present. (3) Reshaping of personal identity narratives happens gradually. At times throughout psychotherapy, the therapist has to take stock of how much a patient has grown. It is the deep persistence in IdN change, not just a temporary, expressed change in autobiography, that will account for progress. One would be wary of rapid artificial growth as “pseudoinsights,” masked resistance to treatment. Such states are sometimes difficult to ascertain, especially with adolescents. (4) Paradigm shifts in understanding and implicit emotional reactions do occur throughout psychotherapy. With children and adolescents, one should always remember the affiliative need and evolutionary component of social affiliation. It is here that conjoint sessions and expansion of therapy may heavily influence the reshaping of identity narratives. (5) Given lasting changes are related to implicit (unconscious) storing and transformation in identity narrative and autobiography, one needs to keep in mind the neurobiology and brain circuitry of memory. In some cases, symptomatic individuals will require a restoration of their normal neurotransmitter circuitry via pharmacological interventions before their ability to modify identity narratives is restored. Conclusions History and life experiences shape personal narratives and, in turn, personal narratives mediate autobiographical reshaping, which is evolutionarily adaptive. In this contribution we argue autobiographical memory is built on a platform of preverbal implicit memory, the IdN (a form of the unconscious), which is encoded early and rapidly into the underlying brain structures of the self and A. NOVAC ET AL. 20 constitute a scaffolding for the gradual “uploading” of the autobiographical self. IdN may be part of an underlying structural network, which includes connectivities between brain midline structures and the lateral language brain (“communication beltway”). IdN is a building block of personality and identity and has a stabilizing effect on the autobiography. The exchange between IdN and the autobiographical self continues throughout life. IdN is governed by the same socially interactive paradigms as autobiographical memory (Nelson & Fivush, 2004; Siegel, 1999, 2010). The submitted theory of implicit rerouting refers to an internal organization of implicit and explicit memories linked to and reshaped by social interactions throughout life. This is only possible because a large neural network is prepared to process and encode narratives. Such a network would developmentally and evolutionarily precede the encoding of explicit memories and human language. In this sense, a set of highly interconnected higherorder neurons, referred to as “rich-club” neurons, have been identified (Colizza et al., 2006). This may be consistent with the classical concepts of “universal grammar” and the theory of language acquisition (Chomsky, 1965).21 In essence, individual growth and development regarding language, personal (autobiographical) memory, and attachment occur simultaneously and parallel the development of identity narratives. These human attributes seem to have a deep evolutionary significance. This is accomplished by creating continuity and stability through defining the self through identity narratives and allowing for the ability to reshape and repair narratives after trauma; attachment and mood regulation, which are positive predictors of social bonding and altruism (Pfaff & Sherman, 2015); and self-awareness of continuity. They all contribute to maintaining social affiliations, which have a high biological value. Ultimately, implicit rerouting and IdN reshaping have a fundamental survival function by allowing the creation of real-world social networks in which humans can survive and strive. Notes 1. In circumstances where a developing individual is exposed to abusive unnatural relationships, it skews that initially uploaded set of implicit values. 2. All philosophy and social commentary has used history for the purposes of prediction and meaning making. Personalities including Aristotle, St. Augustine, Rousseau, Freud, Marx, Spengler, and Benjamin Franklin have reread history to gain insight about human nature. History has inspired the enlightenment and renaissance of a new reality for humanity, but history can also be misused to justify aggression and human suffering. Regardless of the purpose, history is incorporated into identity narrative, allowing for deep convictions which often blinds people to moral imperatives. 3. Declarative (explicit) memories are episodic and semantic. Nondeclarative (implicit), outside the conscious awareness are classified into procedural and priming. 4. The timeline may be part of an implicit organization of IdN. 5. European-Americans have a shorter amnestic period compared to Asian-Americans. 