......Actually, it is the troubled character patterns of humanity that are the daily bread and butter of psychoanalysts and psychodynamic/psychoanalytic psychotherapists -- the castrating hysteric, the covertly stubborn defiant obsessional, the orally hungry needy tormenting borderline, the self-defeating masochist, the disavowed or not so disavowed sadistic narcissist. These and a few others, with lots of interesting permutations and combinations, are the categories of people that make up the world. This is what psychoanalysts make conscious -- the patterns that disable and limit people -- ones that give ulcers either to individuals themselves, or to recipients in their orbit.......
Housework Is an Academic Issue: How to keep talented women scientists in the lab, where they belong. By Londa Schiebinger and Shannon K. Gilmartin on the Academe Online website.
I think so, for to truly think and work contextually (Orange, Atwood, & Stolorow, 1997), and not diminish the experience of the inescapable embodiment of our non-corporeal being, it helps to have a working knowledge of our physiological functioning, as we tussle with the marvel that the interrelatedness of body and spirit is.
It seems that Freud was grappling with these issues for he published closely together (1893-1895) Studies in Hysteria which launched the talking cure, and The Project for a Scientific Psychology. The latter reflects Freud’s abiding interest in understanding the biological foundations of the psychological processes and phenomena with which psychoanalysis is concerned. But, as Gallese (2007b) points out, given the limited state of knowledge and technologies at the time, the Project could not be carried very far.
In his illuminating discourse on empathy last weekend, Frank Lachmann alerted us to several of its components which he calls procedural precursors and describes as nonconscious automatic processes: cross-modal transfer, vocal rhythm coordination, affective state sharing, and entering the behavioral, affective, and proprioceptive streams of another person. These processes are subsets of neurophysiological functioning and Lachmann mentioned in passing the mirror neuron system (“...everything seems to be mirror neurons these days...”).
This evoked for me the neuroscientific and psychoanalytic work of Vittorio Gallese which is summarized in a number of papers published in psychoanalytic periodicals (2003, 2006, 2007, 2007a, 2007b, 2008, 2009, 2009a, 2009b). This body of knowledge points to the Mirror Neuron System as the network in the Central Nervous System that coordinates, mediates, Lachmann’s precursors of empathy, as well as a number of other important functions. I find the details of Gallese’s discoveries and formulations endlessly fascinating. But here (Gallese et al., 2007b) he conveys the idea pithily:
“The neural circuits activated in a person carrying out actions, expressing emotions, and experiencing sensations are activated also, automatically via a mirror neuron system, in the observer of those actions, emotions, and sensations... this finding of shared activation suggests a functional mechanism of “embodied simulation” that consists of the automatic, unconscious, and non-inferential simulation in the observer of actions, emotions, and sensations carried out and experienced by the observed... the shared neural activation pattern and the accompanying embodied simulation constitute a fundamental biological basis for understanding another’s mind… The implications of this perspective for psychoanalysis are discussed, particularly regarding unconscious communication, projective identification, attunement, empathy, autism, therapeutic action, and transference-countertransference interactions.” (emphasis added).
With Orange, Atwood, and Stolorow (1997), I believe that the central domain of psychoanalytic inquiry is subjective experience and its vicissitudes, and that each psychoanalytic process is concerned with the emergence of understanding, of relatedness, of stable and positive self-experience. I am not proposing here that neural mechanisms become a central concern. I am suggesting that taking into account biological factors (the embodiment of our existence) provides a fuller context for our theorizing and for our work.
Ernesto Vasquez, MD February 18, 2009.
Gallese V. The roots of empathy: The shared manifold hypothesis and the neural basis of intersubjectivity. Psychopatology, Vol. 36, No. 4, 171-180, 2003. — (2006), Mirror neurons and intentional attunement: A commentary on David Olds. J Am Psychoanal Assoc, 54:46-57. — (2007), Empathy, embodied simulation and mirroring mechanisms. Commentary on “Towards a neuroscience of empathy” by Doug Watt. Neuropsychoanalysis, 9, vol 2: 146-151. —, Eagle M.E., and Migone P. (2007a), Intentional attunement: Mirror neurons and the neural underpinnings of interpersonal relations. J Am Psychoanal Assoc, 2007a, 55: 131-176. — (2007b), Dai neuroni specchio alla consonanza intenzionale. Meccanismi neurofisiologici dell’intersoggettività. Rivista di Psicoanalisi, LIII, 1: 197-208. — (2008), Empathy, embodied simulation and the brain. J Am Psychoanal Assoc, 56:769-781. — (2009), Mirror neurons, embodied simulation, and the neural basis of social identification. Psychoanalytic Dialogues, 19:519-536. — (2009a), We-ness. Embodied simulation and Psychoanalysis. Reply to commentaries. Psychoanalytic Dialogues, 19: 580-584. Eagle M.E., Gallese V., Migone P. (2009b), Mirror neurons and mind; Commentary on Vivona. J Am Psychoanal Assoc, 57(3): 559-68. Orange, D., Atwood, G., Stolorow, R. (1997), Working Intersubjectively. Contextualism in Psychoanalytic Practice. Hillsdale, NJ, The Analytic Press.
