PRESENCE BEFORE THE SYMPTOM
- drissboussaoud
- 3 days ago
- 6 min read
When suffering becomes a question of presence
Psychological suffering often begins with a symptom: the onset of anxiety, the lingering depression, the persistent exhaustion, hypervigilance, relationship difficulties, avoidance behaviors, emotional crises. These are generally the reasons people seek help: they are suffering from something they wish to understand or find relief from. But this perspective, however legitimate, leads to a more fundamental question: what happens before the symptom appears?
What if some forms of psychological suffering didn't begin with anxiety or depression, but much earlier, in the way the brain learned to feel safe?
The clinic and neuroscience of presence - The Brain of Presence
Imagine a person walking alone down a dark street. Their attention is focused, their body slightly tense, their nervous system remains alert. Then someone they know and trust joins them. The environment hasn't changed—the street is the same, the darkness is the same, the potential danger is the same—and yet something immediately shifts. Breathing becomes easier, tension eases, the situation seems more manageable.
Why? Because a presence has appeared.
This experience is commonplace—we all experience it in different ways. Some presences reassure us, others unsettle us. Some allow us to think more clearly, others silently heighten our vigilance. Even before any interaction, the presence of others already contributes to our sense of security.
The brain seeks safety
We often tend to think of the brain as an organ primarily designed for thinking, reasoning, or problem-solving. Yet, before it can learn, explore, or build relationships, it must answer a more fundamental question: Am I safe enough? Much of the nervous system's activity seems organized around this ongoing assessment. Can I relax? Can I take a risk? Can I explore? Can I trust?
When security is sufficient, energy can be devoted to learning, creativity, projects, and relationships. When it becomes uncertain, priorities shift: attention narrows, vigilance increases, and the body prepares to cope. Before being a matter of well-being, security is a condition for the brain's own proper functioning.
We don't always regulate ourselves
We often tend to view emotional regulation as an individual skill—as if everyone had to learn to calm themselves down, manage their anxiety, and regain their balance on their own. Human development, however, tells a different story.
From the very first moments of life, emotions are regulated in the presence of other human beings. A voice soothes. A look reassures. Physical closeness reduces distress. A steady presence helps the nervous system regain its balance. Even before being able to calm themselves, children learn to calm themselves with others—and this reality never completely disappears.
Even in adulthood, certain presences foster a sense of security while others increase tension or vigilance. Some facilitate reflection and recovery while others silently mobilize a portion of the nervous system's resources. Emotional regulation is therefore not solely an individual matter: it also depends on how human beings contribute to each other's well-being.
The symptom is not the starting point
When we encounter a symptom, we naturally tend to consider it the problem—anxiety becomes the problem, depression becomes the problem, relationship difficulties become the problem. Yet, from a developmental perspective, these manifestations appear relatively late in a person's life.
Long before symptoms appear, the brain has already learned something fundamental about the world around it. It has learned whether others are available or unavailable, predictable or unpredictable, reassuring or threatening. It has learned what presence means. From these repeated experiences, the nervous system gradually builds its way of assessing safety, regulating emotions, asking for help, trusting, and coping with uncertainty.
Symptoms often appear much later, as a way in which a brain built under certain conditions tries to adapt to the challenges of the present.
When presence becomes uncertainty
While the presence of others contributes to building a sense of security, a question naturally arises: what happens when this presence becomes uncertain? The problem is not necessarily the absence of others. It can also be an unpredictable, inconsistent, or sometimes threatening presence—a presence upon which security depends, but which simultaneously constitutes a source of anxiety.
The developing brain then adapts to this environment. It learns to be more vigilant, to anticipate, and to quickly detect signs of rejection, withdrawal, or danger. It develops strategies designed to preserve safety in a world where it is never completely guaranteed.
These adaptations are often intelligent—they allow the child to cope with their environment. But they can also have a lasting influence on how the nervous system regulates emotions, builds confidence, develops a sense of self-efficacy, and interacts with others. Hypervigilance and certain persecutory experiences can thus be interpreted as a persistent overemphasis on the threat signal; conversely, certain states of derealization or depersonalization, as an underemphasis on a very real signal of presence; and social anxiety, as a chronic rather than a temporary bias in judgment.
Anxiety, hypervigilance, certain relational difficulties or certain states of psychological exhaustion sometimes appear in this area, not as failures of the system, but as the consequences of strategies that have long been necessary.
Suffering as a story of presence
Psychological suffering can obviously never be reduced to a single cause. Biological factors, life events, traumas, and the current context all play a significant role. Yet, when we listen carefully to the stories of many people in distress, one question often arises in different forms: how did they learn to feel safe? Who could they turn to when they were in distress? Who was available when they needed help?
Over time, these experiences help shape how each person perceives others, inhabits their relationships, regulates their emotions, and copes with uncertainty. From this perspective, psychological suffering can sometimes be understood as the current expression of a much older history—a history that is less about the symptoms themselves than about how the brain has developed through certain experiences of presence and absence.
Psychotherapy as an experience of presence
This perspective also leads us to consider psychotherapy from a slightly different angle. Therapy is not simply a place where problems are analyzed, behaviors are modified, or new tools are acquired. It also constitutes a particular relational experience: over the course of the sessions, the nervous system repeatedly experiences a relatively stable, predictable, and attentive presence—a presence that seeks neither to control, nor to invade, nor to abandon.
Therapeutic techniques, of course, play a crucial role. EMDR, trauma therapies, schema therapy, and approaches based on emotional regulation often enable profound changes. But these interventions take place within a more fundamental context: that of a sufficiently secure relationship to allow the brain to explore what was previously difficult to access.
Psychotherapy is therefore not just about understanding the past. It also allows the nervous system to experience, in the present, new forms of security, regulation, and presence.
What this changes
If this hypothesis is correct, then symptoms are not always the starting point of psychological suffering. They often represent the visible part of a much older story—the story of a brain that developed through certain experiences of presence, absence, security, or uncertainty. From this perspective, the clinical question becomes not simply "what is the symptom?" but also: how did this nervous system learn to feel safe?
Before anxiety, before depression, before protective strategies, before even the first memories — the brain was already learning something fundamental about the presence of others.
Clinical practice often begins with a symptom. But it sometimes leads to a deeper question: how did the brain develop in the presence of others?
Articles and links to explore
General presentation of the project and the question that constitutes its starting point.
How social neuroscience has transformed our understanding of the brain, and why the question of presence could complement this theoretical framework.
Why certain ordinary experiences — shared silence, feeling watched, soothing or threatening presence — can help us understand the role of presence in human experience.
In an elevator, a waiting room or a train, the mere presence of another person is often enough to transform our experience.
How attachment theory can be reinterpreted in light of presence.
Videos, reflections and explorations around the neuroscience of presence, attachment, development and psychotherapy.
Comments