We have seen the role of "nurture" in “The Nature-Nurture Question - Nurture”. We will now turn to the other half of the dynamic: "nature". It is a commonly believed fallacy that the role of "nature" in human beings is defined by genetically determined physiological brain mechanisms. As a result, it is believed that certain genes or gene clusters determine behavior; or neurotransmitters like serotonin cause depression; or localized areas of cortex or parts of the amygdala and limbic system create behaviors and psychiatric symptoms. These prevalent ideas are faulty as they confuse the parts for the whole. In other words, the various components of our brain all work together as a whole to create consciousness. Localized functions contribute to the operations of consciousness, but do not function in some independent, stand-alone way. Human consciousness is organized as a play in the theater of the brain–a representational world that consists of a cast of characters who relate together by feeling, scenarios, plots, set designs, and landscape. See “The Play of Consciousness: Consciousness is biologically organized as a Drama in the Brain”. The play is the top down organization of the limbic-cortex for the moment to moment living of a life–for our social relatedness, personal authenticity, creative imagination, emotional intimacy, intention, everyday functioning, etc.

To understand the operations of "nature," we need to understand how it acts on the formation of consciousness as a whole. We are talking about temperament, which is genetically programmed in each of us. The role of temperament is to field and digest the impacts of "nurture" into the cortex. Our temperament is composed of four pairs of genetically determined elements that order and organize the formation of the play of consciousness. The four elements of temperament are: Internalizing/ Externalizing, Introversion/ Extroversion, Active/ Passive, and Participant/ Observer. Each element operates on a different aspect of play formation. All four temperamental pairs work in concert to write the final form of our internal dramas and our character.

Each of these four elements of temperament will be the subject of a blog. This one will focus on the first element of temperament: Internalizer/Externalizer.

Keep in my mind that the three elements of nurture–responsiveness, abuse, and protection–are mapped by the amygdala and limbic system into the cortex as the personas of "self" and "other". These personas reflect the actuality of responsiveness, abuse, and protection that has been experienced. In other words with considerable loving and minimal abuse, the "self" is mapped as authentic and the "other" is mapped as loving. The two relate together in the rudimentary play through tenderness. If there is considerable abuse or deprivation, the "self" is mapped as abused, and "other" is mapped as an attacker. A play composed of a steady state of internal attack between this abused "self" and the abusive "other" traffics in ongoing sado-masochistic aggression, mediated through serotonin and cortisol etc. In this case the two relate together in the play on the basis of sadistic aggression. The personas of "self" and "other", throughout the first three years of life, are mapped as formless feelings of beings, because the cortex hasn’t yet matured enough to create representational images.

Internalizers and Externalizers handle the persona of "other" in opposite ways. Externalizers re-project the "other" back outside onto the projection screen of real people. As a result, Externalizers locate and experience the feeling of "other" as coming from other people. For example, if the predominant persona is loving, an Externalizer will be oriented to feel and seek love from others. Internalizers, on the other hand, retain the persona of "other" inside the theater. Consequently, it remains an invisible formless, presence inside the theater. An Internalizer, with a predominantly loving "other" persona, will experience the source of love, the feeling of relatedness, as coming from his own insides. He would carry the feeling and assumption inside that he is loved.

How does an Internalizer inform the writing of a play, when there is significant abuse and deprivation? In this case, the Internalizer retains an extensively mapped Abuser on the inside, with no actual form. Consequently, the scenario of this play will be that the abuser "other" on the inside attacks the abused "self" who is also on the inside. This means that the location of the attacks between the "self" and "other" in the sadomasochistic play take place internally. Since the source of attack as coming from inside him, he experiences the attacks as self-hate: “I’m bad; I’m inadequate, I’m stupid, I’m ugly,” etc. In the context of shaming abuse, an Internalizer feels “ashamed”.

This ongoing internal war of continuous self-attack and self-hatred feeds on one’s serotonin supply. Eventually, later in life, this neurotransmitter gets overtaxed, and the ongoing war will flower into a fuller so-called depression. This limbic-cortical mapping defines the depressive position of the sadomasochistic play. Since an Internalizer views himself as the problem, these people are often oriented to seek a solution by changing oneself, rather than blaming others. As a result, Internalizers are more drawn to fixing themselves in psychotherapy.

On the other hand, an Externalizer, who has the same sadomasochistic play, derived from abuse, would generate a very different scenario. An Externalizer projects the Abuser back onto other people. He is predisposed and oriented to feel attacked or criticized by others. He locates the source of attack, hatred, or criticism as coming from a person outside of him. For example, from a legacy of shaming abuse, an Externalizer experiences being “shamed” by a person outside him, as opposed to feeling “ashamed”. His orientation is as a blamer. As such, he would be inclined to blame, and fight with others. Psychiatric symptoms for Externalizers are paranoia (believing other people are out to get them), blaming, and fighting.

Now, no one is a pure Internalizer or Externalizer. Each element of temperament is really on an axis, on which there is a predominant, prevailing position. But we all have both elements inside us. For example, Internalizers have some degree of Externalization, and vice versa. In other words, one may be an extreme 90/10 Internalizer/Externalizer; or a 60/40 Internalizer/Externalizer; or it could be 50/50. This is true for all four elements of the temperamental pairs. Not only that, but one or another of the four temperamental elements may be more pronounced and powerful than the other ones in the formation of one’s character.

The next blog will address the second element of temperament–Introversion/ Extroversion.

 Robert A. Berezin, MD is the author of “Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain”


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