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Embodied Simulation, Mirror Neurons, and the

Reenactment of Trauma in Early Childhood
a
Theodore J. Gaensbauer
a
Department of Psychiatry, University of Colorado Denver Health Sciences Center, Denver,
CO, U.S.A.
Published online: 09 Jan 2014.

To cite this article: Theodore J. Gaensbauer (2011) Embodied Simulation, Mirror Neurons, and the Reenactment of Trauma
in Early Childhood, Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 13:1, 91-107,
DOI: 10.1080/15294145.2011.10773665

To link to this article: http://dx.doi.org/10.1080/15294145.2011.10773665

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 Neuropsychoanalysis, 2011, 13 (1) 91

Embodied Simulation, Mirror Neurons, and the Reenactment of Trauma

in Early Childhood

Theodore J. Gaensbauer (Denver, CO)

The question of why children would repeatedly replicate painful, frightening events in their behavior or play, often in very destructive
ways, has long challenged clinicians and researchers alike. The recent identification of “mirror neurons” in the premotor cortex of
macaque monkeys and the ongoing elucidation of their role in facilitating empathic resonance with, and imitation of, the observed
actions of others in both monkeys and humans have opened up new perspectives on this question. Initially, an overview of post-
traumatic reenactment behaviors as they are manifested in young children is presented, highlighting important developmental and
Downloaded by [Gazi University] at 17:28 17 August 2014

therapeutic issues that such behavior raises. Next, recent research on embodiment, early imitation, and mirror neuron functioning
is reviewed, with an emphasis on those aspects most relevant to the clinical manifestations of early trauma. The significance of this
recent research for furthering our understanding of the mechanisms underlying posttraumatic reenactment is outlined. In addition,
some of the implications of this research for our understanding of the nature of early traumatic memories, the availability of such
memories for conscious processing, and the role of such memories in the reenactment of preverbal trauma are described. Finally, the
clinical implications of this work for the fashioning of effective therapeutic interventions is discussed.

Keywords: early childhood; early memory; embodied simulation; mirror neurons; trauma; reenactment

Reenactment of a traumatic event in action or in play
has long been recognized as a common, if not universal
sequellae of trauma in children (Cohen, Chazan, Lern-
er, & Maimon, 2010; Terr, 1981, 1991), occurring with
such frequency in very young children as to be one of
the cardinal signs for the diagnosis of posttraumatic
stress disorder in this age group (APA, 1994; Schee-
ringa, Zeanah, Myers, & Putnam, 2003; ZERO TO
THREE, 2005). The question of why children would
repeatedly replicate painful, frightening events in their
behavior or play, often in very destructive ways, has
long challenged clinicians and researchers alike. The
recent identification of “mirror neurons” in the premo-
tor cortex of macaque monkeys and the ongoing eluci-
dation of their function in both monkeys and humans
have opened up promising new perspectives on this
question.
In this report, I provide an overview of posttrau-
matic reenactment behaviors as they are manifested
in young children, highlighting some of the impor-
tant developmental and therapeutic issues that such
behavior raises. I next review recent research on the
function of mirror neurons, emphasizing those aspects
that are most relevant to the clinical manifestations of
early trauma. I then describe how the growing under-
standing of mirror neuron function sheds new light
not only on the mechanisms underlying posttraumatic
reenactment, but also on the nature of early traumatic
memories, their availability for conscious processing,
and their role in the reenactment of preverbal trauma.
Finally, implications of this work for the development
of effective therapeutic interventions for early reenact-
ment behavior is briefly discussed.
Reenactment behavior in young children
To bring the issues discussed in this paper to life within
their clinical context, I offer the following four clinical
vignettes as illustrations of the range of reenactment
behavior and play that may be observed in young chil-
dren following a trauma.

Theodore J. Gaensbauer: Department of Psychiatry, University of Colorado Denver Health Sciences Center, Denver, CO, U.S.A.
Correspondence to: Theodore J. Gaensbauer, 3400 East Bayaud Avenue, Suite 460, Denver, CO 80209, U.S.A. (email: Tgaensbauer@aol.com).

© 2011 The International Neuropsychoanalysis Society • http://www.neuropsa.org

 92
Case #1: At 2½ years, Kevin witnessed his father
being stabbed fatally in a fight. When evaluated at
age 4 years, Kevin was showing persistent reenact-
ment behavior, including marked aggression that
was frequently associated with repeated stabbing
actions and threats with a knife, both with doll fig-
ures and in fights with siblings and peers. His doll
play involved repetitive, almost obsessive physical
fighting between “good guys” and “bad guys,” with
the “good guys” often being the ones killed. He fre-
quently expressed a wish to join his father in heaven
and on one occasion stabbed himself in the nose
with a fork with sufficient force that he drew blood.
At our first meeting, when I greeted him in the wait-
ing room Kevin approached me and then abruptly
hit me in the leg. He said he did that because he
thought I would “hit [him] back.” In the playroom,
he immediately began playing out physical fights
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with army-doll figures, though he had the figures us-
ing swords instead of guns. In a subsequent session,
he described a bad dream about clowns who killed
people with big, sharp teeth. Asked about the wish
to join his father in heaven, he responded “I could
kill myself.” When asked how he could do that, he
said, “Easy. With a knife” (Gaensbauer, 1996).
Case #2: At age 3 months, Jennie was placed in
foster care after suffering a skull fracture at the
hands of her father. When evaluated three weeks
later, as I initially approached her she became dis-
tressed, avoided eye contact, arched backwards
away from me, and made several defensive-appear-
ing batting motions with her arm. This batting ges-
ture was repeated a number of times during the
session whenever I made a close approach. The ges-
ture was not observed during interactions with her
mother or my female assistant (Gaensbauer, 1982).
Dr. Suzi Tortora systematically reviewed the video
of this session using the Laban Movement Analysis
System (Tortora, 2006). She concluded that the bat-
ting movement was a “clearly defined and repeated
action within Jennie’s movement repertoire” and
was “quite distinctive in comparison with the nor-
mal reaching and swinging arm movements seen in
infants at this age.” She also noted that it occurred
only in the context of my presence as a trigger and
was consistently accompanied by “a tension, firm-
ness, or stillness to her facial expression” and “head
and torso reactions that . . . seem to contribute to a
quality of distress and behavioral disorganization”
(Tortora, personal communication). The specificity
of the action and the context within which it consis-
tently occurred lent itself to the interpretation that it
Theodore J. Gaensbauer
was an imitation of the blow(s) she had received at
the hands of her father.
Case #3: Prior to her placement in a foster/adop-
tion home at age 16 months, Margaret’s life was
very traumatic. She was exposed to chaotic living
situations, brief periods of homelessness, and mul-
tiple caregivers. Significant domestic violence was
suspected. At age 3½ years she began treatment
because of ongoing problems in her attachment re-
lationships and aggressive, provocative acting out.
