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

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.
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.”

“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

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 that 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.

The Film Purple Triangles documents the “spiritual resistance” of a family of Jehovah Witnesses as an example 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 the 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:

*Form more information on the persecution of the Jehovah Witnesses from a doctrinaire perspective visit: and read Purple Triangles: A Story of Spiritual Resistance by Jolene Chu

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

Wednesday, April 7, 2010

Affect and Emotional Life

“Psychoanalysis is emotional medicine for emotional ills.” (Orange, 1995). “Ideas, insights, interpretations, and other cognitive approaches may support emotional healing, but they do not provide it… only if the analyst can find room in inside herself or himself for THIS patient is there any hope.” (emphasis added).
Accordingly, Orange outlines an intersubjective theory of affect and emotional life. She emphasizes three features of emotional life. First, the complexity of emotional life. “Emotional life, an irreducibly complex process, requires an epistemology that resists the urge to oversimplify. Relational history makes understanding emotional life an intricate task. We continually organize and reorganize [experience] in layers of meaning.

Therefore, “[w]hen we attempt to extract an “affect’ from the continuity and complexity of any emotional life, and use that affect to explain something, we make two mistakes. First, we abstract and extract what is inextricable. Second, we may violate the integrity of the person’s experience. Although some of this violence is unavoidable, patients often point it out to us. When we attempt to help a patient articulate a feeling, we often hear: “But that is not all,” or “It’s more than that,” or “It keeps changing.”

Orange points out that one “effect of the psychoanalytic tendency to speak of single emotions has been the focus on ambivalence and its acceptance as a model of mental health. In this view we are always torn between love and hatred, conceived as two basic and simple affects. We must feel both toward the same person at the same time. On the contrary, I see emotional life as originally complex. It makes more sense to wonder how it disintegrated, how it became oversimplified. How did the responses in a given family bring a child to feel that loving a parent was incompatible with anger, or disappointment, or interest in something else besides the parent? How did the child develop the conviction that feeling itself was dangerous to significant ties?”

In addition to isolating some emotions from the whole of emotional life, another difficulty is that “[m]any emotions, like shame and dread, are themselves internally layered. Shame involves self-hatred in the face of explicit or implicit other’s perceived or expected disapproval. It is complex, often multiply layered, and usually continuous with moments of more intense pain. People often say, “I’m ashamed that I’m ashamed about this.” (I plan to consider of shame as part of the experience of emotional trauma in a subsequent post which I suggest to read in the context of the present one.)

“A second essential feature of emotional life,” Orange continues, “is its relational character. Emotions are responses to relational events or needs, and emotional expression is an attempt to connect, or to regulate connection, with another. The social smile of infants is a social smile. Smiling and crying are methods of “object seeking” (Fairbairn, 1952). Any thoroughly relational theory of human nature or psychoanalysis must treat emotional life in that context. Emotional experience begins, continues, and heals in specific intersubjective contexts. When emotional experience is presented as independent of context – psychiatry speaks of “inappropriate affect,” for example – this may mislead us into thinking of emotion as a mere internal signal. Instead, from the perspective of intersubjective theory, we see the emotional expression of the moment as formed by relational history and as evoked or triggered by the intersubjective fields of the present. Its reference to the future often consists in the expectation that the relational experience of the future will resemble that of the past, but it includes an anxious hope that someone will respond differently.” (emphasis added).

Third, “[n]ot only complex and relational, emotional life is emotional. This apparent tautology is important only because both psychiatric and psychoanalytic languages have attempted to describe and work with emotion as if it were a cognition or an instinctual derivative. In either case it is viewed as residing in the individual. On the contrary, I see emotion as a primarily noncognitive and nonverbal relational response. It can be linked to cognitions and schemata, but it has its own reality.”

Recognizing that intersubjectivity theory had a cognitive cast, Orange (1995) began, and has continued, ((Orange et al (1997), Stolorow et al (2202)), to point out that the principal components of subjectivity, the organizing principles, “often unconscious, are the emotional conclusions [or emotional convictions] a person has drawn from lifelong experience of the emotional environment, especially the complex mutual connections with early caregivers. Until these principles become available for conscious reflection, and until new emotional experience leads a person to envision and expect new forms of emotional connection, these old inferences will thematize the sense of self. This sense of self includes convictions about the relational consequences of possible forms of being. A person may feel, for example, that any form of self articulation or differentiation will invite ridicule or sarcasm.” (emphasis added).