In addition to Orange’s (1995) initial view of empathy as emotional availability, Lachmann’s discourse on empathy (February 13th, Tampa) also brought to mind this treasure she gave us in 2006: an elaboration of emotional availability as psychoanalytic compassion. Although it is best to study this essay in its entirety, for brevity I will review here only the section on ‘Compassion as Emotional Understanding’. In footnote 4, Orange explains: “I think of empathy as a larger capacity to understand another's emotional experience from within an intersubjective field (Orange, 1995). Compassion, in my view, is that part of empathy that makes me willing and able to descend into and to explore the Dantean realms of suffering with the other.” Deriving from the Latin patior (to suffer, undergo), patient, as a designation, is not pejorative, for “a patient is one who suffers, one who bears what feels unbearable. Compassion, then, is a suffering with, a bearing together.”
Orange notes that the capacity to share the suffering of another “can gradually restore the shattered, alien-feeling, frozen, lost, dehumanized other a sense of belonging to the human community,” and therefore, along with others, Orange “would restore the concept [of compassion] itself to a central role in the “therapeutic action” discourse. In this paper, however, she focuses “on the attitude and capacity that the analyst brings to the psychoanalytic engagement.”
Not technique, and even less a rule of technique, compassion is, instead, both process and attitude. As process, compassion approximates Gadamer’s (1975) dialogic process of “undergoing the situation with the other” and arriving at an understanding, which is something Orange (1995) elucidates as emotional understanding. “Together we make sense of the patient's emotional predicament within the relational system that we experience together, and gradually this shared world changes by means of a personal reorganization of experience (of both participants)” (emphasis added).
Something that, at times, may not seem gentle or nice, and may occasionally even challenge, contradict, or introduce alternative perspectives, “[a] compassionate attitude... enables hitherto unknown and impossible forms of experiencing. Implicit and explicit forms of participation in the patient’s suffering create a world of compassion that introduces new experiential possibilities” (emphasis added). Ah, therapeutic action, how analysis cures, rendered less elusive, less mysterious!
But that is not all. “This participation, however, is a way of being-with, not a formula for doing psychoanalysis. Where there was indifference, humiliation, rejection, shattering loss, and the like, compassionate psychoanalytic understanding does not simply replace or heal by intentionally providing new experience. Instead, when the analyst treats a person as endlessly worth understanding and his or her suffering as worth feeling-together, this attitude of compassion implicitly affirms the human worth of the patient. Instead of being preoccupied with the question of the patient's recognition of the analyst as a subject, the psychoanalytic relationship accords to the patient, often for the first time, the dignity of being treated as the subject of one's own experience (the reciprocity may come later).”
And what about interpretation? “Because of their previous experience in life and in treatment, patients most often come to us expecting to be classified, judged, treated with rigidity, or exploited. If, however, we are not too intent on naming pathologies and defenses or with being right, but instead relentlessly seek to understand and accompany the sufferer, an implicitly interpretive system emerges. For me, close and compassionate listening is itself an important form of interpretation, dissolving the interpretation-gratification duality, and fully deserves to be considered psychoanalytic. It says to the analysand: "You are worth hearing and understanding." ” (emphasis added).
Orange then adds detail. “This listening involves attention to the ways the patient's experiential world has created suffering for the patient as well as for others in the patient's life. Without leaving the patient's side or becoming judgmental, we can understand how one could come to be so hurtful to oneself and to others. We can understand the simultaneous two-sided experience, so often dissociated, of being both hurt and hurtful. Recognizing context and complexity [the two preceding sections of the essay] prevents reduction and judgmental attitudes and enables compassionate understanding. ”
To make the concept of psychoanalytic compassion more complete, Orange offers the notion of accompanying the other. “In recent years I have become more aware of the importance of simple accompanying that some would contrast with proper "analytic" work and might disparage as "supportive" psychotherapy. Whether my patient suffers from an incurable, painful, and debilitating disease or from terminal cancer or lost a family member in the World Trade Center tragedy, I must not look for ways to see my patient as causing or even contributing to her own suffering; if I did so, I would be joining those who tell her just to accept it or get over it. There is no way to fix the situation or to "cure" the patient, so I must accept my own powerlessness to help. I must simply stay close to her experience, sorrowing and grieving and raging with my patient, even if this means that my practice feels very heavy to me. Even when the story is very complex -and it always is - a willingness to walk together into the deepest circles of the patient's experiential hell characterizes the attitude of compassion ... that the process of psychoanalytic compassion requires.”
Orange summarizes this way: “The interpretive gesture of reaching out to embrace the patient in a sustained, even relentless, struggle to find an understanding is what I mean by psychoanalytic compassion...[it is] an implicitly interpretive process of giving lived meaning and dignity to a shattered person's life by enabling integration of the pain as opposed to dissociation or fragmentation. A compassionate attitude says to every patient: your suffering is human suffering, and when the bell tolls for you, it also tolls for me.”
Orange, D. (1995), Emotional Understanding: Studies in Psychoanalytic Epistemology. New York: Guilford Press. Orange, D. (2006), For Whom the Bell Tolls-Context, Complexity, and Compassion in Psychoanalysis. International Journal of Psychoanalytic Self Psychology, 1 (1):5-21. Gadamer, H. (1975), Truth and Method. New York: Crossroads, 1991.
In her post of February 15th, Lycia Alexander-Guerra gives us a cogent summary of Frank Lachmann’s formulations of empathy at the Society’s day-long meeting on Saturday February 13th, 2010. I would like to focus here on one particular aspect of Lachmann’s presentation.
