The Experiential Foundations for Change

An integrative perspective on healing a wounded self.

This article is published with two goals in mind.

As a stand-alone read, this article embodies a selection of definitions, findings and arguments exploring the role of subjective experience in facilitating long term improvements in mental health.

In addition, it functions as an introduction to the next part in the series “What Makes Music Therapeutic?”, where I will introduce the concept of musical enactment, building on definitions outlined in this article.

What Is The Nature Of Change ? (Prelude)

This question is central to every inquiry into mental health.

And the degree to which we approximate the right answers to this question, will be reflected within the real-world effectiveness of the therapies that emerged from these answers.

The real world-effectiveness of many of the current mental health care treatments is, to state so politely, pretty saddening. It tells that something essential might be missing in the ways mental health is understood, conceptualised and treated.

Psychedelic therapy research is giving many in the field some new hope. For long however, this field of research has always seemed to me to hint towards a mechanism of action that is potentially more impactful than the therapy method itself.

As I will return to in more detail in the postlude of this article, I believe this emergent and overarching insight to holds a potential to turn the field of medicine and its core foundations on its head. In a constructive manner.

Subjectivity and Blind Spots

In this article I argue for one simple but key principle. That subjective experience plays as central a role in the healing of the self as it does in the original wounding of the self.

The first publications from Roland Griffith’s lab that documented changes in behavior, personality and outlook after a single dose of a psychedelic, caused an avalanche of conversations.

It challenged the wide-held belief that personality traits are largely fixed in adulthood. But arguably more remarkable may be that these changes sustained long-term and were linked to specific subjective qualities of the acute drug experience. This finding has by now been reported amongst primary outcome meassures in 93 psychedelic therapy clinical trials.

But should this be surprising?

Although not to be romanticised or simplified, the notion of experience-facilitated long-term changes in personality and behavior do align quite well with perspectives from neuroscience research on learning and development.

Outlining the reasoning behind this statement is a central aim of this article.

“Although we have created the most powerful and successful form of knowledge of all time, we lack a comparable understanding of ourselves as knowers. We have the best maps we’ve ever made, but we’ve forgotten to take account of the map makers. Unless we change how we navigate, we’re bound to head deeper into peril and confusion.”
- Frank, Gleiser, Thompson (2025)

In each eye, the retina contains a point where the optic nerve exits the eye and connects to the brain. As a result, any image that falls on this part of the retina is not seen, creating a small blind spot in each eye's visual field. Adam Frank, Marcelo Gleiser, and Evan Thompson use this as a metaphor in their book "The Blind Spot: Science and the Crisis of Uncertainty" and argue that modern science operates with a foundational blind spot: Its inability to account for subjective experience within its objective framework.

A Hero With A Thousand Faces

Mental health disorders defy simple explanations. Its faces are as diverse as the lives they disrupt.

This article argues for a central role of experience-based learning (implicit- or procedural learning) for sustained mental health improvements. I want to start this piece however by emphasising clearly and upfront that I am well aware of the complexities surrounding the topic of mental health.

There are many contributing factors to mental health problems, ranging from biological and contextual factors, and their interactions. Ranging from the foods we lack to a grief that lingers, from imbalanced hormones and inflammation to emotional wounding or deprived learning in childhood.

The perspective I will outline here does therefore not simply imply applicability across the entire wide spectrum of diagnoses and individual cases.

But what I will illustrate and am confident in, is that the points about to be made are more likely than not to have relevance for a significant portion, if not a majority of such cases.

From the best understandings at hand on the nature of change, this article will highlight that in order to modify the processes that define and underlie an individual’s mental health, utilising experience-based learning mechanisms might be a true prerequisite.

I will start with defining mental health as the dynamic, adaptive expression of the self. I will then outline reasons the self cannot, in most cases, be talked or medicated into change, but must be lived into these new configurations.