After a therapy session in which Margaret’s very
conflicted feelings about her biological mother, with
whom she remained in contact, were discussed,
Margaret awoke from a nap in a state of terror. She
became completely out of control, screaming, hit-
ting, kicking, and throwing things. She began to at-
tack her adoptive mother in a rageful way, following
her around despite her adoptive mother’s attempts
to back away. Just as abruptly, when her adoptive
mother would step forward and attempt to calm her,
she would become terrified and would run away into
a corner, yelling “No, no, no!!” and “Don’t touch
me!” as if her adoptive mother were going to attack
her. This dramatic oscillation between violent at-
tacks and terrified retreats went on for over an hour
before she was finally able to be calmed. During the
episode, Margaret seemed completely out of touch
with her current surroundings and unresponsive to
anything the adoptive mother said or did, consis-
tent with a dissociative state. When told about this
episode, her biological mother acknowledged that
the man she had lived with during the period when
Margaret was between 6 and 13 months had had a
violent temper, was destructive of property, and had
beaten the mother on a number of occasions. Her bi-
ological mother denied that Margaret had ever been
physically abused, although this possibility could
not be absolutely ruled out since the man her mother
lived with had been a frequent babysitter.
Case #4: Odelia was adopted from a foreign coun-
try at age 2 years. For the first 18 months of her life,
she had lived in a single-room house with her grand-
parents and eight other members of her extended
family. She was then given up by her grandparents
to a well-managed orphanage, where she remained
for five months before being adopted. She appeared
to have been well cared for both in her family of
origin and in the orphanage, and she went through
very intense grieving during the first six weeks in
her adoptive home. Two months after her adoption,
her mother found her in the family playroom lying
 Embodied Simulation, Mirror Neurons, and the Reenactment of Trauma in Early Childhood
on top of a very large stuffed animal. The stuffed
animal’s legs were spread and Odelia was making
thrusting motions with her pelvis that unmistakably
replicated the movements of the male during sexual
intercourse. She had a very intense, concentrated
look on her face but did not show any evident ex-
citement or other emotion. Detailed history taking
could not identify any other explanation for this iso-
lated behavior except the likelihood that she had ob-
served sexual intercourse in the single-room house
where she had lived with her extended family. There
were no other indicators of sexual overstimulation,
and this particular “reenactment” was observed only
once. At follow-up five months later, there had been
no further episodes of sexually explicit behavior.
As reflected in the clinical vignettes, reenactment be-
haviors are not only important criteria for the diagnosis
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of posttraumatic stress disorder, but they can be hugely
problematic both for young children and for those
around them. Patterns of traumatic reenactment can
persist for long periods of time, can have a repetitive,
almost driven quality, and can be highly resistant to
change (Alessandri, 1991; Gil, 1998; Varkas, 1998).
They can be carried out in an almost automatic fashion,
without apparent affect (as seen with Odelia) or can be
accompanied by very strong affects, such as anxiety or
destructive anger (as with Kevin, Jennie, and Marga-
ret). The propensity to reenact experienced and/or wit-
nessed traumatic events can significantly distort young
children’s developmental trajectory, can result in the
acting out of aggressive, sexual, or other impulses that
place both themselves and others at risk, and can be ex-
tremely difficult for caregivers to manage (Scheeringa,
Zeanah, Myers, & Putnam, 2005; Terr, 1979). It can
also have profound effects on children’s sense of self
and their internal representations of the world around
them, resulting in distorted character development (Py-
noos, Steinberg, & Wraith, 1995; Terr, 1990). From
a therapeutic standpoint, interrupting these persisting
patterns of behavioral reenactment, when they have
been powerfully programmed at such an early age and
where traditional therapeutic interventions that depend
on verbal communication are often not applicable, can
be extremely challenging.
A number of explanations for the phenomena of
traumatic reenactment have been proposed. From the
psychological perspective, traumatic reenactments in
children have been seen as vehicles for abreaction
and psychological processing whereby overwhelming
events are assimilated piecemeal in order to master
them (Waelder, 1933); as the result of rigid defense
mechanisms that serve the purpose of maintaining
93
safety by, for example, converting passive into active
through identification with the aggressor (A. Freud,
1937; Freud, 1920; Levy, 2000); as the product of the
repression of traumatic memories resulting in dissoci-
ated behavior (Chu, 1991; Freud, 1920); as a means of
self-anesthesia (Terr, 1990); as a defense mechanism
for disavowing the reality of a traumatic experience by
making it play rather than reality and/or by facilitating
the construction of alternative realities and/or out-
comes (Arlow, 1987; Terr, 1990); as behaviors driven
by unconscious needs such as for the alleviation of
guilt (Azarian, Miller, Palumbo, & Skriptchenko-Gre-
gorian, 1997); and as products of a repetition compul-
sion, linked controversially by Freud (1920) to a death
instinct. Biologically based explanations have been
proposed as well, such as the hypothesis that reenact-
ments of a painful event may mobilize opioid receptors
that serve to reinforce the behaviors in question (van
der Kolk & Greenberg, 1987). All of these expla-
nations have had great relevance for understanding
reenactment behavior, but none of them has been com-
pletely satisfying in explaining its repetitive, enduring,
and often destructive nature.
For reenactment behavior in very young children,
interesting questions have been raised about how to
conceptualize the forms of memory that such reenact-
ments represent (Bauer, Kroupina, Schwade, Dropik,
& Wewerka, 1998; Gaensbauer, 2002; Gaensbauer,
Chatoor, Drell, Siegel, & Zeanah, 1995). Of particular
interest are children who carry out behavioral actions
that are clearly reflective of a preverbal trauma, but
do so months or even years later (Gaensbauer, 1995).
Most clinicians have considered such reenactments to
be forms of procedural or implicit memory, outside
conscious awareness. Terr (1988) has used the term
“behavioral memory” to describe such reenactments,
and Siegel (1995) has emphasized their implicit nature.
At the same time, a number of clinical reports have
suggested that even in very early childhood, explicit
memory systems may be involved (Gaensbauer, 2002,
2004; Paley & Alpert, 2003). Looked at from the frame-
work of developmental research, reenactment behavior
may be conceptualized as a form of deferred imitation,
in that children are carrying out actions to which they
were witness at an earlier point in time. Questions
about the extent to which various forms of nonverbal
memory such as deferred imitation fit into implicit ver-
sus explicit categories have been the subject of much
recent debate, particularly since both deferred imita-
tion and visual-compared comparisons—two forms of
non-verbal memory widely studied in the first year of
life—utilize neuroanatomical pathways associated with
declarative or explicit memory systems (McDonough,
 94
Mandler, McKee, & Squire, 1995; McKee & Squire,
1993). The degree to which the young child can be
consciously aware that a reenactment or verbal report
is a reflection of an event experienced in the past is also
very much in question (Gaensbauer, 2002; Howe &
Courage, 1997; Nelson, 1993).
