Wednesday, November 26, 2014

Ferguson and Thanksgiving

In the wake of Ferguson, MO’s Grand Jury decision not to indict a white police officer’s killing of a black teenager, residents expressed their concerns. Whether police brutality or self defense, black young men are in danger, aggravated by lack of accountability on too many sides. One mother tearfully asked, “What am I to tell my son when he grows up?...You try to have hope.” Another woman tearfully expressed a more universal need, “We just hope for one time that our lives will matter; that somebody will see that our lives are valuable.” This latter plea speaks to the human motivation to be seen, to be recognized for who we are and still be accepted.

As we gather around the Thanksgiving table with our families of origin and the families we have made, may we take a break from seeing what we expect and, instead, look anew from an other’s point of view, accepting her or him just the way they are, and, hopefully, being accepted in return. What might we be thankful for? That in the best of relationships we are loved, warts and all.

Wishing a Happy Thanksgiving to you and yours.

Thursday, November 20, 2014

Dissociation and Enactment

Unlike Kohut, who believed in a unitary self and thought health was an increased cohesiveness in one’s sense of self, Bromberg says that we all exist in a multiplicity of self states, each with its own memory, experience, and unconscious. “Health is not integration. Health is the ability to stand in the spaces between realities without losing any of them.” (p.186), that is, it is simultaneous awareness of these many discrete selves.  The sense of a unitary self, writes Bromberg, is an adaptive illusion. Dissociation of certain self states, with their untenable affects (such as shame) occurs in all of us, often in response to the traumas of misattunement, misrecognition, or attacks on our reality. Bromberg recommends that analysts learn to see the validity of a patient’s psychic reality alongside their own, careful not to claim ownership of arbiter of reality. In this capacity to see both realities, space is made to construct consensual meaning. Their relationship is continually renegotiated.

Sometimes the only way to access dissociated experience is through enactments which can painfully draw the analyst into the early object relations of the patient. Sometimes these enactments additionally allow the patient to see his impact on the analyst. Enactments are

…an example of what Levi (1971) called “a powerful though perverted attempt at a self cure” (p.184). It involves a need to be known in the only way possible – intersubjectively—that is different from the old and fixed patterning of self-other interactions, a version of the situation that led to the original need for dissociation. (p.172)

For a patient in analysis to look into his own nature with perceptiveness, and to utilize creatively what is being enacted, there must exist a simultaneous opportunity for the patient to look into the analyst’s nature with an equivalent sense of freedom and security. (p.176)

In the clinical situation, those patients with the most dissociation, often called personality disorders, cannot resonate with interpretations which address conflict because, until contradictory self states are in simultaneous awareness, the contradiction/conflict cannot be 'seen' by the patient. Because psychic reality varies by self state, an issue already explored in one self state may come up again later in another self state. As one candidate noted to herself as her patient spoke, "Didn't we already go over this!" In this 'Groundhog Day' phenomenon, and the going over and over the same ground, is what I like to call 'the joy of Sisyphus,' and the candidate asks, "So where's the joy?"

From STANDING IN THE SPACES: Essays on Clinical Process, Trauma, and Dissociation (1998). Psychology Press. New York, London; Chap. 12, Shadow and Substance.

Tuesday, November 18, 2014

Envy as refused desire

Gerhardt’s rich paper on the intersubjective contribution of envy elucidates the part played by the mother’s (and analyst’s) failure to identify with the infant (later, analysand). Unlike Klein who saw envy as primary and related to aggression and the death instinct, Gerhardt frames envy in terms of refused desire. She sees envy as secondary to thwarting of this wish to be at one with the object, to both have and be the object, to matter to the object, as when the mother refuses to accept desire from the child as well as fails to help the child feel desired by her. The failure of the mother to adapt to the needs of the infant and her failure to see the infant’s demands for recognition as legitimate, renders her unable as well to experience maternal identification with the infant’s (secondary) envy. When the analyst (or mother) dissociates her own disavowed envy, dependence, and shame, she cannot identify with the patient’s split off self-states, and is less able to contain and transform them for the patient’s use. Gerhardt’s patient felt contained when Gerhardt invites and sustains a kind of one-ness, in part, through the analyst’s mutual identification with her patient, rendering horrible affects less terrifying.

Gerhardt writes that envy results when the “normal identificatory processes have gone awry,” and quotes Benjamin: “when desire to identify goes unanswered, envy takes its place.” [I think of penis envy and father’s rejection –or mother’s prohibition— of the female child’s identification with the father.] Envy, for Gerhardt, is an attempt at “denial of difference” and “repudiation of dependency” in response to the mother’s failure to identify with and manage the infant’s expelled and intolerable states, in particular those in which the infant (later, analysand) feels abject and defective, full of shame.  Envy, then, is also secondary to shame. Gerhardt also invokes Bion’s “protesting the separation between knower-known” [which calls to mind the humiliation engendered in the patient when the analyst insists on being the only ‘knower’ in the dyad]. [As an aside, she reminds us that Bion had noted that the mother’s failure to contain the infant’s fear evokes in the infant “nameless dread.”]

Oelsner takes the classic object relations approach, taking umbrage with Gerhardt seeing aggression and envy as secondary, and recommends the repeated analysis of aggression. He reminds us that Bion conceived of envy as an attack on linking. Envy destroys otherness by denying, through projective identification, recognition of separateness. Ornstein, on the other hand, as a self psychologist, agrees with Gerhardt that envy is secondary (this time, to empathic failure of participation of the analyst’s subjectivity and rejection of patient’s efforts) and sees Gerhardt’s eventual capacity to empathize with her patient— by giving up her “decoding interpretations” (experienced by the patient as “counter-attacks”) and by recognizing her part in thwarting the patient’s desires. Ornstein recommends seeing what transpired between them not as an attack by patient on analyst, but as a forward edge in terms of being able to make a demand of the analyst that the patient could not make as a child on her mother.