“The art of living is just as much about making productive use of our suffering whenever it arises, as about cultivating the joyous moments in life. [ ] Any system which denies this with quick-fix solutions or anaesthetics dramatically impedes the productive suffering which I have shown to be so necessary to our living fully and artfully.”
- James Davies (2012)

In the Hindu myth of Samudra Manthan, gods and demons churn the cosmic ‘Ocean of Milk’ to obtain Amrita, the nectar of immortality. In this process, instead a deadly poison called Halahala is unleashed, jeopardizing all existence. In this moment of crisis, Shiva intervenes by drinking the poison in order to protect creation, symbolically conveying that true power lies not in avoidance, but in facing inner darkness with courage and equanimity. Photo from temple in Angor-Wat, credit to Wikicommons.

Mental Health As The Functioning Of The Self

Mental health is typically defined by an individual’s capacity to engage with self and other. This relational and functional essence can be found in all popular definitions of mental health

Regardless of the theoretical framework used, mental health is mostly viewed as a function of interfacing between self and other. Here, I use the term “other” to encompass all that is distinct from the self (other individuals, the society, the world, and the broader external context with which the self interacts).

Therefore, efforts to improve mental health would logically need to act upon this interfacing process that we will define as the “self”, impacting both the perception and actions upon self and other.

These points will be gradually expanded and eleborated on in more detail over the next sections.

“A state of cognitive, emotional, and behavioral well-being in which an individual can function in society and meet the ordinary demands of everyday life.”
- American Psychological Association

Mental health is a state of well-being in which the individual can use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.”
- European Commission

“Mental health is the foundation for emotions, thinking, communication, learning, resilience and self-esteem. It is also key to relationships, personal and emotional well-being, and contributing to community or society.”
- Public Health England

“Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices.”
- National Institute of Mental Health

“Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or her community.”
- World Health Organisation

“Mental health is not merely the absence of mental illness, but the presence of flourishing — positive emotions, psychological well-being, and social well-being.”
- Keyes, C.L.M.

The Self Is A Process Of Enactment

The self should not be seen as a fixed structure, and more like a collection of processes that determine the interfacing between outside and inside, between “me” and “other”.

From the sense of owning a body to owning a personal story, from our social identities to our answers to the most existential dimensions of living. All of these present themselves within a unified and integrated sensation of self.

These definitions reflect leading insights from cognitive neuroscience. It recognises that the processes that define the self are internalised from lived experiences, and enacted by the world, or more broadly, the context.

Enactment refers to the dynamic emergence of cognition through ongoing processing of and interactions with its environment. Although originally introduced and used in psychoanalysis, Franciscio Varela, Evan Thompson, and Eleanor Rosch applied the concept to the field of cognitive neuroscience in their seminal work “The Embodied Mind: Cognitive Science and Human Experience”.

The concept offered an important reframing to our understanding of consciousness, cognition and the self, illustrating that the self is “not only embodied but also embedded in the world”.

For subjective experiences to not be seen as something passively received, but instead as enacted through ongoing sensorimotor and affective engagement with the world.

Within this engagement lie the roots of the self.

“Overall, the picture of the mind not as a unified, homogenous entity, nor even as a collection of entities, but rather as a disunified, heterogenous collection of networks of processes seems not only attractive but also strongly resonant with the experience accumulated in all the fields of cognitive science”
- Varela, Thompson & Rosh (1991)

The Self Is A Process Of Re-Enactment

From the experiences we had as infants to those we had just one minute ago, our history continues to influence the lived realities of our present moments.

Although the underlying mechanisms may remain largely unconscious, in a myriad ways inform our past experiences the ways and qualities by which the self is expressed in later life.

A key component to the concept of self-enactment is more precisely that it operates upon the history of processes that are internalised as memory, through accumulated life experiences. The self thus emerges from the engagement of memory systems, activated by the present context, and actively re-experienced within it.

The sense of self can therefore be viewed as a process of ongoing re-enactment. In “Structures of Subjectivity”, the authors Robert Stolorow and George Atwood described re-enactment not as mere unidirectional repetitions of trauma, but as the “co-created intersubjective field between patient and therapist.”