Embodied simulation, mirror neurons, and early
imitation
The concept of “embodiment,” referring to the bodily
states that arise during the perception of an emotional
stimulus, has a long and distinguished history in psy-
chology, having been articulated most notably by Wil-
liam James (1890), among others. Over the past several
decades, emotion researchers have provided strong
evidence that people “embody” the emotional behavior
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of others—that is, experience a set of bodily sensations
and emotional states that correspond to those being
expressed by a person they are observing (Niedenthal,
Barsalou, Ric, & Krauth-Gruber, 2005). This capac-
ity to “embody” the emotions of others via a number
of somatosensory modalities, including facial, vocal,
and postural expression, has been demonstrated for a
number of different affects, including happiness, an-
ger, sadness, and fear (Dimberg, 1990; Duclos et al.,
1989; Flack, Laird, & Cavallaro, 1999; Hatfield, Hsee,
Costello, Weisman, & Denney, 1995). Although such
bodily sensations can generate conscious “feelings”
that influence subsequent behavior in a purposeful
manner, these emotional imitative processes and their
motivational effects have also been shown to occur
relatively automatically and often outside conscious
awareness (Scherer, 2005; Winkielman, Berridge, &
Wilbarger, 2005). Although research on the neuro-
logical substrates of such emotional “embodiment”
has been carried out, the recent identification of mir-
ror neurons has dramatically broadened and deepened
our understanding of the mechanisms underlying the
human brain’s capacity to internally “embody” not
only the emotional states of others but multiple mo-
dalities of observed experience (Bastiaansen, Thioux,
& Keysers, 2009; Damasio & Meyer, 2008; Meyer &
Damasio, 2009)
So-called mirror neurons were first identified by Riz-
zolatti and Gallese and their colleagues (Gallese, Ga-
diga, Gogassi, & Rizzolatti, 1996; Rizzolatti, Fadiga,
Gallese, & Fogassi, 1996) in the course of their studies
of the neural bases for motor activity in nonhuman
primates. Recording the electrical activity of single
neurons in the ventral premotor cortex of the macaque
monkey (neurons in this area of the monkey brain do
Theodore J. Gaensbauer
not code for elementary movements, as neurons of the
primary motor cortex do, but activate when the mon-
key is carrying out goal-directed actions such as grasp-
ing, manipulating, or tearing objects), they discovered
a group of nerve cells that discharged not only when
the monkey carried out a grasping action with its own
hand, but when the monkey simply observed another
individual executing the same grasping action. In other
words, the observation of an object-related hand action
resulted in the activation of the same neural network
that would have been involved in the organization of
its actual execution. Because of this apparent identity
between visual perception and premotor activation,
these neurons were termed “mirror neurons.”
Subsequent studies not only confirmed the hypoth-
esis that neurons in this area were activating motoric
representations corresponding to another’s act, but
demonstrated that they were mediating comprehension
of the meaning of the action rather than just replicat-
ing its visual features (Rizzolatti, Fogassi, & Gallese,
2004). Neurons associated with a particular motor
action were found to activate not only when visual
stimuli were presented, but also when the action was
indicated by other cues, such as sounds associated with
the action or where the goal was clear but where the
actual completion of the act was screened from view.
These particular neurons were inactive or fired much
less weakly when the same gestures were performed
at random or when no object was present (Fogassi et
al., 2005; Kohler et al., 2002; Umilta et al., 2001). The
implications of this research for the elucidation of the
neural mechanisms underlying imitation and social
cognition were immediately recognized, leading to an
explosion of subsequent studies in both monkeys and
humans. Several recently published volumes provide
excellent reviews of this extensive research (Braten,
2007a; Meltzoff & Prinz, 2002; Stamenov & Gallese,
2002).
Although it has not been possible to measure activ-
ity in isolated neural cells in humans except under rare
clinical conditions, studies using a variety of measures
of brain activity have provided strong evidence for
the presence of mirror neurons in humans (Fadiga
& Craighero, 2007; Rizzolatti, Craighero, & Fadiga,
2002). Such neurons appear widespread in the hu-
man brain, being found not only in premotor areas
associated with hand movements, but in areas close-
ly associated with mouth movements and language
(Rizzolatti & Arbib, 1998; Studdert-Kennedy, 2002;
Wadkins, Strafella, & Paus, 2003). A circuit of mirror
neurons that includes areas in the temporal, parietal,
and frontal lobes, and with close connections to the
limbic system subserving emotional responsiveness,
 Embodied Simulation, Mirror Neurons, and the Reenactment of Trauma in Early Childhood
has also been identified, leading to the conceptualiza-
tion of a mirror neuron system (Carr, Iacoboni, Du-
beau, Mazziotta, & Lenzi, 2003; Iacoboni, 2005).
Affect appears to be an integral part of this mirror-
ing process. For example, recent studies have demon-
strated that for pain and disgust (two affects that can
be reliably elicited and thus more easily investigated),
facial and emotional neural circuitry in the observer
that corresponds to the affective displays accompany-
ing the observed action will also be activated (Decety,
Michalska, & Akitsuki, 2008; Singer & Lamm, 2009;
Wicker et al., 2003). As neuroimaging studies become
increasingly precise, specific neural patterns associated
with each emotion (Damasio et al., 2000; Phan, Wager,
Taylor, & Liberzon, 2000) and the degree of correspon-
dence in neural circuitry activation between observer
and observed across a range of affects will be further
delineated. For example, in examining these questions,
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Bastiaansen, Thioux, and Keysers (2009) found that
while seeing the emotions of others recruited regions
of the brain involved in the experiencing of similar
emotions, there did not seem to be a reliable mapping
of particular emotions onto particular brain regions.
Rather, emotion simulation seemed to involve a mosa-
ic of affective, motor, and somatosensory components.
A number of studies have emphasized the important
role of such simulation and the mirror neuron system
in facial emotion processing, social cognition, and
the development of empathy (Decety & Meyer, 2008;
Enticott, Johnston, Herring, Hoy, & Fitzgerald, 2008;
Iacoboni, 2007; Kaplan & Iacoboni, 2006). This kind
of direct mapping of observed actions onto the equiva-
lent neural structures in the brain of the observer has
been given a number of different labels by different
theorists, including “primary intersubjectivity” (Trev-
arthen, 1979), “embodied simulation” (Gallese, 2005),
“participatory memory” (Fogel, 2004), “unmediated
resonance” (Goldman and Sripada, 2005), and “alter-
centric participation” (Braten, 2007a).
With its extensive circuitry, work to date has strong-
ly suggested that the overall purpose of the mirror
neuron system and its closely associated networks
is not simply to elicit a veridical imitation of an-
other’s actions, but, rather, to promote “experiential
understanding”—that is, comprehension not only of
the overt goals of an observed action but the motiva-
tional purposes behind it (Fogassi et al., 2004; Gallese,
Eagle, & Migone, 2007). “We understand other’s ac-
tions through a mechanism of resonance, in which the
motor system of the observer ‘resonates’ (i.e., mirror
neurons activation) whenever an appropriate visual
and/or acoustic input is present . . .” (Ferrari & Gallese,
2007, p. 78). The internal representations created by
95
the observer’s bodily “resonance” with what has been
observed not only promote comprehension of the ob-
served party’s intentions, but also contribute to various
forms of response facilitation (the automatic tendency
to reproduce observed movements when appropriate
stimuli are presented), including imitation and emula-
tion (Rizzolatti et al., 2002). Recent studies have also
provided evidence that the observation of particular
motor acts does not simply produce transient excita-
tion, but can lead directly to the formation of enduring
“motor memories” in the observer’s primary motor
cortex (Stefan, Classen, Celnik, & Cohen, 2008; Stefan
et al., 2005). Decety (2002, p. 305) has described the
mirror neuron system as constituting “a common neu-
ral substrate that directly translates sensory experience
into action or schemas of actions.” From the standpoint
of the representation of early trauma, the words “sche-
mas of actions” are significant. The capacity to form
such “motor memories” or “schemas of actions” likely
contributes to infants’ ability to carry out multiple-step
deferred imitation tasks many months after they were
initially presented (Bauer, Hertsgaard, & Dow, 1994;
Meltzoff, 1995) and, by inference, to their ability to
carry out multistep actions associated with a traumatic
reenactment.
