Meeting the continual challenges…
We in the Tampa Bay area are all very fortunate to have a number of remarkable ongoing educational opportunities – see the Tampa Bay Institute for Psychoanalytic Studies, Inc’s educational program for trainees for this year, posted on this blog, the Tampa Bay Psychoanalytic Society, Inc’s excellent 2010-2011 Speakers Series and its, along with the USF Humanities Institute 2010-11 Film Series (a report from which was just posted on this blog).
I am very grateful to our colleagues who took the trouble and made the effort to put all this together for I cannot think of a better way to help us meet the continual challenges we face as contemporary clinicians – “our everyday struggle to understand and heal by way of the ‘talking cure’; the conflicts between old and new ideas in psychoanalytic theory and practice; the challenge of developmental thinking; the need to recognize our work as situated historically, culturally, and politically; the pervasiveness of cognitive neuroscience, of ‘evidence-based’ treatments like cognitive-behavioral approaches, biological/pharmacological reductionism, and many more“ (Orange, 2010).
Sometimes one can experience these challenges as daunting, as in these lines (my free translation) from Spanish poet Antonio Machado (1917): “Traveler, your footprints
are the road, and nothing more;
you make the path as you walk…
Traveler there is no road,
only wind-grooves on the shoals.”
Fortunately, Orange (2010), contends that “[t]houghtful psychoanalysts and other humanistic clinician are practicing philosophers.” For whom “Socrates remains the dominant ideal for Western philosophy. Simple-living, ever-questioning, relentlessly seeking the good human life…”
As clinicians our personal and professional ideals resemble those of Socrates; we “long to understand, but know how little we know. We are always questioning our assumptions, our reactions, and the inevitable limitations of our points of view. Our field is human emotional life – in particular the lives of those suffering others (the word PATIENT coming from the Latin PARTIOR, meaning to suffer) who come to us full of hope and dread (Mitchell, 1993): hope that a human connection may save them, and dread that it may fail them once more.” She suggests, moreover, that a “hermeneutic sensibility,” a “hermeneutic attitude,” makes our clinical work possible, and that such hermeneutic clinical sensibility includes:
“a) a strong sense of one’s own situation – including one’s theories, personal history, and personality organization –
that constantly and inevitably shapes and limits both one’s actual understanding and one’s capacity to understand
a particular patient;
b) a sense of experiential world or system, one’s own, the patient’s, and that formed with the patient;
c) a strong sense of complexity that resists all forms of reductionism and technical rationality [that is, technique]
in clinical work;
d) a sensitivity to the languages of personal experience, including their nonverbal backgrounds and forms of expression;
e) a strong developmental-historical [and, I would add cultural] sense that gives, overall, equal emphasis to past and future,
one that attends to processes of emergence, including emergence of defense and dissociation, throughout the clinical process;
f) a belief that understanding is effective, that is, that understanding in the rich sense is curative;
g) a conviction that dialogue and conversation are the best way to create and register that emotional resonance indispensable
to meaning-oriented work; and
h) a sense of vocation and devotion similar to Friedrich Schleiermacher’s “rigorous practice.” For Schleiermacher,
“misunderstanding occurs as a matter of course, and so understanding must be willed and sought at every point”
(Schleiermacher, 1998:110).”
Ernesto Vasquez, MD
October 21, 2010
Orange, D. (2010). Thinking for Clinicians. Philosophical Resources for Contemporary Psychoanalysis and the Humanistic Psychotherapies.
New York: Routledge.
Machado, A. (1917). Poesias Completas. Madrid: Residencia de Estudiantes.
Thursday, October 21, 2010
Meeting the Continual Challenges... by E. Vazques
Saturday, October 16, 2010
Tampa Bay Psychoanalytic Society And Humanities Institute Film Series: Developing Passions: LOVE AND ANARCHY
In Love and Anarchy, Italian director Lina Wertmuller (Seven Beauties, Swept Away) brings us the romantic notion of love triumphing over personal politics. This notion calls into question the age old misogynistic idea that women divert men from their important worldly tasks, and overpower men with their potent sexuality. Much like the existential angst of death looming over all of us, death comes at the end of Love and Anarchy, and so makes Tonio’s (Giancarlo Giannini, who won Best Actor in 1973 at Cannes for this role) and Tripolina’s (Lina Polito) one normal day in the countryside so poignant.
In the film, Tonio learns as a boy (from a beloved, old, anti-fascist) what an anarchist is. His mother, with her pretense of a rope around her neck foreshadowing his fate, draws the picture of an anarchist more acutely. As a man, Tonio travels to the capital, and we see Rome in all its grandeur, skylines and statues. Tonio, however, seeks out its alleys and brothels, one in particular with Salome (Mariangela Melato), with whom he meets to execute her plan to assassinate Mussolini. [Salome wants Mussolini’s head on a platter, so to speak.]
Tonio, a farmer, and somewhat the country bumpkin made ugly with freckles or pockmarks, is out of his element. There is humor in his discomfort around women. Though Tonio can barely utter a word, he is very much aware of the swinging buttocks exiting down the brothel’s hallway. Perhaps out of pity, or perhaps to ensure Tonio’s cooperation, Salome urges Tonio to stay quiet. Just as with a hungry kitten, she says she is happy to satisfy him: that way it’s over with and he can get his head back on track.
Salome, during a day of comic idyllism in the countryside -- with Tonio,Tripolina,(another prostitute) and the high ranking black shirt Spatoletti -- believes Spatoletti cares for her enough to be duped by her wiles. Spatoletti first checks out the church square where Mussolini is to visit (and is to be assassinated), then the party travels on to a country café, where we see Spatoletti for the villain he is, threatening the proprietor for the wait, and misogynistic with women. Tonio too, scouts out the square, then falls asleep in a field as if without a care. Later he and Tripolina make love, falling in love. Tripolina had tried to make it a business transaction, but Tonio is loving and gentle. Tonio seems everything Spatoletti is not, even compassionate with an alley cat.
In his room, Tonio practices with a gun in the mirror, but the room seques to a carnival shooting gallery. Next we see the more literal ‘carnival’ of prostitutes at the brothel pedaling their wares, tits and winks, flirting and insults. But the concomitant fascist gathering has detained all the swells. Tonio enters and seems shocked to see Tripolina at work; he pays and takes her upstairs while the Madam insists they hurry, for it is rush hour. Tonio entreats Tripolina to stay with him for two days before he must go away forever. He reveals his plan and Tripolina asks if Tonio is an anarchist. He replies that someone has to say 'basta!' (enough) and he will do it.
Death is again foreshadowed as Salome, Tonio, and the Madam transport a dying patron to the cemetery. Salome and Tonio fight about the anarchist’s cause, and Tonio confesses his fear (Salome retorts that fascists are not scared) and how he inadvertently became involved in the cause: delivering a suitcase to the comrades of/ for a dying friend. Salome, both compassionate and taunting, calls him “Saint Antonio” and foreshadows death again: “They’ll beat you to death and no one will know.”
Tonio, in bed, considers his plan. Tonio and Tripolina make love in the dark, and we again see the rooftops of Rome. As Tonio sleeps, Tripolina, after praying to the Virgin Mary, sits over him like a guardian. Salome has set the alarm clock, but she and Tripolina fight about waking Tonio. Tripolina says no cause is worth Tonio dying, but Salome thinks it is better to die like a dog than live like one. Salome asks what would happen if all women stopped their soldiers [what, indeed?], then relenting, agrees with Tripolina, remarking, “They are right, never trust a whore.”
Tonio is awakened by the sound of the marching band below. He strikes Tripolina for not awakening him. As the black shirts arrive downstairs, Tonio bursts in to confess, and starts firing at the police. Once out of bullets, he runs into the street where he is punched and kicked by soldiers and sailors before being taken away. Salome shouts: "He was a poor guy with a big heart."
In a well-appointed office, where the statue of a wolf suckling two infants (the founders of Rome)is displayed, Tonio is beaten and threatened, but he will not name names. The news reports that an unknown man, in a fit of madness, shot at police during a routine inspection, and died violently beating his own head against a wall.
******************************************************************************
This Film Series, Developing Passions, is a collaboration of the Humanities Institute and the Tampa Bay Psychoanalytic Society, Inc. and free to the public. All films in this monthly line-up will are on Sundays at 200pm in MDA 1097 at the USF Medical Center. All films will be discussed with the audience by a local university scholar and by a local clinician. Tomorrow, October 17, 2010, Ang Lee’s Eat, Drink, Man, Woman will be viewed and discussed.
Silvio Gaggi, PhD, Director of the Humanities Institute, and Robert Porter, PhD, local psychologist, discussed Love and Anarchy on September 12, 2010.