Re-enactment refers to the emerging of early developmental woundings, enacted by “the mutual interplay of two subjective worlds”. These become actively embedded and direct-lived experiences within this intersubjective climate.

I need to emphasise that the term should not be confused to only have relevance for these psychodynamic schools of thinking. Rather the opposite. I use the term to illustrate the intrinsic relation and dependency between the processes of self-enactment and the memory system.

As I will show over the next sections, the concept has strong interdisciplinary validity and offers a helpful framework for understanding the development, enactment, wounding, and healing of the self.

"Cognition is not the representation of a pre-given world by a pre-given mind but rather the enactment of a world and a mind on the basis of a history of the variety of actions that a being in the world performs."
- Varela, Thompson & Rosch (1991)

The Self Develops Through Experiential Learning

In the same way that we learn how to talk by talking, and how we learn how to walk by walking - The most primal building-blocks of the self are predominantly non-verbal, unconscious and acquired through direct-lived experiences.

A differentiation between self and other emerges chronologically and gradually from the first months after birth, and stabilises when the child is approximately 4–5 years of age.

Between ages 2 and 4 first symbolic representations and explicit linguistic skills consolidate gradually. More complex reasoning and abstract thinking develop more fully between ages 5 and 7, and continue to mature throughout adolescence.

Implicit learning or procedural learning mechanisms, often referred to as “learning by experiencing”, are well established far before birth. In contrast, explicit learning refers to the conscious consolidation of life episodes, facts, or information, and is considered immature within the first years of life.

The foundations of the self, as developed in the first years of life, are therefore largely, if not entirely, encoded and internalised as implicit memory. This includes the formation of mechanisms of perception, schemes of information processing, development of skills, affect-regulation, behaviors and patterns of pre-verbal sensory memory.

“Neurons that fire together, wire together” Eric Kandel, the neuroscientist who identified implicit learning mechanisms famously said. It works outside conscious awareness, without reliance on explicit memory systems, but is entirely dependent upon and driven by direct experiences.

The earliest life is therefore not remembers as stories, but are as Allan Schore put it, “somatic patterns, physiological expectations, and affective tones that structure the self.”

“The origins of the self lie in patterns of implicit knowing, not in the content of conscious thought. [It] emerges through lived experience well before the child has access to language or symbolic thought.”
- Daniel Stern

Neuroscience Professor Karl Friston elaborating on the concepts of embodied cognition, learning and and enactment.

The Self Is Biased By Salience

The likelihood of and the degree in which an experience influences the re-enactment of the self in the future, is determined by the significance perceived within this experience to the self .

When looking at the development of the self through insights obtained from neuroscience research of memory, it becomes evident that this process is by its very nature highly selective and biased.

The brain is evolutionarily tuned to selectively encode what matters most. It has innate mechanisms that treat experiences differently when their salience is high: the perceived importance of a stimulus or event, often based on its novelty, intensity, and relevance to the survival and regulation of the self.

Salience activates a complex interplay of neurotransmitter systems and brain networks that prioritize a selective strengthening of the neural networks that encode the event as it occurs, promoting long-term memory consolidation and biased memory recall.

This process is not a flaw but a neuro-economic strategy: salience functions as a filter through the noise, guiding the brain to allocate its limited resources with maximal efficiency. As Antonio Damasio wrote, “What the brain perceives as ‘important’ becomes the scaffolding upon which it builds the story of who we are”

“The self is not a passive construct but an ongoing act of prediction and meaning-making, shaped by the salience of past experiences.”
- Karl Friston (2010

This figure shows a synapse that is affecting another synapse. Short term memory can be produced when a weak stimulus (thin arrows in the left lower part of the figure) is causing a protein phosphorylation of ion channels, which leads to a release of an increased amount of transmitter. For a long term memory to be created, a stronger and more long-lasting stimulus is required (bold arrows in the figure). Image and image description taken from nobleprize.org.

The Self is Bounded By Its History

Guided by what matters, the self is constrained by what’s been lived.