Although in the morning session Lachmann said that “[e]mpathy, like any skill, can be acquired and enhanced by training and learning,” in the afternoon session, I believe he modeled empathy as a quality of the person, a human attribute, a disposition, an inclination, an attitude, a capacity, a sensibility, a way of being-in-the-world.
For, in the course of our dialogue, something quite remarkable emerged very naturally from within Lachmann, imperceptibly at first - a delicacy, a caring, a respect, almost a reverence for the human condition as he shared his understanding of the adolescent who had murdered his parents and about the Tramp’s plight in Charlie Chaplin’s film ‘City Lights. ’ Then, by the inflection in his voice, his stance, and nearly transcendent facial expression, Lachmann seemed to be saying appreciatively “behold the patient,” that is, the one who suffers. We were so fortunate, I believe, to witness the emergence of an analyst’s spirit, of his capacity for empathy, an ability cultivated over time and in many ways, rather than something (a skill) one can simply go out and get. This was for me an experience full of wonder, and a richly evocative one at that.
It brought to mind the notion of emotional availability, Donna Orange’s (1995) synonym for empathy. She describes psychoanalysis as conversation, “as patient and analyst making sense together, reaching an emotional understanding.” Further, she proposes that “the only sort of understanding that can heal emotional wounds is emotional understanding.” And argues that “each person’s perspective is inevitably partial and that a more adequate view of anything requires dialogue. In such conversation we attempt to reach, practically speaking, a good-enough understanding of whatever is under discussion. In psychoanalysis, where the subject matter is a person’s emotional life, understanding that heals requires a mutually experienced emotional connection between patient and analyst.”
Orange suggests that among the conditions and attitudes that support good-enough emotional understanding, “[o]ne requirement is the emotional availability of particular analyst for a healing connection with the particular person who comes for therapy or analysis. This implies the willingness and the ability of the therapist to p rovide for that person a developmental second chance at a rich and integrated emotional life.” Orange continues, “Psychoanalytic understanding is knowledge gained from inside the intersubjective field formed by the intersection of two differently organized subjectivities. In dialogue, both participants attempt to expand their original subjective perspectives to take in, comprehend, and understand more of the other’s experience. We do this. . .b y placing ourselves, as consistently as we can, in the other’s shoes, both cognitively and emotionally. We understand by participating in the emotional experience, in the being, of the other.” (emphasis added).
A relational mode of knowing emotional reality, empathy not only emerges from personal relation but it creates the other as a subject, since “subjectivity becomes real only when two subjectivities meet in a personal relation. Only in such a relation can we empathically know - not just know about - one another.” Orange later concludes, “[a]n analyst must be Gadamer’s “person with understanding,” able and willing to enter the patient’s suffering and share the painful history, able and willing to “undergo the situation” with the other. I will call this combination of capacity and willingness “emotional availability.” Only when it is present can patient and analyst make sense of what seems senseless...”
In sum, “[e]mpathy is emotional knowledge gained by participation in a shared reality. It is knowledge arising from attunement...Empathic response comes from attunement to this shared reality, and must take the form at a frequency an d in a mode (auditory or visual, for example) that the receiver can comprehend. An empathic environment ...is one in which each person can feel like a Thou, a respected and admired partner in a conversation... Thus, empathy, including empathic response, is a necessary condition for understanding.” Emotional availability thus understood is a general disposition, a readiness to respond. “This readiness to offer our emotional expressions - verbal, semiverbal, or nonverbal - is a crucial component of the conversation that creates psychoanalytic understanding. We offer our emotional expressions, not as substitute for those of the patient, but as pump-priming, or facilitating, responses, our participation in the analytic squiggle game...often our attempts will be inaccurate, but in the atmosphere of emotional safety provided by this very responsiveness, many patients can use what we offer as a kind of catalyst for their own emotional expression. We show by those attempts that we are trying to understand, that we can imagine the patient to be having some emotional response, and that various - and perhaps less-than-elegant - expressions of emotion are more than acceptable to us. These attempts are trial balloons...and they convey to the patient that guessing is just fine. Together we are attempting to find an understanding.”
- Orange, D. M. Emotional Understanding. Studies in Psychoanalytic Epistemology. New York, New York, Guilford, 1995.
Thanks to everyone for making this year's film series a success. Don't miss our March 28, 2010 event at 2pm, University of South Florida, College of Medicine, MDA 1097 (Behind the Medical Clinic)
Film: A Secret Scholar: Madeline Camara, Ph.D., USF Associate Professor of World Languages
Clinician: Lycia Alexander-Guerra, M.D. Psychiatrist/Psychoanalyst
About A Secret: A Secret follows the saga of a Jewish family in post-World War II Paris. Francois, a solitary, imaginative child discovers a dark family secret that ties his family s history to the Holocaust and shatters his illusions forever. Adapted from psychoanalyst, Philippe Grimbert`s celebrated truth-inspired novel Memory.
About Dr. Camara:
Born in Havana, 1957. BA in Hispanic Lang and Lit in University of Havana, MA in Women Studies in Colegio de Mexico, Ph.d in Hispanic Lang and Lit in SUNY at Stony Brook. Has taught at University of La Havana, UNAM, and San Diego State University, California. Was the founder and editor of literary journal Letras Cubanas, in La Habana (1986-1992). Presently she writes a literary column for El Nuevo Herald. She has received a Rockefeller Resident Fellowship in the Humanities in Florida International University, in 1997, as well as a Fullbright Award Border Program in 2001.She is the author, among others, of Vocacion de Casandra (NY, Peter Lang: 2000) and co-editor of Cuba: the Ellusive Nation (Gainsville, Florida UP, 2000). Next books are La letra rebelde: estudios de escritoras cubanas (Miami:Universal, 2002) and La memoria hechizada (Barcelona:Icaria, 2002) Her present research deals with the image of the mulata as an icon for Cuban identity.