Gaggi noted how Love and Anarchy portrayed anarchy as a romantic idea, where the father figure is killed with the hope that men could live free and equal, the way nature intended. Gaggi also noted in this film how a scene often begins with a panoramic view, then shrinks to the close up. [I preferred the Opposite approach of the camera, as when the face of famished Tonio is eating heartily, and the scene widens to show him surrounded at the table by prostitutes. While either approach would lend itself to the importance of context, each has a different impact. ]
Robert Porter, PhD in psychology, and clinical discussant, highlighted the theme of adolescence and the struggle to oppose ones parents, who, like fascists, are seen to oppose freedom. But rebellion itself incurs responsibility, and new constraints of maturity, as adolescents grow up. Porter noted, too, that fascists allowed their own hedonism while disallowing it for others. Though a female director, a more complex theme of misogyny exists in the film: Salome in the end was too weak to be an anarchist. Women are seen as weaker and potentially dangerous, distracting men from their role as soldier or anarchist.
The audience was divided on whether or not the prostitutes in the film had real power over their clients.[Perhaps women’s power lies in the ability to foster connectedness, not submission, just as real consolidation of identity (the developmental task of adolescence) is better achieved by transcending doer-done to dynamics of violence and fostering an appreciation of difference. It was love that drove both Salome and Tonio to profess their allegiance to anarchy, as both wanted to avenge someone, killed by fascists, whom they loved. When Tripolina and Salome decide not to wake Tonio, they choose love over anarchy. ]
Lycia Alexander-Guerra, MD
Sunday, September 12, 2010
“Psychoanalytic Process”
On the afternoon of September 11, 2010, Sanford Shapiro, MD , referring to his paper “Psychoanalytic Process” explored what is mutative. Shapiro recalled that Ego psychology teaches that interpretation of defense leads to insight. But he reminded us that many experiences, trauma, disorganized attachments, chronic and severe lack of mentalization, may occur before language acquisition, leaving the experiences implicitly encoded but without connection to symbolization or language and, so, unavailable to interpretation. Many experiences are non-conscious (implicitly encoded) such that they never make it to consciousness. These experiences do not follow Freud’s model of the unconscious, that is, are not made up of what was once conscious but repressed.
Additionally, Shapiro has given up allegiance to an intrapsychic experience, recognizing that all experience is contextualized in an interpersonal world (Atwood, Orange, Stolorow).
Implicit relational knowing (Daniel Stern) is not conscious, and, therefore, not accessible to interpretation and insight. [must be enacted and made explicit.] Benjamin writes: what can’t be told must be shown. These automatic behaviors impact all subsequent relationships, including transference, throughout life.
Neuroscience now knows that our neurons are both plastic and their number is not fixed at birth. We know that the development of the brain is context dependent. This allows the possibility for the hope of changing neuronal dendritic branching and neuronal connections through psychoanalytic therapies. What this means is that new relational experiences offer options to automatically triggered relational patterns.
The analyst helps the patient develop reflective curiosity about automatic relational paradigms, often done by ‘perturbations’ (systems theory) which may disorganize a stable system and momentarily allow for the possibility to reconfigure experience in a new way. Patients can be very forgiving when we do not blame them for ruptures and we allow for repair.
Shapiro also spoke about pathological accommodation (Brandchaft). He noted that normal accommodation is a negotiation between two people such that neither feels the integrity of either individual has been compromised. He referred to Ghent’s paper on masochism, submission, and surrender, noting that surrender is not at one’s expense, but that submission is when one subverts one’s own integrity to someone else’s authority. Brandchaft agrees with Mahler’s individuation process (but disagrees about separation): parents must negotiate the child’s individuation so that the child remains safe and can be assertive. If negotiation does not occur, the child complies or is rebellious, and pays the price with isolation.
Clinically, says Shapiro, pathological accommodation is triggered by certain events and are signaled by subtle shifts in affect (not content). Shapiro says it is important to go back and see what happened immediately before the shift, inviting the patient‘s curiosity, and admitting a mistake was made by the analyst. Taking responsibility for the rupture is sometimes a new emotional response, and the patient may begin to experience that h/she does not have to go along or comply to stay connected. It is also important to take the shame out of any rupture, e.g reframing a motivational experience from aggression (about which one can be ashamed) to a survival mechanism or a way of regulating tension (about which one might feel good).
The empathic introspective mode helps a patient “feel mentalized by the analyst." This, in turn, helps the patient begin to get a sense of self. The patient finds her/himself in the therapist’s mind. Mentalization (Fonagy) elaborates the intersubjective capacity to know that another has a separate mind with differing contents. Stern says we are born with the capacity to be intersubjective; Benjamin sees it as a developmental achievement, created via the third.
“The Evolution of Contemporary Psychoanalysis”
On Sept 11, 2010 the Tampa Bay Psychoanalytic Society, Inc hosted Sanford Shapiro, MD referred to his paper on “The Evolution of Contemporary Psychoanalysis—A Fifty Year Perspective.” Author of Talking to Patients, a self psychological view of creative intuition and analytic discipline, (Jason Aronson) the revised edition 2008, includes implicit memory and relational psychoanalytic thinking. Referring to Victoria Hamilton’s The Analyst’s PreConscious , Shapiro noted that theory helps us stay calm in face of patient assaults and added: Do not underestimate the ability to stay calm.
Shapiro, approaches each session ‘without memory or desire’ (Bion)and asks himself: how is this patient planning to use me at this moment? He notes how patients test us. The initial test is about safety. Patients expect from us what they got from their parents (the transference test). This is sometimes evident when the patient, turning passive into active, attacks e.g. our competence. Just ‘survive’ (Winnicott); surviving (without retaliation or withdrawal) the test is passing the test. Weiss noted that analysts confirm or disconfirm patients’ beliefs; when we respond in new way, we may disconfirm their beliefs.
Using empathic introspection, we need to ask ourselves: How are the patients to feel good about themselves if we are always pointing out their shortcomings? Sometimes patients comply with our theories to avoid further hurtful interpretations.
Reenactments or enactments were classically thought to be disruptions. Donnel Stern (relational) believes they are necessary before they can be made explicit and then interpreted. Frank Lachmann (self) calls them ‘rupture and repair’ . This contemporary psychoanalytic acceptance of enactments has allowed analysts to ‘come out of the closet’ into the public forum about their private theories.
Shapiro says his theory is simply investigation, or inquiry. He tries to avoid being loyal to a theory or technique so as to allow himself to be with the other. Shapiro follows the moment to moment affective response of the patient to his interpretations to know if he is on track.
***
In his paper, “The Evolution of Contemporary Psychoanalysis” Shapiro states that Contemporary Psychoanalysis is a two person psychology born out of the cross-fertilization between interpersonal and self psychologies. He also juxtaposed interpersonal and relational theories against Freudian, Kleinian, Ego and Self psychologies, Intersubjective, and social constructionists.
Shapiro, a student of Sterba, interpreted Sterba’s “The Fate of the Ego in Psychoanalysis” (1934)as a pioneering relational perspective because Sterba describes dissociation as the split between observing ego and experiencing ego, the former which allies itself with the analyst’s ego. But the analyst is an active participant, not an objective observer.
Shapiro explored contributions from Winnicott, Kohut, and Intersubjectivity which he had found personally useful in his professional helping of patients. For example, seeing things from the perspective of the patient (empathy) helps the patient to feel understood, more confident, and opens up explorations with lessened shame or guilt; or focusing on the impact the analyst has on the patient before interpreting transference distortions. From relational (Mitchell) was added the focus on the patient’s impact on the analyst. Because patients can sense analysts’ reactions, sometimes acknowledging what the patient already knows in self disclosure can be useful.
Shapiro changed his view of resistance. Classically, resistance was seen as arising from instinctual wishes from within the patient. Ego psychologists interpret this resistance and other defenses. But intersubjectivists [like Benjamin] view resistance as also, in part, the patient’s fear of the therapist’s response. In a two person model, we are interested, then, in exploring as well what contribution the therapist may have made to the patient’s fear. Shapiro’s clinical example illustrated staying with the patient’s perspective instead of confronting the distortion. [He did this by what sounded like ‘wearing the attributions of the patient’ ala Lichtenberg.]
Shapiro also changed his views on motivations. Likewise, he re-examined his belief in his analytic authority and expertise and became more of a facilitator, helping others overcome obstacles to resume their growth and development. He recognized that sometimes the relationship itself, and implicit communication, is mutative, and that interpretations were not always necessary. In his technique, Shapiro draws on the empathic-introspective mode from Self Psychology and the impact the patient and he have on each other from relational theory.
Thursday, August 5, 2010
TAMPA BAY INSTITUTE FOR PSYCHOANALYTIC STUDIES, INC
Program Offerings 2010-2011
About our Program: TBIPS is a professional community which embraces pluralism and a comprehensive contemporary view of psychoanalysis within the context of a mutually respectful and open learning atmosphere.
We invite you to:
* Deepen and develop your clinical skills.
* Join colleagues to network and share practical issues.
* Enroll in an individual class or in a training program:
Two year certificate program in Psychoanalytic psychotherapy
Four year certificate program in Psychoanalysis
Courses:
Classes are open to mental health professionals with an interest in psychoanalytic ideas. The courses may be taken independently, but, in order to optimally elaborate concepts, we suggest that you enroll in the full semester.
Distance Learning:
Long distance learning options available through use of Skype video conferencing.
