Monica and role of Polyvagal Theory

Question 1: Monica’s case in terms of the biological and neurobiological components

1. Parts of the nervous system and structures in the brain that are being impacted and how.

This situation necessitates a knowledge of the effects of abuse and neglect in early childhood and how it leads to biological vulnerability in the growing brain and nervous system. For instance, neurons move to different brain parts during fetal development as they differentiate, specialize, or control specific body functions in response to chemical signals (Child Welfare Information Gateway, 2015). Therefore, due to neglect, a lack of emotional attachment, and affect regulation during her childhood,  Monica’s limbic system and cerebral cortex were underdeveloped in areas that “regulated emotions, language, and abstract thought.” (Child Welfare Information Gateway, 2015). Monica is neurobiologically susceptible since this link is destroyed or deleted during synapse elimination. Monica’s inability to integrate knowledge or experiences hindered her progress in thinking, memory, and emotion management when her brain and cortex were myelinating. This was due to the unclear neurotransmission. (Child Welfare Information Gateway, 2015).

As Monica experiences prolonged exposure to chronic stress due to poverty, inability to form intimate relationships after Darnell’s death, and withdrawal from the childrearing of her daughter, it is essential to normalize and validate these experiences from a neurobiological perspective. This will ensure that Monica can better comprehend her actions’ cognitive process. Toxic stress may limit the hippocampus’s ability to restore normal cortisol levels, which may explain why Monica cannot recover from Darnell’s death and instead enters a condition of withdrawal or mental shutdown. As Monica was sexually molested for three years as a kid, the abuse may have resulted in a diminished volume in the orbitofrontal cortex, which is crucial to emotion and social control, which will explain her self-isolation from her classmates (Child Welfare Information Gateway, 2015). (Child Welfare Information Gateway, 2015) She may have an overactive amygdala due to her anxiety of bumping into her ex-boyfriend in the neighborhood, having stimulated and hyperaroused it. (Child Welfare Information Gateway, 2015)

1. The role of stress in Monica’s case

As Monica endured sexual assault at the age of nine, her frontal lobe, which “controls planning, impulse control, and thinking,” may have been affected. (Child Welfare Information Gateway, 2015). At this age, Monica’s limbic system is transitioning, which limits her ability to perceive certain unpleasant feelings because she lacks a better-developed “cortex that can override the limbic reaction.” (Child Welfare Information Gateway, 2015). As Monica’s brain responds to frequent stressful stimuli, plasticity declines. She presents the psychodynamic hypothesis of Fonagy’s Mentalization model, according to which she cannot mentalize due to extreme physical and emotional insecurity. Unnecessary stress promotes suboptimal prefrontal function, promoting hyperarousal in the amygdala and other subcortical structures; therefore, it impairs mentalization ability. (Fonagy’s Mentalization Model Async 2.9) Monica underwent three years of sexual assault; due to her chronic state of dread and stress, her sympathetic nervous system was in a continual state of arousal and flight, as she feared that her ex-boyfriend might return to the area.

1. The biological aspects of trauma, memory, and affect regulation apply to the vignette.

Monica’s frontal lobe, which “controls planning, impulse control, and thinking,” may have been affected by her exposure to sexual molestation at the age of nine. (Child Welfare Information Portal, 2015) At this age, Monica’s limbic system is undergoing a metamorphosis, hindering her perception of some unpleasant feelings since she lacks a “cortex that can override the limbic reaction” (Child Welfare Information Portal, 2015). As Monica’s brain responds to repeated stressful stimuli, plasticity declines. She presents the psychodynamic hypothesis of Fonagy’s Mentalization model, according to which she cannot mentalize due to extreme physical and emotional insecurity. The amygdala and other subcortical regions in Monica’s brain become hyperaroused when she is under extreme stress, which ultimately affects her capacity to think logically. (Async 2.9 Fonagy Mentalization Model) Under a chronic condition of dread and stress, Monica’s sympathetic nervous system reacted by being in a constant state of alertness and flight. She was alert/concerned that her ex-boyfriend may be in the area.

