Adult Growth, Internalizations, and Synaptogenesis

February 2007, Vol. XXIV, No. 2

Clinicians, I believe, have little opportunity to learn about adult psychological growth other than that which results from psychotherapy. Almost by definition, patients who present for psychotherapy have not experienced major periods of growth arising out of other life experiences. A different picture emerges when one has the opportunity to interview nonclinical subjects in depth. Here, subjects' life narratives often contain major turning points that appear to usher in periods of psychological growth. During many decades I have had the opportunity to interview-usually in depth-more than 800 nonclinical subjects. Research volunteers, applicants for a psychiatric residency, and more recently, candidates for ordination in the Episcopal ministry came for interviews as one part of what was required to attain other goals. Some, but certainly far from all, described major life turning points.

• A 33-year-old physician applying for a psychiatric residency after several years of practice as a radiologist described her earlier self as intense, driven, and uncomfortable with emotional closeness. The turning point in her life involved her relationship with her new husband. “There is a calmness about Jim,” she said. “[He has] an ability to enjoy the moment, an acceptance of life's uncertainty, and a deep empathy [for] others. Somehow-first with him and now more generally-I began to be less tense and driven. Most of all, I'm less rigidly structured-more able to just hang loose. He's the best thing that ever happened to me.”
• He was 47 years old, married with 2 teenaged daughters, and practicing law part-time as he attended a local seminary. His law practice had been successful and, he said, enjoyable. Always religious and for years a leader in his parish church, he had had no thoughts of the priesthood until, 8 years earlier, he experienced a major depression. The combination of an antidepressant and psychotherapy had been very helpful and as he gradually recovered, he found himself spending more and more time thinking about his life's meaning. “It was,” he said, “as if I began to recognize that my life had been totally centered on career, marriage, and family-that it was, in a strange way, very self-oriented. I spent a lot of time talking with my wife about it and she encouraged me to continue to explore other options. I also began to meet with my priest and, after a year or so, he raised the question of whether God was calling me to the priesthood. More and more I came to feel that way-that I could serve Him through helping others. The whole process has changed who I am: I've found an inner peace I've never felt before.”
• She was 42 years old and described herself as a survivor. “All my life,” she said, “I've had to deal with unusual stress. First, I was an only child, and my parents were killed in an accident when I was 11. I lived with my grandparents until I was 17 and went off to college. I had to pay for it myself-my grandparents couldn't-so I worked several jobs while I took classes. After graduation, I got a good job and was successful-many promotions and all of that. When I was 32, I met my husband and we were very happy. Four years ago, a brain tumor developed, and he was dead in 3 months. I was absolutely devastated but kept working. I relied some on my friends, but mostly, I struggled on my own, one day at a time. Finally, I got into therapy-which was very hard for me to do because, except for my husband, I've always kept my personal feelings to myself. But my therapist was wonderful-she very gradually got me more in touch with my hurt and rage about important others abandoning me. She also helped me become less distant and defensive-more open with others. My several years of therapy really changed who I am-or at the least, who I feel myself to be.”

These 3 much-abbreviated vignettes illustrate several of the most commonly heard turning points in the life narratives of nonclinical subjects. Healing marriages, religious/spiritual experiences, and psychotherapy all involve a new and transforming relationship either with another person or with God. Each of the new relationships is described as leading to changes in the self-changes that sound like manifestations of psychological growth. Some readers may react to these premises with skepticism-these are, after all, only stories. There are no careful before-and-after personality measurements documenting positive changes. I will not, for reasons of space, discuss the issues involved in how we know what we know, historical truth versus narrative truth, different forms of causal thinking (probabilistic and narrative), and other complexities. Rather, I ask the reader to assume, at least for the moment, that the narratives of turning points and psychological growth reflect substantial reality. Doing so allows me to move to the next issue-what are the mechanisms or processes that translate these life experiences into psychological growth?

Processes underlying growth
Throughout my career and until quite recently, the most common answer to questions about the underlying processes of psychological growth involved the idea of internalization. We are assumed to take into ourselves those persons (or certain characteristics of those persons) whom we love and who love us in return. The major problem with this concept is that it doesn't tell us much that we need to know. Although Vaillant's¹ effort at distinguishing different types of internalization (and their relative maturity) has been helpful at the descriptive level, there remains the mystery of what he calls “metabolizing the internalized other.” What is involved in metabolizing? Is it just a convenient metaphor?

During the past few years, several new parameters have been added to the internalization-metabolism model of psychological growth. First, enduring changes in behavior must be associated with actual changes in brain structure and function. New synapses are formed (perhaps new neurons also) as the consequence of life experiences. Thus, psychological growth and brain growth are parallel processes. Second, for synaptogenesis to occur in response to life experiences, previously inactive genes must be “turned on” in order to produce the required proteins. Psychological growth, like psychopathology, is thus the product of gene-environment interactions-nothing very surprising about that. Further, we think we know a good deal about the relationship characteristics that are associated with psychological growth but we know very little about the actual genes involved. Although it is commonplace to read about “genes for closeness” and to see statements such as “connecting to others is hard-wired” and the like, there are no systematic data.

The relationship structure associated with individual psychological growth was described years ago by our research group at the Timberlawn Research Foundation in Dallas.² A major task of relationship formation is establishing a balance of separateness (autonomy) and connectedness (intimacy) that is acceptable to both partners. In growth-facilitating relationships, the partners contribute more or less equally to the process of negotiating a balance suitable to each. Thus, shared power (in defining the relationship) is a crucial variable. This facilitates the development of exploratory conversations that over time produce psychological intimacy. Shared power also contributes to the development of the negotiation skills that are crucial for dealing with the inevitable differences. Thus, problem-solving skills come to be highly developed. In all this, however, each partner maintains a strong capacity for autonomous functioning. The strong interdependence does not erode individuality.

Thus, experiencing such a co-constructed relationship sets the stage for each partner to internalize desirable attributes of the other. The experience of such relationships and, perhaps as suggested by Siegel,³ in particular the exploratory, intimacy-producing conversations turns on those genes that are necessary for the production of new synapses.

Increasingly, we know more useful questions to ask. In this way, our understanding of how certain types of relationships appear to facilitate individual growth is gradually expanded.

Dr Lewis is chairman emeritus of the Timberlawn Psychiatric Research Foundation and clinical professor of psychiatry at the University of Texas Southwestern Medical School in Dallas. He is also in private practice of individual, marital, and family therapies in Dallas.

References1. Vaillant GE. The Wisdom of the Ego. Cambridge, Mass: Harvard University Press; 1993.
2. Lewis JM, Beavers WR, Gossett JT, Phillips VA. No Single Thread: Psychological Health in Family Systems. New York: Brunner-Routledge; 1976.
3. Siegel DJ. The Developing Mind: Toward a Neurobiology of Interpersonal Experience. New York: Guilford Press; 1999.