Faculty: Lycia Alexander-Guerra, MD; Horacio Arias, MD;Nancy Brehm, PhD;Heather Pyle, PsyD; Arnold Schneider; Edward Stein; Kim Vaz,PhD
Adjunct Faculty: Ghislaine Boulanger, PhD; Jim Fossage, PhD; Susan Horky,LCSW; Lauren Levine, PhD; William Player, PhD; Bruce Reis, PhD; Peter Rudnytsky, PhD, MSW;
Daniel Shaw, LCSW; Frank Summers, PhD; Judith Teicholz, PhD;Anthony Virsida, PhD.
Fall Semester 2010 and Spring Semester 2011 will emphasize the contemporary relational approach to psychoanalytic technique and theories.
Fall Semester 2010
Narcissism and Development of Shame Throughout the Life Cycle
This course offers a contemporary understanding of narcissism, both its developmentally appropriate and pathological aspects. It includes discussion on shame, envy, rage, deficits in mentalization, as well as how to treat these in the clinical situation, with an emphasis on recognition, containment, empathy and mirroring.
(16 weeks) Instructor: Lycia Alexander-Guerra
Clinical Case Conference
This course is designed to support the clinician’s work and offers opportunity to integrate clinical material with psychoanalytic concepts, including ethics, and ways to deepen the psychoanalytic process, with a focus on the therapist’s self reflection, the clinical relationship, and ways to facilitate what is mutative for the patient. Attendees are encouraged to present their own case material.
(16weeks) Instructor: Susan Horky
Relational Technique and Therapeutic Action (SPECIAL COURSE OFFERING)
This course is designed to elucidate some of the differences between classical and postclassical psychoanalytic technique, for it is crucial to appreciate the different assumptions underlying each.
Dr. Reis will compare assumptions about minds and clinical process in relational and other traditions, and the reasoning behind an analyst’s decision to intervene or not to intervene, whether the analyst needs “reasons” to intervene, or even whether the analyst sees what they do as “intervening,” with the ultimate goal to self reflect on what we do and don’t do in our consulting rooms. We will, in discussion, explore how we locate each of our selves in the ongoing debates within our field.
(13 hour weekend course Sept 25, 26, 2010) 13 CE credits available for this course only.
Instructor: Bruce Reis (NYU Post Doc in Psychotherapy and Psychoanalysis)
Objectives:
1) To differentiate the assumptions of classical and postclassical psychoanalytic approaches to mind and illustrate how a theory of technique follows from those assumptions.
2) To examine the specific areas of technique that relational psychoanalysts claim as responsible for the mode of therapeutic action (e.g. disclosure, enactment, influence).
3) To consider and critically discuss the often posed question of what constitute the limits or parameters of relational psychoanalytic technique.
IMPORTANT DISCLOSURE INFORMATION FOR ALL LEARNERS:
None of the planners and presenters of this CME program have any relevant financial relationships to disclose.
Continuing Education Credits: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of The American Psychoanalytic Association and the (insert your organization). The American Psychoanalytic Association is accredited by the ACCME to provide continuing medical education for physicians and takes responsibility for the content, quality, and scientific integrity of this CME activity. The American Psychoanalytic Association designates this educational activity for a maximum of 4 hours in category 1 credit towards the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. IMPORTANT DISCLOSURE INFORMATION FOR ALL LEARNERS: None of the planners and presenters of this CME program have any relevant financial relationships to disclose.
The Tampa Bay Psychoanalytic Society has been approved by the Florida Dept. of Health to provide Continuing Education Accreditation to Psychologists (Provider # PCE-46, Exp. 5/12) and Clinical Social Workers, Marriage & Family Therapists, Mental Health Counselors (Provider # BAP 423, Exp. 3/11). The Society certifies that these courses meet the requirements of the Board on an hour-per-hour basis for continuing education credits.
Spring Semester 2011
Developmental Issues in the Analytic Setting
This course will examine the ways in which development informs our clinical work with adult patients. Life events and developmental transformations throughout the lifespan will be explored in terms of their relevance for adult treatment. Papers will be paired with clinical material. We will address major developmental concepts in this course.
(16 weeks) Instructor: Heather Pyle
Clinical Case Conference
This course is designed to support the clinician’s work and offers opportunity to integrate clinical material with psychoanalytic concepts, including ethics, and ways to deepen the psychoanalytic process, with a focus on the therapist’s self reflection, the clinical relationship, and ways to facilitate what is mutative for the patient. Attendees are encouraged to present case material.
(16weeks) Instructor: Lycia Alexander-Guerra; Nancy Brehm
Relational Concepts and Implications for Treatment
This course will explore the relational co-creation of the treatment situation, reviewing influences on Relational ideas and technique from Object Relations, Interpersonal, Intersubjectivity, and Self Psychology. We will discuss: mutuality, intersubjectivity, dissociation, disclosure, as well as look at clinician contribution to the therapeutic matrix, among other topics.
(16 weeks) Instructors: Horacio Arias, with Lycia Alexander-Guerra
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TBIPS Registration Form FALL 2010
Name______________________________________
Discipline _____________________ Degree_____ State ____ License # _________
Address_____________________________________________
City__________________________________________ State____ Zip___
Phone____________________________ E-Mail_____________________________
Request Long Distance Learning (check one, if applicable): ___phone or ___Skype
Fall Semester 2010
___ Clinical Case Conference
Meets 16 Wednesdays, 345-515pm
(Sept 15, 22, 29; Oct 6, 13, 20, 27; Nov 3, 10, 17; Dec 1, 8, 15; Jan 5, 12, 19)
Fee: $250 for a single course; $200 if enrolled in full semester
Registration deadline August 27, 2010
Venue: 14043 N Dale Mabry Hwy, Tampa, FL 33618
___ Narcissism and Development of Shame Throughout the Life Cycle
Meets 16 Wednesdays, 530-7 00pm
(Sept 15, 22, 29; Oct 6, 13, 20, 27; Nov 3, 10, 17; Dec 1, 8, 15; Jan 5, 12, 19)
Fee: $250 for a single course; $200 if enrolled in full semester
Registration deadline August 27, 2010
Venue: 14043 N Dale Mabry Hwy, Tampa, FL 33618
SPECIAL COURSE OFFERING
___Relational Concepts and Implications for Treatment
A weekend workshop on Saturday, September 25 and Sunday September 26th, 2010
Sat 9am-12pm and 1-5pm (one hour for lunch on your own); Sunday 9am-12pm and 1-4pm
Taught by Bruce Reis, PhD. of the NYU Post doc Program for Psychoanalysis and Psychotherapy
CEUs available for this course only: 13 hrs (CEUs sponsored by Tampa Bay Psychoanalytic Society)
Venue: Club Redington, Northern Rec. Room, first floor: 17408 Gulf Blvd, Redington, Fl, 33708
Fee: $300; $250 if enrolled in one additional course at TBIPS; $200 if enrolled in two additional.
Registration deadline August 27, 2010
Spring Semester 2011
___Developmental Issues in the Analytic Setting
Meets 16 Wednesdays 200-330pm
(Jan 26; Feb 2, 9, 16, 23; Mar 2, 9, 16, 23, 30; Apr 6, 20, 27, May 4, 11, 18, 2011)
Fee: $250 for a single course; $200 if enrolled in full semester
Registration deadline December 17, 2010
___ Clinical Case Conference
Meets 16 Wednesdays 345-515pm
(Jan 26; Feb 2, 9, 16, 23; Mar 2, 9, 16, 23, 30; Apr 6, 20, 27, May 4, 11, 18, 2011)
Fee: $250 for a single course; $200 if enrolled in full semester
Registration deadline December 17, 2010
___Relational Concepts and Implications for Treatment
Meets 16 Wednesdays 530-700pm
(Jan 26; Feb 2, 9, 16, 23; Mar 2, 9, 16, 23, 30; Apr 6, 20, 27, May 4, 11, 18, 2011)
Fee: $250 for a single course; $200 if enrolled in full semester
Registration deadline December 17, 2010
_____ Number courses taking Fall Semester 2010
_____ Number courses taking Spring Semester 2011
$_____ Total amount Enclosed
Please Make Check Payable to: TBIPS, Inc. Please mail completed registration forms and check to:
TBIPS, Inc.
14043 N Dale Mabry Hwy
Tampa, FL 33618
Refund Policy:
85% refunds available for cancellations received at least seven days prior to start of course.
Sunday, August 1, 2010
Interview with Wilma Bucci on Psychoanalysis
An Interview with Wilma Bucci, Ph.D., on Psychoanalysis and Cognitive Science
Monday, June 7, 2010
Poem
A Season that Travels
But light is not only this,
for nothing is just something
anymore, my friends. But everything,
everything is this and light,
and everything.
And there is no way of saying it
but by contradicting and immersing
ourselves in the vertigo, and being
the swirl and the vertigo and the light.
Not only.
For if time is made of coming and going,
then, we, who are in time or above time,
will rest for a few moments,
and be contemplative,
simply beholding how the sun rises,
crosses and flees, and returns
in light everyday.