As elaborated below, even more significant from
the standpoint of the reenactment of preverbal trauma,
a number of studies have demonstrated that neurons
implicated in the mirror neuron system activate not
only when one is observing an action or carrying it
out, but also if a person is simulating the action in his
or her mind—that is, “the mental simulation of action
is assigned to the same motor representation system as
preparation and execution” (Decety, 2002, p. 299). Not
only are mirror motor neurons responsive to externally
observed representations of a particular act, but they
are activated when internal representations of that act
are mobilized as well (Decety, 1996, 2002; Decety &
Grezes, 2006).
Developmental considerations
Conceptualizing how these various mirror neuron
functions might operate in early childhood, Meltzoff
(2002), Gallese, Eagle, and Migone (2007), Stern
(2000), Braten (2007a), and others have postulated
processes whereby through this “shared neural map-
ping” infants become aware of the particular men-
tal and/or emotional states that accompany their own
bodily actions while also becoming increasingly aware
of the resonance between their own bodily actions and
those of others, either through observing others acting
 96
similarly or through stimulation of their own mirror
neuron system. As articulated by Meltzoff and Brooks
(2007), “exteroception (perception of others) and pro-
prioception (perception of self) speak the same lan-
guage; there is no need for associating the two through
prolonged learning because they are bound together
at birth” (p. 153). The infant’s growing awareness of
the commonality between what he or she experiences
when in a certain affective or behavioral state and what
another person is likely experiencing when showing
the same behaviors or affective expressions is believed
to lay the foundational groundwork for the develop-
ment of empathy, intersubjectivity, and a sense of self
and other, including a theory of mind (Meltzoff, 2002).
Supporting their important role in these areas, a num-
ber of recent studies have identified either decreased
or poorly modulated mirror neuron activity in autistic
children (Dapretto et al., 2006; Oberman et al., 2005;
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Williams, Whiten, Suddendorf, & Perrett, 2001).
As suggested by the Meltzoff and Brooks quote
cited above and based on the pioneering studies of
Meltzoff and Moore (1977) and numerous subsequent
studies demonstrating that newborn infants can imitate
a range of tongue and lip movements, and even facial
expressions of emotion, it would appear that neurons
mediating this mirroring capacity are present from the
first days of life (see also Bertenthal & Longo, 2007;
Lepage and Theoret, 2007). Interestingly, although an
approximate imitative response to a facial expression
stimulus will be observed immediately, infants will
also “work at it” over a matter of minutes to hours in
the process of achieving a response that more closely
duplicates the movement they are observing. Meltzoff
and his colleagues (Meltzoff, 2002; Meltzoff & Moore,
1997) have proposed that this early facial imitation
is based on a mechanism they have termed active
intermodal matching (AIM), a “matching-to-target”
proprioceptive feedback loop that allows the infant’s
motor performance to be compared against the seen
target and then corrected to achieve a closer and closer
match. Also notable is that successive “matching to
target” efforts can take place even in the absence of
an immediate stimulus model—that is, during peri-
ods when the adult model is absent or demonstrates
a neutral face, suggesting that newborn imitation can
occur on the basis of some sort of stored representation
(Meltzoff & Moore, 1994).
That newborns are not limited to rote imitation along
isolated sensory modalities has been demonstrated by
their capacities to synthesize incoming stimuli through
cross-modal matching, such as mouthing a ball with
bumps on it and then differentiating a picture of that
Theodore J. Gaensbauer
ball from a picture of a smoothly surfaced ball, or rec-
ognizing when a voice and a picture of a person speak-
ing are synchronized or not, in both cases as evidenced
by preferential looking (Kuhl & Meltzoff, 1984; Melt-
zoff & Barton, 1979). Although not postulating a spe-
cific cognitive mechanism, Meltzoff and Moore (1997)
have hypothesized that the observation and execution
of human acts are coded within a common framework
that they have termed a “supramodal act space,” in that
the processing of information by the infant is not limit-
ed by the modality by which that information was per-
ceived. Through this “supramodal” function the infant
is able to internally experience, assess, and integrate
information coming from different sensory modalities,
converting the disparate stimuli into a more holistic,
multimodal schema that results in a more sophisticated
comprehension of the stimulus situation and ultimately
to more adaptive responding. Presumably, as the child
matures this supramodal capacity becomes increasing-
ly complex and intertwined with the child’s advancing
cognitive capabilities, such as self-conscious aware-
ness of the actions of self and others and the verbal
labeling of thoughts and feelings.
Consistent with this notion of a “supramodal act
space” that is able to handle increasingly complex in-
formation over time, there is increasing evidence that
the mirror neuron system is plastic in nature and that
the specifics of its functioning are strongly influenced
by developmental experience. For example, profes-
sional dancers trained in a particular dance style, or
nonmusician subjects taught to play a particular piece
of music, demonstrate increased activation in premotor
mirror neuron networks when observing others dance
in the same style as opposed to a different style or lis-
tening to the piece of music they learned as compared
to musical pieces that had not been learned (Calvo-Me-
rino, Glaser, Grezes, Passingham, & Haggard, 2005;
Lahav, Saltzman, & Schlang, 2007). Mirror neuron
function can also be modified by experiential learning,
such as through “incompatibility training.” If subjects
perform one kind of motion (moving their little finger)
while observing a different motion (movement of the
index finger or a foot), within a short period the mir-
ror neuron areas in the motor cortex will no longer be
preferentially activated when the subject is observing
the movement that corresponds to their own original
(little finger) movement. Instead, the mirror neuron
area implicated in the original movement will be ac-
tivated when the subject observes the “incompatible”
movement (index finger or foot) (Catmur, Walsh, &
Heyes, 2007; Catmur et al., 2008).
Although the findings reported above are consistent
 Embodied Simulation, Mirror Neurons, and the Reenactment of Trauma in Early Childhood
with a picture of the mirror neuron network as a dy-
namic system that develops and changes in conjunction
with a child’s brain maturation and particular stimulus
environment, at this point in time almost nothing is
known about the ontogenesis of either single mirror
neurons or the distributed mirror neuron system. Clear-
ly, this will be one of the most important and intriguing
areas of research in the coming years. In the meantime,
a number of theorists have begun to provide conceptual
frameworks designed to stimulate such developmental
investigations. To cite two examples, Damasio and
Meyer have posited the creation of both lower and
higher level “convergence–divergence zones” (CDZs)
within the brain that are able to coordinate informa-
tion from multiple somatosensory regions and have
the potential to reconstitute the original distributed set
of memories and information through retroactivation
of the somatosensory sites (Damasio & Meyer, 2008;
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Meyer & Damasio, 2009). Based on single-cell elec-
trical monitoring in epileptic patients, Iacoboni and
his colleagues have identified “super mirror neurons”
whose postulated role is to control and modulate the
activity of the “more classical and simpler mirror neu-
rons.” Such cells are found in the orbitofrontal cortex,
anterior cingulate gyrus, and presupplementary motor
area—regions of the brain that, as Iacoboni points out,
are among the least developed in early infancy and that
show very dramatic developmental changes over time
(Iacoboni, 2008a; 2008b, pp. 200–203).
A logical conclusion to be taken from all of this
work is that, although the mirror neuron system and its
associated networks can be initially activated implic-
itly and automatically in response to external stimuli,
the emotions and behaviors mediated by these acti-
vated neural assemblies are available to higher level
cortical processing that includes conscious awareness.