The brain has an innate drive to optimise itself. it does so by constructing internal models of the world that are continuously updated when proven insufficient.

This process, often referred to as predictive coding, is understood to occur across all levels of the neural hierarchy, from low-level sensory cortices encoding the elementary perceptual building blocks for sound, vision and other sensory modalities, to higher-order cognition encoding our autobiographical narrative, our sense of identity, our beliefs, our hopes and our dreams.

Through both perceiving and acting upon the world, the brain constantly refines the accuracy of the models it creates. The result of this ongoing cycle of “experiencing-learning” or “sampling-modelling”, is that the brain essentially creates a growing repertoire of possible meanings the more experiences it accumulates.

Therefore, the range of possible interpretations and responses at hand will be limited by the learning opportunities it had in life. When the repertoire is extremely uniform, or when certain needs in life are unmet or compromised, this naturally influences the enactment of the self in later life.

“In the ontological view, a character disorder can be understood only in terms of a person’s entire mode of being in the world. A theme, such as inferiority and dominance, which is usually only one dimension among many used by an individual in defining his world, becomes fixated, through an early experience, such that it becomes the only mode through which the person can experience himself in the world. It becomes like the light by which objects are seen - the light itself cannot be seen as an object- and thus there is no comparison possible with other modes of being in the world.”

- Varela, Thompson & Rosh (1991)

Although the perspectives have evolved since the recording of the video above (in 1965), the list of essential developmental needs identified for different periods of infancy and childhood, has grown to be large and well-established. It ranges from the consistency of emotional safety, the availability of stable, nurturing relationships, the reliable presence of responsive and emotionally attuned caregiving, positive sensory and perceptual, experiences, play-based learning, early exposure to language and communication, opportunities for early success and confidence building, protection from adverse childhood experiences (ACEs), and more.

The Implicit Nature of Wounding

Language follows the wounding. Explicit recall never captures its original form. There is therefore something inside all of us that has never been fully articulated, and quietly yet significantly shapes our lives.

If we define mental health as the effective functioning of the interfacing process we call the self, then any process that compromises, impairs, or limits this functioning can be understood as an experience of wounding the self.

Although mental health is heterogeneous, the view of mental health as the outcomes of a compromised, wounded self, can be applied to a significant portion of individuals suffering mental health problems.

A large body of research reported links between early adverse life events and mental health problems in adulthood. Significant proportions (>50%) of diagnoses of depression and addictions co-occur with a history of trauma. Adverse experiences in childhood and adolescence are systematically linked with higher risks in later life for depression and anxiety, heightened sensitivity to later life stressors, alongside altered sensory processing and brain functioning.

All woundings that occur in the earliest years of life are, by definition, encoded in implicit memory. This is the primary memory system available during that developmental stage. And this could explain why adversities happening in younger age (<12 years) are particularly predictive for mental health problems in later life.

“The catastrophe the baby anticipates is not the trauma of what happens, but of what fails to happen.” Wrote Donald Winnicott, emphasizing that implicit wounding of the self does not necessarily only stem from intrusional experiences, but also from deprivation of an essential need, from misattunement, from neglect, or from emotional unavailability.

However, the deeper point I want to make here is that all experiences of wounding are fundamentally preverbal and encoded in implicit memory.

“We are not thinking beings who feel, but feeling beings who think” Wrote Antionio Damasio.

No matter at what stage of life the wounding occurs, it acts through the realm of subjective, embodied experience. The wounding always precedes the words that may later be used to describe it. The act of verbalizing, is per definition secondary and retrospective to the actual wounding experience. The formulation and the explicit recall, is per definition always a post-hoc experience.

“The act of symbolizing an experience does not recreate it, it transforms it. Language is always secondary to the event.”
- Wilma Bucci, Multiple Code Theory (1997)

The Zen proverb “The finger pointing at the moon is not the moon” succinctly illustrates the distinction between linguistic representations and direct subjective experience.