For we ourselves are truly the miracle –
with one another, we can create
the fountainhead of light
in our pupils and the gardens
of stillness in our hearts.
And there can be no light
without our eyes, old Plato,
nor would there be time, my friends,
but with this patient and heroic
and almost never-ending being alive.
So I come here to sing the day
and the day is this,
boundless.
Inauguration of sun.
Almost Sunday.
Adventure of audacious light.
Onward. Lets continue.
The day is also this, my friends.
A being in light everyday,
under the sky, or within.
A luminescent being in light
someone gave to us
for us to attain.
Behold how the day lugs its cart
of minutes. One after another.
Always. With no repose.
What we had, dispersed in the air.
Ah pain, ah love, what we had!
What descended to silence.
What went from vibrant green leaf
to the garland of oblivion.
And time goes on, my friends,
time continues.
And yet I cannot say it.
This is barely sensed.
Or savored like a sin
or the violet bouquet of old wine.
This day is also a season.
Let’s stay here.
With the day lets travel.
A season that travels, this is.
And we with it, until the hour,
a little gray, a lot somnolent,
the bell tower’s dark corner will sing,
when the sea of stars shivers.
We already know it. To be still. To sleep.
With no light. Tranquilly, my friends.
As in a night train that has lowered
the eyelids, a train with windows like
unyielding guillotines that behead in each
frame the landscape’s enduring reason.
Onward.
Onward.
To another season.
With another light.
The same and different.
To embark again,
on the sun and the air,
the contention and the secret
and the struggle.
Much as a scintillating wave
over another scintillating wave,
in this tide imperturbable and ours.
Ernesto Vasquez, MD
Monday, May 10, 2010
The Nasty Girl
On Mother's Day the Society and its cosponsors, screened a film about an original meaning of Mother's Day. Julia Ward Howe, who famously wrote the Battle Hymn of the Republic, called for a Mother's Day of Peace in 1870 when she asked women to oppose all forms of war. The film The Nasty Girl is based on a true story Anna Rosmus of Bavaria. Attacked by her community as a busy body and much worse, uncovered the participation of her town's citizens in their complicity and compliance with the Nazis, Rosmushas braved harassment and death threats to exhume history and facilitate commemoration.
According to Professor Plays, Anna Rosmus decided to research her town's history during the Third Reich when the President issued an essay contest on the topic. While she did not make the deadline because she was blocked at every turn from finding out information, this passion to know about her town’s participation came to define her life. In a presentation to an American university audience, Rosmus, explained that she wanted people to gain knowledge from her work. “Once people pay attention to what happened, I hope they learn to understand that action or nonaction has consequences. Whether you intend crimes or just let them happen by looking the other way, going about your private life as if that were not the case; there are consequences are there nonetheless. The guilt is there. People lose their lives and other people have to live with the loss of these lives.”
The film’s director, Michael Verhoeven's, first film was about the White Rose resistance. His interest was piqued when his parents explained that this was an oppositional movement of young people active during the rule of the Nazis. It gave him pause because he had been taught that resistance was not possible and he was intrigued by what they had managed to achieve. His film, The Nasty Girl, is a further uncovering of hidden history.
Professor Dana Plays is an internationally recognized filmmaker and digital media artist. She teaches cinema studies, world cinema, women’s studies, and film and digital production at The University of Tampa, and has held previous teaching appointments at Syracuse University and Occidental College, since 1990. Plays' filmography consists of 31 works in film and digital video. Her work has been exhibited at the Whitney Museum of American Art: Color of Ritual, Color of Women, Avant-Garde Women Filmmakers of the Twentieth Century, and more than 50 international film festivals, including Edinburgh, Montreal Nouveau, and Seattle International Film Festivals. Her films have garnered more than 23 film festival awards including the prestigious First Prize Jurors' Choice Award at the Black Maria Film and Video Festival for Nuclear Family; Tom Berman Award for Most Promising Filmmaker at the Ann Arbor Film Festival for Zero Hour; Best Experimental Film at the Houston International Festival for Across the Border; and Best Documentary Award at the New Orleans Film Festival for Love Stories My Grandmother Tells, which also was broadcast on VPRO, a Dutch national television network. Since arriving at The University of Tampa in August 2005, Plays has had national awards and exhibitions including a Black Maria Film Festival award; a solo retrospective in Boulder, CO, at First Person Cinema, the longest standing American showcase for independent film; a digital installation of her piece Salvage Paradigm, at the Play Space Gallery, in San Francisco; a digital installations of and her video montage of Hollywood films situated in the Los Angeles River, River Madness, at the Skirball Center in Los Angeles. Plays served on the board of directors of Film Forum, in Los Angeles, Canyon Cinema, in San Francisco, and the board of trustees of the Putney School, in Putney, VT. She has ongoing membership with the College Art Association, Society of Film and Media Studies and University Film and Video Association.
Sunday, April 18, 2010
A Therapist's Use of the Self
On April 17, 2010 I attended the Tampa Bay Psychoanalytic Society’s “Day with Lauren Levine, PhD.” Dr. Levine, both a delightful person and a sensitive and talented clinician, eloquently managed to convey, both implicitly and explicitly, her relational approach to psychoanalytic psychotherapy. Weaving throughout her clinical paper the story of her patient and herself with the ideas of her teachers and mentors at the NYU Post Doc she elucidated the use of the analyst’s self to facilitate transformation in the patient. Noting from Adrienne Harris that ‘the analyst’s wounds that must serve as tools,’ Dr.Levine said, “Our own relational stories at times facilitate, and at times hinder, our capacity to engage deeply in the analytic process.”
In her paper, Dr. Levine explores the ways in which, as analysts, "transformative aspects of our personal analyses reside, often unconsciously, or preconsciously in the analyst, creating unexpected opportunities in our work with patients." She describes how a profound piece of work in her own analysis around efforts to connect with her young son "resonated in her work with a patient, enlivening and deepening the treatment." "In the process, her patient discovered new places within herself which enabled her to reach out to her teenage son in new and reparative ways."
From Dr. Levine's relational perspective, it is critical for the analyst to have the capacity, and the courage to go to those darker places within herself, and draw from that emotional reservoir in deconstructing enactments, so that the analysis is "safe, but not too safe" (Bromberg) for analyst as well as patient.
Dr. Levine used the experiences in her own analysis and with her son to open up the analytic space with her patient, seeking, as Stephanie Solow Glennon proposed, ‘to foster authenticity, aliveness, and creativity.’ Recognizing the wisdom of Emanuel Ghent’s words that each of us has ‘a deep yearning to be found and recognized,’ Dr. Levine strives to create the safety, as suggested by Adrienne Harris, necessary ‘to open access to unbearable affects.’ She strives to help her patients “begin to feel less ashamed and humiliated of those split-off, unacceptable parts of oneself.”
Darlene Ehrenberg described the ‘intimate edge’ as 'not simply at the boundary between self and other; it is also at the boundary of self-awareness…. It is a point of expanding self-discovery, at which one can become more intimate with one’s own experience through the evolving relationship with the other, and then more intimate with the other as one becomes more attuned to oneself. '
For the complete and eloquent illustration of the use of the self by Lauren Levine, see her paper "Transformative Aspects of Our Own Analyses and Their Resonance in Our Work With Our Patients” in Psychoanalytic Dialogues, 19:454–462, 2009.
Thursday, April 15, 2010
Emotional Trauma in Review - Part 3
The Dialectical Opposites of Emotional Trauma
Herman (1992) says that in the fallout of emotionally traumatizing experiences, “the two contradictory responses of intrusion and constriction establish an oscillating rhythm. This dialectic of opposing psychological states is perhaps the most characteristic feature of [emotional trauma]. Since neither the intrusive nor the numbing [manifestations] allow for the integration of traumatic [emotions], the alternation between the these two extreme states might be understood as an attempt to find a satisfactory balance between the two. But balance is what the [emotionally] traumatized person lacks. She finds herself caught between the extremes of amnesia or of reliving the [experiences], between floods of intense, overwhelming feeling and the arid states of no feeling at all, between irritable, impulsive action and complete inhibition of action. The instability produced by these periodic alternations further exacerbate the traumatized person’s sense of unpredictability and helplessness. The dialectic of trauma is therefore potentially self-perpetuating.”
“In the course of time,” Herman explains, “this dialectic undergoes a gradual evolution. Initially, the intrusive reliving of the traumatic [experiences] predominate, and the victim remains in a highly agitated state … as the intrusive symptoms diminish, numbing or constrictive symptoms come to predominate. The traumatized person may no longer seem frightened and may resume the outward forms of her previous life. But the severing of the [experiences] from their ordinary meanings and the distortion in the sense of reality persist. She may complain that she is just going through the motions of living, as if she were observing the events of daily life from a great distance. Only the repeated reliving of the moments of horror break through the sense of numbing and disconnection.”