On Holocaust Remembrance Day, Join Yale Strom and Michael Poff as they discuss the hidden victims of the Holocaust
Sunday, April 11, 2010 *Program Begins at 2 PM*
Films: And the Violins Stopped Playing and Purple Triangles
Presenter: Yale Strom, Artist-in-Residence, San Diego State University
Clinician: Michael Poff, MSW, Psychoanalyst
Purple Traingles: Excellent documentary showing that it wasn't just the Jews persecuted during the Holocaust, Jehovah's Witnesses were also victims. They had all kinds of underground printing operations and even some of the songs that we sing presently at the Kingdom Hall were composed in the concentration camps.And the Violins Stopped Playing: Based on a true story, Ramati's novel depicts the atrocities committed by the Germans against the Gypsies during World War II. In the early 1940s, Roman Mirga learns thatGypsies in Germany are being rounded up and shipped to "relocation camps" for extermination. He warns his clan about the impending danger but is able to convince only a handful of them to flee with his family to Hungary. From Publishers Weekly
YALE STROM
“He's a gifted photographer and author, a talented documentary filmma
ker and has his own klezmer band... Strom's multifaceted career is a wonder, and his work schedule is downright fiendish.”
- New York Jewish Week.
“An award-winning musician, author, filmmaker and scholar, this maverick does so many things with such great skill and vision that he's in a league of his own."- George Varga - Music Critic of the San Diego Union-Tribune. " “Through his art, Strom has brought back his spiritual ancestors."
- Time Magazine.
Yale Strom is one of the world's leading ethnographer-artist of klezmer and Roma music and history. Strom's klezmer research was instrumental in forming the repertoire of his klezmer band, Hot Pstromi, based in New York and San Diego. Since organizing his band in 1981, he has composed original New Jewish music that combines klezmer with Khasidic melodies, as well as Roma, jazz, classical, Balkan, Arabic and Sephardic motifs.Strom's compositions range from several quartets to a full symphony. These works have been performed by the St. Louis Symphony Orchestra, SanDiego Chamber Orchestra, and the Ostrava Philharmonic of the CzechRepublic.He has composed original music for the DenverCenter’s production of Tony Kushner's The Dybbuk ; as well as composing all the original music for the National Public Radio series, Fiddlers, Philosophers & Fools: Jewish Short Stories from the Old World to the New, hosted by Leonard Nimoy.In addition, Strom has composed music for The History Channel, ESPN, and countless other TV offerings.Yale’s thirteen CDs run the gamut of traditional klezmer to "new" Jewish jazz. His CD's have received major rave reviews and been featured on Top Ten Album of the Year lists. In 2006, he was appointed artist-in-residence in the Jewish Studies Program at San DiegoStateUniversity.Prior to this appointment, Strom taught for many years at New YorkUniversity.
As a collaborator Strom has hadnumerous world-renowned partners, including Andy Statman, Mark Dresser, Marty Ehrlich, Mark O'Connor, Alicia Svigals, Joel Rubin, Hankus Netsky, Peter Sprague, Samir Chatterjee, Salman Ahmad, Gavin Rossendale, Damian Draghici and Kalman Balogh, to name but a few.With Salman Ahmad, Strom is cofounder of the world music ensemble Common Chords and together performed at the United Nations General Assembly in the recent "Concert for Pakistan".He is also the first klezmer violinist to be invited to instruct master classes at the Mark O'Connor Fiddle Camps.
Strom has directed seven award-winning documentary films: "At the Crossroads"; "The Last Klezmer" (winner best ecumenical film at the Berlin International Film Festival); "Carpati: 50 miles, 50 Years" (Emmy award);"L'Chayim, Comrade Stalin!"; "Klezmer on Fish Street" (Special Jury Selection, Palm Beach International Film festival; "Man From Munkatsh" (produced for Hungary's Duna TV).He was the first documentary filmmaker in history to be given his own run at LincolnCenter's prestigious Walter Reade Theatre, where his films broke box-office records.Currently, Strom is in pre -production on the feature film "Canaries" and the documentary "Detroit: In Black and White". He co-directed the feature documentary “The Harry Agganis Story”, now in post-production.
Strom 's original stage play . . . from man. . . to beast... to crawling thing , was given a fully-staged workshop in June of 2001 by the Streisand Festival ( La Jolla , California ). His play "The Education of Hershel Grynszpan" was workshopped by the San Diego Rep and the North Coast Rep as well as in New York City , Connecticut and Los Angeles . Yale was featured in the May 31, 2004 issue of Time Magazine for this play, and the scholarship behind it.
As a photographer, Strom has exhibited extensively. His solo photo exhibit The Roma of Ridgewood , about Gypsy communities in Queens, New York, was mounted at the Queens Museum of Art and was the first of its kind in NYC. He has had numerous solo and group photo exhibits (depicting Jewish and Roma life) throughout the U.S. and Europe. His photos are part of many collections including Beth Hatefusoth, The Skirball Museum, The Jewish Museum of NYC, The Frankfurt Jewish Museum and the The Museum of Photographic Arts.