For example, the postulate that children who are ob-
serving another person are making inferences about
that person’s state based on a sampling of their own
internal feelings (“That person is reaching for [must
want] a cookie” or “That person looks [must be] sad”)
would carry with it the implication that some sort of
preconscious or explicitly conscious cognitive process
is also taking place. When a 14-month-old child shows
an empathic expression of concern and demonstrates
prosocial behavior by going over to give a pat or a hug
to a person in distress (Zahn-Waxler, Radke-Yarrow,
Wagner, & Chapman, 1992), one would reasonably
infer that the child has consciously recognized the
distressed emotional state of that person and is acting
purposefully to reduce that distress. Such an inference
is consistent with studies indicating that distinctions
97
between the actions of self and others and a sense of
agency emerge very early in infancy (Decety & Meyer,
2008). This presumed accessibility of implicit experi-
ence to conscious awareness beginning very early in
childhood has important implications for conceptual-
izations about the nature of early memories of trauma
as well as for treatment.
Implications for the understanding of traumatic
reenactments in early childhood
I believe these recent findings have important im-
plications for our understanding of the mechanisms
underlying the enduring power of traumatic experi-
ences to affect very young children’s internal schemata
and behavior. Just as with early imitation, there is no
need to postulate any a priori motivation or conscious
purpose to reenactment behavior. Rather, for the young
child the act can come first and the thought can come
later. In its most basic form, reenactment behavior can
be considered as a product of an unmediated “match
to target,” reflecting how the human brain is uniquely
programmed, without intentional awareness, to auto-
matically translate the perception of an external event
into an internal representation of that event within
areas of the brain that organize the motor actions
and somatosensory/emotional pathways corresponding
to those being perceived. These internal representa-
tions, or “schemas of action,” in turn can serve as the
templates, or “response facilitators,” for emotionally
suffused behavioral actions when they are triggered
by relevant stimuli. Young children, given their neu-
ropsychological immaturity, particularly in regard to
prefrontal cortical development, will be exceptionally
predisposed to absorb this translation from perception
to internal representation in direct, unadulterated, and
highly impressionable forms. Moreover, when these
internal schemata are expressed through action, it is
likely to be in relatively unmodified and uninhibited
forms.
In normal development, the mirror neuron system
has been postulated to play an integral role in the day-
to-day, moment-to-moment, intersubjective processes
of empathic identification by which the young child
cumulatively internalizes and in turn expresses in his
or her own behavior the nurturance received from
caregivers (Braten, 2007a ; Stern, 2000). Under less
optimal circumstances, these processes can contribute
to intergenerational cycles of abuse, as the child expe-
riences an empathic identification with a maltreating
parent and a circular reenactment of an abusive pattern
 98
is set in motion. Utilizing his concept of allocentric
participation, Braten (2007b, p. 305) movingly writes
how “
the victim may come to experience engagement in the
bodily motions and feelings of the abuser, not just the
suffering. That leaves the victim with a compelling
bodily and emotional remembrance that increases the
likelihood of circular re-enactment of abuse in peer re-
lations or towards younger children later in ontogeny
. . . no conceptual or verbal “memory” is required for
experiences of abuse in felt immediacy to give rise to
re-enactment.
Anticipating many of the ideas expressed in this paper,
in their case report of an anxious, gender-disordered
3½-year-old, Coates and Moore (1997) provide a poi-
gnant example of the pathological effects of “empathic
identification” with an emotionally abusive parent.
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As a phenomena, traumatic reenactments provide
strong evidence that enduring motoric representations
or “behavioral memories” (Terr, 1988) can be gener-
ated by a single event. As with deferred imitation, these
motor memories can be created in the absence of any
actual carrying out of motor or behavioral actions at the
time of the original event—that is, they are not “behav-
ioral memories” in the procedural sense. Furthermore,
the internal representations manifesting themselves in
reenactment are not limited simply to the “motor” or
“behavioral” realm, nor are they carbon copies of the
actions that had been experienced. I would hypoth-
esize that, when a child experiences a trauma, through
“shared neural mapping” the mirror neuron system,
with its associated networks, is mediating “action un-
derstanding,” capturing not just the action itself but the
goals and motivation behind the action, including the
subjective state of the person(s) being observed. What
is thus being activated and internalized is a holistic, af-
fectively charged, and multimodally integrated schema
of the observed action rather than a simple behavioral
replication. Gallese (2006, p. 54) writes, “We do not
just ‘see’ an action, an emotion, or a sensation. Side by
side with the sensory description of the observed so-
cial stimuli, internal representations of the body states
associated with these actions, emotions, and sensa-
tions are evoked in the observer, ‘as if’ he or she were
performing a similar action or experiencing a similar
emotion or sensation.” He further states, “By means
of a shared neural state realized in two different bodies
that nonetheless hew to the same functional rules, the
‘objective other’ becomes ‘another self’” (p. 53).
Unfortunately, in the young child single episodes of
trauma appear to have a power to produce a pathologi-
cal fusion between the “objective other” and “another
Theodore J. Gaensbauer
self” that is comparable in many respects to that which
can result from the cumulative effects of repeated
interactions. As demonstrated by Kevin, traumatized
young children appear capable not only of internal-
izing and imitating isolated violent motor actions to
which they have been witness, but also of absorbing
both the goals of those actions (to do harm) and the
emotions associated with them. Kevin appears to have
internalized the angry, sadistic, and murderous aggres-
sion of the men who assaulted his father, exemplified
by his frequent angry outbursts, sadistic attempts to
hurt others, and preoccupation with knives and sword
fighting in his play. Strikingly, he also appears to have
internalized his father’s experience as victim, carried
forward not only in the form of wishes to join his father
in heaven, but in the specific identification of dying by
being stabbed with a knife. Similarly, in her apparent
dissociated acting out of the domestic violence she wit-
nessed, Margaret appears to have identified alternately
with the role of perpetrator and the role of victim.
Jennie’s repeated batting motion in reaction to being
approached by an adult male would suggest that an
“empathic identification” with an abusive parent can
occur within the first months of life.
Given the seamless transition from outside to inside
that characterizes the internalization of these trauma-
driven, affectively charged “schemas of actions,” it is
no surprise that as they are enacted they will be expe-
rienced as part of the self and can profoundly shape
the child’s identity, as Terr’s work has so compellingly
demonstrated (Terr, 1990). A dramatic example of this
from my own practice was the case of Audrey, who at
12½ months witnessed her mother and a friend of her
mother being killed by a letter bomb. At age 5 years,
Audrey was preoccupied with what she experienced
as two sides of her personality: the “good Audrey”
who was happy and loving and the “other Audrey”
who, plagued by traumatic images and reenactment
impulses, was angry and wild and thought about kill-
ing baby ducks (Gaensbauer, 1995). Consistent with
Kevin’s and Margaret’s apparent identifications with
both perpetrator and victim, in interviews with acutely
traumatized children Pynoos, Steinberg, and Wraith
(1995) have observed a similar “flexibility in identifi-
catory roles, varying even within a single interview
session, in their identification with assailant, victim, or
rescuer” (p. 87).