Herman concludes, “The constraints upon the traumatized person’s inner life and outer range of activity are negative symptoms. They lack drama; their significance lies in what is missing. For this reason, constrictive symptoms are not readily recognized, and their origins in [traumatic experiences] are often lost. With the passage of time, as these negative symptoms become the most prominent feature of [emotional trauma], the diagnosis becomes increasingly easy to overlook. Because [emotional trauma] symptoms are so persistent and so wide-ranging, they may be mistaken for enduring characteristics of the victims personality. This is a costly error, for the person with unrecognized [emotional trauma] is condemned to a diminished life, tormented by memory and bounded by helplessness and fear.”
”Thus, the very “threat of annihilation” that defined the traumatic moments may pursue the survivor long after the danger has passed. No wonder Freud found, in the traumatic neurosis, signs of a “daemonic force at work.” The terror, rage, and hatred of the traumatic moments live on in the dialectic of trauma.”
In treatment, the dialectical opposites of emotional trauma can be solved in the process of making sense together with our patients and reaching a deeper, clearer emotional understanding of the problems at hand (Orange, 1995; Frie & Orange, 2009).
E - Shame - A Blow Falling Upon a Bruise
From the perspective of intersubjective systems theory (as articulated by Stolorow & Atwood, 1979; Atwood & Stolorow, 1984; Stolorow, Brandchaft, & Atwood, 1987; Stolorow & Atwood, 1992; Orange, 1995; Orange, Atwood, & Stolorow, 1997; Stolorow, Atwood, & Orange 2002; Stolorow, 2007; Frie & Orange, 2009), “developmental emotional trauma consists in the shattering of our world of experience, a world that exists always in the relational context of interaction with other such worlds; emotional trauma results from the experience of intesubjectively derived unbearable affect…”
“…Painful or frightening affect becomes traumatic when the attunement that the person needs to assist in its tolerance, containment, and modulation is profoundly absent.” One of the consequences of developmental emotional trauma is that “traumatic affect states can take on enduring crushing meanings.” Another consequence is “a severe constriction and narrowing of the horizons of emotional experiencing, so as to exclude whatever feels unacceptable, intolerable, or too dangerous in particular intersubjective fields.”
Herman’s (1992) account of emotional trauma provides evidence to support the notion that what the above authors theorize about emotional trauma in early life also applies to the experience of trauma at any age.
One of the “traumatic affect states can take on enduring crushing meanings” is shame. And it is to its complexity, to ‘the many faces of shame’ (Nathanson, 1987) that I now turn.
The experience of shame
The experience of shame is described poetically by Silvan Tomkins(1963): “Shame is felt as an inner torment. No other affect is more disturbing. If distress is the affect of suffering, shame is the affect of indignity, of defeat, of transgression, and of alienation. Though terror speaks to life and death, and distress makes of the world a vale of tears, yet shame strikes deepest into the heart of man. While terror and distress hurt, they are wounds inflicted from outside which penetrate the smooth surface of the ego; but shame is felt as an inner torment, a sickness of the soul. It does not matter whether the humiliated one has been shamed by derisive laughter or whether he mocks himself. In either event he feels himself naked, defeated, alienated, and lacking in dignity or worth.”
With eloquence, Gershen Kaufman (1996) echoes Tomkins. I have consolidated Kaufman’s descriptions as follows: Shame is the affect of inferiority and of exposure. To experience shame is to feel inherently bad, fundamentally flawed as a person. To feel shame is to feel seen in a painfully diminished sense. Whether all eyes are upon us or only our own, we feel fundamentally deficient as individuals, diseased, defective. To live with shame is to experience the very essence of oneself as wanting. It is the most poignant self-experience, whether felt in the humiliation of cowardice, or in the sense of failure to cope successfully with a challenge.
Shame is inevitably alienating, isolating, and deeply disturbing. Shame is alienating because it compels us to hide, separating us from others. Indeed, shame is derived from an Indo-European root, SKAM or SKEM, which means to hide, and from which also derive our words SKIN and HIDE, the latter in both its meanings: the hide that covers us naturally, and that within which we seek cover. We learn to hide first for the sake of shame, and later for protection from physical danger.
The exposure inherent in shame creates the sense of nakedness before an audience: it feels as if others can see inside us or actually read our thoughts. In the experience of shame we feel exposed, which opens us further to painful inner scrutiny. When the attention turns inward, we are suddenly watching ourselves, scrutinizing critically the minutest detail of our being. The excruciating observation of oneself that results, this torment of self-consciousness, becomes so acute as to create a binding, almost paralyzing effect. Sudden, unexpected exposure, coupled with binding inner scrutiny, characterize the essential nature of the affect of shame.
Shame is loss of face, whether at the hands of a bully or a parent. Shame is hanging the head, whether in response to, "You should be ashamed of yourself' or "I'm so disappointed in you." Shame is exquisitely painful, it feels like a wound made from the inside by an invisible hand. Shame is dishonor, fallen pride, a broken spirit.
Shame is felt as an interruption, and it functions to further impede verbal communication. However, the physical experience of shame itself is communicated non-verbally. The individual whose head hangs, or whose eyes lower, or whose gaze is averted, however briefly, is directly communicating shame. The beaten, humiliated individual, whether defeated as a child by a brutalizing parent or defeated as an adult by a dead end career or marriage, has been defeated by shame.
Repeated experiences of shame can engulf the whole of our being, immersing us deeper into despair. To live with shame is to feel alienated and defeated, never quite good enough to belong. And secretly we feel we are to blame; the deficiency lies within. Shame is without parallel a sickness of the soul. The source of low self-esteem, poor self-concept, or diminished self-image is shame. That is the affective source of later feelings of inadequacy or inferiority.
In the early years of life, shame is predominantly a wordless experience irrespective of its duration. Later, shame experiences become transformed by language, becoming a partially cognitive, self-evaluative experience. (Kaufman, 1996).
The unfolding of shame
Jones (1995) articulates the evolution of shame as follows. The presymbolic roots of shame lay with experiences of inefficacy during the first 18 months of life as we try to acquire competence and mastery over our body and our environment. Shame is further refined when our competence is tested in the crucible of competition between 6 and 12 years of age. During this period we learn the rules of engagement in a very tough and competitive world. We also learn to socialize our affects and develop increasingly complex emotional convictions. A third layer of shame complexity starts to emerge during adolescence and continues for the rest of our lives as we develop and refine ideals which guide our being-in-world.
Shame and the sense of self
Kaufman (1996) interprets Erickson’s (1950) eight stages or identity crises as “linguistic transformations of shame. The negative pole of each crisis is actually an elaboration of shame, given a new or wider meaning. Each subsequent crisis involves, at least in part, a reworking of shame.”
Kaufman goes on to say: “Consider the poles of each identity crisis more closely: basic trust versus basic mistrust, autonomy versus shame and doubt, initiative versus guilt, industry versus inferiority, identity versus role confusion, intimacy versus isolation, generativity versus stagnation, ego integrity versus despair. The affect most critical to the development of mistrust, guilt, inferiority, isolation, and so on, is shame... Certainly, other affects may become fused with shame in the formation of these recurring crises, but the one affect central to the sense of identity is shame.”
Shame as psychobiological dysregulation
Introduced in 1987 by McGuire and Troisi, regulation-dysregulation theory studies the effect intersubjective attunement and misattunement on physiological states. It is an approach derived from an evolutionary analysis of social behavior that emphasizes the psychobiological nature of intersubjectivity and of intersubjective sequences.
Similar to the medical notion of homeostasis, the term regulation refers to a state of steady attuned responsiveness in which physiological and psychological systems function optimally. In a regulated state one feels well, has the energy and confidence to do what one wants to do, thinks clearly, feels in control of one’s own thoughts and emotions, and is free of symptoms.
The term dysregulation refers to disorganized physiological and psychological states caused by erratic, misattuned responsiveness, and associated with symptoms, and reduced capacities to concentrate and act efficiently. The degree of dysregulation varies along a continuum. In moderate to severe instances, we are unable to control our emotions and thoughts. Examples include the demobilized, fretful state of the infant whose mother does not respond to his or her facial signals; the fearful anticipation of a parent waiting for a child to return home when he or she is late; the pining and distress of grief; a quarrel between lovers; and of course, the anxious, withdrawn, ruminative states of the shamed.
In posts number 2 and 3 of this series, I examined the affective-symbolic disintegration and the psychobiological dysregulation inherent in emotional trauma, a dysregulation which, according to Gilbert and McGuire (1998), we can now understand as shame.
E - A personal account of emotional trauma
In the last few years I have experienced two intertwined and devastating professional losses. My emotional surround throughout was inhospitable, and that, at least initially, rendered my predicament unbearable.
In the words of Gershen Kaufman (1996), the loss of my Medical License felt “like a wound made from the inside by an invisible hand.” Evelyn Waugh’s (1945) words from his novel ‘Brideshead Revisited’ are fitting to describe the second loss, for it felt like “a blow falling upon a bruise,” and was for me of far greater import than the first one, since it exiled me from this community to a life of relative isolation.
