Prof. Joseph Levine

Senior Psychiatrist

Mar

23

2024

Conversation 47: Understanding the post-traumatic syndrome through the Sensitivity Channels and the internalized characters of the individual

By Prof. Levine & Dr. Salganik

Greetings

Below we will detail the model we propose for "Self". First we note that in our model the self includes most of the components of the human soul. The model distinguishes between the "primary self", or the "initial self" which is in fact the basic biological core consisting of a number of innate structures and subject to further development during life, this self includes the emotional and cognitive instinctive parts of the person. A special structure whose characteristics are fed by the cognitive and emotional parts of the primary self is that of the six "channels of sensitivity" of the individual that are related to: status, norms, attachment to others, threat, routine, and energy level. The exact structure of the primary self and the relationship between its parts still requires clarification and it seems that the channels of sensitivity are structures whose instinctive emotional and cognitive characteristics and more are found in the reserves of the primary self.

Based on the structures of the primary self, using its memory stores and abilities, cognition, emotion and more, develops an epistructure of the "social self" [consisting of "secondary selves"], which is a structure that develops during the person's exposure to social influence, and consists of the internalization of characters that are significant to a person, originating from external groups or imaginary groups (related, for example, to a story, myth, movie, etc.) that greatly influenced the person. It is possible that it can also include the personification of objects and agencies that are extremely important to a person.

We will note here that parts of the self are conscious while other parts can be unconscious.

A schematic illustration of the structure of the self that makes up most of the mental matrix,

See the epistructure of the social self the channels of sensitivity [belonging to the primary self]

whose cognitive, emotional and other characteristics are intertwined in the primary self. The Reference groups are mainly groups in the external reality influencing the individual. The subculture group is internalized in the directorate of internal figures as a schematic figure, the reflective self is also part of the social self enabling mentalization and self reflection.

Below we will discuss the structure of the social self: it consists of "secondary selves" included in the structure above that of the "social self" The following are their types:

1) the variety of representations of the "Me" that originate from attitudes and feelings towards the self and its representations in different periods of life

2] representations of internalized characters that often originate from the significant characters that the person was exposed to during his life, but as mentioned there may also be imaginary characters represented in books, movies, etc. that had a great impact on the person.

3] internalized representations of "subculture" [subculture refers to social influences in the environment in which the person lives and are not necessarily related to a particular person].

We call the social self metaphorically the "directorate of characters" or more precisely the "director of internalized characters", or the "council of characters". We note that in this internalized board of directors

there is usually a hierarchy in which there are more influential and dominant figures that we metaphorically called "the dictator selves" or "the internal dictators" and these set the tone and even censor and determine which contents, positions and behaviors cannot be included in the council of figures.

We note that the person as a whole is not usually aware of the influence of the internalized characters' board and recognizes its influence as arising from his own desires and attitudes. We will also note that, as a general rule, the board is very dynamic and there are constant struggles and power relations between the internalized characters that make it up regarding the positions they will express, with the internal dictator or dictators usually dictating the tone and managing internalized characters. This is how you can internalize various external characters that influence the person, but we emphasize that usually the most important internalization is that of what we called the "dictator self". Here it is about internalizing a character that has a great influence and shapes the person for good and/or bad, that has a great influence on the panel of internal characters that build the social self.

We assume this internal dictator to play a decisive role and a profound influence on the internalization of external figures [or in the professional parlance external objects]. The dictator's attitudes play a central role in making decisions about internalizing a character. He decides whether to reject the internalization or, if accepted, in what form it will be internalized. In other words, we assume that this influential figure is also a form of internal censorship. It should be emphasized that we are not talking about or raising concrete hypotheses about the presence of internalized figures in the inner world of the individual as a kind of "little people inside the brain", but rather in their representation in different brain areas whose nature and manner of representation in the brain still require further research.

We will also note that although we call this figure a "dictator", with the exception of a certain type, its characteristics are not the same as those of a dictatorial ruler in a certain country, but rather that this figure is dominant and influential among the internalized characters.

This model holds that the social self consists of "internalized key figures [commonly human], usually referring to the significant people in a person's life who have played a central role in shaping the individual's beliefs, values, and self-concept. These figures may include family members, friends, mentors, teachers or any other influential person who left a lasting mark on the person's psyche. Sometimes, these will also include historical, literary and other figures who left a noticeable mark on the person and were internalized by him.

The term "internalized" implies that the influence of these key figures has been absorbed and integrated into the individual's thoughts, attitudes, and behaviors. This internalization occurs through a process of observing, interacting with, and learning from these important people. As a result, the individual may adopt certain values, perspectives, and approaches to life that mirror those of the influential figures. These internalized figures can serve as guiding forces in decision-making, moral thinking and emotional regulation. Positive influences can contribute to a person's well-being, security and resilience, while negative influences can lead to internal conflicts or challenges in personal development. Recognizing and understanding the influence of internalized human key figures is essential to self-awareness and personal growth.