Any particular reenactment pattern, while initial-
ly mediated by mirror neurons and their associated
networks and triggered relatively automatically, can
through the development of secondary autonomy take
on a life of its own and become increasingly the prod-
 Embodied Simulation, Mirror Neurons, and the Reenactment of Trauma in Early Childhood
uct of conscious and purposeful action. The more
nonspecific forms of aggression shown by Kevin and
Margaret years after their original trauma would be
examples of how a set of symptoms derived from a
specific traumatic event, while retaining elements of
the original experience, can expand into a more gen-
eralized and autonomous pattern of behavior. With
advancing social and cognitive development, reenact-
ment patterns and identification processes can become
increasingly sophisticated both in action and motive
by, for example, manifesting more variable and com-
plex forms of interpersonal sadism or masochism. For
example, at age 5 years, Margaret continued to have
episodes of rage expressed in a variety of ways, includ-
ing provocatively teasing family pets, marking rugs
and walls, and breaking parental belongings. Pynoos,
Steinberg, and Wraith (1995) note that it is not uncom-
mon over time for one particular traumatic identifica-
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tion to become increasingly prominent and rigidified,
to the point that it becomes dominant in the child’s
developing personality and sense of self.
Reenactment variability and cross-modal
processing
These multiple identifications and varied forms of re-
enactment as manifested in the case examples and
the clinical literature highlight a characteristic feature
of traumatic reenactments in young children as seen
over time. While core themes can remain constant,
children’s reenactments will by no means be exact,
veridical replicas of what the child has experienced
or witnessed. Even though there appears to be an
innately programmed set of neuronal pathways that
prime the child to internally represent and behaviorally
reenact what he or she has experienced, these neuronal
pathways do not operate in isolation from other parts
of the brain, and the child’s mind is not simply a pas-
sive receptacle upon which these pathways are traced.
Within the perceptual-cognitive-affective-sensorimo-
tor templates dictated by the traumatic experience, the
particular forms that traumatic reenactments may take
can be highly variable, or, looked at from a different
perspective, creative. As the cases illustrate, they may
be manifested through a variety of expressive path-
ways (through different sensory modalities, through
behavioral actions, through symbolic play with toys,
etc.) and reflect varying perspectives (first vs. third
person). Templates may be broken down and expressed
in fragments, particular elements (including elements
not part of the original experience) may be added or
99
subtracted, different aspects may be emphasized at
different points in time, and/or the purposes or goals
of the actions may be satisfied by different means. Re-
enactments can also be triggered by a wide and often
unpredictable range of internal and/or external stimuli
in a variety of modalities (affective, visual, auditory,
tactile, kinesthetic, etc). Over a more extended period,
a traumatic experience is likely to manifest itself in the
form of traumatic themes, such as a preoccupation with
violence or death, or through more symbolic forms of
expression, such as a clown with sharp teeth rather
than a knife. It is this capacity to creatively rearrange
or “play” with the internalized elements of a traumatic
experience, even when much of the rearranging may
take place out of conscious awareness, that provides
pathways to therapeutic intervention and helps explain
the many psychological functions of reenactment play
that have been identified in the treatment literature.
The capacities for cross-modal processing, integra-
tion, and expression, described earlier in the context of
Meltzoff and Moore’s concept of a “supramodal” rep-
resentational framework, Damasio’s concept of “con-
vergence–divergence zones”, and Iacoboni’s “super
mirror neurons,” present from infancy onward, provide
a mechanism for understanding this wide-ranging vari-
ability. Defining the neuroanatomical location of the
representational space where this ongoing reprocess-
ing and integration is occurring is both difficult and
beyond the purposes of this paper, other than to say
that it must reflect the complex associative networks
within the brain, including the prefrontal cortex, that
are linked to the mirror neuron system and that serve
to integrate internal and external stimuli. Psychologi-
cally, the concept captures what might be thought of
as the infant’s capacity for executive functioning—in-
tegrating stimuli coming through multiple modalities,
organizing these stimuli into meaningful patterns, and
facilitating adaptive responses.
An important point to be taken from this wide vari-
ability in behavioral expression is that even when a
trauma has been internally represented or “embodied,”
it will not be activated in every instance in which a
triggering stimulus is present (just as in the original
observations of Rizzoletti and colleagues, premotor
neurons were activated but the motor neurons car-
rying out the act were not). There will be great indi-
vidual variation in whether traumatic reenactments
will occur and/or what form they might take, particu-
larly over time. The number of factors possibly influ-
encing such individual expression is huge, but these
would include variables such as the manner in which
the trauma was registered, the quality of caregiver
 100
support and/or intervention, potential genetic vulner-
ability, cognitive strengths and weaknesses, executive
function capacities such as impulse control and emo-
tional regulation, the frequency of exposure to trig-
gers, the types of defenses and coping strategies being
utilized, and even the sensitivity of the child’s mirror
neuron system, among many others. While beyond the
scope of this paper, investigation into the neural bases
underlying an individual’s ability to differentiate self
and other in the presence of shared representations
mediated by the mirror neuron system and to inhibit
the automatic imitative response tendencies associated
with these shared representations is ongoing (Bien,
Roebroeck, Goebel, & Sack, 2009; Brass, Ruby, &
Spengler, 2009; Decety and Meyer, 2008).
Behavioral reenactment of preverbal trauma
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From a memory standpoint, a very striking feature of
reenactment behavior in early childhood is that some
children traumatized in the preverbal period appear
able, months or even years after their original trauma,
to carry out behavioral actions or symbolic play re-
flecting their traumatic experience, including elements
that their caregivers either did not know about or were
certain had never been discussed (Gaensbauer, 1995,
1997, 2000, 2002, 2004; Paley & Alpert, 2003; Terr,
1988, 2003). Assuming the validity of the observa-
tions, they raise an obvious question: How is it pos-
sible for an older child to carry out behavioral actions
derived from events that occurred at an age when the
motor pathways necessary to carry out the actions
were not even in place? A common explanation for
such reenactments in the past was that they were based
on information derived from external sources, such
as overheard conversations. However, in a significant
number of published clinical cases, including those cit-
ed in this paper, the specificity of the reenactments, the
contexts in which they were triggered, the affects and
associated symptoms that accompanied them, and the
defensive operations they engendered all strongly sug-
gested that they were the result of internalized person-
alized experience rather than declarative knowledge
obtained from outside sources (Gaensbauer, 1995).
To help explain how such carryover might occur,
I would propose the following line of reasoning. The
first assumption is that infants are capable of evocative
memory. The second is that the internal imagery asso-
ciated with evoked memories of a trauma is the equiva-
lent of a “simulation.” The third is that this “simulation”
activates mirror neurons and their associated networks
in the same way as would an external perception. The
Theodore J. Gaensbauer
fourth is that when the neural pathways mediating the
relevant motor acts become available developmentally,
“simulated” mirror neuron activation can result in the
carrying out of the motor acts that correspond to the
trauma-based internal imagery.
Extensive research on early memory has strongly
suggested that the same mechanisms by which mem-
ories of an experienced event are laid down along
distributed sensory pathways in older children and
adults are operative in very young children as well
(Howe, Cicchetti, & Toth, 2006; Howe & Courage,
1997). The quantity and quality of what is perceived
and registered will, of course, vary with the degree
of brain maturation at the time of the trauma. Al-
though infants cannot tell us in words about images
that might be going through their minds, I believe the
assumption that such images are present is consistent
with the vast body of memory research that has been
carried out in the last four decades, including the fact
that many of the symptoms required for the diagnosis
of PTSD, such as re-experiencing, reenactments, and
avoidance, depend on some form of memory (Schee-
ringa & Gaensbauer, 2000). A clinical example of af-
fective reexperiencing in a very young child would be
4-month-old Jennie’s distress when exposed to a man,
distress that could be evoked not only by seeing a man
but also by hearing a man’s voice (Gaensbauer, 1982).