These two emotionally crushing experiences had two shame themes in common. The first theme had to do with a disconcerting sense of emotional and bodily disorganization, of dysregulation as described above, which brought on a feeling of incompetence, of disability, of not being to stand on my own two feet. The second theme was that of a loss within each of these losses: I felt dispossessed of the esteem of others; that is, deemed, seen as diminished, dishonored, and no longer good enough to belong; and my self-esteem began to organize around this harrowing sense of diminishment. These experiences radically altered for a while my way of being-in-the-world. Eventually, my therapist and his consulting room afforded me refuge and opportunity for understanding and healing.
The work of Douglas L. Cairns (1993, 2009) was also illuminating in my effort to arrive at a clearer understanding of the dynamics involved in the experiences I just described. As a Classicist, Professor Cairns works on ancient society and ethics, especially the emotions, and especially as they are reflected in early poetry and classical tragedy. He has delineated the linguistic, psychological, social, and ethical contexts in which the term aidos appears in Greek literature of the classical period. Aidos is a very complex Greek word, truly a concept, which encompasses the notions of shame, honor and morality, identity, respect, modesty, and integrity, and their dialectical opposites in community life.
Cairns’ conclusions about how these complex emotions operate in the emotional life of individuals and communities are remarkably similar to some of the conclusions that appear in contemporary psychoanalytic thinking (relational theories, intersubjective systems theory, for example). The individual does not exist in isolation but ‘intricately bound’ with other individuals (today we speak of interacting subjective worlds of experience, and of mutual recognition, for example); individual identity is bound up with group membership; self-esteem depends, in part, on the esteem of others; ideas of selfhood are mediated through the concept of aidos, comprising all the meanings indicated above, and at every step of development, the sense of self upon which aidos rests is promoted and maintained by a focus on the standing of self and others as the bearers of honor; the crucial point is that aidos includes the notion that the honor of the individual and that of the group are reciprocally bound.
It was very helpful to be reminded that one’s honor, as so much else in human life, is inextricable from that of others; that transgression affects both the transgressor as well as the community; and that certain measures taken in these situations are meant to restore at least some equilibrium to both. As I regained this perspective, I felt more grounded. I was able then to reach out to this community, and to my surprise some of you began to guide my return here. Why was I surprised, I wondered. Well, in my befuddlement, I had overlooked yet another important consideration.
In the early 1990s, I attended a 3-day summer seminar on shame Don Nathanson (1996) gave in Cape Cod. In his last lecture he examined some aspects of narcissistic injuries and shame, and the not-uncommon self-protective stance of pride, indicating that in this predicament “the reciprocity of shame was to pride,” one of the possible outcomes in what he called ‘the compass of shame.’ He concluded the seminar movingly and memorably with this suggestion: “… the reciprocity of shame is to be not to pride but to love; for only true love, a love rooted in the will to affirm the value of the other, can absorb shame!” And so it is to be, I believe, with emotional trauma as well.
What I have encountered both in being helped to return, as well as in being in this community is true love.
I am grateful to you all…
Ernesto Vasquez, MD
April 14, 2010
References
Atwood, G.E., & Stolorow, R.D. Structures of Subjectivity. Hillsdale, NJ, The Analytic Press, 1984.
Cairns, D.L. Aidos. The Psychology and Ethics of Honour and Shame in Ancient Greek Literature. Oxford University Press, 1993.
Cairns, D. L. Honor and Shame in Homer. Lecture at the 8th Annual Platsis Symposium, University of Michigan, September 13, 2009.
Jones, J. Affects as Process. Northvale, NJ, The Analytic Press, 1995.
Frie, R., & Orange, D.M. (Eds). Beyond Postmodernism. New York, NY, Basic Books, 2009.
Gilbert, P., & McGuire, M.T. Shame, Status, and Social Roles. In P. Gilbert and B. Andrews. Shame: Interpersonal Behavior, Psychopathology, and Culture. New York, NY, Oxford University Press, 1998
Herman, J.L. Trauma and Recovery. New York, NY, Basic Books, 1992.
Kaufman, G. The Psychology of Shame, Second edition. New York, NY, Springer Publishing Co., 1996.
Nathanson, D.L.(Ed.) The Many faces of Shame. New York, NY, Guilford Press, 1987.
Nathanson, D.L. Knowing Feeling. Affect, Script, and Psychotherapy. New York, NY, Norton, 1996.
Orange, D.M. Emotional Understanding. Studies in Psychoanalytic Epistemology. New York, NY, Norton, 1995.
Orange, D.M., Atwood, G.E., & Stolorow, R.D. Working intersubjectively. Hillsdale, NJ, The Analytic Press, 1997.
Stolorow, R.D. & Atwood, G.E. Faces in a Cloud. Northvale, NJ, Jason Aronson, 1979.
Stolorow, R.D., Brandchaft, B., & Atwood, G.E. Psychoanalytic treatment. Hillsdale, NJ, The Analytic Press, 1987.
Stolorow, R.D. & Atwood, G.E. Contexts of Being. Hillsdale, NJ, The Analytic Press, 1992.
Stolorow, R.D., Atwood, G.E., & Orange, D.M. Worlds of Experience. New York, NY, Basic Books, 2002.
Stolorow, R.D. Trauma and Human Existence. New York, NY, The Analytic Press, 2007.
Waugh, E. Brideshead Revisited, Chapman and Hall, 1945.
Emotional Trauma in Review - Part 2
C - The Neurobiology of Stress
According to Herman (1992), “[t]he ordinary response to danger is a complex, integrated system of reactions, encompassing both body and mind. Threat initially arouses the sympathetic nervous system, causing the person in danger to feel an adrenalin rush and go into a state of alert. [Adrenalin] also concentrates a person’s attention on the immediate situation. In addition, threat may alter ordinary perceptions: people in danger are often able to disregard hunger, fatigue, or pain. Finally, threat evokes intense feelings of fear and anger. These changes in arousal, attention, perception, and emotion are normal, adaptive [stress] reactions. They mobilize the threatened person for strenuous action either in battle or in flight.”
In what follows I mean to update our understanding of the physiological stress which undergirds our acute adaptive responses to danger, and which becomes severely disrupted in the process of prolonged emotional trauma, a dysregulation which itself triggers stress, thus compounding the physiological and psychological burden, the suffering.
Different stressors require different responses
From: Joels, M. & Baram, T.Z. (2009).
The ability to change neuronal activity (and hence behavior and cognition) both rapidly and enduringly in response to threatening challenges is crucial for survival and has thus resulted in a highly coordinated, complex and evolutionarily conserved stress-response system.
Because different challenges require distinct responses (for example, social decisions or flight) that involve different sets of neuronal populations acting in concert or sequentially, the brain has evolved a system that can produce such diverse alterations in neuronal activity.
This system consists of the stress mediators shown above, which not only occupy characteristic niches of time, space and function, but also are exquisitely coordinated at multiple levels to create an orchestrated stress-response symphony.
This ‘stress neuro-symphony’ provides the capacity to generate precise, focused alterations in neuronal activity in response to stress signals. These alterations can range spatially from individual synapses up to the whole individual, and temporally from milliseconds to days.
Emotional Trauma in Review - Part 1
A - The Complexity of Emotional Trauma
Judith Herman’s (1992) synthesis of psychological trauma remains, in my opinion, unsurpassed. It is the standard to which I return time and again.
“Psychological trauma is an affliction of the powerless. At the moment of trauma the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When the force is that of other human beings, we speak of atrocities. Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning.”
In other terms, traumatic events shatter what Stolorow (2007) refers to as ‘the absolutisms of everyday life’: “When a person says to a friend, “I’ll see you later” or a parent says to a child at bedtime, “I’ll see you in the morning,” these are statements whose validity is open for discussion. Such absolutisms are the basis for a kind of naïve realism that allow one to function in the world, experienced as stable and predictable. It is in the essence of emotional trauma that it shatters these absolutisms, a catastrophic loss of innocence that permanently alters one’s sense of being-in-the-world.” (emphasis added).
In Herman’s view, “[t]raumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life…They confront human beings with the extremities of helplessness and terror, and evoke responses of catastrophe…the salient characteristic of the traumatic event is its power to inspire helplessness and terror.”
According to Jones (1995), “If trauma is limited to what is “shattering” and “devastating” –war neurosis, concentration camp phenomena, massive physical and/or sexual abuse- then we are likely to miss the more subtle manifestations of traumatic states. What is needed is an operational definition of traumatic states. I suggest that our behavioral response points toward a definition…affects are presymbolic signals that convey information; the organism uses these affective signals to appraise the situation and take effective action. Defined operationally, a traumatized state occurs when a person is unable to respond appropriately and effectively to a situation; in turn, this inability to respond is signaled by anxiety-panic… If we reserve the term trauma for those situations that evoke anxiety-panic, then we have defined both in operational terms. This is the definition of traumatic anxiety that Freud (1926) proposed, but which has been lost due to the shifting meanings of “trauma.”’