1. Application of the role of Polyvagal Theory to Monica’s case

Applying the Polyvagal Theory to Monica’s scenario, the Polyvagal theory describes how the nervous system responds to specific stressful conditions, and in using this theory, Monica’s behaviors and actions are the results of the interaction between neurobiology and stress. In the instance of Monica, the Polyvagal hypothesis may assist explain why her great stress led to her separation and isolation from her friends following Darnell’s death and her inability to enjoy life again since she developed severe depression. When Darnell died, Monica resorted to maladaptive coping strategies by ignoring her kid and abusing alcohol. The Polyvagal theory explains why Monica’s parasympathetic nervous system would keep her frozen as an adaptive survival strategy. (Dana & Porges, 2018.) With the extra trauma of losing her spouse’s money in a restaurant venture, Monica cannot advance in her life. She may feel separated from the world, remorse, shame, and despair. The dorsal motor nucleus will also explain her reduced sexual urge through the unmyelinated vagus nerve. (Dana & Porges, 2018.) One of the methods to pull Monica out of her withdrawn state is to encourage her to participate in good social interaction or form another healthy bond. (Dana & Porges, 2018.)

Question 2: Monica’s case in terms of the psychological components

Examining Monica’s case in terms of its psychological components, a modern psychodynamic theory of Contemporary Attachment revealed that Monica had a disordered attachment style and intergenerational cycles of poor attachment with her daughter. A frigid aunt raised Monica since her mother was unavailable owing to being a single working mother living in poverty. Monica fits Berzoff’s (2016) description of disordered attachment since she was sexually molested for three years. When facing the sex abuse, Monica did not get the reassurance she needed to feel secure. Therefore she was hypervigilant for danger in her area. As she mourned the loss of her husband, Monica could not build a continuous relationship with her daughter due to her extreme sadness. Berzoff (2016) analyzed the correlation between early attachments and eventual adult attachments and discovered a 70-80 per cent range of correlation, indicating that a misattuned father is likely to produce a misattuned daughter. (Berzoff et al., 2016.) Monica could not comprehend Danielle’s physical and mental challenges from relocation to Los Angeles since she never made any positive parenting or therapeutic adjustments. (Berzof et al., 2016.) As Monica cannot meet her daughter’s needs, she may dread bonds and close relationships after Darnell’s passing.

Question 3: Monica’s case in terms of social contexts

Examining Monica’s case in terms of the social contexts of the ACEs and the toxic stress of poverty from childhood to adulthood, the emotional development and relational experiences Monica had been exposed to would have a negative impact on her quality of life and mortality. Furthermore, the systemic pressure of poverty, lack of social and financial support, unsafe living conditions, violent communities, and more created an environment of chronic stress for Daniel. Due to the severity of social risk factors, adverse childhood experiences (ACEs), sexual abuse/trauma, chronic stress, and grief, Monica has a greater chance of depression and suicide attempts. Monica’s accumulated childhood and chronic adulthood stress and her disposition. At the same time, she is locked in systemic poverty may lead to drug misuse, unemployment, debt, and family disintegration if she does not accept LA County DMH’s assistance.

Conclusion

In conclusion, Monica’s behaviors, actions, and psychopathology are interrelated and mutually impact one another. Examining psychodynamic and psychosocial theories, the integration of health and mental health reflects Monica’s case, as they are inextricably linked. The neurobiology impact of early childhood abuse and neglect has long-lasting consequences as a biological vulnerability in the developing brain and nervous system. Knowledge of the effects of abuse, stress, and trauma on brain development has implications for policy and practice that may help clinicians better serve their clients. It is essential to comprehend, legitimize, and normalize what is occurring inside the brain by giving scientific evidence to explain behavioural, emotional, and psychological functioning. Using this understanding might repair broken treatment systems and boost efforts to avoid health-mind-body misalignments.