Gerhardt, J. (2009). The Roots of Envy: The Unaesthetic Experience of the Tantalized/ Dispossessed Self. Psa. Dial., 19:267-293
Oelsner, R. (2009). One Envy or Many?: Commentary on Paper by Julie Gerhardt. Psa. Dial., 19:297-308.
Ornstein, P.H. (2009). A Comparative Assessment of an Analysis of Envy: Commentary on Paper by Julie Gerhardt. Psa. Dial., 19:309-317

Saturday, November 15, 2014

Daniel Shaw on Traumatic Narcissism

If Freud said our personal ideologies are our “private religion” (convictions with unfaltering ritualization of behavior, repetition compulsion, if you will), Shaw adds that our private religions spring from our attachment story for we are all subjugated by our internal objects.  Shaw defines traumatic narcissism as the need to defend against dependency, for dependency is intolerably shameful and humiliating, and must be disavowed. Instead, dependency and neediness is seen in the other for the traumatic narcissist has everything within the self and needs no one. Traumatic narcissism is a relational dynamic requiring both the narcissist and its object to be subjugated. The easiest target is its child.

While all parents may sometimes attack the reality of their children, self aggrandize the child’s accomplishments, and have hope that the child will make up for their own failures, the traumatic narcissist can never admit fallibility, can never apologize, and continually  attempts to control and erase the subjectivity of their children. This is the cumulative relational trauma. The traumatic narcissist despises the child’s neediness, yet, paradoxically, any attempts by the child towards independence and agency are punished (by withdrawal or retaliation) for the narcissist requires the child to be the container for shameful neediness, Bateson’s classic double bind. This child, shamed for its dependence (and what is a child but dependent?), made to feel selfish and greedy, recognizing that only the attachment figure’s  needs are deemed valid, grows up to identify with the hated, but much needed, aggressor, an intergenerational transmission of traumatic narcissism.

Objectification of the child by the traumatic narcissist  is an absence of recognition, or a presence of negation. In analytic love, the therapist envisions the potential that cannot be realized, much like the good enough parent sees what the child can become. The children of traumatic narcissists, when they become our patients, demand not only that we recognize their trauma, but that we recognize our own disavowed traumatic narcissism! What a dangerously fraught journey for both patient and analyst as we struggle together toward freedom from the tyranny of our inner objects.

Tuesday, November 4, 2014

Lansky on Shame

Lansky delineates shame and guilt for us, and refers to the classical literature to make his points. He describes shame as resulting from failure to live up to one’s aspirations (ego ideal) and it signals fears of loss of relationship or separation and/or fears of exposure with concomitant humiliation. Weakness, defectiveness, vulnerability are all words patients might use to describe their shame. When shame is triggered, it may result in impulsive action, such as the intimidation of others (e.g. domestic violence) or compulsive binging, as one tries to regain control over one’s disorganizing sense of weakness. Guilt, on the other hand, results from failure to live up to superego expectations and can be used to defend against shame, for it gives a sense of action (some committed transgression) rather than the helplessness or powerlessness which evoke shame.

Shame is a hidden affect (there is shame in being ashamed), but Lansky says that it is not the affect itself which is hidden, but the consequences (social annihilation) of the affect. His idea alludes to the relational nature of shame, though when shame is consequent to failure to live up to one’s ego ideal it does not necessarily involve the other. Freud had previously noted that neurotic symptoms were an attempt to hide from awareness that which would evoke painful affect, as are defenses. (Not until 1926, in Inhibitions, Symptoms, and Anxiety, did Freud made explicit his signal theory of affect.)

Freud relegated shame to conflicts around toilet training, but Erickson spoke closer to the problem in his stage Autonomy v. Shame and Doubt, which is contemporaneous with Freud’s anal stage. Freud places guilt, and fear of retaliation (by castration), in the oedipal phase, whose heir, as you may recall, is the superego. Klein puts shame in the paranoid-schizoid position when, in addition to fear of attack and destruction, the expectation of one’s vulnerability being exploited by others with the intent to humiliate exists. Klein places guilt in the depressive position, which for her precedes the oedipal phase, when the infant becomes aware of the injury it inflicts on the mother. Kohut “divorced the notion of shame from any notion of conflict”, but Lansky opines that had Kohut linked ‘fragmentation anxiety’  in terms of its failure to live up to an ego ideal of maintenance of self image and self respect, Kohut might not have been so ostracized by the classical psychoanalysis of his day.  

My favorite nod to shame comes from Tomkins; He proposed that shame results from an interruption of joy. [How felicitous is that to remind us to meet our children’s joy with our own!] Many of the patients I see have indeed experienced the failure of their ‘love affair with the world’ to be met with attuned parental joy. Analysts, too, are called upon to meet our patients in the same direction affectively, though somewhat modified and without the disorganizing intensity, if lucky.

What Lansky might have elaborated more is the analyst’s shame, a powerful impetus to our dissociation, as when the struggle of our patients with their helplessness, their humiliation, and fears, trigger our own. He does note that “the shame of others makes us feel about ourselves what we do not like to feel: vulnerable, weak, powerless, dependent, contingent, disconnected, and valueless” and that “the emerging shame of the other stirs up our own difficulty bearing shame, our helplessness, and our anxiety that we may prove defective and fail in our professional roles because we, in facing the patient's incipient experience of shame, will be found to have nothing effective to offer.”

Lansky, M.R. (2005). Hidden Shame. J. Amer. Psychoanal. Assn., 53:865-890.

Tomkins, S. 1963 Affect, Imagery, Consciousness. Vol. II The Negative Affects New York: Springer.