Strom was the guest curator for the Eldridge Street Project's "A Great Day on Eldridge Street".Strom conceived this idea for a musical and photographic celebration of the newly restored landmarked Eldridge Street Synagogue in October 12-14, 2007 with a parade, a historic archival photo shoot, numerous panels and performances and a New York state-wide tour. The historic photo is now available as a poster from the Eldridge Street Synagogue in NYC.
Strom is a dedicated educator and has lectured extensively all over the world.His lectures and concerts at schools across the United States have ranged from how kids can use art to further their understanding of their ever changing world, to an examination of how music can be used to reach across various cultural, ethnic, racial and religious divides, and how to be a professional artist.
Strom's work as an author includes "The Book of Klezmer: The History, The Music, The Folklore" ( Chicago Review Press, 2002), a 400-page history with original photos and sheet music gathered by Strom during his sixty-plus ethnographic trips to Central and Eastern Europe. "A Wandering Feast: A Journey Through the Jewish Culture of Eastern Europe" written in collaboration with his wife, Elizabeth Schwartz, is part cookbook, part travelogue (Jossey-Bass, 2005). He is also the author of "The Absolutely Complete Klezmer Songbook" (URJ Press, 2006). His Young Adult books: "Uncertain Roads: Searching for the Gypsies" and "Quilted Landscapes: Immigrant Youth in America Today"have been critically used in schools throughout America. His first illustrated children's book, "The Wedding That Saved A Town" (Kar-Ben, 2008) won the Best Children's Illustrated Book award from the San Diego Library Association.Additionally, he was the author of the klezmer edition of the prestigious "Music Minus One" series of instructional books with accompanying CD's, as well as numerous other photo documentary books. Strom’s music and gregarious personality has been able to reach the multi-ethnic youth of America today and make a genuine difference in opening up their ears, eyes, and hearts.
Monday, February 15, 2010
Opening Pandora’s Box: The 19 Worst Suggestions For DSM5
By Allen Frances, MD | February 11, 2010
Dr Frances was the chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.
I have previously criticized the DSM5 process―for its unnecessary secretiveness, its risky ambitions, its disorganized methods, and its unrealistic deadlines.1-6 Now, it is finally time to evaluate the first draft of the recently posted DSM5 product (at www.DSM5.org).
Three Principles of Salience In his early morning presentation on Saturday, February 13, 2010 to the Tampa Bay Psychoanalytic Society, Inc, Dr. Lachmann encouraged attendees to include an awareness of the leading edge of a patient’s strivings, and not to overemphasize the trailing edge. For example, a patient’s competitiveness with the therapist may be an advance for the patient, a moving beyond what he/she could previously achieve [previously may have been unable to assert her/himself]. This new striving needs to be recognized as growth, and not merely be interpreted as a wish to usurp (Oedipal) or steal from the analyst the interpretations. Lachmann also distinguished between the Self Psychological approach:‘I learned from the patient…’; and other approaches: ‘I pointed out to the patient… [which, I think, speaks to co-creation and a collaborative effort, as distinguished from the one who knows, the omniscient analyst].
To provide the underpinnings for what we may find useful clinically/ how transformation comes about,Lachmann (and B.Beebee) in their book "Infant Research and Adult Treatment" elaborated three principles of salience, developed from infant research: 1) an infant builds its psychic structure (representations; organizing principles, RIGs) through its ongoing experiences of regulation, both self regulations and interactive regulations. For the latter, day to day activities between infant and mother build up what to expect from the particular dyad. The accrual of these built up experiences, which are mutually influenced by each partner in the dyad, is a dialectic of ever changing, moment by moment, influence on the self and other. [You can never stand in the same river twice.] In the clinical setting, session to session activities, such as greetings and parting rituals [or how either approach or withdraw from certain topics], also build up representations of interactions which become generalized (Dan Stern’s RIGs). Important, in addition to interpretation, are these built up expectations. 2) disruptions inevitably occur, when , e.g., mother is over or under responsive to the infant, and repairs must then follow to reestablish regulation. In the clinical situation, ruptures (e.g. the end of the session) do not require apology but, instead, ruptures in dialogue are to be investigated. 3) Heightened affective moments (from Fred Pine), whether due to joy or trauma, have a more powerful organizing effect than the mere passage of the time they take to occur would warrant. [similar to “attractor states” in systems theory, per one attendee]. The three principles of salience are clinically useful to think about in session: e.g. what produced the disruption? How might it be explored? What was a heightened affective moment? A clinical example was used to illustrate this. ************************* Empathy and Affect In his later morning presentation, Lachmann talked about empathy and affect. Empathy, “vicarious introspection" [Kohut] or ‘feeling oneself into the subjective experience of another,’ is advocated from the very beginning of treatment. (Later, citing Robert McKee, lecturer on structure of film narrative, McKee says that -- a “like me” experience from the viewer, a resonance with the character who must have a shred of humanity, a moment of recognition, is required to maintain the audience’s emotional involvement).
Lachmann countered critics who erroneously characterize Self psychology as using empathy as the only way that an analyst conveys information or effects transformation. Empathy, Lachmann says, is necessary but not sufficient. Differing from Kohut, Lachmann stated that it is not the transformation of archaic narcissism (which needs mirroring and idealizing transferences) into mature narcissism (empathy, humor, creativity, recognition of transience, wisdom), but, rather, it is affect and only affect which is transformed in therapy, and done so only as a result of affective engagement. It is not defenses, self states, or ego organization, but affect, which is transformed.