The varied manifestations of emotional trauma can be grouped into three main categories: hyperarousal, intrusion, and constriction. “Hyperarousal reflects the persistent expectation of danger; intrusion reflects the indelible imprint of the traumatic moments; constriction reflects the numbing response of surrender.” (Herman, 1992)
“People subjected to prolonged, repeated trauma develop an insidious, progressive…[condition]…that invades and erodes the personality. While the victim of a single acute trauma may feel after the event that she is “not herself,” the victim of chronic trauma may feel herself to be changed irrevocably, or she may lose the sense that she has any self at all.”
I will consider physiological and psychological hyperarousal in post number 2 of this series.
Intrusion
Intrusive symptoms after a single acute trauma tend to abate in weeks or months. In survivors of prolonged, repeated trauma these symptoms persist for many years with little change. The traumatic experiences become encoded in memories which break spontaneously into consciousness, both during waking hours as well as during sleep. Small, seemingly insignificant occurrences can also evoke these memories which are experienced with their original vividness and emotional force.
Traumatic memories are encoded as vivid sensations and images, and lack verbal narrative and content, thus resembling the memories of young children. The intense focus on fragmentary sensation, on image without context, gives the traumatic memories a heightened reality. Lacking symbolic content, these memories are expressed in action. This is most apparent in the repetitive play of children. Commonly, traumatized people find themselves reenacting some aspect of the damaging experience in disguised for, without realizing what they are doing. Some reenactments put the survivor at risk for further harm. According to Herman, “There is something uncanny about reenactments. Even when they are consciously chosen, they have a feeling of involuntariness. Even when they are not dangerous, they have a driven, tenacious quality. Freud named this recurrent intrusion of traumatic experience the ‘repetition compulsion’.”
There is general agreement in the field, that the repetitive reliving of traumatic experiences are spontaneous, unsuccessful attempts at healing. The driving force of the reenactments is the emotional rather than the cognitive experience of the trauma. What is reenacted are the overwhelming, crushing emotional experiences in an attempt, however unsuccessful, to integrate them. In treatment, in Herman’s words, “[b]ecause reliving a traumatic experience…[entails]…such intense emotional distress, traumatized people go to great lengths to avoid it. The effort to ward off intrusive symptoms, though self-protective in intent, further aggravates the {emotional trauma], for the attempt to avoid reliving the trauma too often results in a narrowing of consciousness, a withdrawal from engagement with others, and an impoverished life.”
Constriction
“When a person is completely powerless, and any form of resistance is futile, she may go into a state of surrender. The system of self defense (see post number 2) shuts down entirely. The helpless person escapes from her situation not by action in the real world but rather by altering her state of consciousness. Analogous states are observed in animals, who sometimes “freeze” when they are attacked … These altered states of consciousness are at the heart of constriction or numbing … “
In a superbly crafted paragraph, Herman goes on to say, “Sometimes situations of inescapable danger1 may evoke not only terror and rage but also, paradoxically, a state of detached calm, in which terror, rage, and pain dissolve. Events continue to register in awareness, but it is as though these events have been disconnected from their ordinary meanings. Perceptions may be numbed or distorted, with partial anesthesia or loss of particular sensations. The sense of time may be altered, often with a sense of slow motion, and the experience may lose its quality of ordinary reality. The person may feel as though she is observing from outside her body, or as though the whole experience is a bad dream from which she will shortly awaken. These perceptual changes combine with a feeling of indifference, emotional detachment, and profound passivity in which the person relinquishes all initiative and struggle. This altered state of consciousness may be regarded as one of nature’s small mercies, a protection against unbearable [emotional] pain.”
Herman explains further, “These detached states of consciousness are similar to hypnotic trance states. They share the same features of surrender of voluntary action, suspension of initiative and critical judgment, subjective detachment or calm, enhanced perception of imagery, altered sensation, including depersonalization, derealization, and change in the sense of time. While heightened perceptions occurring during traumatic events resemble the phenomena of hypnotic absorption, the numbing symptoms resemble the complimentary phenomena of hypnotic dissociation.”
The features of emotional trauma that become most pronounced in chronic trauma are avoidance or constriction. Herman suggests “[w]hen the victim has been reduced to the goal of simple survival, psychological constriction becomes an essential form of adaptation. This narrowing applies to every aspect of life –to relationships, activities, thoughts, memories, emotions, and even sensations– …this constriction…also leads to a kind of atrophy in the psychological capacities that have been suppressed and to the overdevelopment of a solitary inner life.”
She continues, “The constrictive symptoms of [emotional trauma] apply not only to thought, memory, and states of consciousness, but also to the entire field of purposeful action and initiative. In an effort to create some sense of safety and to control their pervasive fear, traumatized people restrict their lives.”
And concludes, “In avoiding any situations reminiscent of the past trauma, or any initiative that might involve future planning and risk, traumatized people deprive themselves of those new opportunities for successful coping that might mitigate the effect of the traumatic experience. Thus, constrictive symptoms though they may represent an attempt to defend against overwhelming emotional states, exact a high price for whatever protection they afford. They narrow and deplete the quality of life and ultimately perpetuate the effects of the traumatic [experiences].”
Nevertheless, if as therapists, we keep in mind the ‘incomparable power of human recognition’, then we can acknowledge to our patients their countervailing efforts to reintegrate a fragmenting world and restore a sense of continuous and coherent being, thus providing one more opportunity for healing (Stolorow, Atwood, & Orange, 2002).
In closing, I would like to offer an important question that Stolorow, Atwood, & Orange (2002) address. “Why does one person respond to trauma with a successful act of dissociation, leaving the organization of his or her world otherwise relatively intact, whereas another react with an experience of self- and world dissolution?”
They begin to provide an answer pointing out that intersubjective systems theory as a “post-Cartesian psychoanalytic theory, while not denying the existence of an individual’s strengths, recognizes that anyone ‘s resources only come into play within specific intersubjective fields. In addition, the nature of trauma itself is understood to vary as a partial function of the relational and historical context in which it occurs (Stolorow & Atwood, 1992). The trauma experience that leads to annihilation, embedded in its own distinctive context, is likely to differ markedly from the one in which dissociation takes place.”
Then, they conclude: “The trauma that annihilates subverts the person’s whole way of making sense of his or her life and attacks sustaining connections to the human surround at their most fundamental level; the trauma that can be dissociated, although also a threat to existing organizations of experience, leaves sustaining ties intact to some degree, so that a stable platform of selfhood and worldhood survives for the encapsulation and dissociation of the traumatic event.”
B - Affective-Symbolic Disintegration
Jones (1995) defines the sense of self as “the personal organization we experience when we are able to effectively integrate our affective experience with what we think in a relatively stable internal relationship. In other words, it is the ability of the individual to create a relationship between his feeling core and his thinking “I” that is at the heart of selfhood. It is the affective-symbolic integration that leads to the creation of a sense of self.”
Jones holds that affects are our primary process because they are our first and only information processing system until the arrival of thought at about 10-12 months of age. He conceptualizes affects as “the experiential representation of a nonsymbolic information-processing system that can serve as the central control mechanism for all aspects of human behavior, including the control of physical movement, memory, and all interactions with the environment... affects, and affects alone, serve as the primary control signals for all animals and presymbolic infants.” The developmental task during this period is learning to use our body.
Thought is our second information-processing system. “At some specific point in time, perhaps as early as eight to ten months of age, the program that will eventually lead to speech is activated… Consequently, symbolic functioning –what we usually call thinking- must be layered upon and eventually integrated into the smooth, presymbolic affective information processing system of infancy. These two discrete ways of processing information form the substrate of the “divided mind”; the necessity of integrating them results in the rapprochement crisis…” The developmental task with the arrival of thought becomes learning to use our mind, that is, “effectively [integrating] our affective experience with what we think in a relatively stable internal relationship.” I try to capture the essence of this process with the metaphor of ‘learning to think with our heart.’
Jones describes an example of affective-symbolic integration in his discussion of the attainment of object constancy as cognitive development: “At somewhere around 10 to 12 months, the infant begins to acquire the ability to use symbols, a process crowned by the first spoken word at approximately 18 months; the ability to attach names to things leads to the formation of concepts. Nouns are the first type of speech the infant uses; typically, they describe phenomenologic objects in the world-out-there (Mama, Daddy, cat, etc.). As used in the psychoanalytic literature, the term internal object must refer to these first concepts; otherwise, the term is simply redundant for a presymbolic schematic representation or has no meaning at all. Similarly, the term object relations does not refer to the infant’s first experience of relationship, but, rather, to his first attempts to symbolize or conceptualize that experience. If one holds to this definition of object, object constancy occurs when the infant achieves the ability to maintain the concept of his mother in his mind even when experiencing high-intensity negative feelings –rage, hatred- directed toward her. In other words, object constancy (or its equivalents, libidinal object constancy and emotional object constancy) implies conceptual stability despite the presence of intense affectivity.” (emphasis in original)
I believe the relative stability of the reciprocally -regulating affective-symbolic network is the crucial factor, too much or too little of each component can cause a disruption. Thought can act as a brake on emotions to keep us from acting impulsively; we call the outcome of this exercise will power. Emotions enliven our intellectual life, rendering it colorful and creative; intense affectivity, however, can cause conceptual instability. These assumptions parallel our everyday observations about ourselves and others; we experience greater difficulty in maintaining our integrated state –“keeping our shit together”- when experiencing intense negative emotions.