It allows people to evaluate the values they hold, question assumptions, and make informed decisions about the kind of person they want to be. In addition, the awareness of these internalized influences can contribute to building healthier relationships and fostering positive relationships with others. We note that there is an interaction and mutual influence between the special structure of the individual's sensitivity channels and the epistructure of the internalized figures so that the dominant figures in the management of internalized figures are both affected by and also influence the expression of the individual's sensitivity channels, and we suggest that an explanation for various aspects, disorders or mental pathologies can involve in so doing.

Thus sensitivity channels influence the internalization of characters and even the creation of the dictatorial self. We also suggest that the censorship of the dictator self is fed by channels of sensitivity. As mentioned, the social self is a structure above the primary self while the storage of the characters and their positions exist within the primary self.

As a general rule, we note that in evolutionary processes, when something else develops, it usually develops on the background and from an older existing base. And so the social self as mentioned, is epistructural because their basic characteristics are stored in the primary self.

We will now briefly recall what characterizes post-traumatic syndrome:

Post-traumatic stress disorder (PTSD) is a mental condition induced by a threatening and frightening event – whether experienced or witnessed. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Most people who go through traumatic events may experience temporary difficulty adjusting and coping, but with time and good self-care, they usually get better. If the symptoms get worse, last for months or even years, and interfere with your daily functioning, it may be PTSD.

Getting effective treatment after PTSD symptoms develop can be critical to reducing symptoms and improving functioning.

Symptoms of PTSD may begin within a month of the traumatic event, but sometimes the symptoms may not appear until years after the event. These symptoms cause significant problems and difficulties in social situations or at work and in relationships.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional responses. Symptoms can change over time or vary from person to person.

Intrusive memories

Symptoms of intrusive memories may include:

• Recurring and unwanted disturbing memories of the traumatic event

• A renewed experience of the traumatic event as if it were happening again (flashbacks)

• Disturbing dreams or nightmares about the traumatic event

• Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Avoidance

Withdrawal symptoms may include:

• Attempts to avoid thinking or talking about the traumatic event

• Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

• Negative thoughts about the self, other people or the world

• Hopelessness about the future

• Memory problems, including not remembering important aspects of the traumatic event

• Difficulty maintaining close relationships

• Feeling disconnected from family and friends

• Lack of interest in activities that the person used to enjoy

• Difficulty experiencing positive emotions

• A feeling of emotional numbness

Changes in physical and emotional responses

Symptoms of changes in physical and emotional responses (also called arousal symptoms) may include:

• Tendency to startle or startle easily

• Constantly being on guard against danger

• Destructive behavior, such as excessive drinking or driving too fast

• Sleep problems

• Difficulty concentrating

• Irritability, angry outbursts or aggressive behavior

• Overwhelming guilt or shame

An AI illustration of a traumatic event related to a car accident

We will now try to understand how the theoretical framework related to the concept of the internalized character directorate and the dictatorial internalized self as constructs of the social self can possibly help in explaining post-traumatic stress disorder (PTSD).

In this context:

1. Traumatic event: PTSD is usually triggered by a traumatic event. In the context of the directorate of internalized figures, a traumatic event can be one that significantly threatens the dominance or control of the internalized dictator-self over other internalized figures.

2. Effect on the “directorate”: the traumatic event may disrupt the hierarchy within the directorate of internalized characters. The disruption of the hierarchy may challenge the authority of the internalized dictator self, and cause a struggle for dominance among the internalized characters.

3. Failure to censor: The dictatorial self, being the dominant figure, usually functions to censor and control unwanted material or memories associated with the traumatic event. However, in cases of PTSD, this censoring mechanism may fail, leading to intrusive and disturbing memories, flashbacks, or nightmares related to the traumatic experience.

4. Internal conflict: The traumatic event may create an internal conflict within the directorate. The internalized characters may react differently to the trauma, and cause a struggle for control of the characters’ directorate. The individual may experience inner turmoil as different characters in the directorate attempt in vain to understand and deal with the traumatic memories.

5. Unawareness: The individual is usually unaware that his social self is made up of these internalized characters, but the internal conflict and disturbing symptoms manifest in his conscious experience as symptoms of PTSD.

6. Hierarchy disruption: The traumatic event may disrupt the hierarchical order in the “directorate”. The previously dominant dictator self may struggle to maintain control, leading to heightened emotional arousal, hypervigilance, and other symptoms of PTSD.