Kohut did not spell out how transformation is brought about. Using the three principles of salience, Lachmann says transformation is bi-directional, impacting both therapist and patient, and co-created (the analyst may have empathy, but the patient must be ready to be empathized with), and embedded in the therapeutic process, ongoing throughout the therapy. It is through ongoing regulation, rupture and repair, and heightened affective moments that transformation takes place. [of Lachmann’s 2007, Transforming Narcissism: Reflections on Empathy, Humor, and Expectations the following is written: “He asserts that empathy, humor, and creativity are not the goals or end products of transformations, but are an intrinsic part of the ongoing therapist-patient dialogue throughout treatment. The transformative process is bidirectional, impacting both patient and therapist, and their affect undergoes transformation - for example from detached to intimate - and narcissism or self-states are transformed secondarily as a consequence of the affective interactions. Meeting or violating expectations of emotional responsivity provides a major pathway for transformation of affect.”]
Precursors to empathy are procedural and non-conscious, but none the less lead to an understanding of the patient’s subjective experience. They indicate the capacity for later empathy and accessibility to our inner states, and include: cross modal transfer (e.g. where one hears the words, but imagines/sees the scene) . This precursor is present from birth, as illustrated in neonates who imitate sticking out the tongue (what has been seen is transfer to body movement), or in infant’s ability to attend to a ball (smooth or nubbed) previously felt, but not seen; state sharing (different from projective identification, as state sharing is bi-directional and co-created, and as it is a natural occurrence and not necessarily defensive); and entering in to the behavioral stream of another (one may change posture or vocal tone to be commensurate with the other’s). Resonance does not have to be exact to be effective. [In fact, the analyst, being close enough to be reminiscent of an old object—transference, but also different enough to be new object and to allow for the possibility of a new experience—new relational paradigm or new organizing principle, is therapeutic.]
In ongoing regulation, patient and therapist negotiate closeness/distance, intimacy, and attachment via their posture, body movements, vocal tones, and rhythms, all which lead to transient shifts in the affective states of both partners. Each self transforms, each changes, leading to something unique and new. Tronick’s “still face”(of previously responsive and engaged mother) paradigm was used for illustration, in which violation of expectations leads to distress, disengagement, and withdrawal in infants. ***************************
Expectations: met, surpassed, violated. In the afternoon, Lachmann discussed infant research further, and later dissected the reports on the school shooter Kip Kinkel, who first murdered his parents before killing classmates. Lachmann, noting Edward Tronick’s and Dan Stern’s works on the violations of expectations of affective responsivity (and Andre Green’s paper on the ‘dead mother’), reminded us that infants meet/imitate affective states of the mother to be in connection with her and not merely as a defense against loss.
Violations, when repeated, can become strain trauma, and early trauma of chaos, unpredictability, abuse, and other indiscriminate behavior, may leave a person vulnerable to feeling unsafe with others or when alone, and handicap the capacity for reciprocity in relationships. Such a person may lack resources to right self esteem when narcissistically injured and therefore erupt with rage, and may have learned, early on, to violate (invading privacy—as in obscene phone calls; assault; rape) the expectations of others. But joyful violations (irony, humor, creativity, and well-timed surprise-- about three seconds for infants)may be welcome. On the other hand, expectations too closely met, as when mother echoes infant’s distress without some irony or modification, may increase the infant’s terror or anxiety. One may have expectation of welcome or rejection, invasion or intimacy.
Therapeutic action may confirm (meet) or contradict (violate) expectations. Lachmann asks: What is the nature of the different experience that the analyst effects with the patient?, and, What specifically is the effect of this differing experience on the patient?, for a different experience in itself is not sufficient to promote change.
Lycia Alexander-Guerra, MD photos by John Lambert, LCSW
The Summer of Aviya is a 1988 Israeli film directed by Eli Cohen and is based on the autobiographical novella of the same name by Gila Almagor, who also stars in the film as Henya, Aviya’s emotionally unstable mother. But Henya was not always troubled. She had been known as a woman of valor and was sent to the camps for her efforts as a partisan during World War II.
According to the Jewish Partisan Education Foundation “during World War II approximately thirty thousand Jews escaped ghettos and work camps and formed organized armed resistance groups to fight the Nazis. These groups were known as partisans. Despite the odds, women were able to join the partisans. Their work in the partisan camps ranged from domestic duties such as cleaning cooking and nursing, to reconnaissance, weapons transport, as well as armed combat. Women made up approximately 10% of the partisans.”
After the war, Henya, a Holocaust survivor settles in the struggling new state of Israel. Her treatment by the local villagers is a continuation of her outsider status and she and her daughter are treated as pariahs. Gila Almagor’s Under the Domim Tree, which was released as a film in 1995 is a sequel to Summer of Aviya and chronicles Aviya’s search for the missing pieces of her past.
The film’s themes suggested by Rina Donchin include: rejection, relationships between parents and children, social norms, and acceptance of Holocaust survivors in Israel in the early 1950s when survivors did not want to talk about their experiences and Israelis’ by and large did not want to hear about them.
To a question posed by an audience member about what accounted for the treatment of survivors in Israel, Rina Donchin noted that the enormity of the massacre of the Jews was not fully understood by the Israelis; but also, there was suspicion about what a person had to do to survive.