Arising as “emotional inferences a child draws from intersubjective experience in the family of origin… [t]hese principles [or convictions] may concern relatedness, as in “I must adapt to others’ needs (moods, expectations, and so on) if I am to retain significant emotional ties. They may also consist in a fundamental sense of self, still intersubjectively configured: “I will never amount to anything,” I am always a burden,” “I am worthless and god for nothing…” More often, these principles are emotional inferences drawn as the child attempts to organize some sense of self out of chaotic, traumatic, or more subtly confusing early and later relational experience.”

Orange (1995) concludes “[i]f emotional life is truly complex, relational and “emotional,” then certain clinical consequences follow. One is that our patient’s “Yes, but…” may not be defensive but instead may be a plea for a fuller understanding of “complex mental states”(Kohut, 1959). If we believe that emotion really differs from cognition, then we will distinguish emotion and cognition in talking with patients and support a respect for the contribution of each to a whole human life. We will show regard for a “sense of things”- ours or the patient’s – whether or not this sense is verbalizable. In a Winnicottian spirit, we will make more room in many psychoanalytic treatments for art, music, and poetry as a means of creating a shared emotional life. We will also have less need to reduce these “forms of feeling” Hobson, (1985)to any form of cognition or insight.” (emphasis added).
Ernesto Vasquez, April 6, 2010

Orange, D. (1995), Emotional Understanding: Studies in Psychoanalytic Epistemology. New York: Guilford Press.
Orange, D., Atwood, G., & Stolorow, R. (1997), Working Intersubjectively. Contextualism in Psychoanalytic Practice. Hillsdale, NJ: The Analytic Press.
Stolorow, R., Atwood, G., and Orange, D. (2002), Worlds of Experience. Interweaving philosophical and clinical dimensions in psychoanalysis. New York: Basic Books.

Sunday, April 4, 2010

Today’s Easter Sunday marks the forty-second anniversary of the assassination of Dr. Martin Luther King, Jr.

King, the Moses of black Americans, though never to see it himself, was to deliver his people to the Promised Land, a promise of freedom afforded under the protection of the U.S. Constitution. His assassination marked, to the utmost, the failure of recognition of the other as a separate center of subjectivity (Benjamin), just as white Americans for centuries had failed to see black Americans as subjects, treating them instead as objects, property, inferiors, where different than meant less than, as if there were no self that survives the destruction of otherness, as if we could not be enriched by different perspectives and points of view. Were it that this split complementarity of otherness could instead be the source of newness and creativity to be savored as an enriching newness that lifts us up out of the ashes and dust of conformity, complacency, and deadness of the soul. Is this not the resurrection that we all may celebrate?

Saturday, April 3, 2010

Affect. A Trilogy. Part 3. Thinking with our Hearts

There were two presenters for the ‘Meet the Authors’ session at the fall meeting of the International Association of Psychoanalytic Self Psychology in 1995, Joseph Jones and Donna Orange. In his presentation, Jones offered a sustainable argument for his hypothesis that affect is the center of all of psychological life, a sketch of which I present in the first two posts of this trilogy.

Thinking with our heart is the metaphor with which I try to capture Jones’s (1995) understanding of a 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…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 affective-symbolic integration that leads to the creation of the sense of self.” To which I would add that thinking with our heart is what truly distinguishes humans from the rest of the animal kingdom. I would also like to say that, in my opinion, the relative stability of that network is the crucial factor: too much or too little of each component can cause a rupture. Our patient’s report that disruption sometimes saying: “and when she or he said that!, right then I lost it…”; thought acts like a brake to regulate affect, but this function becomes ineffective in the presence of increased affect, the network falters.

Orange’s presentation was so vastly rich that any attempt to summarize it would be a daunting project; Emotional Understanding (1995) and her subsequent books are to be carefully studied over time. Some of her comments, however, were directly applicable to certain aspects of the work on affect Jones had just reported.

Regarding terminology Orange suggested to use “the words “emotions” or ‘emotional life” for what can only be known by introspection or empathy, that is, psychoanalytic methods of observation... “Emotional life” [refers] also to the totally or complexity of subjectively experienced feeling.”

Orange, moreover, challenged “an atomistic treatment of single primary affect states, such as excitement, as underlying prime matter... These views suggest the existence of original or fundamental affects, which, like the elements of the periodic table, may combine, that we can study in isolation. Emotions in such view are like the empiricist’s sense data, lacking the complexity and relational meaning they should have if…they are intersubjectively regulated and maintained.” She suggested to replace the atomist conception of affects with an attentiveness to the totality and complexity of person’s emotional life. The details and the history of the particulars are important but only as far as they conduce toward understanding a person’s organized emotional “sense of things”. We must neither reduce the whole of emotional life to the sum of its parts nor mistake the affective tress for the emotional forest.”

