Case Study: Sheldon

Sheldon was a man in his late 60’s who came to therapy for help with his many anxieties and fears. As a child, his parents had hidden him from the Nazis in a storage room behind the home of family friends. One day, after finding out that she and Sheldon’s father would soon be taken to the concentration camps, Sheldon’s mother told him to be a good boy, said goodbye, and left. While the family friends were kind to him, he spent his days alone with few toys, his small tricycle, and some scraps of food. Describing these days, Sheldon recalled alternating states of terror and boredom, during which he would either sit and rock or ride his tricycle around in slow tight circles. The slightest noise would startle him and he feared that each passing siren might be the police coming for him. Each day, exhausted by fear, he would eventually fall asleep.

The intervening decades had not diminished the impact of his experiences during the war; 60 years later, he still found himself reflexively rocking or walking in small slow circles when he became frightened. His life felt like one long, fear-filled day. In repeatedly recalling these experiences in treatment, he sometimes mentioned how he wished he could have left the house where he was hidden and traveled down the narrow streets to his grandmother’s house. Sheldon remembered long afternoons he spent there before the war, listening to stories of her childhood on her father’s farm. His grandmother and his parents perished in the war, and he never saw them again.

One day, I asked him for permission to change his memories just a bit. After a few quizzical looks, he agreed to close his eyes and tell me the entire story again, at which point I would interrupt him and make some suggestions. As he came to the part of the story where he rode around in circles, I asked him, “What would you do if this was a magic tricycle and it could take you through walls without getting hurt?” I felt Sheldon had sufficient ego strength to allow him to simultaneously engage in the role- play while staying fully in touch with present reality.

After some hesitation, Sheldon said, “I would ride right through the house and out onto the sidewalk.”

“Fine,” I said. “Let’s go!” Sheldon had been primed for our imaginary therapy play because he had spent many enjoyable hours of storytelling, cuddling, and laughing with his grandchildren. I felt that an imaginative task like this was not only accessible to him but would also serve the purpose of bridging the positive affect from his grandchildren to his lonely and frightened experiences as a child. Imagining he was making up the story for his grandchildren might also help him cope with the embarrassment of doing this with another adult.

After some mild hesitation, he pedaled through the house. As he got close to the door, however, he said, “They’ll see me and kill me.”

 “What if the magic tricycle has the power to make you invisible?” I asked.

“I think that’ll do,” said Sheldon, and he pedaled through the front of the house and out onto the sidewalk. Once he got out of the house, he knew what to do. He described the street to me as he pedaled toward his grandmother’s house. The storekeepers, the neighbors, the park, his rabbi, even some of his young friends were all alive in his memories. Sure enough, when he finally got to his grandmother’s house she was home and, as always, happy to see him. He told his grandmother about his invisible tricycle and how scared he was in his hiding place. He went on to tell her of the end of the war, his travels, and raising his family. Finally, almost like a prayer, Sheldon told her how, many years from now, she would have the most beautiful great-great-grandchildren living in freedom, redeeming her suffering.

Over the next few months, whenever Sheldon experienced his childhood fears and anxieties, we would revisit his story and modify different details. These changes seemed to grow more detailed and more vivid in his mind. His imagination gave him the power to master many of his past fears. Because memory is modified each time it is remembered, Sheldon’s brain was able to gradually contaminate his painful childhood with his present safety and joy (Bruner, 1990). He even began to tell his grandchildren stories about a little boy with a magic tricycle who accomplished great things with his courage and wit. Sheldon was a very special man who was able to take advantage of the malleability of memory to make his inner world a safer place. Nothing had changed about his childhood except that now, when he remembered his hiding place, he also remembered his magic tricycle.

An important part of restructuring memory is something Freud called Nachtraglichkeit, which means the ability to reconceptualize a memory based on evolving maturity. This process requires being able to hold the memory in mind without being emotionally overwhelmed and simultaneously bringing it into the present, picturing it as it would look from the perspective of who we are and what we know today. Both Freud’s idea and Sheldon’s experiences highlight the fact that memory is an evolving process that is subject to positive influence.

The construction and reconstruction of autobiographical narratives requires that the semantic processing of the left hemisphere integrate with the emotional networks in the right. Storytelling also invokes participation of the body as we gesture and act out the events we are describing. As such, narratives are a valuable tool in the organization and integration of neural networks prone to dissociation. Because we can write and rewrite our own stories, new ones hold the potential for novel ways of experiencing. In editing our narratives, we change the organization and nature of our memories and, hence, reorganize our brains. This is a central endeavor in many forms of psychotherapy.

This is an excerpt from Dr. Cozolino’s book The Neuroscience of Psychotherapy