One audience member remarked that even as a little girl in the United States, she remembered that her parents talked in an animated way to people with accents and numbers on their arms; but would not discuss their circumstances with her. She knew something important had happened to these people, but she knew not to ask questions about it. As a mental health professional, she has come to understand this reaction of the avoidance of survivors as reflecting how we feel about coming close to victimization. Nonsurvivors have guilt, fear, and harbor suspicions that survivors must have done something untoward to have survived.
Rina Donchin noted that the government opened its arms and gates to the refugees from Europe. The Jewish community in Palestine made a particular effort during, and after, World War II to break the British policy that denied Jewish refugees entry to Palestine.However, on a personal level it was hard for the Israelis to personally accept them. Locals judged negatively those people who chose to exist in Europe and outside the promised land and not with “God’s chosen people.” The poverty of Israel in the 1950s made it a harsh place and people responded in kind. Both food and housing were rationed; eggs were scarce and meat was nonexistent. There was also the health of the survivors that was at issue. If a survivor carried lice, she or he could also spread typhus, which was an illness that ultimately killed, the legendary Anne Frank, for example. And then, there was the mental problems that haunted the survivors. Locals, dealt with this consequence, not by embracing them, but by distancing themselves from the mentally ill.
In fact, in Israel of those days mental illness was stigmatized. The mentally ill were considered “mad” (Meshuga) and hospitals for the mentally ill were called “House of the Mad” (Beit Meshugaim). תמונה מתוך הקיץ של אביה
Rina Donchin also noted that, sadly, Aviya was not exceptional being an orphan in the 50ies in Israel. A very large number of Israelis died fighting in Isael’s War of Independence (1947-48). Many of the fighters were older, and had established families. What was somewhat exceptional about Aviya is that she was growing up with virtually no relatives playing a role in her life. The one aunt she does have in Israel is, for reasons not explained in the movie, does not play any role in her, and Henya’s, lives until the very end of the movie.
Discussion focused on the developmental plight of Aviya. Early in the film once audience member remarked that examples of Aviya’s mistreatment was akin to “repeated mis-attunements that causes a child to have certain ideas about her worthwhileness and ability to connect to others.” These examples from the film include Aviya becoming dumbstruck as she sees her mother arrive while she performs a leading part in the play. The teacher chastises, rather than soothes her, by saying that Aviya ahs ruined everything and can not be counted on. Once her mother discovered lice in her daughter’s hair, she refuses to have Aviya sit close to her on their journey from the boarding school to their home in the village. Contextually, those in the audience and Professor Donchin remarked that like concentration camp survivors, Israelis guarded assiduously against the spread of lice because of the lack of contemporary medicines at that time, hair had to be cut.
Dr. Harris Feinstein commented on Henya’s limitations in parenting her daughter. Henya stressed the need for Aviya to be clean, not that she should have a pretty dress and be with peers because this was the world Henya came from. Further, the women in Aviya’s life are rejecting. They betray and disavow her; and are unemotionally unavailable. Nonetheless Aviya “pushes herself along developmentally.” She tries to connect with her mother. She wants to connect with other children and the world around her.
Dr. Harris Feinstein noted that Aviya’s father hunger is palpable and characteristic of children who have grown up without their fathers. Dr. Fienstein was fearful for Aviya’s future development. He felt that as a latency-stage child she was stalwart, smart, and resilient. But as she enters adolescence will she be able to attach, to keep friends or will she become promiscuous and search relentlessly for someone to think of her as wonderful. Will she be the strong individualist, who can manage by herself and detach from others?
Dr. Stein discussed the position of Henya and Aviya as “others;” those not accepted as integral parts of the community. The mother was repeatedly referred to as ‘crazy’ and her daughter was labeled as ‘baldy.’ Henya was met with scapegoating, ostracism and bullying. In her fragile state, what she really needed was acceptance.
According to Dr. Stein, this film does not belong to the early Israeli cinema which stressed Zionism and the centrality of the strong man who makes the land produce. Women in this genre are consigned to the marginal roles of bearing and nurturing children. This movie raises questions about the Zionist culture as Aviya blurs boundaries and crosses spaces: new immigrant, how Holocaust survivors were not welcome, the role of women in early society, Diaspora Jews vs. Zionist Jews, misfits and the question of the mentally ill. These spaces in Israeli society Aviya crosses with courage and resilience. Her running back and forth is an important symbol of traversing chasms. By the end of the movie she has been transformed. She gives up her idealized image of Maya who stands for ‘civilized’ or ‘cultured’ existence and she is able to accept that her own father is dead and gives up the father fantasy. That is a sign of healthy development.
Importantly, Dr. Stein’s remarks centered on the difference between a person’s ability to self-regulate her or his emotions versus requiring that another person regulate those emotions (i.e. interactive regulation). In interactive regulation ties with others are of paramount importance and children do whatever they must to stay connected to their caretakers. By the end of the movie, she is better able to self-regulate and she becomes a parent to her mother (i.e., parentified child). Dr. Stein interprets her ability to manage herself as healthy maturation.
An audience member was concerned that a 10 year old child was being called on to perform this developmental task is at best pseudo-maturity. Another audience member supported this perspective that maturity requires both self-regulation and interactive regulation and in America, self-regulation is privileged. A third audience member said that refugee children grow up quickly and the idea of pseudo-maturity is moot. The more important task in his perspective for those in 1950s Israel (and even America then) was to quickly blend into the new society and not be seen as a greenhorn.