6. Cognitive self develops at approximately the first 24 months of age. 7. More elaborate exchange about the events leads to more recall. 8. We propose that among the multitude of life events, some become part of autobiographical memory as they are incorporated in IdN, “ego-ped,” memories, while others are encoded as simple episodic memories, “ego-fugue.” 9. Stern has referred to such acquisition as RIGS (Representations of Interactions that have been Generalized) (Stern, 2000). 10. More recently, both long-term memory storage and its underlying synaptic plasticity have been found to be mediated by a prion-like transregulational regulator, the CPEB3 (cytoplasmic polyadenylation element-binding protein) (Fioriti et al., 2015). 11. The substantia innominata includes the nucleus of Meynert and the Sanides Islands, which are rich in cholinergic and other neurotransmitter neurons. They constitute a neurochemical reserve material for cellular changes related to learning processes, including implicit learning (Yun Shu et al., 2003). 12. Other areas were designated as a “secondary” network comprising the dorsolateral prefrontal cortex, superior lateral and medial corteces (B6), the anterior cingulate, medial orbitofrontal, temporo-polar, occipital corteces, the thalamus, and amygdala. 13. Rochat (2003) describes five phases of acquisition of self-consciousness: confusion (the infant is oblivious to her mirror reflection); differentiation (baby notices in the mirror one’s felt movements); situation (the noticed self- JOURNAL OF INFANT, CHILD, AND ADOLESCENT PSYCHOTHERAPY 14. 15. 16. 17. 18. 19. 20. 21. 21 image in the mirror is further explored with numerous movements of one’s self); identification (when there is a perception of “me” in the mirror); permanence (when self is identified beyond the reflection in the mirror); and self-consciousness or “meta” self-awareness (when the image is perceived also from a third-person perspective, i.e., how she presents to someone else.) Clinical experience may suggest that, in Winnicott’s term an “average expectable environment” (Ed. by Caldwell & Joyce, 2011) is necessary in adults to create an optimum nonthreatening living environment in a pluralistic society that promotes the personal evolution of IdN. The adult attachment interview uses as a benchmark the four linguistic maxims of Grice (1975) for optimal interactive speech: balanced in quality (present evidence), quantity (be succinct), relations (relevant to topic), and manner (be clear and ordered). For instance, in adults, minimal or no violations of Grice’s maxims predicts secure attachment. Specific violations of Grice’s maxims have been quantitatively determined for subtypes of insecure attachment, for example, dismissive, angry/preoccupied, disorganized/disoriented (Hesse & Main, 2000; Hesse et al., 2003; Main, 1991; Steele, Steele, & Fonagy, 1996; van Ijzendoorn, 1995). The term “communication beltway” mirrors terms such as “core,” “belt,” and “parabelt,” describing the neural activity of tone perception in the auditory cortex (Burton, Firszt, Holden, Agato, & Uchanski, 2012). A recent study demonstrated that traumatic experience in rats prior to the formation of contextual memories resulted in subsequent long-term aversion, anxiety, and cortisol and glucocortical receptor changes. This constitutes a model for implicit memories, albeit of a traumatic nature (Poulos et al., 2014). In the management of patients with trauma, most treatment modalities for PTSD seek a reduction of psychological pain by reshaping the IdN and providing mood regulation. Processing traumatic memories modifies identity narratives to allow for a safer, hypo-symptomatic IdN. The old information is still stored and could be reactivated during states of regression, as demonstrated by clinical experience (Novac, 1986). A recent study demonstrated that traumatic experience in rats prior to the formation of contextual memories resulted in subsequent long-term aversion, anxiety, cortisol and glucocortical receptor changes. This constitutes a model for implicit memories, albeit of a traumatic nature (Poulos et al., 2014). The deeper structures of language as described in linguistic theory are linked to the development of psychological defenses which allow for negation, turning a meaning into an opposite meaning, and creative manipulation, which beyond their survival value also bring about new possibilities of action and development. Disclosure statement No potential conflict of interest was reported by the authors. References Abbott, H. (2002). The Cambridge introduction to narrative. Cambridge, England: Cambridge University Press. Adler, J., Wagner, J., & McAdams, D. (2007). Personality and the coherence of psychotherapy narratives. 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