In Herman’s (1992) view, “[t]raumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life…They confront human beings with the extremities of helplessness and terror, and evoke responses of catastrophe…the salient characteristic of the traumatic event is its power to inspire helplessness and terror.”
Extreme helplessness and terror (intense affectivity) cause affective-symbolic disintegration; that is, the disintegration - characteristic of a traumatized state of mind- of our world of experience at the center of which is our sense of self, our enduring center in relation to which the totality of our experiences are organized. This is truly a psychological catastrophe (Stolorow, Atwood, & Orange, 2002). I examine the physiological aspects of this catastrophe in post #3.
Ernesto Vasquez, MD
April 11, 2010
References
Jones, J. Affects as Process. Northvale, NJ, The Analytic Press, 1995.
Herman, J.L. Trauma and Recovery. New York, NY, Basic Books, 1992.
Stolorow, R.D., Atwood, G.E., & Orange, D.M. Worlds of Experience. New York, NY, Basic Books, 2002.
Stolorow, R.D. Trauma and Human Existence. New York, NY, The Analytic Press, 2007.
Sunday, April 11, 2010
Forgotten Holocausts: Remembering the Roma and Jehovah’s Witness Victims and Survivors of the Holocaust.
And the Violins Stopped Playing is the 1988 film adaptation of the book And the Violins Stopped Playing: A Story of the Gypsy Holocaust by Alexander Ramati. Ramati’s book is a biography of Roman Mirga who plays the accordion while his father played the violin and his mother a sings in a restaurant. The film chronicles the family’s attempts to escape the Nazi’s round-up and extermination of the Roma.
According the United States Holocaust Memorial Museum “between 1933 and 1945 and Roma ("Gypsies") suffered greatly as victims of Nazi persecution genocide. Building on long-held prejudices, the Nazi regime viewed Gypsies both as "asocials" (outside "normal" society) and as racial "inferiors"—believed to threaten the biological purity and strength of the "superior Aryan" race.” “In a decree dated December 16, 1942, Himmler ordered the deportation of Gypsies and part-Gypsies to Auschwitz-Birkenau. At least 23,000 Gypsies were brought there, the first group arriving from Germany in February 1943.”
The distinguished scholar and artist-in-residence at San Diego State University, Yale Strom provided a rich historical and cultural context in which to view the film. You can hear his comments by following this link.
According to psychoanalyst Michael Poff, the story is about memory of different kinds; the ability to remember the time before (the holocaust), a time that was happier. It was also about communication and language and about how music integrates the cognitive aspects of our experience
with our unconscious experience. Poff located his remarks in the work of ego psychoanalysts Heinz Hartman. In his book, Ego Psychology and The Problem of Adaptation, Hartman moved psychoanalysis away from drive theory to an analytic focus on the human capacity to adapt. For Poff, the Roma’s lives were about adaptation and sublimation at the highest levels of creativity.
Poff also distinguished between Dymitr who is elected by the “kris” or the clan council and the ousted clan leader. Shero Rom (meaning Big Person) is highly respected and has the last word on clan matters. Unlike the Shero Rom in the film, Dymitr has the capacity to adapt to reality versus the fixation on his position. Poff noted all the things the Roma had to let go to manage the adaptation to reality. Dymitr’s music allowed him to reach out from himself to the people he was leading that allowed him to make choices about group survival that alluded the ability of the Shero Rom.
Poff also contrasted the kind of knowing that the notorious physician, Josef Mengele pursued versus that which Dymitr found most useful. For Mengele, knowledge was all narcissistic and it was not used for the principles of love and reaching higher purposes.
There were so many dimensions to the movie t
hat we did not have a chance to discuss from a psychoanalytic perspective such as, the need for love and the desire to experience sex and sensuality at least once in one’s life in spite of the horrific circumstances; the ability to be in community and coalition with one another; the little girl who is forced to leave her family and run to a total stranger in the hope that she will be taken in and the the emotional and moral compass of the one who is not hunted by the Nazi’s to help the one who is; the ability of rivals to move beyond their differences to work together to enable their own survival and for former foes to willingly give their lives for their past enemies to keep the family/community together – their altruism and selflessness; why women had to be subjugated and not incorporated into the decision-making of the ruling councils and so on.
xample of the suffering of many Jehovah’s Witnesses under the Nazis.“The Christian theology of the Witnesses diametrically opposed Nazi ideology on three basic points: The Witnesses rejected racism, ultra-nationalism, and the deification of the State and its führer. The Witnesses obey governmental authority, but they owe prior allegiance to God and his Kingdom. Therefore, if a government demands what God prohibits, or prohibits what God requires, the choice for the individual Witness is clear. This position threw thousands of Witnesses into a pitched spiritual battle with the Nazis.
On the streets, at factories, in schools, and even in homes, the Hitler salute signaled the people’s fidelity to the führer. The calculated messianic symbolism of the Hitler salute, meaning in essence “Salvation comes from Hitler,” was not lost on the Witnesses. They couldn’t heil a mere man. This daily, visible refusal soon led to beatings, firings from jobs, destruction of property, and prison sentences. Out of obedience to God and love of neighbor, Witnesses would not join the Nazi Party, Labor Front, or Hitler Youth, nor would they vote in elections, observe boycotts of Jewish businesses, serve in the military, or perform war-related work.”*
Yale Strom’s comments were instructive on the impact of faith on surviving the despair and torture of being in the camps or confronting th
e SS. Noting that in the true story of the Kusserow family in which the father was imprisoned, the mother and sister were placed in a concentration camp, one brother was shot to death and another was beheaded, their faith became stronger. Few Jews and other people of faith converted for the sake of saving their lives. Poff noted that faith made them more resilient and allowed them to not get eaten up by anger and drawn down by hate.Strom recalled that a friend of his who survived the Holocaust and the camps had initially given up. He had become one of the individuals who lost their minds and rocked back and forth near the barb-wire fence. Until one day, he heard the voices of his parents telling him he was not ready to go and then he heard the voice of God also telling him he was not ready to go. He vowed that if he survived he would dedicate his life to teaching tolerance for all people.
Strom reminded the audience that the current genocides of Rawanda and the Sudan were caused because of intolerance and because the world turned a blind eye.
For more information:
For more information on the Roma and the Holocuast visit: http://fcit.coedu.usf.edu/holocaust/people/USHMMROM.HTM
*Form more information on the persecution of the Jehovah Witnesses from a doctrinaire perspective visit: http://www.baycrest.org/Spring%202001/article12.htm and read Purple Triangles: A Story of Spiritual Resistance by Jolene Chu
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HIMMLER'S CIRCULAR OF DECEMBER 8, 1938:"COMBATTING THE GYPSY NUISANCE"
Experience gained in combating the Gypsy nuisance, and knowledge derived from race-biological research, have shown that the proper method of attacking the Gypsy problem seems to be to treat it as a matter of race. Experience shows that part-Gypsies play the greatest role in Gypsy criminality. On the other hand, it has been shown that efforts to make the Gypsies settle have been unsuccessful, especially in -the case of pure Gypsies, on account of their strong compulsion to wander. It has therefore become neces-sary to distinguish between pure and part-Gypsies in the final solution of the Gypsy question.
To this end, it is necessary to establish the racial affinity of every Gypsy living in Germany and of every vagrant living a Gypsy-like existence.
I therefore decree that all settled and non-settled Gypsies, and also all vagrants living a Gypsy-like existence, are to be registered with the Reich Criminal Police Office-Reich Central Office for Combating the Gypsy Nuisance.
The police authorities will report (via the responsible Criminal Police offices and local offices) to the Reich Criminal Police Office-Reich Central Office for Combating the Gypsy Nuisance all per-sons who by virtue of their looks and appearance, customs or habits, are to be regarded as Gypsies or part-Gypsies.
Because a person considered to be a Gypsy or part-Gypsy, or a person living like a Gypsy, as a rule confirms the suspicion that marriage (in accordance with clause 6 of the first decree on the implementation of the Law for the Protection of German Blood and Honor... or on the basis of stipulations in the law on Fitness to Marry must not be contracted, in all cases the public registry officials must demand a testimony of fitness to marry from those who make such an application [to be married].
Treatment of the Gypsy question is part of the National Socialist task of national regeneration. A solution can only be achieved if the philosophical perspectives of National Socialism are observed. Although the principle that the German nation respects the national identity of alien peoples is also assumed in combating the Gypsy nuisance, nonetheless the aim of measures taken by the State to defend the homogeneity of the German nation must be the physical separation of Gypsydom from the German nation, the prevention of miscegenation, and finally, the regulation of the way of life of pure and part-Gypsies. The necessary legal foundation can only be created through a Gypsy Law which prevents further intermingling of blood, and which regulates all the most pressing questions which go together with the existence of Gypsies in the living space of the German nation.
Translated in Michael Burleigh and Wolfgang Wipperman, The Racial State: Germany 1933-1945 (New York, 1991), pp. 120-21