Re-Enactment As Transdiagnostic

The dance between past and present that re-enactment represents, offers insight into the implicit architectures of the self, its wounding and its potential paths to recovery.

The salience that drives the formation of the self, are therefore not only a filter. They can also be seen to function like a mirror, showing that what the self has become is reflecting what has mattered most in the past.

The self is “not a structure, but a configuration of affective states and inner objects that are dynamically shaped through relationships and defended against anxiety”, Heinz Kohut asserted.

Perhaps this point is most vividly and clearly illustrated in Post-Traumatic Stress Disorder (PTSD), where trauma is not merely remembered but re-experienced through flashbacks, nightmares, and somatic responses when reminded of the trauma.

But extending beyond PTSD, from both a cognitive neuroscience and object-relations theory perspective we can explain how the re-enactment of maladaptive learnings in early life can lead to a diverse array of behavioral dysregulations and relational problems in adult life.

The anxieties experienced and the defences developed in early life are not left behind, but re-emerge later in life through symbolic or relational re-enactments. Abusive but familiar relational dynamics in childhood are recreated in later life. And experiences of neglect, invalidation or misattunement may be sought unconsciously as paradoxical harbours of safety.

The unconscious re-livings represented within re-enactment this way shines a light onto the wounds that are mostly or entirely implicit. Its non-verbal, relational, symbolic and somatic expressions are points of access into an unspoken history of the self.

“The personifications of self (good-me, bad-me, not-me) are developed in the attempt to deal with the appraisal of others and the tension of anxiety.”
- Harry Stack Sullivan (1953)

Re-Enactment As Adaptive

Re-enactment is a primary mechanism of the self. The self will always, by the very nature of its functioning, re-enact the histories it internalised, within a context perceived to have resemblances of and significance to these histories .

Increasingly, a picture emerges of the self as a dynamic, highly adaptive, self-organising system. A set of processes shaped by history and continuously restructured through experiences within the world.

The internalised processes underlying the re-enactment of the self are however not rigid. The brain has an endogenous drive to learn and improve itself.

One way it does so is by an ongoing updating of its models, changing them through new experiences. Another way is by encouraging behaviors that shape its reality in accordance with those models.

This latter process is known in cognitive neuroscience as active inference, and this framework has been applied to explain maladaptive responses in depression, Post-Traumatic Stress Disorder( PTSD), neurodevelopmental disorders and other conditions.

Not only will most salient experiences result in the brain overweighting or biasing certain processes of sense-making, it can also cause an unconscious avoiding of certain experiences. To confirm and reinforce existing expectations.

Denial, delusions, repression, splitting, distorted self-concepts, projection, or trauma flashbacks - these can be seen as “epistemic shielding”, defences (i.e,. avoid cognitive dissonance with present internalised models), or homeostatic regulation (i.e. protecting the self against anxiety and overwhelm).

The main point here is that no matter how destructive or paradoxical such responses may occur to be for others, they reflect the brain’s best effort of coping with life. They remain dominant and entrenched, because they managed to reduce uncertainty effectively at some point in the past. Even if at a psychological cost in the present.

"Subjective experience -including its distortions and defences- is not epiphenomenal, but rather fundamental to the brain’s ongoing work of self-organisation."
- Holmes (2021)

Re-Enactment in Therapy

When mental health is defined by the functioning of the self, then effective therapy must constitute a process of modifying the internalised implicit models that underlie the self.

From what we gathered and discussed so far, a set of core ingredients and concepts can be considered as integral for the brain to change, and for the self to heal - particularly relevant in adulthood.

Characterised by novelty, individualisation, and its experiential and direct, competitive nature - I define these ideal conditions below in more detail.

Then, from this perspective we can view effective therapy as a space in which care-seekers can access re-enaction and embodied learning experiences that are developmental or referential, and are contained by an informed co-regulating care-provider.

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I will unpack these perspectives in greater detail below, followed by implications for clinical practice and a postlude that includes reflections on the fields of psychedelic therapy research and more broadly for the field of mental health care.

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