I believe Orange’s comments about affects are equally applicable to the study and understanding of intellectual functions (thought). We must reread Piaget’s work then with contextualist eyes, keeping in mind that what he researched in such detail and described so well is really our intellectual life.

But I wonder if these notions, whether affect and thought or emotional life and intellectual life, can be seen in yet one more light. In Being and Time (1927), Heidegger talks about ‘affectivity’ (emotions, moods) as a mode of living, of being-in-the world, a human quality or attribute, profoundly embedded in constitutive context, a notion of something which “underscores the exquisite context-dependence and context-sensitivity of human…life.” (Stolorow, Atwood, and Orange, 2002).

Perhaps we could consider ‘thinking with the heart’ as well-- a quality of being human, a sensibility, an inclination, one which, like the capacity for empathy, we are to value, to care for, and to cultivate over time, and in many ways.

Ernesto Vasquez, MD
April 3, 2010

Heidegger, M. (1962). Being and Time. Transl. J. Maquarrie and E. Robinson. New York: Harper and Row. Original edition 1927.
Jones, J.M. (1995), Affects as Process, An Inquiry into the Centrality of Affect in Psychological Life. Hillsdale, NJ, The Analytic Press.
Orange, D. (1995), Emotional Understanding: Studies in Psychoanalytic Epistemology. New York: Guilford Press.
Stolorow, R., Atwood, G., and Orange, D. (2002), Worlds of Experience. Interweaving philosophical and clinical dimensions in psychoanalysis. New York: Basic Books.

Affect. A Trilogy. Part 2. Affect as Process

In his foreword, Lichtenberg offers this guidance: “Affects as Process is a book that merits study but must be read. By this I mean that the book is packed with information about the organization and processing of information and the nature of symbolization – all in reference to emotion... Affects as Process calls for perusal with pauses for reflection. It reflects the author’s having spent years of tussling and puzzling with the unresolved conundrums of cognition, affect, and behavior; of information processing, intercommunication, and motivation; of subjectivity, intersubjectivity, and objectivity.

Lichtenberg continues, “…[for example,] the reader may have only limited knowledge of the…literature on information processing in pre-symbolic and symbolic forms that are key to all of Jones’s assumptions about the role of affects. Consequently, when asked to entertain [a particular] hypothesis…the reader may have an acute attack of terminological shock. I can only advise: Hang on. There is a point to be learned here, and, once mastered, a new, more empirically based view of infant development will be your reward.”

On a personal note, what Lichtenberg describes is what I experienced on the initial reading of both Jones’s Affects as Process and Orange’s Emotional Understanding and her subsequent books. I would always hope there would be enough time until the next contribution for me to assimilate the richness of their work. Of course, there never is…!

In the first post of this trilogy, I indicated that Freud retained Descartes’ hypothesis of the divided mind but said that the critical dualism was not between affect and thought, but between two types of information processing – primary process (the instinctual drives) and secondary process (thought). Freud’s theoretical shift from affect to drive stripped affect from its process role and assigned it to the drives (primary process). The conundrum of affect was thus established.

If our capacity to use symbols (thought) emerges at approximately 15 to 18 months of age, how then do we process information until the arrival of thought?

Affects are easily observable in animals which are presumed to be unable to think, and in infants before symbolic abilities come on line. “Affective information processing - an analogic system - is what we share with the rest of the animal kingdom.” Jones describes six types of emotional experiencing: impulses that regulate physical movement; sensations (thirst, hunger), which give us information about our body; simple moods with which we can process only a single environmental event at a time during the first 8 weeks of life; complex moods which appear after 8 weeks because of brain maturation (the ascendancy of limbic circuitry) and with which we can process multiple environmental events; simple emotions (fear, joy, anger) beginning at 8 weeks when the limbic system comes on-line; and complex emotions which appear with the arrival of thought and represent the integration of affect and thought (love, futility, hatred, compassion, serenity).

Jones argues that if affects are process, then the experience of any affect is itself cognitive because the affect adds to our knowledge of our body or the world. If one thinks in terms of a process theory of affects, then affects are not composites [Freud’s (1916-1917) original formulation, perpetuated by Bruner (1964) and Horowitz (1972) in the cognitive theory of emotions], “they are simply part of the cognitive process.”

Affects are non- symbolic signals that convey and process information, our first means to process information. Affects are our primary process, that is, the first to arrive. They form a non-symbolic ‘vocabulary,’ they are our first language, our first way of knowing. As non-symbolic ‘vocabulary’ they simplify a vast complex of neurophysiologic data into relatively simple, easy-to understand signals.