At the end of the film Henya complains of hearing train whistles and becomes psychotic. Was this breakdown provoked by the leave-taking of a man who had befriended her and the fact of her little girl returning to boarding school? And what of Aviya’s fate? The pessimist may fear for her and the optimist champions her resilience.
Controversies:
Some have been critical that Holocaust Survivors are portrayed stereotypically as ‘crazy’ without a balancing of the perspective that they have been resilient and have made something of their lives. Many have gone into the social service fields because they learned to care by caring for their parents. How to balance the outward success of survivors and their children, against the very real emotional difficulties that continue to haunt such families is a thorny representational issue. (See the book Indelible Shadows: Film and the Holocaust for more on this topic.) One audience member recalled that her husband’s parents who are survivors are obsessed with eating and with food. The memory of starvation is still with them and they always take food along with them on outings.
Rina Donchin wondered how viewers who know nothing about the Holocaust would understand certain references in the film such as allusions to trains, putting biscuits in one’s pockets, and references to being “from there” (i.e. Poland under the Nazis). An audience member countered that the film can be understood universally as scenes such as no one coming to a child’s birthday party and not fitting in speak to everyone.
A controversy erupted about the meaning of Aviya – my father or my father has disappeared. Hebrew speakers said that the meaning is ‘my father’. Yah or god (God the father) is whom Aviya prayed to, not simply her own father as she invoked the spirit of her father to cure Maya whom she had struck out of frustrated rage. In addition, everyone kept mistaking her name for ‘Aviva’ a very common Israeli name for girls, as “Aviv” which means spring or renewal. Dr. Fierstein noted that the theme of regeneration was submerged in the film. Rina Donchin also noted that the name of the girl in Hebrew, as spelled in the Hebrew characters, is “Avi-Ha” which unambiguously means “Her father”. This is the name Almagor chose for the girl and that is the way she pronounced the name in her one-woman shows based on the book. Unfortunately, it is not an easy name to pronounce in English, and therefore the name in English is spelled “Avi-Yah”, opening the gate to all sorts of Godly speculations, as “Yah” in Hebrew does mean “God”.
Reference:
Annette Insdorf ElieWiesel (2002). Indelible Shadows: Film and the Holocaust. Cambridge University Press; 3 edition
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Rina Donchin was born and raised in Israel, and lived there during the period described in the movie, Summer of Aviya. She is the Director of the Hebrew Program in the World Language Department and has been in this role since 2001. She came to the University of South Florida from the University of Illinois in Urbana-Champaign where she taught in the Hebrew Program for 32 years, and directed the program for more than 20 years. She earned an MA in Linguistics from the University of Illinois. Her general area of interest is Second Language Acquisition. At USF, she teaches both Hebrew, at all levels, and also Israeli Literature and Culture. Each Spring she teaches, in English, “Israeli Films and Fiction" (FOL2100) which surveys the history of Israeli culture from the 19th to the 21st Century through an examination of Israeli fiction in translation and films based on this fictional works.
Edward H. Stein, M.D. attended medical school at Johns Hopkins in Baltimore and did his psychiatric residency at the University of Cincinnati. Then, following two years as an Army psychiatrist, he went to Chicago for psychoanalytic training at the Chicago Institute for Psychoanalysis. During this time he was on the faculty of the University of Chicago Department of Psychiatry, and later in private practice in Chicago. He was at the Chicago Institute when Dr. Heinz Kohut was developing and teaching Self Psychology, and has been very interested in Self Psychology and Intersubjectivity ever since, with interests extending more recently into Relational psychoanalysis. He presently teaches in the Tampa Bay Institute for Psychoanalytic Studies (TBIPS) and in the Psychiatry Department at the University of South Florida School of Medicine.
Harris Feinstein is a child, adolescent, and adult psychiatrist who has been in private practice here in Tampa since 1988. He has had a long standing interest in psychotherapy and is presently teaching a seminar on psychotherapy to Child and Adolescent Fellows in the Department of Psychiatry here at USF. He also loves movies.
Welcome to "Contemporary Psychoanalytic Musings," the blog of the Tampa Bay Institute for Psychoanalytic Studiesor, as it is conveniently known, T-BIPS. We invite you to post your comments on psychoanalysis and books, film, conferences, the media, art, theory, clinical situations, current controversies, social issues, and anything else as seen through a psychoanalytic lens. We look forward to a spirited dialogue with you. Lycia Alexander-Guerra, M.D. TBIPS President Gabcast! Welcome! #3
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In 2005 a group of psychoanalysts & psychoanalytic psychotherapists convened to explore possibilities for meeting the educational needs of clinical professionals in the Tampa Bay area. Out of those discussions evolved a new institute, the Tampa Bay Institute for Psychoanalytic Studies. Consistent with the spirit of collegiality, openness, and diversity that inspired its development, the new Institute is non-authoritarian and democratic. Training programs utilize progressive and classical concepts which have been endorsed by contemporary critiques of psychoanalytic education. Believing that the capacity to think psychoanalytically best develops in an atmosphere of inquiry, open dialogue, and active participation the founding members sought to integrate these values into the structure of the new Institute and into the process of training. A precedent of collaboration and mutual respect for the contributions of all faculty and candidates was established enabling our mission to gain immediate representation in our actions.