Given the ongoing presence of internal representations
of a trauma that can be triggered by external stimuli, it
seems reasonable to assume that neural networks as-
sociated with such internal representations will also be
triggered “spontaneously” by internal stimuli as well,
including physiological or affective states (Gaensbau-
er, 2002).
When present, these internal representations of a
trauma will presumably be mobilized and experienced
according to the various sensory modalities through
which they were originally perceived (Meyer & Dama-
sio, 2009). While visual imagery and somatic sensa-
tions are likely to be the most prominent, every sensory
modality can be involved. For years afterward, Audrey,
the 12½-month-old girl who was hit by debris emanat-
ing from the explosion that killed her mother, would
become distressed when exposed to a high wind or
when particles such as dustballs or flies landed on her
skin. The internalization of auditory stimuli was ex-
emplified by a boy who spent the first nine months of
his life in the hospital, much of it in the ICU, because
of congenital anomalies that required numerous opera-
tions. At age 3 years, the most troublesome symptom
reported by his parents was his complete inability to
be around children his own age or younger; the minute
he would hear sounds of a child crying or exclaiming
 Embodied Simulation, Mirror Neurons, and the Reenactment of Trauma in Early Childhood
loudly, even on television, he would cry inconsolably
and want to get away. The only explanation that his
parents and I could come up with was that he had been
sensitized by his constant exposure to crying children
in the hospital, analogous to the crying “contagion” that
can be observed in young children in hospital settings
(Sagi & Hoffman, 1976).
Characteristic of traumatic memories, particularly
visual ones, is their deep imprint, their “burned-in”
quality (Pitman, 1989; Terr, 1988). Depending on the
severity of the trauma and other variables, such “burned-
in” tapes or flashback images are likely to play recur-
rently in the young child’s mind and be experienced as
something that is happening in the present, just as they
might in an older child or adult. In keeping with the
contribution of mirror neurons to response facilitation,
the fact that these representations are intimately tied to
stimulus cues, such as those provided in the playroom
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setting, helps explain why traumatized children might
automatically respond with a reenactment action. It is
also likely that everyday stimuli of which caretakers
are unaware frequently account for the triggering and
reinforcement of traumatic memories and reenactment
behavior in the home environment.
Assuming that traumatic representations do endure
in the form of internal imagery, the fact that the mirror
neuron system activates not only when an individual is
observing someone carrying out an action or carrying
it out him/herself, but also when the person imagines
carrying it out, helps explain how a child might carry
out motoric actions derived from events that occurred
long before the motor system underlying those ac-
tions came into being. Internalized representations of a
trauma, when triggered, are likely to be the equivalent
of “simulations.” As persisting “tapes” or “flashbacks”
of a traumatic event are evoked and as the child’s mo-
tor system matures, mirror neurons and other neurons
responsible for organizing the corresponding motoric
behaviors will be activated as well. It would be expect-
able that such activation could, under certain circum-
stances, result in the actual carrying out of behavioral
actions reflecting the early traumatic experience. Kev-
in’s explanation that the reason he hit me at our first
meeting was because he thought I would “hit [him]
back” suggests that the equivalency between simula-
tion and actual motoric activation can be sufficiently
compelling as to result in a “simulated” reenactment
being experienced as something that has actually oc-
curred. The implication of Kevin’s comment is that in
his mind he had already hit me (i.e., internal images of
a fight were interpreted as actions that he had actually
carried out) and was defending himself against my an-
ticipated retaliation.
101
Traumatic reenactments and early memory
Although the innate synchrony between perception
and action would suggest that traumatic reenactments
would most appropriately be categorized as forms of
implicit learning, out of the child’s conscious aware-
ness, there is good reason to believe that even if reen-
actment pathways are triggered automatically, they are
at the same time accessible to conscious awareness and
to neural pathways associated with explicit memory
systems. As described earlier, at the neurological level
the neuronal networks that serve a mirroring func-
tion and mediate embodied simulation are intimately
connected to other regions of the brain, including the
frontal lobe. At the psychological level, the fact that
feelings and sensations evoked in the observer are used
to draw conclusions about the subjective state of the
observed (as was pointed out in the earlier discussion
on early capacities for empathy) carries with it the
implication that the young child observer is processing
both the external and the internal information at some
conscious level. Applying this observation to trau-
matic reenactment, I would assert that just as children’s
awareness of how they feel when they carry out a be-
havioral act helps them to understand the experience
of others, so too does children’s potential awareness of
the reenactments they are carrying out open the door to
conscious cognitive processing of their own traumatic
experience.
That implicit memories would be available for ex-
plicit, conscious processing is supported by the work
of a number of developmental researchers studying
nonverbal memory who have argued that infants are
capable of declarative memory in the first year of life
and that implicit and explicit memory systems develop
simultaneously rather than in sequence from implicit
memory (early) to explicit memory (late) (Meltzoff,
1990; Rovee-Collier, 1997). Even separate from how
one categorizes nonverbal memory, the clinical lit-
erature on preverbal trauma has certainly provided
evidence of an early developing declarative memory
system, with a number of clinical examples of young
children “declaring” aspects of preverbal traumatic
experiences through behavioral enactments and ver-
bal communication months and even years after the
original trauma (Gaensbauer, 2002; Paley & Alpert,
2003). A relevant example would be Terr’s (2003) re-
port of a child who was placed in foster care at age 13
months after her 25-day-old sister was found dead as
a result of child abuse. During her first meeting with
Terr at 29 months of age, while holding a baby doll she
murmured, “Baby die.” Later in the same session, as
she threw two wooly stuffed animals on the floor, she
 102
stated “Sheep die.” In addition to strongly suspecting
that the child had witnessed her sister being killed, Terr
learned six years later that the child’s grandparents had
indeed slaughtered sheep in her presence.
My clinical experience would suggest that the rela-
tionships between implicit and explicit memory sys-
tems are not only extremely complicated but are also
quite fluid, with multiple feedback loops. In working
with traumatized young children, it has been my fre-
quent observation that when children are provided an
appropriate vehicle for communicating their experience
(such as cues in the form of structured play situations
that recreate the setting in which the trauma occurred),
it can be as if a “light bulb” goes on and the children
immediately engage in playing out some aspect of their
experience. My initial interpretation of this phenom-
enon was that the children had just been waiting for
the appropriate vehicle by which to communicate their
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experience and that the play reflected a conscious, non-
verbal (i.e., explicit) memory of the earlier trauma. In
light of the work on mirror neurons, I have come to see
this behavior as much more complicated. For a number
of children, this initial jump into the playing-out of
some aspect of their trauma has seemed completely
unpremeditated, as if once the cues were registered and
the children “got it” (i.e., recognized consciously or
unconsciously that the play situation corresponded to
the situational context in which their trauma occurred),
they could not help but carry out the action.
The fluidity between implicit and explicit memory
systems in the context of such reenactments has been
evidenced by the fact that a cognitive and affective ap-
preciation of the significance of what a child has reen-
acted can come after the fact. For example, at age 4½
years, Audrey, the child whose mother had been killed
by a letter bomb when she was 12 ½ months of age,
responded to a play setting that reflected the scene just
prior to the bombing by knocking over all of the dolls
and furniture with an explosive gesture. Other aspects
of her experience were reenacted in the same session
as well, such as when, shortly after I had asked her
how her mother died, she abruptly fell to the floor and
began thrashing back and forth. It was only on her way
out of the session that she seemed to experience the
full emotional impact of the reenactments she had just
carried out as she turned to her adoptive mother and
said, “That doctor hurt me so bad.” Another child who
at 22 months of age played out an automobile accident
that had occurred at 9 months of age also did not show
a great deal of affect in the session, yet she experienced
a major resurgence of symptoms associated with the
accident following the session. These included, four
days after the session, calling out “Car in there!” as she
Theodore J. Gaensbauer
and her mother drove past the river embankment where
the accident had occurred (Gaensbauer, 1995).