Affects are also the language of motivation. Etymologically, motivation comes from the Latin movere, and its past participle motivere. Affects or emotions can be understood as something that moves us to action, as in e-motion. Affects serve as signal to the self and to others indicating under what motivation we are operating.

Jones defines affects as “the experiential representation of a non-symbolic 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.” Say what…!? Terminological shock, indeed, but one that, hopefully, will stimulate our curiosity.

Implied in Jones’ formulations is the notion that human development can be conceptualized as taking place in two broad phases. The first phase occurs before the arrival of thought and is concerned with the progressive unfolding of pre-symbolic affect. The main developmental task during this period is to learn to use our body.

The second phase of development takes place after the arrival of thought and comprises the emergence of thought itself, the development of our intellectual functions, and the integration of thought and affect. The emergence of the capacity to use symbols leads to the fork in the road where we become a very different kind of animal.

Jones proposes that thought emerges through the differentiation of the positive and negative valence of affects to form the yes/no algorithm which is fundamental to the process of categorization. Language - the naming process - creates the categories with which we think; we then manipulate categories through the process of symbolic logic. Symbolic functioning, akin to a digital system, must be layered upon and eventually integrated into the analogic, pre-symbolic affective information processing of infancy. We see the manifestations of the initial integration of these two information processing systems in the rapprochement crisis, the ‘terrible twos.’

Piaget et al. have amply documented the development of our intellectual functions. The use of symbols, with spoken language being perhaps the best example of thought in action, gives rise to a new type of affects. These affects, which I have called ‘complex emotions,’ transcend their origins as biological signals because they are integrated with thought and thus have acquired meaning. Love, futility, hatred, compassion, serenity are but a few examples. They are what we most often associate with the term affect. Affective-symbolic integration is a progressively sophisticated process which evolves over the rest of our life span. The main developmental task here is to learn to use our mind, that is, to think with our heart.

Jones’s notion of affective-symbolic integration finds validation in recent neuroscientific work. In a review of the subject, Luiz Pessoa (2008) writes: “Historically, emotion and cognition have been viewed as separate entities… Research in the past two decades has shown that such view is deficient and that, if we are to understand how complex behaviours are carried out in the brain, an understanding of the interactions of the two is indispensable… Central to cognitive–emotional interactions are brain areas with a high degree of connectivity, called hubs, which are critical for regulating the flow and integration of information between regions… As stated by Gray and colleagues, “at some point of processing, functional specialization is lost, and emotion and cognition conjointly and equally contribute to the control of thought and behaviour.””

Jones (1995) has constructed an all-affect information-¬processing model of the mind in which thought emerges from affect, and behavior can be determined by affect and thought. In other words, Affect ➔ Thought ➔ Affect AND Thought➔ Action (behavior). His process theory clearly establishes the centrality of affect in psychological life as the subtitle of his book aptly indicates.

Ernesto Vasquez, MD
April 2, 2010

Jones, J.M. (1995), Affects as Process, An Inquiry into the Centrality of Affect in Psychological Life. Hillsdale, NJ, The Analytic Press.
Pessoa, L. (2008), On the relationship between emotion and cognition. Nature Rev. Neurosci. 9: 148-155.

Affect. A Trilogy. Part 1. The Conundrum

In his discussion of empathy during his (Feb. 2010) visit, Frank Lachmann examined affective communication in caretaker-infant interactions and said, in part, “The link between the perception of facial expression and brain activation patterns in the perceiver provides one way of coordinating the emotional state of caretaker and infant. These findings [from caretaker-infant studies] demonstrating how one person resonates with the affective state of the other are relevant to our investigation of the precursors of empathy. They are relevant to precursors of empathizing as well as feeling empathized with.”

It seems that to study empathy is to study affect and since emphatic understanding or psychoanalytic compassion (Orange, 2006) is one important way to help our patients develop new, benign forms of emotional experiencing, I would like to sketchily, for now, review the evolution of our psychoanalytic understanding of affect, that is, the conundrum of affect. What follows is a summary of the first essay in Joseph Jones’s 1995 book, Affects as Process.

Descartes (1641) held that humans differ from animals in a fundamental way. All animals have affects but only humans have the power to reason. We know his philosophy as rationalism. He was the first modern philosopher to propose that the mind comprises two fundamentally different processes: emotions and reason, a dualism known as the “divided mind”. For Descartes the mind (the res cogitans) derives from God, is central to human existence, and operates independently of and is fully different from the body. The emotions or “passions” belong to the body. The body is a kind of automaton, comparable to a machine. As bodily phenomena, the emotions belong to the material world (the res extensa). The relationship between the rational mind and the mechanical body is known as the “mind-body” problem.