7. Personification of the factors of the event: Another interesting point could be that the factors of the traumatic event may be even when they are not human beings [humans such as the predatory driver, the enemy soldier, a sexually exploitative person, a violent person, etc.] but means such as weapons of war and more [for example, a tank, an enemy plane , but also a car in a car accident and more] can undergo a kind of personification and be internalized in the characters’ directorate sometimes as an influential character with characteristics such as deliberate aggression, destruction and more.

8. Therapeutic approach: PTSD therapeutic interventions, in this framework, can include addressing the internalized characters, understanding their role and working to restore a healthier hierarchy within the executive. This may involve using techniques such as cognitive restructuring, narrative therapy, and trauma-focused approaches to help the person process and integrate the traumatic memories.

It is important to note that while this framework offers a creative way to conceptualize PTSD, it is not yet a central and accepted psychological model. PTSD is generally understood using established models such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria, which emphasize the impact of trauma on an individual's mental health and functioning

So far there has been an attempt to explain the post-traumatic syndrome according to changes that occur following the trauma in the directorate of internalized characters. Let's go up a step now.

We mentioned above that there is an interaction and mutual influence between the individual's sensitivity channels and the epistructure of the directorate of internalized figures so that the dominant characters in the “directorate” are affected and influence the expression of the individual's sensitivity channels and vice versa and it is possible that an explanation of different aspects of various mental disorders or pathologies may involve in so doing.

We will note here first that the same potentially traumatic event does not produce post-traumatic syndrome in everyone exposed to the event, we suggest that there are several aspects to this. These aspects are related, among other things, to the nature of the trauma, the composition of the characters’ directorate, the intensity of sensitivity in each of the sensitivity channels and the individual's physical and emotional state at the time of the trauma and history of previous traumatic events.

We will discuss here the composition of the characters’ directorate and the strength of sensitivity in each of the sensitivity channels.

First, when a traumatic event occurs, its essence and consequences may not be in accordance with a person's worldview and internal balance. In fact, an event occurs whose nature and intensity seem to introduce new elements into the inner world of the individual that did not have an adequate prior representation in that person's inner world.

This is where the inner figures and channels of sensitivity come into play. We will first discuss the sensitivity channels: if there is an element of threat in the event, a person who has great sensitivity in the threat channel will likely be more prone to trauma.

It is also possible that hypersensitivity in the attachment channel will manifest itself if a trauma has occurred to a person close to a good friend, spouse, child, etc…

Sometimes hypersensitivity in the routine channel will be important if the event leads to a significant change in the person's routine.

And so additional channels of sensitivity may be involved depending on the type of trauma, for example a dismissal from a job in a person whose work means a lot in his life and he shows hypersensitivity in the status channel, then the status channel will be activated.

It is possible that according to the type of trauma and the person's sensitivity profile, one channel or more will be activated in their sensitivity channels [except perhaps the energy channel whose involvement requires further thinking] and this activation will be a risk factor for the development of the post traumatic syndrome.

Thus, we hypothesize that excessive activation of an individual's sensitivity channel or channels will increase the chance [actually these are risk factors] of developing post-traumatic syndrome.

Regarding the directorate of characters and the internalized dictator self, we will add here that the more rigid and inflexible the dictator self is, the more it constitutes a risk factor.

Here we will also note that the dictator self and the directorate of the internalized characters can strengthen or alternatively weaken the sensitivity of different sensitivity channels according to their characteristics, a topic that will be discussed in more detail in a future conversation.

We will now ask how symptoms are created according to this theoretical concept? Here we give examples of two symptoms.

Let’s open with flashbacks. Here we will take for example a soldier whose traumatic event is related to being hit by enemy soldiers and a tank. Did the involved soldiers and maybe even the humanized attacking tank enter the characters’ directorate and these come up when there are various environmental or internal triggers and appear as flashbacks?

Here there is an interesting question and that is whether such an internalized character can activate a sensory mechanism under certain circumstances since the flashback is a sensory experience. It is said here that it is likely that such an internalized character is associated with a strong emotion, whether of fear or of other strong overwhelming emotions, and when there is an external or sometimes internal trigger, the traumatic memory comes up [actually, the traumatic internalized characters come up, including those of objects and means that have been personified] in contexts that arouse it with the strong emotion which may activate physical sensory sensations including visual ones, i.e. in this case flashbacks.

We will continue and discuss the increased arousal observed in post-traumatic patients. Here the activation of the sensitivity channels and the contribution of the traumatic internalized characters can cause a heightened sense of vigilance to promote any possible danger manifested in the heightened arousal.

We could continue to discuss additional symptoms of the post-traumatic syndrome and their explanation according to the theoretical background we provided, but at this stage we will stop here.

That's it for now,

Yours truly,

Dr. Igor Salganik and Prof. Joseph Levine

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