Therapeutic considerations
Although the therapeutic implications of this new un-
derstanding of the possible mechanisms underlying
traumatic reenactment are not the subject of this com-
munication, a couple of aspects of reenactment behavior
are worth highlighting. On the positive side, by reen-
acting their experience on a public stage, young chil-
dren are making their traumatic experience available
both for self-observation and for therapeutic interven-
tion (Gaensbauer, 2004). They are creating opportu-
nities for themselves to gain awareness of what they
are doing and feeling and to make linkages between
their current reenactment behavior and its traumatic
origins. As children get older and develop a clearer
sense of autobiographical memory, it is possible that
these retained images and reenactment behaviors can
be integrated into a more meaningful autobiographical
narrative. An example would be the case reported by
Garrity (cited in Gaensbauer, 2004) of a child who at
11 months of age witnessed her father stab her mother
to death. In a therapy session at age 26 months, after
playing out a fight between a male and a female doll,
the child turned to her therapist and asked “Did he cut
her?” Validating the child’s perception, the therapist
said “Yes.” Soon after, the child pointed to a spot on
her chest right beneath the clavicle and said “Red,”
confirming the presence of a persisting image. At the
time neither Garrity nor the child’s adoptive mother
had knowledge of the location of the fatal wound and
had actually thought there had been multiple wounds.
Two years later they reviewed crime scene photos
that demonstrated that there had only been a single
fatal wound and that the child had pointed to the exact
spot. As a result, they were able to further validate the
child’s experience.
In this sense, each time a reenactment occurs it can
be seen as an opportunity for cognitive and affective
processing, for integration of the original traumatic
experience, and for the development of a meaningful
autobiographical narrative. It also provides an oppor-
tunity for the utilization of coping mechanisms and
the enactment of alternative outcomes that were not
available at the time of the original trauma (Coates &
Gaensbauer, 2009). On the negative side, as empha-
sized earlier and as clinicians working with severely
traumatized children are acutely aware, reenactment
behavior can be extremely problematic. Not only is
insight about the traumatic origins of acting-out behav-
 Embodied Simulation, Mirror Neurons, and the Reenactment of Trauma in Early Childhood
iors difficult for young children to achieve, but even
when such insight is obtained, reenactment behaviors
themselves do not necessarily go away. Indeed, as not-
ed earlier, the more it is reenacted, the more engrained
a behavior can become. In addition, the secondary re-
inforcement aspects of certain traumatic reenactments,
such as aggressive or sexual acting out, can for a
variety of reasons actually increase the likelihood of
recurrence rather than decrease it, to the point where
the behaviors become autonomous and are no longer
tied to the original experience.
At this point in time, psychosocial treatment ap-
proaches directed toward desensitization and symptom
reduction, affective regulation, cognitive and emotional
reprocessing, the development of a narrative, and res-
toration and repair are the therapeutic mainstays in the
treatment of traumatized young children (Gaensbauer
& Siegel, 1995; Lieberman & Van Horn, 2004; Scheer-
Downloaded by [Gazi University] at 17:28 17 August 2014
inga & Gaensbauer, 2000). The growing knowledge of
the functioning of the mirror neuron system helps ex-
plain how such destructive reenactments can continue
at an implicit level despite the promotion of conscious
efforts to process and contain them. Given an aware-
ness of how these early events have been encoded, the
development of treatments that can promote some sort
of reprocessing at the procedural level of the affec-
tively charged, sensorimotor “memories” mediated by
the mirror neuron system and its associated networks
would seem crucial. Such awareness certainly helps
confirm the historically important role of play therapy,
which involves every aspect of the child’s being, as a
vehicle for working with traumatized young children.
Therapeutic approaches explicitly taking this new
understanding of mirror neurons systems into ac-
count—for example, through nonverbal media such as
the use of music, art, and dance—are beginning to be
developed (Berrol, 2006; Buk, 2009; Kirkebaek, 2007;
Schogler & Trevarthen, 2007). Dance and movement
therapy for young traumatized children would seem to
have considerable potential in this regard, through the
generation in a controlled setting of physical move-
ments that would have a high likelihood of mobilizing
motor memory pathways created by the trauma (Tor-
tora, 2006). Once mobilized, the creative movement
opportunities afforded by dance might pave the way
for modifications in the ways in which these traumatic
motor memories are expressed, such as through ampli-
fication of the movements in new directions, modifica-
tions in the intensities of movement expression, and
the introduction of new “goals” in the movements. The
overall goal would be a sublimation of the destructive
impulses being expressed in the reenactment behavior
into more socially acceptable forms.
103
Conclusions
Much more research is needed on the ontogenesis,
distribution, interconnections, and overall functioning
of mirror neurons before their role in emotional and
physiological embodiment, complex mimicry, inter-
subjective communication, and the differentiation of
self and other can be more precisely defined. Ongo-
ing studies using both brain imaging techniques and
single-cell recordings (such as with epileptic patients)
will no doubt further clarify these issues and provide
the basis for further understanding of the brain’s pro-
cessing of traumatic experience. At this point, the
direct examination of mirror neuron activity in young
children, particularly in relation to a specific stimu-
lus event such as a traumatic experience, is extreme-
ly difficult given the need for an immobile patient.
Neuroimaging studies of traumatized adults exposed
to stimuli that evoke internalized representations of
a trauma or that evoke internal simulations of trau-
matic action will help clarify not only mirror neuron
function but the role of multiple brain areas in the
embodiment of traumatic experience. I believe stud-
ies of adults will be very relevant to the understand-
ing of the mechanisms of traumatic reenactment in
young children, in that the automatic, unconscious
internalization of a trauma and its subsequent reenact-
ment (obviously in more complicated forms than seen
in young children) is a recurring feature with adult
trauma victims as well, as psychoanalysts from Freud
on have understood and which is so richly captured in
van der Kolk’s felicitous phrase “the body keeps the
score” (van der Kolk, 1994).
Even though so much is yet to be learned, I believe
that enough is known at this point to call attention
to the potential mediating role of mirror neurons in
what has long been a confusing and challenging clini-
cal problem—namely, the deeply embedded patterns
of reenactment behavior that can follow a traumatic
experience in early childhood. The fact that such reen-
actments are likely rooted in a bedrock of hard-wired
neuronal pathways that can be activated automatically
and outside conscious awareness helps account for
their repetitive and almost driven quality and their re-
sistance to change, even in the face of destructive con-
sequences. The fact that the mirror neuron system is not
just registering motor actions, but, rather, is facilitating
“experiential understanding,” also helps to explain the
more global identifications and strong affective ele-
ments that are commonly associated with reenactment
behavior. Awareness of its role in the internalization of
single events such as trauma in early childhood opens
up new perspectives on current conceptions about the
 104
nature of early memories and their availability for
conscious processing. As has been widely appreciated,
the significance of this new area of research for under-
standing both normal and psychopathological develop-
ment is immense, with the clinical implications of this
work just beginning to be explored.
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