Descartes assumed that thought and affects were primary. Action or behavior was derivative and the consequence of one of the other two. Descartes, therefore, constructed an affect-thought model of the mind: Affect OR Thought ➔ Action. Philosophically speaking, affect and thought have metaphysical sanction; action or behavior does not. In the language of systems theory, feeling and thinking are processes, that is, “an internally coherent, integrated way of receiving, processing, and communicating information.” Action or behavior is not a process but a derivative of the other two.

Responding to Descartes’s proud claim that humans were “different,” and influenced by Darwin’s theory of evolution, Freud sought to restore “the bond of community between [humans] and the animal kingdom,” while simultaneously creating a set of grounding assumptions for a “scientific dualism.” Freud retained Descartes’s hypothesis of the divided mind but said that the critical dualism was not between affect and thought, but between two types of information processing – primary process and secondary process. Primary process is the concept with which Freud sought to maintain the “bond of community” with the animal kingdom.

Freud’s theorizing sequence was as follows. In his first formulation of psychoanalytic theory, Freud (1893) accorded pride of place to affect --patients became symptomatic because of repressed, affect-laden experiences (“Hysterics suffer mainly from reminiscences”) and recovered when the affects were brought back to into consciousness; importantly, “[r]ecollection without affect almost invariably produces no result.”

By 1897, Freud had come to the conclusion that his patients’ memories of traumatizing infantile seduction were not reports of actual experiences but fantasies. Accordingly, Freud’s interest shifted from affect to the instinctual drives as the agent that created the fantasies. Freud’s metapsychology represents his attempt to establish a non-Cartesian dualism that could ultimately be derived from an “instinctual dualism” as the ground for his theory of mind. This theoretical shift from affect to drive stripped affects of their process role, and assigned it instead to action or behavior. In so doing Freud went on to articulate an action-thought model of the mind (Action OR Thought ➔ Affect) that turned Descartes upside down.

By 1915, Freud considered affect a “process of discharge,” arising only when the drive was not carried through to completion. He also considered affects as composites of some kind of “action impulse” and some mechanism that gives the action impulse its cognitive content. These new conceptualizations of affect, in turn, not only led to an unsuccessful and therefore seemingly unending search for some type of ‘primitive thought’ to explain the cognitive content of affect, but also became a significant hindrance in constructing a usable theory of affects. They made it impossible to consider affects for what they simply are: non-symbolic signals that, in and of themselves, convey information.

Unrecognized metaphysical assumptions subtly and unconsciously affect the way we think. Such is the case with Freud’s notion that “affects are composites.” It shows up more than 60 years later as the central tenets of the cognitive theory of emotion. This theory emphasizes knowledge, how we come to see the world, how knowledge organizes our internal world, and therefore how we then react to the world-out-there. Central to the theory is that some sort of cognitive-evaluative process accompanies emotion. Metaphysically speaking, the cognitive theory of emotion is a complicated working out of Freud’s action-thought model of the mind. Freud’s reformulation of affect as a mixture of drive discharge plus some cognitive component was by the 1980s still having the powerful effect of a controlling paradigm on affect theory development, not only in psychoanalysis but in psychology in general.

The roadblocks erected by the notion of affects as composites, helped create another major difficulty in theorizing about affect. The problem is the subtle shifts in the meaning attached to the word cognitive by the authors of the cognitive theory of emotion. The word cognitive derives from the Latin word cognoscere, to know. But, as used in the cognitive theory of emotions, the word cognitive has become a hidden synonym for thought. For example, in Theories of Emotions, Plutchik (1980) entitled his section Emotions and Cognitions. The simple word “and” has had a powerful effect. It subtly shifted the meaning of cognitive from a global term encompassing all types of mental activity to an academic synonym for thought. Plutchik’s use of the word “and” implies that emotions are not “cognitions.” This new vocabulary –cognitions for thought – will lead all but the most careful reader to believe that some progress has been made to resolve the longstanding affect-thought problem. This is not the case; it simply translated the unsolved philosophic problem into the language of cognitive science.

Nowhere have I found a more thorough effort to restate, appreciatively appraise, and respectfully and lovingly critique Freud’s theory of affects, than in Joseph Jones (1995) landmark contribution to the development of a contemporary psychoanalytic theory of affect.” Jones’s work significantly moves forward the effort to resolve the conundrum of affect. I will examine his contributions in a subsequent post.

Ernesto Vasquez, MD
March 30, 2010

Jones, J.M. (1995), Affects as Process, An Inquiry into the Centrality of Affect in Psychological Life. Hillsdale, NJ, The Analytic 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.